Basic First Aid and Emergency Care

BASIC FIRST AID AND EMERGENCY CARE

Firs Aid
 An immediate care given to a person who has been injured or suddenly taken ill.
 Given to someone before the arrival of an ambulance, physician or other qualified personnel.
 It includes self-help and home care if medical assistance is not available.

First Aider
 The person providing first aid.

Roles and Responsibilities of First Aider

1. Bridge that fills the gap between the victim and the physician
2. Ensure personal safety and that of patient/bystanders
3. N access to the victim
4. Protect victim and others at the scene from possible danger
5. Summon more medical personnel
6. Provide early and appropriate treatment to victim
7. Assist EMT and medical personnel
8. Record all assessments and care given to the patient

Objectives of First Aid

1. To alleviate suffering - to lessen the pain/suffering
2. To prevent an added/ further harm or injury
3. To prolong life

Characteristics of a Good First Aider

1. Gentle – should not cause pain
2. Resourceful – should make the best use of things at hand
3. Observant – should notice all signs
4. Tactful – should not alarm the victim
5. Empathetic – should be comforting
6. Respectable – should maintain a professional and caring attitude

Hindrances in Giving First Aid

1. Unfavorable surroundings
2. Presence of crowds
3. Pressure from the victims or relatives

Golden Rules in giving Emergency Care

What to do:
1. Do obtain consent, when possible
2. Do think the worst, its best to administer first aid for the gravest possibility
3. Do remember to identify yourself to the victim
4. Do provide comfort and emotional support
5. Do respect the victim’s modesty and physical privacy
6. Do be as calm as direct as possible

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7. Do care the most injuries first

8. Do assist the victim with his or her prescription medication
9. Do keep the onlookers away from the injured person
10. Do handle the victim to a minimum
11. Do loosen tight clothing

What not to DO: (Don’ts)

1. Do not let the victim see his/her own injury
2. Do not let the victim alone except to get help
3. Do not assume that the victim’s obvious injuries are the only ones
4. Do not make any unrealistic promises
5. Do not trust the judgment of a confused victim and require them to make decision

First Aid Equipment and Supplies

1. Basic Equipment
 Spine board
 Poles
 Sets of splints

2. Suggested First Aid Kit Content (Basic)

- Rubbing alcohol - povidone iodine
- Cotton - scissors
- Gauze pads - bandage (triangular)
- Tongue depressor - elastic roller
- Penlight - gloves, plaster, band aid

3. Clothe material commonly used in First Aid

 Dressing or compress – any sterile cloth materials used to cover the wound
Other use of a dressing or compress
- Control bleeding
- Protect the wound from infection
- Absorbs liquid from the wound such as blood, water and pus

Application of bandages
- Must be proper, neat and correct
- Apply snugly not too tight or not too loose
- Always check for tightness may cause later swelling
- Tie ends with a square knot
Advantages of square knot
1. Easy to tie and easy to untie
2. It had comfortable flat surface
3. Once secured does not slip nor tightened or loosen

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II. GUIDELINES IN GIVING EMERGENCY CARE

Guidelines in Giving Emergency Care
I. Getting Started
1. Plan of Action
2. Gathering of needed materials
3. Perform initial response as follows:
A – ask for help
I – intervene
D – Do no further harm
4. Instruction to helper/s

II. Emergency Action Principles

a. Survey the scene
- Is the scene safe?
 Safety of the first aider, victim and the bystander
- What happened
- How many people are injured
- Are there bystanders who can help?
- Identify self as first aider
- Get consent before you give treatment
 Consent must be given by the victim/ relative
 Implied consent – unconscious victim
Ways to get consent
 State your name
 Tell that you are a trained first aider
 Ask if you can help
 Inform the victims’ condition
 Inform what you plan to do

b. Activate Medical Assistance (AMA) or transfer facility

- Call first
- Care first

Information to be remembered in AMA

 What happened
 Location of emergency
 Number or persons injured
 Condition of casualties
 First aid given if any
 Telephone number from where you are calling
 Person who activated medical assistance must identify him/herself and drop the phone
last

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c. Do Primary Survey
 Check consciousness
- Gently tap the victim’s shoulder
AVPU (Neurological Examination)
A – alertness
V – Voice/ Verbal
P – Pain
U – Unresponsive

 Airway
- Open the airway and check for any obstruction

Ways to open the airway

Head tilt chin lift maneuver – if the victim has no cervical spine injury
Jaw thrust maneuver – if you suspect your victim to have a cervical spine injury

