FIRST AID 2020

By Birhanu Wondimu Bsc,Msc

Email Birhanu [email protected]
Unit One

Emergency or First Aid

 Definition:
 First Aid is the immediate or initial treatment given to an injured or sick person before
medical help is made available with the materials available.
 Reason or Aim of first aid (emergency care)
1.To preserve life of the casualty
2.To prevent further injury & deterioration of the condition.
3.To prevent complications related to injuries or illness.
4.To make the victim as comfortable as possible.
5.To promote recovery
6.To put the injured person under professional care.
 First aider (Emergency care provider)
 First aider is a person who offers emergency care to a casualty. The term first aider is
applied to someone who has completed a theoretical & practical instruction course,
passed a professional supervised examination & certified. The certificate is valid for 3
years; to keep up date the first aider must be re-examined after further training.
 Most peoples can offer first aid. However, first aid is a skill, based on knowledge,
training & experience.
 The person who offering this help to a casualty must act calmly, with confidence and
above all must be willing to offer assistance whenever the need arise.
 Responsibility of first aider in the management of casualty:
 Assessment of the situation.
 Arriving at the diagnosis for each casualty.
 Giving adequate and immediate treatment.
 Arrangement for the transport of casualty according to the seriousness of his condition
without delay.
 Qualities of first aider
 Good observer.
 Self-confident
 Able to lead & control the seen
 Knowledgeable
 Able to understand his or her limitation
 Principles:
1. Be calm, take charge and be confident.
2. Talk, listen and reassure the conscious casualty.
3. Check safety of casualty and of your self: - then check bleeding, breathing and
consciousness.
4. Get others to help (call for help!!!)
5. Look for dangers to yourself & to the casualty.
6. Never put yourself at risk.
7. Look for resources available to you & the kind of help that you may need.
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 Assessment: - Steps of Assessment

1. Check for consciousness
-If the casualty does not respond when spoken to, he/she may be unconscious.
 -Try to elicit a response by asking simple questions, if no responses gently shake the
shoulder of the casualty.
 -Don’t move the casualty’s head & neck because you may cause further injury.

 2-Open the airway
 -An unconscious casualty’s airway may be blocked by the tongue falling back. In such case
open the airway by tilting the head & lifting the chin method. This method removes tongue
from the airway & allows the casualty to breath.

 3-Check for breathing
 A. Air way (Breathing)
 -Once the casualty’s airway is open, establish whether he/she is breathing or not.
 -See air way is clear
 -If breathing has ceased, commence artificial respiration immediately
 4-Check for circulation
 -Maintain potent blood circulation
 -If heart is beating you should able to feel a pulse
 -In adult & child casualty check inside the groove of neck on the carotid artery.
 In infant check on the upper inside of arm brachial artery
 5-Check for bleeding
 -Sever loss of blood reduces the circulation to the vital organs & can cause serious shock. So
that control bleeding as soon as breathing and pulse are established.

 Diagnosis:
 The history of the incident must be taken in to consideration and an examination made to
determine the signs and symptoms and level of consciousness.

 History:
 How the accident happened (from casualty or bystander)
 Symptoms:
 Sensation or feeling that are described by the casualty.
Example: - I feel pain
- I feel cold
- My arm is numb.
 Signs:
 Check variation from normality Example: pale, cyanosis of face, lips, tongue
 There may be evidence of poisoning : example medications, alcoholic smell,
bottles, container beside the victim, etc
 Level of consciousness: - using GCS.
 Full conscious: - able to speak and answer questions normally.
 Drowsiness: - easily aroused but lapses in to unconsciousness.
 Stupor: - can be aroused with difficulty to painful stimuli.

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 Coma: - cannot be aroused by any stimuli.

 Action:
 If the cause of the condition is still active, remove the cause.
Example: a log of wood on the casualties’ legs, contaminated clothing or remove
casualties from the cause such as traffic, fire, water, poisonous fumes, etc.
 Make the area safe
1. Road accident
 Instruct bystander to control traffic directing it away from causality and you.
 Watch for fire risks from split petrol
 Switch off vehicle ignition
2. Gas and poisonous fumes
 Cut off source
 Remove causality to fresh air
3. Electrical contact
 Break contact, taking necessary precautions
4. Fire or collapsing building
 Move causality away to place of safety
 Give treatment you consider essential to sustain life:
 Emergency resuscitation.
 Control bleeding.
 Prevent the condition from becoming worse (complication).
 Immobilize fracture, large wounds and injured part.
 Place the casualty in correct and comfortable position.
 Prompt recovery and reassure.
 Relive pain.
 Protect from cold
 Transport the victim with out delay to the hospital or home.
First aid kit
 First aid kit is equipments essential to provide emergency care. These are: -

