First Aid Blueprint NS FED 2024 PDF

# College of Nursing, GMU ## Blueprint NS FED 201 ### Semester 3, Year 2 – Fall 2024 | S.N | Topics | Sub - Topics | Practice Context | Adult | Task | Competency level | Instrument used | |---|---|---|---|---|---|---|---| | 1 | Introduction to First aid, emergency and disaster nursing | Golden rule...

# College of Nursing, GMU ## Blueprint NS FED 201 ### Semester 3, Year 2 – Fall 2024 | S.N | Topics | Sub - Topics | Practice Context | Adult | Task | Competency level | Instrument used | |---|---|---|---|---|---|---|---| | 1 | Introduction to First aid, emergency and disaster nursing | Golden rules of first aid Scene Survey Call for emergency help Emergency & Disaster nursing -Preimpact, impact and post-impact | X | X | X | X | A Type MCQ | | | | | X | X | X | X | | | | | | X | X | X | X | | | | | | X | X | X | X | | | 2 | Wounds and Bleeding | Types of bleeding Recognizing internal bleeding Types of open wounds | X | X | X | X | | | | | | X | X | X | X | | | | | | X | X | X | X | | | 3 | Poisoning | Classification of poisoning International hazard symbols Care for ingested poisoning, intoxicated individual Carbon dioxide poisoning | X | X | X | X | | | | | | X | X | X | X | | | | | | X | X | X | X | | | | | | X | X | X | X | | | 4 | Heat and cold injuries | Heat cramps, exhaustion, stroke Cold related injuries- Hypothermia- its types, Frostbite & its types Heat related injuries - Types | X | X | X | X | | | | | | X | X | X | X | | | | | | X | X | X | X | | | 5 | First aid for sudden illnesses | Seizures and convulsions Anaphylaxis Stroke Nosebleed | X | X | X | X | | | | | | X | X | X | X | | | | | | X | X | X | X | | | | | | X | X | X | X | | | 6 | Bone and Joint Injuries | Diabetic emergencies Strain, sprain, dislocations DOTS, CSM RICE Muscle injuries | X | X | X | X | | | | | | X | X | X | X | | | | | | X | X | X | X | | | | | | X | X | X | X | | | | | | X | X | X | X | | | 7 | Lifting and moving of injured patients | Types of lifting with pictures First aid management in bites and stings | X | X | X | X | | | | | | X | X | X | X | | | | Bites and stings | | X | X | X | X | | **Practice context Task** - 1- Emergency - 2-Non-emergency - 3-Principles - 4-Merits & Demerits - 5-Strategies/Process - 6-Nurses Role **Competency level** - 1-Knows - 2-Knows how - 3- Shows how - 4-Does **Test Instrument** - 1-A Type MCQ ## Golden Rules of First Aid 1. Be calm, quick and methodical. Note all major injuries and give first aid accordingly. 2. In case of stoppage of breathing, start artificial respiration. 3. Try to stop bleeding as early as possible. 4. Do not allow a patient to go with shock. If it is not possible, transport the patient to a near by hospital as quickly as possible. 5. When serious accident takes place inform the police immediately. 6. Keep the patient warm and do not move him unnecessarily. Keep him in a comfortable position. ## Golden Rules 7. Do only what is necessary. 8. Reassure the casualty by using encouraging words and obtain help of his/her relatives. 9. Do not allow people to crowd around the casualty. Allow fresh air. 10. Be careful in removing her/his clothes. Do not cause injury. 11. Send the patient to hospital immediately by quickest means of transport. ## Scene Survey Includes: **Scene Assessment:** - Environment and Hazards - Mechanism of Injury (MOI) and Chief Complaint - Number of Casualties - Additional Resources Required - Personal Protection Equipment - General Impression/Introduction **Primary Assessment:** - Chief Complaint - Level of Responsiveness - Spinal Motion Restriction - Airway, Breathing, and Circulation (ABCS) - Rapid Body Survey - Pulse Oximetry (Sp02) - Transport Decision - Patient Positioning ## Steps: Calling for Emergency Help (1) In many first aid situations, help from the emergency services may be required. Ensure you know which number to call! - **UNITED KINGDOM:** 999 - **UNITED STATES:** 911 - **EUROPEAN UNION:** 112 - **UAE:** 998- AMBULANCE/997 - FIRE DEPARTMENT ## Calling For Emergency Help (2) - **GIVE