 Breathing
- Check breathing for 10 seconds in LLF position
LLF Stands for:
L – look
L – listen
F – feel for air coming out on the air passages
*** if the victim is breathless, give two initial ventilations

 Circulation
- Check circulation for 10 seconds in LLF position
- Check for circulation/ pulse in different body part
o Adult : carotid pulse
o Child: carotid pulse
o Infant: brachial pulse
*** if the victim has no pulse, perform CPR

d. Do Secondary Survey
 Interview the victim
Basic information
SAMPLE history
 Signs and symptoms
 Allergies to food or medication
 Medication (is the victim taking maintenance medication)
 Past medical history
 Last intake and output
 Events prior to episode

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 Check Vital Signs

- Body temperature
- Pulse rate
- Respiratory rate
- Blood pressure

 Do head to toe assessment

- Head
- Face
o Assess victim’s lips, face and record for skin appearance (temperature,
moisture and color)
o Assess pupils reaction to light
Dilated pupils: bleeding and state of shock
Constricted pupils: heat stroke / drug stroke
Unequal pupils suspect head injury / stroke
- Neck shoulder
- Chest and rib cage
- Abdomen
o Assess for tenderness (4 quadrants)
- Arm
o Assess one arm at a time and check for any injuries
o Assess capillary refill
- Leg
o Assess one leg at a time and check for any injuries
o Assess capillary refill
- Spinal column
o Place victim into side lying position

- Assess DCAP-BTLS and blood sweeping from head to toe

D-eformity; C – ontusion; A – brasion; P – uncture; B – urn; T – enderness; L – aceration; S - welling

III. SHOCK

It is the failure of the heart and vascular system to pump enough blood to all parts of the body. It also
the state of collapse resulting from reduced blood volume and pressure usually caused by severe injury or
emotional reaction.

Causes of Shock:
 Hemorrhage
 Emotional stress
 Extensive burn
 Heart attack/stroke

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 Poisoning
 Severe illness
 Bullet wounds

Factors that contribute to shock:

P – pain
R – rough handling
I – improper transportation
C – continuous bleeding
E – exposure to extreme heat/cold environment

Dangers of Shock
1. Lead to death
2. Predisposes to body infection
3. Lead to loss of body

Signs and Symptoms of Shock

1. Early stage
 Pale or cyanotic in color
 Cold and clammy skin
 Irregular breathing
 Rapid and weak pulse
 Nausea and vomiting
 Weakness
 Thirsty

2. Late stage
 Victim may become apathetic or relatively unresponsive
 Eyes will be sunken with vacant expression
 Pupils are dilated
 Blood vessels may be congested producing mottled appearances
 Low BP
 Unconsciousness may occur, body temperature falls

Objectives of First Aid

1. To improve circulation of the blood
2. To ensure an adequate supply of oxygen
3. To maintain normal body temperature

First Aid and preventive management of shock

1. Proper position
2. Proper body heat
3. Proper transfer

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Types of shock
1. Anaphylactic shock – it is due to severe allergic reaction. It constricts the air passages preventing
the intake of any oxygen at all. Signs and symptoms include difficulty of breathing, blotches on the
skin, rapid pulse and breathing and heart stopping.
2. Cardiogenic shock – happens after cardiac arrest or severe heart attack wherein the heart is
deprived of the normal supply of blood.
3. Hypovolemic shock – severe hemorrhage resulting to decrease blood volume. Signs and
symptoms include rapid weal pulse, decrease blood pressure, cyanosis, change in mental status,
cool, clammy skin.
4. Metabolic shock – usually as a result of an illness which has been present for a long time (chronic)
or has been extreme over a brief period (acute). Illness due to vomiting, urination, diarrhea where
there is excessive loss of fluid and electrolytes. Signs and symptoms include rapid weak pulse,
cool clammy skin.
5. Neurogenic shock – it is due to the injury or trauma to the head accompanies spinal cord injury.
Signs and symptoms include bradycardia, blood pressure and signs of neck injury.
6. Psychogenic (emotional) shock – sudden reaction of the nervous system which produces partial or
temporary vascular dilation resulting to a temporary reduction of blood supply to the brain since the
blood temporarily pools in the dilated vessel in the other parts of the body. Signs and symptoms
include rapid pulse, normal to low blood pressure.
7. Septic shock – as a result of severe bacterial infection. Signs and symptoms include warm skin,
decrease blood pressure and tachycardia.