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 Gauze  Thermometer
 Rolls of gauze bandage  Tourniquet
 Adhesive tape  Ambu bag
 Antiseptic solutions such as alcohol,  Plastic apron
normal saline, iodine, savlone etc  Plastic eye glass
 Gloves  Safety pin & clip
 Scissors  Note pad with pencil
 Spatula (tongue depressor)  Torch
 Splint

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 If the above equipments are not available, don’t put yourself at risk; provide the care while
protecting your self as much as possible by using equipments which are available in that area.
 Protecting yourself against infection:
 Protective measures against diseases spread by blood and other body fluids should be
maintained for all patients at all times.
 To avoid cross-infection when giving first aid, if possible, you should:
1. Avoid direct contact with body or fluids where possible body substances requiring the
same handling precautions as blood:
o Cerebrospinal fluid (CSF)
o Peritoneal fluid
o Pleural fluid
o Pericardial fluid
o Synovial fluid
o Amniotic fluid
o Semen
o Vaginal secretions
o Breast milk
o Any other body fluid containing visible blood
o Unfixed tissues and organs.
2. Wear protective gloves
3. Cover your sores or skin wounds with a water proof plaster.
4. Wear a plastic apron when dealing with large quantities of a casualty’s body
fluids.
5. Wear plastic glasses to protect your eyes against splashes.
6. If your eyes, nose or mouth or any wound on your skin is splashed by the casualty’s
blood wash with soap & water as soon as possible, &consult a doctor.
First-Aid priorities
 Decide the priorities basing them on:
 The safety of the causality and yourself.
 The availability of others to help.
 Determining treatment.
 The availability and access to formal assistance
E.g. Ambulance, medical team police etc,

Unit 2
Managing Cardiopulmonary Resuscitation
2.1Respiratory Emergencies/Accidents
Definition- Respiratory emergency is one in which normal breathing stops or in which
breathing is reduced so that O2 intake is insufficient to support life.
 Respiratory accident interfere with the normal up take of oxygen by the lung, there by the
body tend to develop asphyxia.
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Asphyxia: -is a medical word for suffocation & it may occur due to decreased oxygen in the air
or increased carbon monoxide (CO) or other toxic gases

Causes of respiratory accidents

Respiration can be impaired in various ways
1-Low oxygen level in the air e.g. high altitude
2-Gas poisoning
3-Obstruction of air passage e.g. Chocking, Drowning
4-Depression of respiratory center
5-Compression of thoracic cage
6-Respiratory diseases
7-Strangulation

Managing different types of respiratory accidents

The management depends up on the causes of the accident.
 For airway obstruction:-
 Chocking –Try back slap, if fail try abdominal or chest
thrust method.
 Drowning -Use prone pressure method or place the casualty
in supine & compress chest & abdomen then resuscitate
 Strangulation- First removes the tie around the neck of casualty & resuscitate if
necessary.

2.2 Airway Obstruction

Definition:-Airway obstruction is the reduction of the diameter of either the upper or lower
conducting airway.
 This is the most common type of respiratory accident.
 Breathing requires more effort because air passes through a narrow passageway.
Air way become obstructed in several ways
- The lumen can become plugged by foreign materials
 Mucus
 Abnormal growth
 Aspirating objects (in small children)
 Chronic bronchitis
 Cystic fibrosis from excessive mucus secretion
 Asthma
These can be summarized as
 Anatomic obstruction
 Mechanical obstruction

Causes of airway obstruction

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Aspiration of foreign bodies

E.g. Food, Vomitus, Button, coins
Food is the most common causes in adults
Buttons & coins are the most common causes in children in addition to foods.
Inflammatory diseases of respiratory tract like asthma, bronchitis, broncholitis .etc
Lung cancer
Falling down of tongue in to the throat –it is very common in unconscious casualty

Types of airway obstruction

1-Anatomical airway obstruction
 The most common cause of respiratory emergency as interference with breathing caused
by the dropping of the tongue back and obstructing the throat.
 This is very common in unconscious casualty b/c the muscular tone in the throat b/m lost.
Other causes of anatomical obstruction (that causes construction of the air passage) are
 Asthma
 Croup
 Diphtheria
 Laryngeal spasm
 Swelling after burns of the face
 Swallowing of corrosive poisons
 Direct injury caused by blow.