CLEAR, PRECISE INFORMATION ABOUT** - The location of the incident - The number of casualties/people involved - The nature of their injuries - In some cases, their age - Any hazards at the incident (eg. Fuel, fire, electricity) IF THE AREA IS REMOTE/DIFFICULT TO ACCESS, CONSIDER SENDING SOMEONE TO MEET THE EMERGENCY SERVICES. ## Role of Emergency & Disaster Nurses in Different Phases: **Disaster Continuum:** - **Disaster Phases:** - PreImpact - IMPACT - (0-24 hours) Response - (24-72 hours) Emergency management - Mitigation - Postimpact - Greater than 72 hours - Recovery - Rehabilitation - Reconstruction - Evaluation **PRE-Impact** - **PLANNING/PREPAREDNESS, PREVENTION, WARNING** 1. Participate in development of community disaster plans. 2. Participate in community risk assessment: hazard mapping, vulnerability analysis. 3. Initiate disaster prevention measures: (removal of hazard, public awareness campaigns, etc.) 4. Perform disaster drills. 5. Prepare by taking educational training. 6. Develop database of nursing staff. 7. Develop evaluation plans for all responses. **IMPACT** - **RESPONSE, EMERGENCY MANAGEMENT, MITIGATION** 1. Activate disaster response plan 2. Mitigate all ongoing hazards. 3. Activate agency disaster plans. 4. Establish need for mutual aid relationships. 5. Integrate state and federal resources. 6. Provision for ongoing triage. 7. Evaluate public health needs of affected population. 8. Establish safe shelter, sanitation needs and food & water supplies. 9. Evaluate need for/activate additional nursing staff. **POSTIMPACT** - **RECOVERY, REHABILITATION, RECONSTRUCTION, EVALUATION** 1. Continue provision of nursing and medical care. 2. Monitor safety of food and water supply. 3. Withdraw from disaster scene. 4. Restore public health infrastructure. 5. Re-triage and transport of patients to appropriate level care facilities. 6. Reunite family members. 7. Monitor long-term physical and mental health status of survivors. 8. Provide counselling for staff and adequate time for rest. 9. Evaluate disaster nursing response actions. 10. Revise original disaster preparedness plan. ## Bleeding- Types - **A. External bleeding:** refers to blood coming from an open wound. - **B. Internal bleeding:** refers to blood not seen outside and skin is not broken (skin is intact). It can be difficult to detect. Appears bluish or greyish or maroon in color. ## Recognizing internal bleeding- The signs of internal bleeding are: - Bright red blood vomitus from mouth or bleeding per rectum or blood in the urine. - Vomited blood which can be bright red, dark red or look like coffee ground. - Black, foul-smelling, tarry stools - Pain, tenderness or swelling - Mostly -Bruises over the lower chest or a rigid abdomen. ## Types of open wounds 1. **Abrasion:** Top layer of skin is removed, with little or no blood loss. Abrasions tend to be painful because the nerve endings often are abraded along with the skin. 2. **Laceration:** -skin cut with jagged, irregular edges. This type of wound is usually caused by a forceful tearing away of skin tissue. 3. **Incision:** Tend to have smooth edges and resemble a surgical or paper cut. The amount of bleeding depends on the depth, the location and the size of wound. 4. **Puncture:** Usually deep, narrow wounds in the skin and underlying organs such as stab wound from a nail or a knife. 5. **Avulsion:** A piece of skin and/or underlying tissue is torn loose and is hanging from the body or completely removed. This type of wound can bleed heavily. Often involves ears, fingers and hands. 