IV. SOFT TISSUE INJURIES

INTRODUCTION

A. Three major functions of the skin

 Protects the body from the environment
 Regulated the temperature of the body
 Transmits information from the environment to the brain

B. Parts of the skin

 Epidermis – outer layer of the skin
 Dermis – second layer of the skin
 Hypodermis – third layer of the skin

1. WOUND – a break in the continuity of a tissue of the body either internal or external.

Classification of wounds
A. Closed wounds – injuries sustained from a blow with a blunt object collision rupturing blood vessels
internally without penetrating the skin, it involves the underlying tissue without a break in the skin or in
the mucus membrane

Causes:
- Blunt object result in contusion or bruises

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- Application of external forces such as motor vehicle accidents and falls

Signs and Symptoms

- Pain and tenderness
- Swelling
- Discoloration
- Hematoma
- Vomiting or coughing of blood
- Passage of blood in the urine or feces
- Sign of blood along mouth, nose and ear canal

First Aid Management

I – ce application
 Apply ice compress for 20 minutes ON – OFF interval for the first 24 hours to
reduce swelling and reduce pain
C – ompression
 Manual compression
E – levation
 Elevate injured part to reduce swelling
S – plinting
 Immobilize the injured area using splint / sling
B. Open Wound – injuries sustained from a blow with a sharp object causing to be torn. A break in the skin
on in the mucous membrane.

a. Puncture – holes caused by sharp objects such as such as nails or knitting needles. They do not
bleed profusely but may carry dirt into body tissues, which may cause infection.
b. Abrasion – involves damage to top layer of the skin. They do not cause major blood loss but are
often dirty because they tend to have debris embedded within them.
c. Laceration – caused by rough edged instruments such as broken glasses, and tin cans. It has
irregular edges with serious bleeding.
d. Avulsion – tissue is forcibly separated or torn from the body’s victim. There is heavy bleeding.
e. Incision – it is a clean cut caused by razor or sharp blades.
f. Amputation – it is the separation of a body part.

Dangers
 Hemorrhage
 Infection
 Shock

Kinds of bleeding
Arterial bleeding
Infection
Shock

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First Aid Management

Wound and severe bleeding
1. Control bleeding
Direct pressure on the wound
Pressure on the supplying artery
Elevated the affected part
- Cover the wound with dressing and secure with bandage
- Care for shock
- Consult or refer physician
 Wound with bleeding not severe (home care)
- Clean the wound with soap and water
- Apply mild antiseptics
- Cover wound with dressing and bandage
- Raise the affected part to reduce blood flow to the area

2. BURNS
 It is a tissue damage caused by excessive heat regardless of the source. The heat may come from
fire, electricity, chemicals, the sun or stream.

Factors to determine the seriousness of burns

a. Depth
- Superficial (first degree) burn
- Partial – thickness (second degree) burn
- Full – thickness (third degree) burn

b. The extent to the affected body surface area

- Rule of nine
- Rule of palm
c. Location of burn – burn on the upper extremities is more severe than the body part.
- Circumferential burn (burn on the neck, leg, arm, toe, finger) is considered more severe than non-
circumferential one.
d. Victims’ age – victims 5 years old below and 55 years old above can have severe burn than in young
adults because of the skin in 5 years and below and 55 years aboce is thinner than in adults.

Types of burn injuries

a. Thermal burns – caused by heat burn, moist (eg. Steam), dry (eg. Flat iron)

Care for first and second degree burn

- Immerse the burned area in cold water or by applying a wet cold cloth.
- Cover the burn with dry, non-sticking, sterile dressing or a clean cloth.
- Do not attempt to open/break the blister.

b. Chemical burns - caused by chemicals such as acids and alkalis

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Care for chemical burns

- Flush with water for 15 minutes or until medical assistance arrives.
- In cases of dry powder chemicals, brush it first with a towel or gloved hand from the skin before
flushing with water
- Remove the victims contaminated clothing
- Seek medical attention immediately

c. Electrical burns – burns caused by electrical current

- Make sure the area is safe
- Check ABC’s. provide R.B or CPR if necessary
- Treat the victim for shock
- Seek medical attention immediately

DO’s
 Stop burning process by flushing water
 Protect burn area from infection
 Check ABC’s
 Remove constriction from the body
 Transport immediately to medical facility

DON’T’s
 Do not clean 3rd degree burn
 Do not apply ointment to 3rd degree burn

SPECIFIC BODY INJURIES

Care for eye injuries

a. Blows to the eye
b. Eye knock out
c. Foreign object

Care for nose injuries

Care for dental injuries
Care for impaled object
Care for amputations
Care for abdominal injuries

Guidelines using dressing and bandages

1. Use a dressing that is large enough to extend at least 1 inch beyond the edge of the edges of the
wound.
2. If the body tissue or organs is exposed, cover the wound with a dressing that will not stick such as
moistened gauze.
3. If the bandage is over a joint, splint and makes a bulky dressing so the joint remains immobilized.
4. A bandage should fit snugly but should not cut off circulation.