2-Mechanical airway obstruction

 A mass of food or blood goes on the wrong way
 Aspiration of foreign body such as teeth or blood vomit
 Suffocation by pillows, plastic bag
 Compression of the neck caused by tie collar, scar in strangulation
 Conditions affecting the nerves which control respiration.
 Accumulation of fluids in the back of the throat

General signs & symptoms

 Noisy, laboured breathing
 Cyanosis
 Coughing, chocking
 Restlessness
 Loss of consciousness
 Cessation of breathing
 Restricted chest movement
Symptoms needing immediate intervention
 Universal distress signal for complete air way obstruction
 Irregular, slow, swallow breathing
 Apnea

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 High pitched wheezing

 Inability to cough forcibly or at all
 Inability to speak
 Vomitus in mouth or on face
 Cyanosis
 Abnormal pulse
Symptoms not needing immediate intervention
 Ability to speak
 Ability to breath in and out
 Ability to cough
 Stable vital signs
Note: Stay with the patient and allow him or her to cough to clear air way

Aim of first aid for airway obstruction

-To restore a supply of fresh air to the casualty’s lung
-To seek medical care

Chocking
Definition- is inability to breath, because the airway is blocked by foreign objects.
 The foreign object is stuck at the back of the throat & may either block the airway or
induce muscular spasm.
Causes-
Inadequately chewed food
Foreign objects other than food which is common in children
Chocking requires fast action from the first aider.

Aim of first aid for chocking

 To remove the obstruction & restore normal breathing
 To arrange urgent removal to hospital if necessary

Management of chocking
1-For a conscious adult
o Ask the casualty to cough up, but if the casualty unable to do so don’t force him/her.
o Bend the casualty well forward at the waist & give up to five sharp slaps between
scapulas with the flat of your hand.
o If back slap method fail, try up to five abdominal thrust
A-Put your arms around the casualty’s trunk
B-Link your hands below the rib cage
C-Pull sharply inward & upward
D-The obstruction may be expelled by the force against the casualty’s
diaphragm.
o Continue alternating back slap & abdominal thrust until the obstruction clears.

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2-For unconscious adult

o First check casualty’s Airway, Breathing, Circulation
o Turn the casualty on to his side & give up to five sharp slaps with the flat of your hand
between scapula. Check his/her mouth for the presence of obvious obstruction.
o If back slap method fails, kneel along the side of the casualty.
o Place the heel of one hand below his/her rib cage & cover with your other hand.
o Press inward & upward up to five times.
o If at any stage the casualty begins to breathe normally place the casualty in recovery
position.

3-For a conscious baby (0-12 months)

o Lay the babies face down on your forearm, supporting his/her back & chin.
Give up to five sharp slaps on his back.
o Check the baby’s mouth; remove any obvious obstruction with one finger.
o If this fails turn the baby’s face up on your lap.
Give up to five sharp thrusts in to his/her chest.
o Push down ward one finger’s breadth below nipple line with your finger tips.
o Check the baby’s mouth.
o If the obstruction still has not cleared, repeat the above step, if relieved, and place in
recovery position.

Prevention of Airway obstruction

 Restrict children form running, walking or playing with food or foreign objects in their
mouth
 Keep small objects away from children < 3 years
 Avoid feeding pop corn, peanut and others for < 3 years
 Cut food in small pieces
 Teach parents and care givers in the prevention and management
 Chew thoroughly
 Avoid laughing and talking while swallowing & chewing
 Avoid excessive alcohol before and during meals

The Recovery Position

Recovery position is the safest & comfortable position that is indicated for unconscious casualty
who is breathing.
This position prevents the tongue from blocking the throat.

Methods
1- Kneel beside the causality, then open the airway, straighten his/her leg. Tuck the hand
nearest to you, arms straight & palm upward, under his/her upper thigh. Before turning
him/her, remove any fragile or bulky objects from his/her pockets.

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2- Bring the arm furthest from you across the chest, and hold the back of the hand, against the
casualty’s nearer cheek. With your other hand, pull up the far leg just above the knee keeping
the foot flat on the ground.
3- Keep the casualty’s hand pressed against his/her cheek, pull on the upper leg to roll the
casualty toward you and on to his side.
4- Use your knees to support the casualty so that he /she is prevented from rolling too far
forward.
5- Tilt the head back to ensure the airway remains open. If necessary, adjust the hand under the
cheek.
6- Adjust the upper leg.
7- Adjust the lower arm so that the casualty is not lying on it.
8- Monitor & record breathing & pulse every ten minutes until help arrive.