6. **Amputation:** Involves cutting or tearing off of a body part such as finger, toe, hand, foot, arm or leg. ## Classification Poisons can be classified by how they enter the body: - **Ingested (swallowed):** – through the mouth - **Inhaled (breathed):** – through the lungs - **Injected:** – through needle like device (eg. snake's fangs, bee's stinger) - **Absorbed (direct contact):** – through the skin or eyes. ## Poisons come in four forms: - **Solids:** - medicine pills - **Sprays:** – Spray cleaners - **Liquids:** – household cleaner - **Gases:** – Carbon monoxide ## The International Hazard Symbols - **Flammable:** These materials catch fire easily and burn quickly when exposed to any form of ignition (such as fire or heat). - **Toxic:** These materials can harm the respiratory (breathing) system, nervous system, and other systems if they are absorbed through the skin, inhaled, or ingested. - **Explosive:** These materials can explode when exposed to heat, flame, or pressure. - **Corrosive:** These materials can burn the skin and cause permanent blindness. ## Care for ingested poisoning victims If you think someone has been poisoned: - Check the condition of the victim. Call 998 immediately if the person: - Has collapsed (and/or is unresponsive) - Is having trouble breathing; monitor for breathing and if absent, begin CPR - Has severe pain in the chest. - Shows other life-threatening signs. - Try to identify what poison is involved. ## Care for intoxicated Individuals 1. Look for any injuries. Alcohol can mask pain. 2. Monitor breathing and treat accordingly. 3. If the intoxicated person is lying down, place him or her in the recovery position to reduce the likelihood of vomiting and aspiration of vomiť. Be sure to check if the victim is breathing and does not have a spinal injury before you move him or her. 4. Call the poison center or emergency number for help. 5. If the victim becomes violent, leave the scene and find a safe place until police arrives. 6. Provide emotional reassurance if cooperative. 7. Assume that an injured or unresponsive victim has a spinal injury and needs to be stabilized against movement. 8. Many intoxicated people have been exposed to cold, move the person to a warm place whenever possible. Remove wet clothing and cover with warm blankets. ## Carbon Monoxide Poisoning - Closed room where there is cigarette smoking - People who ride long distances in older, poorly maintained cars - Rusted vehicles **Causes: - hypoxia or lack of oxygen.** First, hemoglobin present in RBC has about 200 times stronger affinity to bind to CO than to oxygen present in blood. Second, CO does not allow the cells to use what little oxygen is delivered. In short, CO deprives the body parts that need oxygen the most -heart and brain. ## Heat Cramps - Painful muscle spasms usually in legs and abdomen, caused by loss of fluids and electrolytes due to sweating. - Mild muscle contractions - Moist skin **CARE:** 1. Reduce heat exposure - by moving to a cooler environment. 2. Slowly sip cool electrolyte-replacement drink. If not available- drink water. 3. Gently stretch and massage the cramped muscles. ## Heat Exhaustion - Occurs when body begins to overheat, especially when it loses more fluids and electrolytes through sweating. - Usually happens after long periods of strenuous activity in hot environment - Early indicator that body's temperature regulating mechanisms are overwhelmed. As more blood flows to the skin to remove heat from the body's core, not enough blood flows to the vital organs. **WHAT TO LOOK FOR:** - Normal or slightly raised temperature - Moist skin that is flushed (red) immediately after exertion and then turns pale - Dehydration - Headache, nausea, dizziness or fainting - Weakness or exhaustion **Call 998, if the person has vomiting, has an altered level of responsiveness or is unable to drink fluids.** **CARE:** 1. Remove to colder area. 2. Loosen any tight clothing and remove any extra padded clothing 3. Pour cool water on the person's clothing and/or wet towels or cloths and place them on person's chest. 4. Apply ice or cold packs to the arm pits and chest. 5. If the person is responsive and able to swallow, have him or her slowly sip a cool water/electrolyte replacement solution. 