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Bandaging Technique (triangular bandage)

1. Open Phase
- Head (topside)
- Face / back of the head
- Chest / back of the chest
- Hand ; foot

2. Cravat Phase
- Forehead; eye
- Ear; cheek; jaw
- Shoulder; jaw
- Arm; leg
- Elbow; knee (straight/bend)
- Palm pressure bandage
- Palm bandage of open hand

V. SKELETAL AND MUSCULAR INJURIES

A. Muscle Cramp (spasm)
B. Muscle Strain or Pulled Muscle
C. Muscle Sprain
D. Broken Bones / fracture
 Simple fracture or closed fracture
 Compound Fracture or open fracture
E. Dislocation

VI. POISONING
POISON – any substance that tends to impair health or cause death when introduced into the body or into
the skin

POISONING – absorption of harmful substance

POTENTIAL EFFECTS OF POISON

1. Vomiting
2. Impaired consciousness
3. Change in heart rate
4. Breathing difficulties
5. Erratic and confused behavior
6. Burns
7. Pain
8. Liver and kidney problems

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Ways in which poison enters the body

1. Ingestion - by mouth
2. Inhalation – by breathing of poisonous gases
3. Absorption – by direct contact by skin
4. Injection – by animal bites, stings

A. Poisoning by Ingestion

Sign and Symptoms

 Altered mental status
 Burns around the mouth
 Odd breath odors
 Nausea and vomiting
 Abdominal pain
 Diarrhea

First aid management

- Try to identify poison. Look for empty bottles of medicine or chemicals
- Place the victim in left side lying position
- Save empty container, spoiled food for analysis
- Induce vomiting if poison is cause by non-corrosive poison. Save vomitus.

Instances when vomiting should not be induced

 If unresponsive
 Has ingested an acid/corrosive substances
 Has a medical condition such as heart attack, seizure and pregnancy

B. Poisoning by Inhalation

Cause
- Carbon monoxide
- Fumes from spray chemicals

Signs and Symptoms

 Dizziness
 Weakness
 Difficulty of breathing
 Headache
 Unconsciousness

First Aid Management

- Survey the scene
- If you can the victim, remove the victim from the poisonous environment to get fresh air.
- Check ABC. Provide RB/CPR when necessary

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C. Poisoning by Absorption

Signs and Symptoms

- Liquid or powder on the skin
- Itching and irritation
- Redness, rashes and blisters

First Aid Management

- Remove contaminated clothing
- Liquid poison: blot it with dry cloth, dry powder: brush it of
- Flush it with water
- Monitor patient’s vital signs
- Seek medical advice if severe reaction occurs

D. Poisoning by Injection
 Insect bites (BEE Sting)
Symptoms
- Stinger may be present
- Pain
- Swelling
- Possible allergic reaction

First Aid Management

- Remove stinger using tweezers or id cards
- Wash wound
- Cover the wound
- Apply cold pack
- Watch for signals of allergic reaction

 Marine Life Sting

Signs and Symptoms
- Possible marks
- Pain
- Swelling
- Possible allergic reaction

First Aid Management

- Jelly fish soak area in vinegar
- Sting ray: soak in non-scalding hot water until pain goes away. Clean and bandage the wound
- Seek medical attention if necessary

 Spider Bite / Scorpion Sting

Signs and Symptoms
- Bite mark
- Swelling
- Pain

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- Nausea and vomiting

- Difficulty of breathing/swallowing

First Aid Management

- Wash wound
- Apply cold pack
- Seek medical care to receive antivenin

 Snake Bite
Signs and Symptoms
- Bite mark
- Pain
- Weakness

First Aid Management

- Wash the wound
- Keep the victim still
- Loosen any tight clothing
- Immobilize the leg/arm of the victim in a lowered position below the level of the heart
- Tie a constricting band 2-4 inches above the affected part
- Treat the victim to the nearest hospital

ENVIRONMENTAL EMERGENCIES

I. COLD EMERGENCIES

A. Hypothermia – a condition that occurs when the body temperature falls below the normal range. It
is caused by a low surrounding temperature and can lead to death

A.1 Mild Hypothermia

Signs and Symptoms

- Increased respiratory rate, pulse rate and blood pressure
- Slow thick speech
- Staggering walk
- Apathy, drowsiness
- Uncontrollable shivering