Resuscitation
Definition- Resuscitation is restoration of breathing & circulation in the absence of
spontaneous breathing & circulation.
 It is also defined as recovery from death b/c it restore life by establishing breathing &
circulation.
 If the body’s natural mechanism of breathing & circulation breakdown, it is essential to
resuscitate the casualty by taking over the ventilation& circulation.
 The blood is oxygenated by breathing & is circulated around the body by the beating of
heart so with out breathing & circulation life will not sustain.
 Ventilation is recovered by artificial ventilation.
 Circulation is recovered by chest compression.
 Resuscitation restores the supply of oxygen to the brain.
 The priority in treating any casualty is to establish & maintain effective breathing &
circulation. Therefore this technique helps you what you can do to assist a casualty whose
breathing & heart beat is stopped.
The Resuscitation Sequence
1-Check the consciousness of casualty
Try to get a response by asking simple questions & carefully shaking the shoulder.
2-Open the airway
Open the airway by tilting the head back & lifting the chin.
3-Breathing for a casualty
Look in to the mouth & remove any obvious obstruction.
If the casualty is not breathing, keep the head tilt back, pinch the nostrils closed & give two
breaths of mouth-to-mouth ventilation.
4-Assissing for circulation
Check the pulse for up to ten seconds.
If you can feel pulse, continue artificial ventilation.
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If there is no pulse or any other sign of recovery begin CPR.

Artificial Ventilation
Definition- Artificial ventilation is a forceful introduction of air in to the lungs of a person
who has stopped breathing.
 It is a procedure for making air to flow into and out of a person’s lung when his natural
breathing is inadequate or ceases.

Forms of artificial ventilation

Mouth-to-Mouth Ventilation
1- Place the casualty in supine position & remove if there is any obvious obstruction.
E.g. Broken teeth or displaced dentures
2- Open the airway
3- Close the casualty’s nose by pinching it with your index finger & thumb.
4- Blow in to the casualty’s mouth until you see the chest rise. Takes about two seconds for
full inflations.
5- Remove your lips & allow the chest to fall fully which takes about four seconds.
If pulse is absent & other sign of recovery like return of skin color, any movement such as
coughing, swallowing & breathing.
If there is pulse, continue artificial ventilation & check pulse every ten breathes.
If breathing returns, place the casualty in recovery position.

Mouth – to – Nose Ventilation

– Out of several methods of artificial respiration the most effective is mouth- to- mouth &
mouth to nose
– Mouth to nose ventilation is an alternative form of artificial ventilation that is indicated
- When there is sever injury t the face and mouth
- When the casualty is pinned in face down position
- When vomiting interferes with respiratory resuscitation
- If there is oral bleeding
(Vomiting usually occurs when breathing is re – established and consciousness is
returning)

Methods
1- Place the casualty in supine position
2- Open the airway
3- Close the casualty’s mouth by your thumb
4- Form tight seal with your lips & the nose & blow in to the casualty’s nose
5- Open the mouth of the casualty to let the breath out.
6- Repeat this until breathing returns.

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CARDIOPULMONARY RESUSCITATION (CPR)

Definition: - The sequence of techniques used to sustain life in the absence of spontaneous
breathing & a heart beat.
– It is known as external cardiac massage.
– It is restoration of breathing & circulation by combining artificial respiration & chest
compression
– It is a combination of artificial ventilation & chest compression
– Chest compression circulates blood by pressing the heart b/n sternum & the back bone.
– When you compress the chest push on the lower half of the sternum, above the xiphoid
process don’t press on xiphoid process b/c this may injure the liver.
– If you have a helper, send him/her to call an ambulance
– If you are alone begin resuscitation & give for 1 minute, then call an ambulance, continues
CPR until the breathing & circulation restore.

Steps of CPR
For Adult
1. Kneel beside the casualty & position the hand on the sternum.
2. Place the heel of your hand on the sternum
3. Place the heel of your other hand on the top of first hand & interlock your fingers
4. Leaning well over the casualty, with your arms straight, press vertically down & depress
the sternum don’t lift your hand from the sternum
5. Compress the chest 30 times, aiming for a rate of about 100 compressions per minute.
6. Then give two breaths of artificial breathing
Continue this cycle of alternative 30 chest compression with 2 artificial breathing until help
arrives

For a Child
1. The steps are the same with that of adult, but compress the chest only by the heel of one
hand only
2. Do this 15 times at a rate of 100 per min
3. Give one full breath of mouth to mouth ventilation

For infant
To compress the chest place the tips of two fingers just one finger below the inter-nipple
line
Give one full breath of artificial ventilation by breathing in to the baby’s mouth & nose.