6. Advise the person not to do any more activities in the heat that day. ## Heat Stroke - Heat stroke is the least common but most severe heat-related illness. It is a life-threatening emergency that occurs when the body's cooling system is completely overwhelmed and stops working. - The body stops sweating because the levels of fluid are too low. When sweating stops, the body's temperature rises quickly. When it gets too high, the brain and other vital organs cannot work properly. **SYMPTOMS:** - RED SKIN - DIZZINESS - HIGH FEVER - VOMITING - HEARTBEAT - HEADACHE **Call 998 and get an AED.** **Look for: **high core temperature (above 40°C), hot, dry skin, headache, altered mental status, irritable, progressive loss of responsiveness, weak pulse, shallow breathing, vision problems, seizures or coma **CARE:** - Move the person to a cooler environment. - Quickly lower the person's core temperature by: Immersing the person in cool water, do not remove the person's clothing. - Pour cool water on the person's clothing and/or wet towels on person's chest. - Continue to use the rapid cooling methods till the person's condition improves. - If the person is responsive and able to swallow, have him or her slowly sip electrolyte replacement solution. ## Hypothermia - Core temperature is less than 95°F/ 35°C - Wind / chills: heat loss increases as wind speed rises - Causes: Cold water immersion, shock, cold weather, advancing age, malnutrition, hypothyroidism and inadequate clothing. - **3 categories:** - Mild hypothermia – 32 to 36°C - Moderate hypothermia – 27.8 – 32°C - Severe - Less than 27.8°C | | Mild Hypothermia | Moderate Hypothermia | Severe Hypothermia | |---|---|---|---| | | Shivering | Muscle weakness | Bradycardia | | | Decreased muscle coordination | Increased loss of coordination | Severe hypotension | | | Diuresis | Acute confusion | Decreased respiratory rate | | | Mental slowness | Apathy | Decreased neurologic reflexes | | | | Incoherence | Decreased pain response | ## Cold Related Illness Cold related illness are any conditions that are caused by exposure to colder temperatures. They range in severity from superficial frostbite to life-threatening hypothermia. ## Frostbite Frostbite is a local, superficial injury caused by freezing of the skin and in more extreme cases, the underlying tissues. Extremities such as the toes, feet, fingers, hands, ears and nose are particularly prone to frostbite. There are two levels of frostbite: - **a. Superficial frostbite:** occurs when skin freezes but the underlying tissues are unaffected. It may produce clear blisters, but little or no tissue loss typically occurs. - **b. Deep frostbite:** occurs when tissues beneath the skin (including tendons, muscles and blood vessels) freeze. Inside the body, ice crystals are formed and swelling begin to damage the body's cells, blood vessels and nerves. Deep frostbite may produce dark, hemorrhagic blisters and is more likely to result in tissue loss. ## What to Look For **Superficial Frostbite** - Signs and symptoms of superficial frostbite include: - Hardened skin - Skin that looks paler than the area around it - Pain or stinging pain in the area, followed by numbness. **Deep Frostbite** - Signs and symptoms of deep frostbite include: - Waxy skin that is colder than the area around it. - Skin and underlying tissue that is hard and solid to the touch. - Skin that is white, blue, black or mottled - Complete loss of feeling ## Heat- Related Illnesses - Hyperthermia occurs when the body's core temperature rises above the normal range. - Heat related illnesses will get worse without treatment and can change from one level to another very quickly. **COMMON CAUSES OF ENVIRONMENTAL ILLNESS** | Category | Causes | |---|---| | **Environmental** | - Heat waves, especially if there hasn't been one in recent years - High humidity (above 75%), which decreases the ability of sweat to evaporate | | **Physical** | - Age: Babies, children, and the elderly are less able to sweat and adjust to changes in temperature - Body size and mass: Larger bodies with more fat tissue retain heat and warm up more quickly - Clothing that prevents the loss of heat and moisture (e.g., football padding) - Chronic illness - Heart disease - Skin, hormone, or nervous system diseases - Burns - Poor