First Aid Management

- Check responsiveness
- Cover the patient with warm blanket
- Apply hot compress
- Check vital signs
- Refer to physician

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A.2 Severe Hypothermia

Signs and Symptoms

- Extremely slow breathing rate and pulse rate
- Unresponsiveness
- Fixed and dilated pupils
- Rigid extremities
- Absence of shivering

First Aid Management

- Check responsiveness
- Check ABC, perform CPR if needed
- Care of Shock
- Refer to physician

B. Frostbite – it is caused by freezing temperature where ice forms in the body tissues and destroys it.
Windy conditions increases risk of occurrence of frostbite

Signs and Symptoms

- Numbness
- Redness
- Pain
- Bluish discoloration
- Swelling
- Lower body temperature

First Aid Management

- Take the victim indoor
- Re warm the affected part by immersing it in water
- If finger or toes are part of the affected area, place dry sterile gauze between them to keep
them separated
- Obtain medical assistance as soon as possible

II. HEAT EMERGENCIES

A. Heat Cramps – pain or spasm due to largely loss of salt from the body through sweating or
inadequate intake of salt

Signs and Symptoms

- Muscles cramps, often in the abdomen or legs
- Heavy prescription
- Lightheadedness, weakness

First Aid Management

- Have the victim rest with his/her feet elevated 8-12inches
- Cool the victim
- Give the victim electrolyte beverages

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- Massage the affected part firmly and gently

B. Heat Exhaustion – it is characterized by weakness and collapse due to inadequate intake of

water to compensate for loss fluids through sweating.

Signs and Symptoms

- Cool pale, moist skin
- Dark, hot, red skin
- Dark urine
- Rapid shallow breathing
- Extreme confusion
- Weakness
- Seizure
- Unconsciousness

First Aid Management

- Have the victim rest with his or her feet elevated 8-12 inches
- Cool the victim
- Spray with water
- Give electrolyte beverages
- Monitor the victim for signs of shock
- If the victim loses consciousness give first aid for shock

C. Heat Stroke – a response to heat characterized by extreme high body temperature due to the
disturbance of the thermal regulating system of the body.

Signs and Symptoms

- Raised body temperature
- Dry, hot, red skin
- Dark urine
- Rapid shallow breathing
- Extreme confusion
- Weakness
- Seizure
- Unconsciousness

First Aid Management

- Cool the victim
- Immerse in water if necessary
- Give first aid for shock
- If the victim starts having seizures give first aid for seizure
- Keep the victim cool as you await medical help

MEDICAL EMERGENCIES

I. STROKE – it occurs when the blood supply to the brain stopped due to a blocked blood vessel
that can lead to death of brain tissues

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Causes
- Thrombus – blood clot can form in the brain and remain there
- Embolism – blood clot can form elsewhere in the body, travel to the brain and lodge in the
small vessel
- Ruptured artery in the brain
- Compression of artery in the brain
- Plaque – fatty deposits within the blood vessels attached to the vessel well

Signs and Symptoms

- Weakness on the face, arm, leg often on one side
- Dizziness, headache
- Confusion
- Ringing in the ears
- Difficulty of breathing and swallowing
- Loss bowel and bladder control

First Aid Management

- Check ABC, begin RB/CPR if necessary
- Let the victim rest in his position of comfort
- Seek medical help immediately
- NPO
- Do not leave the victim alone

II. DIABETES – occurs when the body cannot change carbohydrates into energy because of an
imbalance of insulin

A. Insulin Shock – occurs when a person’s blood has more insulin than the amount of carbohydrates
available for metabolism

Signs and Symptoms

- Fast breathing
- Vision difficulties
- Weakness
- Change in level of consciousness
- Sweating
- Hunger
- Headache

First Aid Management

- Conscious: administer sugar
- If unconscious: check ABC and call physician immediately
- Transport victim immediately

B. Diabetic Coma / Ketoacidosis – occurs when the blood has too many carbohydrates and not
enough insulin to metabolize it.

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Signs and Symptoms

- Drowsiness and confusion
- Fruity smell breath
- Thirst
- Deep and fast breathing

First Aid Management

- Administer high concentration of oxygen
- Transport immediately

III. SEIZURE – caused by an abnormality within the central nervous system. This abnormality is
thought to be an electrical problem in the nerve cells.

Two Types of Seizure

1. Grand Mal Seizure – there may be stiffness of the body followed by a jerking action of the muscles.
The seizure last for several minutes. The client usually becomes unconscious, sometimes bites his
tongue and incontinent.
2. Petit Mal Seizure – the client may appear daydreaming. His eyes may roll back and there may be
some quivering of the body muscles. It usually last less than 30 seconds. The client usually has no
memory of the seizure.