Age Chest compression Artificial Ventilation

Neonate ( <28 days) 3 ( with two fingers) 1 (mouth & nose)
< 1 Yr 5 ( with two fingers) 1(mouth & nose)
1-7 yrs 15 (with the heel of one 2 (on mouth only)
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hand)
8 or over 30 (with the heel of both 2 (on mouth only)
hands)

N.B Do not begin external heart compression until you are sure that the heart stopped beating

Drowning
Definition: - it is the result of complete immersion of the nose & mouth in water or any other
liquid.
– Water enters to the trachea & lungs.
– Drowning causes asphyxia by water entering the lungs
– Laryngeal reflex prevents water entering to lungs but this process impairs breathing leading
to hypoxia & death.
– The only important consideration is the duration of hypoxia
– If the person floats face up may survive, but if the face is down he/she will sink.
– Death by drowning normally occurs w/n air can not get in to the lungs.
– Drowning also causes throat spasm, this is b/c any water that enters to the lungs irritate the
mucus membrane of airway passage & the air way b/m swelled.
– If the casualty has been immersed in cold water there is also a danger of hypothermia, so it
is important that the casualty is kept warm.
Hypothermia – a core body temperature below the lower limits of normal (<28oC).
Aim of first aid for drowning
 To restore adequate breathing
 To keep the casualty warm
 To arrange removal of casualty to hospital
Management
1. Choose the safest way to help the casualty. Don’t go to the water if you don’t know
how to swim. Give your hand to the casualty while you are standing on the land or ask
others help. If you can swim & the casualty is unconscious you may have to swim to
the casualty & remove out from the water.
2. Lay the casualty on his/her back on a safe surface, keep the head lower than the rest of
the body, open the airway, check breathing & pulse & be prepare to resuscitate if
necessary. Give artificial ventilation until breathing comes back to normal
3. If artificial ventilation fails start chest compression & abdominal compression method
in order to drain out the water. The head of the casualty should be to the side.
4. Remove wet clothing & replace by dry if possible in order to keep the body warm &
cover with blanket.
5. When the casualty b/m conscious, give hot coffee or tea
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6. Send quickly to the hospital for further diagnosis & treatment

Hanging, Strangling & Throttling

 Pressure exerted on the outside of the neck causes airway obstruction & the flow of air to
the lung cut off.
 The three main causes of such pressure are
o Hanging: - suspension of the air supply by a noose around the neck
o Strangling: - cutting of air supply by intentional constriction
around the neck.
o Throttling: - cutting of the air supply by intentional squeezing of
the person’s throat.
 The first two conditions may occur accidentally or intentionally, but throttling occurs
intentionally.
 A slight compression is sufficient to cause a complete closure of glottis at it forces the
bases of tongue upward & backward against the posterior pharyngeal wall causing
complete occlusion of air passage.
Sign & Symptoms
 Body may still be suspended
 General signs & symptoms of asphyxia (sob, cyanosis, restlessness etc)
 Congestion of the face & neck with the veins b/m prominent
 Constriction may still be visible around neck or it may be hidden in the folds of
the neck skin
 Marks around the neck
Management
1. Quickly remove any constriction around the casualty’s neck. Support the body (lift
the casualty up ward) while you do so, if it is still hanging
2. Lay the casualty on the floor. If he/she is unconscious open the air way & check
breathing & pulse. If the casualty is not breathing resuscitate by using artificial
ventilation.
3. Arrange things to remove the casualty to the hospital

Asthma
Definition: - Asthma is a chronic inflammatory disorder of the airway.
– It is a recurrent attack of breathlessness.
– This is a distressing condition in which the muscles of the airway go in to spasm.

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– Asthma results narrowing of the airway that makes breathing difficult.

– The exact mechanism that cause asthma is unknown, but there are certain conditions that
triggers the attack
– These are allergens (substances that stimulate inflammatory reaction) such as dust, pollen,
animal fur etc.
– Most asthmatic peoples carry a “reliving” inhalers
– The effect of the inhaler is dilating the air passages & easing breathing.
– Because the air way b/m obstructed breathing b/m difficult especially during expiration.

Sign & Symptom

 Wheezing sound as the casualty breaths out
 Distress & anxiety
 Difficult in speaking (dysphonia) & whispering
 Cyanosis
 Dry cough
 Breathlessness
 Rarely the casualty b/m unconscious
Aim of first aid for asthma
 To ease breathing
 To seek medical aid if necessary
Management
1. Keep the casualty calm & reassure him/her
2. Put the casualty in a comfortable position w/c is sitting on a chair & lean slightly
forward. Ask him/her to breathe slowly & deeply. Don’t make the casualty lie down.
3. If the casualty have the inhaler ask to take one dose, inhaler usually works within a few
minutes & repeat after 5-10 minutes.
4. If this is the 1 st
attack or if it is sever
 This is b/c
 The inhaler has no effect
 The casualty is getting worth & exhausted
 Breathing b/m difficult
 Perform the following
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 Give inhaler every 5-10 minutes

 Monitor & record pulse & breathing every 10 minutes
 Take the casualty to the near by hospital immediately
5. If the casualty b/m unconscious & breathing stops open the airway, check breathing &
pulse, be ready to resuscitate. Take to the hospital while doing this.

