First Aid PDF

Arab International University Faculty of Pharmacy FIRST AID Dr Ammar Raiy  What is first aid ? First aid: the immediate help given to a victim of injury or sudden illness before the arrival of medical help. Generally is not all...

Arab International University Faculty of Pharmacy FIRST AID Dr Ammar Raiy  What is first aid ? First aid: the immediate help given to a victim of injury or sudden illness before the arrival of medical help. Generally is not all the treatment the person needs. In many cases victim’s life depends on the first actions during the first few minutes.  Who can do it ?  friend  family member  co-worker  bystander at the scene Most first aid does not require extensive training.  The need for First Aid Cardiac and Respiratory Arrest. Electric Shock. Wounds. Bleeding. Burns. Fractures and Traumatic Injuries. Poisoning. Drowning. Snake bites.  Goals of first aid Keep victim alive. Prevent victim`s condition from getting worse. Help promote early recovery. Ensure that victim receives medical care. Reassuring the victim and providing comfort till medical care is provided.  Deciding to help Recognizing the need for first aid and knowing what first aid to give are the first steps of action for un emergency. You need to make the conscious decision which is not always an easy one (worried about what to do, shy, not sure about emergency situation, upset by blood, fear of catching disease).  Staying prepared Knowing the first aid technique. Be confident in your skills. Have a personal first aid kit at home and in car. Knowing how to make contact with EMS.  First Aid Kit Bandage/dressing CPR Mask Adhesive tape Sterile dressings Eye/skin wash Medical gloves Coverings Scissors-tweezers Burn Gel & Spray  Improvising Gloves → plastic bags, dish gloves, leather work gloves (wash your hands with soap and water especially well after using these). Gauze → clean clothing, bedding or towel (but not paper products). Splints → straight sections of wood, plastic, cardboard or metal.  The emergency medical service system EMS Don`t try to transport a victim to the emergency department yourself (Movement may worsen the condition).  When to call EMS Life threatening injury or illness : Unresponsiveness Difficulty breathing Chest pain Severe bleeding Head or spine injuries Poisoning, drug overdose Seizure Severe burns Drowning Suicide Childbirth  How to call EMS Emergency Medical services Be ready to give the following information: Your name Phone number you are using Victim location What happened to victim Victim conditions Victim age and sex What is being done for victim  Legal concepts in first aid To protect yourself , follow these general guidelines: Get victim`s consent before giving first aid. Act only as you trained to act. Don’t try to transport a victim by yourself. Call E.M.S for professional help. Keep giving care until help arrives. Preventing disease transmission  Infectious disease transmission Blood borne transmission: Contact with infected person blood, other body fluid. Fecal-oral transmission: Ingestion of contaminated water or food. Airborne transmission: Inhalation of a pathogen in droplets from the air. vector transmission: Bites of insect carrying the pathogen. Avoid contact with all victims blood and body fluids  Bloodborne disease Pathogens are transmitted through contact with infected person blood. Pathogens are also present in other body fluids, such as semen, vaginal secretions, breast milk and bloody saliva and vomit. Tears, sweat and urine don`t normally transmit pathogens. 3 serious bloodborne infections are: HIV hepatitis B hepatitis C  Precautions Wear appropriate protective equipment. Treat all persons as if infectious. Wash following completion of the act. Appropriate disposal of disposable protective items and/or equipment. Maintain good hygiene practices before, during and after tasks. Don’t touch your mouth, nose, eyes and objects soiled with body fluid when giving first aid. Avoid being cut by anything sharp. Acting in an emergency Dr Ammar Raiy  Acting in an emergency Six basic steps to follow: 1. Recognize the emergency. 2. Check the scene. 3. Call 110. 4. Check the victim. 5. Give first aid. 6. Have the victim seek medical attention.  Step1:Recognize the emergency When you see an injured or ill victim…. When you see someone acting strangely… You may hear signs of an emergency and realize that someone may be hurt….  