Stages of Generalized Seizure

1. Aura phase – often described as unusual smell or flash of light that split second.
2. Tonic phase – 15-20 seconds of unresponsiveness followed by 5-15 seconds of extreme muscle
rigidity
3. Clonic phase – 1-5 minutes of seizure
4. Postictal phase - 5-30 minutes to several hours of deep sleep with gradual recovery
5.

Signs and Symptoms

- Local tingling or twitching of the body
- Brief blackout
- Sudden falling and loss of consciousness
- Drooling
- Vigorous muscle spasm
- Loss of bladder and bowel control

First Aid for Febrile Seizures

- Remove all clothes and give the child a sponge bath with lukewarm water and turn on the
fan. Stop if the victim shivers
- Give over the counter drugs as prescribed
- Monitor the temperature

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COMMON EMERGENCIES

1. FEVER – a sustained body temperature above the normal range (36.5 – 37.5 °C)

Signs and Symptoms

- Pallor
- Chilled feeling
- Hot flushed skin and sweating
- Generalized aches and pains
- High temperature

First Aid Management

- Allow patient to rest. Place him in comfortable position with light cover
- Give plenty of fluids
- Adult may take paracetamol tablet. Child recommended dose of paracetamol syrup
- Transport victim immediately if fever persist

2. HEADACHE – has many causes but often they can develop with no apparent reason or as a
symptom of common illnesses such as flu. Sometimes they are an indicator of a more serious
condition such as head injury, or stroke.

First Aid Management

- Place patient in position of comfort
- Give paracetamol tablet for adult and paracetamol syrup for the child
- If headache persist refer to physician

3. ABDOMINAL PAIN – pain in the abdomen can range from mild discomfort to agony. It has many
causes most are not serious but others my indicate serious injury

First Aid Management

- Make patient comfortable
- Do not give any medicine or anything to eat or drink
- If pain persist, transport victim

EMERGENCY RESCUE AND TRANSFER

Emergency Rescue – it is the rapid of movement of patient from unsafe place to place of safety

Indications for emergency rescue

- Serious traffic hazards
- Danger of fire and explosion
- Danger of collapsing wall
- Risk of drowning
- Flood

Transfer – it is the moving of patient from one place to another after giving first aid

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Selection of transfer depends upon the following

- Nature and severity of injury
- Size of the victim
- Physical capabilities of the first aider
- Nature of evacuation route
- Distance to be covered
- Sex of the victim

Pointers to be observed during transfer

- Victims airway must be maintained open
- Hemorrhage is controlled
- Supporting bandages and dressing remain
- The patient’s body must move as one unit in cases of head and spinal cord injuries
- Taller first aider must be at the head part of the victim
- First aider must observe proper body mechanics in lifting and moving the patient

Methods of Transfer

1. One man assist / carries / drag

- Assist to walk
- Carry in arms
- Pack strap carry
- Blanket / cloth / feet / armpit drag

2. Two man assist / carries

- Assist to walk
- Hands as a litter
- Chair as a litter
- Carry by extremities

3. Three / four man carry

- Bearer’s along side
- Hammock carry

4. Use of stretcher
- Improvised stretcher
- Ambulance stretcher

5. Use of spine board

TRIAGE – a process used in sorting patients or victims into categories of priority for care transport based
on the severity of injuries and medical emergencies.

a. START SYSTEM – simple triage and rapid treatment

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b. TAGGING SYSTEM
 Highest Priority Red Tag – victims needs immediate care

- Airway and breathing difficulties

- Open chest and abdominal wound
- Severe head injuries or head injuries with decreasing level of consciousness
- Tension pneumothorax
- Major and complicated burns
- Impending shock
- Complicating severe medical problem (diabetes with complications, cardiac
disease)

 Intermediate Priority (Yellow Tag) – delayed care; can delay transport and care to an hour

- Burn with complication

- Back injuries with or without spinal injuries
- Major, open or multiple fractures
- Eye injuries

 Low Priority (Green Tag) – hold care; can delay transport up to 3 hours

- Fracture and sprain

- Laceration
- Soft tissue injuries
- Other lesser injuries

 Lowest Priority (Black Tag) – no care required; patient is dead

BASIC LIFE SUPPORT – CARDIOPULMONARY RESUSCITATION (CPR)

LIFE SUPPORT – a series of emergency lifesaving procedures that are carried out to prolong the life of the
victim life threatening emergencies.