FIRST AID FOR SEVER BLEEDING

Def. Bleeding is the escape of blood from blood vessel.
– When blood vessel is cut or torn blood escape & bleeding occur.
– The amount of bleeding depends on the number & size of injured blood vessels.
– Hemorrhage is an abundant or uncontrollable bleeding. This results in the reduction of
circulating blood volume.
– Stopping bleeding is essential for the survival of the casualty.

Types of Bleeding
A-Based on the type of blood vessel that is damaged there are three types of bleeding
1. Arterial bleeding
– The blood comes from the injured arterial blood vessel.
– The color of the blood is bright red.
– The bleeding is under high pressure.
– This type of bleeding rapidly reduces the volume of circulating blood.
– Blood spurts (can be several feet high) from the wound.
– This is the most serous because blood is being pumped out at a faster rate.
– Bleeding to greater blood loss. This type of bleeding is less likely to clot.
2. Venous bleeding
– The blood comes from the injured venous blood vessel.
– Blood flows or gushes under less pressure so that it is easier to control than arterial
bleeding.
– The color of the blood is dark red.
3. Capillary bleeding
– Blood gushes from injured capillaries.
– This is an oozing type of bleeding.
– This is the most common type of bleeding and is easily controlled.
– Quite often this type of bleeding clots of by itself.

B-Based on the site of bleeding there are two types of bleeding

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1-External bleeding
– The bleeding is from the outside of the body.

2-Internal bleeding
– The bleeding is inside of the body or within the body cavity.
– Internal bleeding occurs when the skin is unbroken, and blood is not seen. It can
be difficult to detect and can be life threatening.
Sign symptom
– Bruise or contusion of the skin.
– Painful, tender, rigid, bruised abdomen
– Fractured ribs on bruises on chest
– Weakness, dizziness and fainting
– Rapid pulse
– Cold moist skin
– Vomiting or coughing up blood
– Stool that are black or contain bright red bleed.
Assessment
Casualty is assessed for the sign & symptom of shock such as:-
 cool, clammy skin
 moist skin(Diaphoresis) this is due to poor peripheral perfusion
 Falling B/P
 Increased heart rate
 Pallor
 Delayed capillary refilling
 Decreased urine output
Goals of emergency management for bleeding
 To control bleeding
 Maintained an adequate blood volume for tissue oxygenation
 Prevent shock (the reduction of circulating blood volume)
 To arrange urgent removal of the casualty to hospital.

Management of external bleeding

 Bleeding can be controlled by using the same method no matter its sources is.
1. Protect yourself against disease by wearing disposable latex gloves or use several layer of
Gauze pad.
2. Expose the wound by removing clothing (cut)
3. Apply firm pressure over the bleeding area
 Pressure may be applied directly or indirectly
Direct pressure – pressure is applied over the wound

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 Place a suitable gauze pad or clean cloth over the entire wound apply direct
pressure in finger or palm
 Don’t use direct pressure on an eye injury, wound and an embedded object,
skull fractal.
E.g. Dressing
Indirect pressure – the pressure is applied closer to the injured area
 Don’t apply pressure bandage so tight that cuts circulation.
E.g. Tourniquet
 If bleeding does not stop with in 10 minutes the pressure may be to light or in
wrong location. Press hands over wide area for another 10 minutes.
4. Elevate the injured area above the casualty’s heart level in order to slow blood flow to the
area.
5. Lay the casualty down. This will reduce blood flow to the site of injury & minimize shock
6. Place cold compress over the injured site.
7. Send the victim to hospital.

Control of Internal Bleeding

 Bleeding within the body cavities may follow injury like fracture or wound or it can also
occur spontaneously e.g. stomach ulcer
 These may take day to appear.
 Internal bleeding is suspected
 If no external sign of bleeding, but if there is s/s of shock
 If blood comes at body orifices
What to do
1. Help the casualty to lie down & raise & support his legs w/c is shock position
2. Monitor & record breathing, pulse & level of response every 10 minutes.
3. Note the type, amount & source of any blood loss from body orifices. If possible send
the sample with the casualty to hospital.
Bruises
Apply an ice pack for 20 minutes protect the victim’s skin from frostbite by having a wet cloth
transfers cold than a dry one which insults.