physical fitness | | **Behavioural** | - Working or exercising too much in hot weather - Not drinking enough fluids to replace the water lost by sweating (dehydration) - Drinking too much alcohol in hot weather - Taking stimulants such as cocaine or amphetamines - Salt depletion - Fatigue | ## Seizures and convulsions - **First Aid for a seizure or convulsion** 1. Perform a scene survey - **During convulsions:** - Do not restrict the casualty's movement. - Loosen tighten clothing - Not to put anything in mouth - Place in recovery position - Do secondary survey - Monitor breathing - Not to give anything by mouth - **Call for medical help if:** - Unconscious for more than 5 minutes - Person's first seizure or cause is unknown. - **First Aid for a seizure or convulsion contd......** - **Call for medical help if:** - Unconscious for more than 5 minutes - Person's first seizure or cause is unknown. ## V. Anaphylaxis - Severe allergic reaction that can be life-threatening. **WHAT TO LOOK FOR** - Skin (rashes, swelling) - Breathing difficulty - Dizziness - Stomachache/vomiting **ANAPHYLAXIS** - **CALL** - Call EMS **CARE:** If the person has an epinephrine auto-injector, help him or her to use it: 1. Remove the safety cap. 2. Firmly push the tip of the epinephrine auto-injector against the outer thigh. A click should be heard. Hold in place as directed, usually for 5 to 10 seconds. 3. Rub the injection site for 30 seconds. 4. If the person's condition does not improve within 5 minutes, repeat the dose. 5. Have the person rest quietly until EMS personnel arrive. ## VI. Nose Bleeds - **CALL** - Call EMS if the bleeding continues for more than 15 minutes. - **CARE** - Have the person sit with the head slightly forward. - Pinch the person's nostrils for 10 to 15 minutes ## CAUSES, SIGNS & SYMPTOMS OF DIABETIC EMERGENCIES | Category | Hypoglycemia (Needs sugar) | Hyperglycemia (Needs insulin) | |---|---|---| | Possible cause | Took too much insulin or oral diabetes medication Not eaten enough or vomited More exercise than usual | Did not take enough insulin Eating too much food Less exercise than usual Casualty has an ongoing illness and needs more insulin | ## Causes, signs & symptoms of diabetic emergencies contd................. | Category | Hypoglycemia (Needs sugar) | Hyperglycemia (Needs insulin) | |---|---|---| | Pulse/breathing | Strong and rapid/shallow | Weak and rapid/deep and sighing | | Skin condition | Sweaty, pale and cold | Flushed, dry and warm | | Level of consciousness | Faintness to unconsciousness Headache | Drowsy, becoming unconscious Thirsty, then nausea and vomiting | | Other signs and symptoms | Confused, irritable and aggressive Trembling, difficulty speaking | Frequent urination Breath has a nail polish (acetone) like odour | ## First Aid for Diabetic Emergencies 1. Perform a scene survey. DR-ABC. 2. If the casualty is conscious, enquire what is wrong. 3. Check blood sugar, if available, using a glucose strip test. 4. Help the casualty to take tablets, if sugar is high 5. If sugar is low, help take glucose tablets, if not use any other dietary sugars. 6. Call for medical help. ## VII. STROKE - A stroke happens when the blood flow to part of the brain is interrupted. A person of any age can have a stroke. **WHAT TO LOOK FOR** - A sudden, severe headache - Dizziness or confusion - Unresponsiveness or temporary loss of responsiveness - Sudden loss of bladder or bowel control **FAST** When trying to determine if a person is having a stroke, Remember the acronym FAST: - **FACE:** Facial numbness or weakness especially on one side. - **ARM:** arm numbness or weakness, especially on one side - **SPEECH:** abnormal speech, difficulty speaking or understanding others or a loss of speech. - **TIME:** time is important; call EMS immediately. **STROKE** - **CALL** - Call EMS **CARE:** 1. Have the person rest in a comfortable position. 