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KINDS OF LIFE SUPPORT

1. Basic Life Support (BLS) – an emergency procedure that consists of recognizing respiratory or
cardiac arrest or both and the proper application of CPR to maintain life until a victim recovers or
advanced life support is available
o Basic A-B-C steps
- airway opened
- breathing restored
- circulation restored
o Use of supplementary techniques

2. Advance Cardiac Life Support (ACLS) – the use of special equipment to maintain breathing and
circulation
o Definitive therapy
- defibrillation
- drugs
o Transportation
o Communication
3. Prolonged Life Support – for post resuscitative and long term resuscitation

CARDIAC CHAIN OF SURVIVAL

 Early Access
 Early CPR
 Early Defibrillation
 Early ACLS
 Post cardiac arrest

RISK FACTORS FOR CARDIOVASCULAR DISEASES:

NON-MODIFIABLE
1. Heredity
2. Gender
3. Age

MODIFIABLE
1. Smoking
2. Cholesterol and triglyceride
3. Exercise
4. Obesity
5. High blood pressure
6. Diabetes mellitus
7. stress

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CHOKING (Airway Obstruction)

CHOKING is the accumulation of foreign matter in the mouth throat and wind pipe that cause airway
obstruction.

Types of Obstruction

 Anatomical Obstruction – occurs when airway is blocked by:

- Back of the tongue drops down into the throat
- Swelling of the airway passages due to illnesses, injuries or inflammation

 Mechanical Obstruction – occurs when a foreign material obstructs the airway passages like fluids
such as sputum / vomitus, blood and saliva

Classification of Obstruction

 Partial obstruction with good air exchange – the victim can cough forcefully, can breathe, can
speak without difficulty
 Partial Obstruction with poor air exchange – the victim has weak ineffective coughing, high pitch
noise while breathing
 Complete or total obstruction – the victim cannot cough, breath or talk

Causes:
o Improper chewing of large pieces of food
o Excessive intake of alcohol
o For smaller children of “ hand to mouth” stage left unattended

The universal sign of choking is clutching the throat

First Aid Management

 Abdominal Thrust (Heimlich Maneuver) – a series of quick movements to the upper abdominal
area or chest to force the obstruction to move

When the person is sitting, standing and conscious:

- Stand behind the person and wrap your arms around his waist
- Put the thumb side of your hand on the abdomen between the navel and the end of the
sternum (breast bone)
- Grasp this hand with other hand and press it into the abdomen with a quick inward and
upward movement
- Repeat and continue the thrusts until the object is expelled. Each thrust should be
separated and distinct

 Chest Thrust ( Adult and child) – is a useful procedure when the person with an obstruction is large
and your arms will not reach around his abdomen but will reach his chest. It is also use when the
person is pregnant.

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- Position the person on his back. Open his airway and attempt to ventilate. If no air enters,
reposition his head and attempt to ventilate again. If unsuccessful, perform the following
steps:
- Place the heel of your hand two fingers above the lowest end of the breastbone.
- Put your other hand on top of this hand, and lean forward. As you do so, exert quick pushing
pressure.
- Give 30 chest thrust
- Open his mouth and look for the object. If you see it, sweep it clear of the mouth. If you do
not see it do not sweep.
- Attempt to ventilate. If unsuccessful, repeat the chest thrust until the obstruction is dislodge.

FINGER SWEEP of the mouth will remove an object that you can see. Do not use this technique
unless you can clearly see the object.

 Combination of 5 back blows and 5 chest slides (infant) – back blows are quick, forceful blows
between the shoulder blades used to dislodge from an infant. Do not use abdominal thrust in infant
as this action can damage the underdeveloped organs.

- Position the infant on his back. Open the airway (tilt head to maximum then return to neutral
position) and attempt to ventilate. If no air enters, reposition his head and attempt to ventilate
again. If unsuccessful, perform the following steps.
- Turn infant face down on your forearm and support his head on your hand. Rest your arm on your
thigh for support and keep the infant’s head lower than his body.
- Deliver up to five back blows forcefully between the shoulder blades with the heel of one hand.
- Sandwich the infant between your arms and turn the infant over as continue to support his head in
your hands. Again support him on your thigh
- Provide up to five quick downward chest slide with two fingers in the same location for chest
compression (the lower third of the sternum, approximately one finger – width below the nipple line)
- Check the mouth. If you see it, do not sweep the mouth
- Open the airway and attempt ventilate. If the airway is still obstructed, repeat this steps until the
airway is clear.