Bleeding from the Ear

 Bleeding that originates from inside of the ear.
Cause
o Rupture (perforation) of the ear drum
 This is due to sharp object pushed in to the ear or blow to the side of the
head
 The appearance of the blood is fresh
o Follow head injury
 The blood appear thin & watery
 This is very serious b/c it indicates skull is fractured & CSF is leaking
from brain.
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Aim of emergency care

 To allow blood to drain away
 To minimize the risk of infection
 To arrange transport to hospital

Management
1. Help the casualty in to a half – sitting position with the head inclined to the injured side
to let the blood drain
2. cover the ear with a sterile dressing or clean pad, lightly held in place
3. send or take the casualty to hospital

Bleeding from the Mouth

 blood comes from casualty’s mouth
 The bleeding is due to cut to tongue, lips or teeth
 Profuse bleeding can be dangerous if swallowed, if blood is swallowed it can cause
vomiting
Cause
o Casualty’s own teeth
o Denture extraction

Management
1. Sit the casualty down, with the head fore ward & inclined towards the injured side, to
allow blood to drain.
2. Place a gauze dressing pad over the wound. Ask the casualty to squeeze the wound &
the pad b/n finger & thumb & press for 10 minutes.
 If a tooth socket is bleeding, take a gauze pad that is thick enough to stop the
casualty’s teeth meeting, place it across the socket, & tell her to bite on it.
3. If bleeding persists, replace the pad with a fresh one. Tell the casualty to let any
escaping blood dribble if swallowed, induce vomiting
 Do not wash the mouth out, as this may disturb a clot.
4. Advise the casualty to avoid hot drinks for 12 hours
 If the wound is large, or if bleeding persists beyond 30 minutes, send the casualty
to a dentist or hospital.

NOSE BLEEDS ( EPISTAXIS)

 Bleeding comes from the nostrils when blood vessels rupture inside the nostrils.
Cause
 Blow to the nose
 Sneezing
 Infection such as cold, flu makes the b/d vessels fragile
 Increased b/d pressure
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 Followed by head injury

Management
1. Keep in a sitting up position & lean forward slightly. If this position is not possible b/c of
other injuries have the casualty lie down keeping head & shoulder elevated.
2. Keep victim’s head bent slightly forward so that blood can run out the front of the nose, not
down the back of the throat, which cause either chocking or nausea and vomiting vomit
could be inhaled into the lungs.
Do not allow the victim to tilt his or her head back ward
Do not probe the nose with cotton tipped swab.
3. Ask the casualty to pinch both nostrils with steady pressure for 5 - 10 minutes, remind the
victim to breath through their mouth and to spit out any accumulated blood.
4. If bleeding continues have the victim gently blow the nose to remove any clots and excess
blood and minimize sneezing. This allows new clots to form. Then press the nostrils again
for 5 minutes.
5. Apply cold compress on the nose, face or back of neck. Tell the victim not to speak, swallow
& cough b/c this may disturb blood clots.
6. If bleeding persists other methods are used which could be tried in addition to nose pinching.
a. Place a roll of gauze in to nostrils
7. If nose bleeding persists beyond 30 minutes send the victim to hospital
8. Once the bleeding is under control, clean nose & mouth with luck warm water.
9. Advise the casualty to rest quickly for a few hours.

Vaginal bleeding
 The blood comes through vaginal orifice
 Vaginal bleeding indicates
 Menstruation
 Miscarriage
 Recent abortion
 Internal disease
 Injury as a result of sexual assault

Management
1. Remove the women, if possible, to a place with some privacy or arrange for screening to
be set up.
2. Find a sanitary pad or a clean towel & give it to her.
3. Make a casualty as comfortable as possible, in which ever position she prefer.
o If she wants to be in sit up, prop her up with rolled – up clothing or cushions.
o Bending knee eases strain on abdominal muscle.
4. If the victim knows her cramps are menstruation she may have pain-killer tablet, so help
her to take her own medications.

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5. If a woman has been assaulted, it is vital to preserve evidence if possible. Gently

encourage her to refrain from washing or using toilet until forensic examination has been
performed by a trained police doctor.