2. Note when the signs and symptoms first started (or the last time the person was known to be well.) ## Strain - An injury or impairment (muscle to bones, tendon etc.) or muscle is stretched, torn or damaged - often by lifting something heavy or working a musclé too hard. - Eg. back strain ## Key words: - **Sprain:** A tearing of ligament (connects bones to bones at a joint) is stretched, torn or damaged resulting in pain, swelling, bruising and unable to move joint. The most common location is ankle. - **Dislocation:** Bone within a joint moves out of its normal position in the joint, usually caused by a violent force. ## Recognizing fractures - - When in doubt, treat the injury as a fracture. - **Use DOTS** - Deformity - Open wounds - Tenderness (sensitivity to pain) - Swelling ## Care for Fractures (2 of 6) - Check blood flow and nerves using the mnemonic CSM. - **C - Circulation** - For arm injury, feel for radial pulse. - For leg injury, feel for posterior tibial pulse. ## Care for Fractures (3 of 6) - **S – Sensation** - Lightly touch or squeeze one of the victim's toes or fingers. ## Care for Fractures (4 to 6) - **M - Movement** - Have the victim wiggle his or her toes and fingers. ## Care for Dislocations - Check the CSM - Use the RICE procedures: - REST - ICE - COMPRESSION - ELEVATION - Use a splint to stabilize the joint. - Do not try to reduce the joint. - Seek medical care. ## Muscle Injuries - Muscle injuries pose no real emergency. - **A severe muscle strain can result in a muscle tear.** The tearing of the muscle can also damage small blood vessels, causing local bleeding (with or without bruising) and pain (caused by irritation of the nerve endings in the area). - Occurs when a muscle is stretched beyond its normal range of motion and tears the muscle. ## Walking Assists for Ambulatory Patients - **One-person walking assist** - **Two-person walking assist** ## Carrying a conscious patient- Single rescuer - **Human crutch** - If a leg or foot is injured. - Take the weight of the casualty's injured side. - Reach the casualty's back with free hand, and grasp the clothing at the waist. ## Carrying an unconscious patient- Single rescuer - **Drag carry:** - Either lying on their back or in a sitting position. - Maximum protection to the head and neck. - If time permits, tie the casualty's wrists together across their chest before dragging. - **As an alternate method, ** - Use a blanket to support and drag the casualty. - The risk of aggravating any injuries, only use drag carries in the most extreme cases when there is an immediate threat to life. ## Carrying a conscious patient- two person rescue - **Chair carry:** - Carry through narrow passages and up and down stairs. - Do not carry with suspected neck or back injuries. - If the casualty is unconscious or helpless: Strap their upper body and arms to the back of the chair ## Carrying an unconscious patient- two person rescue - **Extremity carry:** - Use the extremity carry when you don't have a chair and do not suspect fractures of the trunk, head, or spine. ## Carrying an unconscious patient- four on rescuers - **Blanket lift with four bearers:** - Roll the blanket or rug lengthwise for half its width. - Position bearers at the head and feet to keep the head, neck and body in line. - Place the rolled edge along the casualty's injured side. ## Carrying a conscious patient- two person rescue - **Improvised blanket stretcher:** ## Carrying conscious patient- two person rescue - **Improvised jacket stretcher:** - Invert the sleeves of 2-3 jackets (depending on the size of your victim and what's available) so that they run along the inside of the jacket. - Thread your poles through the jacket sleeves. - Use diagonal lashings to attach cross members at the end of the stretcher to keep the jackets taut and add stability. ## Carrying conscious patient- four person rescue - Four-bearer method -Also called Hammock Carry - "Get ready to lift" and then gives the command "Lift.” - Lift the casualty smoothly to the height of the raised knees. - **Without blanket or stretcher** - **With stretcher** ## Carrying conscious patient- six person rescue - **Without blanket** - **With blanket**