RESPIRATORY ARREST

RESPIRATORY ARREST – stoppage of breathing but circulation and pulse continue for sometimes

Causes:
 Obstruction it is either mechanical or anatomical obstruction
 Disease
- COPD
- Pneumonia
 Other causes
- Electrocution
- External strangulation
- Suffocation

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RESCUE BREATHING ( Artificial Respiration) – is the exchange of air between a rescuer and an
unconscious non breathing person or a person loses consciousness while you are trying to dislodge an
obstruction

Ways to Ventilate the Lungs

 Mouth to mouth breathing – it is quick effective way to provide oxygen and ventilation to the victim.
Seal your mouth around the person’s mouth, pinch the nose of the person and breathe slowly
 Mouth to nose breathing – it is recommended when it is impossible to ventilate through the victim’s
mouth: the mouth cannot be opened, the mouth is seriously injured, or a tight mouth to mouth seal
is difficult to achieve. Close the victim’s mouth and your mouth around the victim’s nose.
 Mouth to stoma breathing – it is used to a victim who has tracheal stoma. The rescuer needs to
seal the victim’s mouth and nose to prevent air from escaping
 Mouth to mask rescue breathing – the rescuer use a transparent mask either 1 way valve or
without a valve
 Bag valve mask device – it consist of a self – inflating bag and non – rebreathing valve attached to
a facemask

TABLE OF COMPARISON ON RESCUE BREATHING FOR ADULT, CHILD AND INFANT

ADULT CHILD INFANT
Opening of airway (head-tilt- Maximum tilt of the head Neutral plus position Neutral position
chin-lift maneuver)
Checking of pulse Carotid pulse (side of the Carotid pulse (side of the Brachial pulse (upper
neck) neck) arm)
Method / ways in ventilating Mouth-to-mouth / mouth-to- Mouth-to-mouth / mouth-to- Mouth-to-mouth and
the lung nose nose nose
Breathing Full, slow breaths Full, slow regulated breaths Gentle, slow breath
Rate 10-12 breaths per minute (1 20 breaths per minute (1 breath every 3 seconds)
breath every 4-5 seconds)
Counting for Standardization Breath 1, 1002, 1003, 1001, Breath 1, 1001, breath 1, 1002, breath 1, 1003 up to
Purposes breath 1, 1002, 1003, 1002, 1040 (40 cycles)
breath 1, 1002, 1003, 1003,
breath 1, 1002, 1003 up to
1024 (24 cycles)

CARDIAC ARREST

Cardiac Arrest – the circulation ceases and vital organs are deprived of oxygen. Cardiac arrest can be
recognized by absent respiration and absent in an unconscious person with deathlike appearance. Begin
CPR immediately when you recognize cardiac arrest.

Cardiopulmonary Resuscitation (CPR) – combines rescue breathing with chest compressions to circulate
oxygen around the body while waiting for further emergency help

 One rescuer CPR

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 Two rescuer CPR – when to professional rescuers are available, they give two rescuer
CPR. One rescuer is giving chest compression and a second rescuer is giving rescue
breathing.
 Compression only CPR – if the person is unwilling or unable to perform mouth-to-mouth
ventilation for an adult victim, chest compression only CRP should be provided rather than
no attempt at CPR being made
 Cough CPR – the increase in intrathoracic pressure that occurs with coughing will
generate blood flow to the brain and maintain consciousness.

Criteria for not starting CPR

 Victim has valid “DNAR” order – “Do Not attempt Resuscitation”
 Victim has signs of irreversible death
 No physical benefit can be expected because the vital functions have deteriorated

When to stop CPR

S- Spontaneous signs of circulation are restored
T – Turned over to medical services
O – Operator is already exhausted
P – Physician assumes responsibility (declares death, take over)
S – Scene becomes unsafe

TABLE OF COMPARISON ON CARDIOPULMONARY RESUSCITATION FOR ADULT, CHILD, AND INFANT

ADULT CHILD INFANT

Compression Center of the chest, lower half of the sternum (2 inches Center of the Center of the
Area above the xyphoid process) chest, chest, 1 finger
measure up width below
to 1 finger the imaginary
from nipple line
substernal
notch
Depth Approximately 1 ½ -2 inches Approximately Approximately
1- 1 ½ inches ½ - 1 inch
How to 30 compression: 2 ventilation
compress
Number of 5 cycles
cycles
Counting for 1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,1,2,3,4,5,6,7,8,9 and 1 breath, breath
Standardization 1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,1,2,3,4,5,6,7,8,9 and 2 up to 5 breath
breath

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