UNIT THREE
EMERGENCY CARE FOR WOUND
Definition – Wound is a break in the continuity of the body tissue
–
It is any break or crack to the skin
Common causes of Wound
– Sharp object like blade, knife
– Pin pointed object like needle, nail
– Bite human, animal .etc.
– Accidents like falling, gun shot, car accident etc
– Mishandling of machines & motor
Types of wounds
There are d/t types of wounds based on d/t classification
1. Based on bacterial invasion or cleanliness
a. Clean wound
– There is no pathogenic microorganism
– This is usually a surgical wound
– It is a fresh wound
b. Contaminated wound
– Microorganisms are present on the wound but the wounds doesn’t show
sign of infection

c. Infected wound
– There are a number of microorganisms & this causes infection
– S/S
 Redness
 Swelling
 Pussy discharge
 heat
d. Colonized wound
– The wound stay for long period of time with out treatment
– Many bacterial colonize the wound
– S/S bad odor
2. Based on the integrity of skin
a. Open wound

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– The overlying skin is broken

– Risk of infection is high
–There is external bleeding
b. Closed wound
– The overlying skin is not broken, but there is damage of underlying
structures.
– No risk of infection
– There is internal bleeding

3. Based on the appearance of Wound

a. Incisional / cut wound
– Occurs w/n body is injured by sharp objects
– Bleeding is heavy & rapid
– Risk of infection is high
– The wound appears straight
b. Laceration wound
– It is a wound with irregular break of skin
– Occurs w/n a greater force is applied on the skin
– Bleeding is heavy & rapid
–Risk of infection is high
c. Abrasion wound
– The superficial layer of skin is scraped off
– Bleeding is limited
– Less or no risk of infection
d. Puncture wound
– Occurs w/n body is injured by pin pointed objects
– The risk of infection is high
– Tetanus & gas gangrene may develop
–Bleeding is limited
e. Amputated wound
– Occurs w/n the part of the body is removed surgically or traumatically
– Risk of infection is high
–Bleeding is significant
f. Avulsion wound
– Occurs w/n there is cut / tearing away from the structure
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– The piece of skin & tissue tear away from the main
– There is incisional & laceration wound at the same time
E.g. Animal bite
– The risk of infection is high
– Bleeding is significant

Factors affecting wound healing

 Extent of the injury
 Location of the injury E.g. on the head more rapidly
 Presence of hemorrhage, hematoma
 Types of tissue injured
 Nutritional status
 Oxygen available to the wound area / hypovolumia, local edema, firm bandage
 Infection of the wound
 Foreign material, E.g. particles, suture, drainage
 Presence of accompanying disease, E.g. Diabetes Mellitus
Dressing of a wound
Defn: - Dressing is applying sterile gauze over the wound.
 Dressing covers a wound, prevent infection from entering it & help the blood-clotting
process.
 Although they may stick to a wound, the benefits outweigh any discomfort caused on
removal
 Use a pre-packed, sterile dressing where possible. If none is available, any clean, non-
fluffy material can be used to improvise a dressing.
Purpose
 To keep wound clean
 To prevent the wound from injury & contamination
 To keep in position drugs applied locally
 To keep the edges of the wound together by immobilization
 To apply pressure
 To promote healing
 To absorb discharge

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Principles of wound dressing

 Give priority for clean wound
 Not pack too tightly & loosely
 The dressing pad should always extend well beyond the wound’s edges.
 Place dressing directly on a wound. Do not slide them on from the slide & replace any
that slip out of place.
 If blood seeps through a dressing, do not remove it; instead apply another dressing
over the top.
 If there is only one sterile dressing, use this to cover the wound, & use other clean
materials as top dressing.
 Be sure the wound is completely covered
 Avoid skin irritation & excoriation (abrasion of epidermis)
 If not have sterile forceps use sterile glove
 Immerse used instrument on disinfection
Types of wound dressing
1. Dressing of clean (aseptic )wound
 Purpose
o To apply pressure
o To prevent infection
o To control bleeding
2. Dressing of contaminated (Septic )wound
 Purpose
o To absorb discharge
o To apply pressure to the area
o To apply local medication
o Prevent pain, swelling & injury

Preventing cross-infection
 Wear disposable glove if available
 Where possible, wash hands thoroughly before dressing a wound.
 Cover cuts & gauzes on your hands with waterproof dressing.
 Avoid touching the wound or any part of the wound while you are treating it.

When gloves are unavailable, use one of the following options.

 Ask the casualty to dress his/her own wound under your supervision.
 Enclose your hands in clean plastic bag.
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 Dress the wound, but wash your hands very thoroughly afterwards.

Antiseptics
 Use it in a safe strength, do not pore it in open fresh wound, be gentle during wound care
to avoid mechanical injury.
 Types
o Iodine 1% - for small wounds & dry, clean wound
o H2O2 3% - to clean septic wounds, & dry, clean wounds
o Savlon – 1% for normal wound care
 3.5% - for every infected wound. Savlon should be autoclaved before
using on wounds & burns. Savlon in stronger concentration will damage
tissue.
o Normal saline 0.9% - is used for wound irrigation
o Gentian Violate /GV/ 1% - used for dry clean wound

4/26/2025

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