Step2:Check the scene Before going to the victim look for: 1. Danger: (DR ABC) – Smoke, flam. – spilled gasoline. – downed electrical wires. – risk of explosion. – building collapse. – roadside dangers. – violence from someone in the scene. 2. Other victims: the priority of actions. 3. Clues that determine what happened.  Step3:Call 110 Call 110 immediately if you recognize a life- threatening injury or illness. Don’t try to transport a victim yourself. You may give some care before calling.  Step 4 : Check the victim Apply the role Dr ABC: – D: danger. – R: response. – A: airway. – B: breathing. – C: circulation. In the absence of life threatening conditions, check for less injuries.  Step 5: Give first aid Basic life support to keep victim alive till the arrival of advanced help. In simple cases you can do some emergency procedures ( stop bleeding…). Don’t administer medication.  Step 6 : Have the victim seek medical attention When the victim needs to go to the emergency department? After the arrival of medical team: – Continue giving first aid until they ask you to stop. – You may still assist with crowd control, obtaining information from bystanders. – At the end, be sure to wash your hands and clean the area well.  ASSESSING THE VICTIM Initial assessment: check the immediate life threatening conditions (responsiveness and breathing). Secondary assessment: victim’s history and physical examination to check for any injuries. THE INITIAL ASSESSMENT Check for life threatening conditions:  unresponsiveness  breathing problem  severe bleeding Don’t move victim when doing the assessment except when absolutely necessary : 1. Victim faces immediate danger if not moved (fire-explosion-hazards-unsafe scene). 2. You cannot give lifesaving care because of the position or location of the victim.  Means that victim is: Speaking, crying or moving. Presenting signal reactions. Responding through purposeful movements. A responsive victim who can`t speak, cry or cough may have an obstructed airway(chocking).  Unresponsiveness is critical emergency. If victim is on his back, the tongue may move backward and block the airway.  AVPU SCALE To assess the degree of responsiveness: A: alert Aware of time and place. V: responds to Verbal stimuli. P: responds to Painful stimuli:  Simply: tap or shake the shoulders  Sternal rub  Nail bed squeeze  Ear lobe squeeze U: Unresponsive to all stimuli. Responsive victim: Talking, crying=> airway is open. Has wheezing => airway is partially blocked which is an emergency. Unresponsive victim: Determined whether victim is breathing by looking, listening , and feeling for breath through the nose, mouth and chest wall. If no signs of breathing, open the airway by tilting the head back and lifting the chin.  If unable to determine whether an unresponsive victim is breathing, move the victim into face-up position to open the airway and check for breathing. Carefully roll the victim onto his back, keeping the head in line with the body then open the airway.  If no signs of breathing within 10 seconds, give rescue breaths. Lack of breathing may be caused by an obstructed airway: o Foreign body (choking). o Swollen airway (allergy). o The tongue.  Quickly look over the victim body for obvious blood. Control any severe bleeding with direct pressure.  Recovery position: An unresponsive victim who is breathing and who is not suspected to have spinal injury, should be positioned on his left side.  It allows fluids to drain from the mouth, so that victim does not choke by blood, vomit.  It prevents victim from inhaling stomach contents if he vomits  It keeps airway open.  The Secondary Assessment If the condition seems stable, then the secondary assessment can provide: -Accident information -History and physical examination Focus your attention on the injured area.  Get the victim’s history Mechanism of injury. SAMPLE format : S Signs and symptoms. A Allergies. M Medications. P Previous problems (DM). L Last food or drink. E Events (what happened).  Physical examination Take the consent to do physical examination. Carefully remove clothes. During the examination watch any changes in victim status. Look for signs : pain when moving or touching. bleeding , wounds. deformity, asymmetry. skin color and temperature, swelling. abnormal sensation.  Check the head and neck Don’t move the head or neck. Gently feel the skull for depression. Check the nose and ears for blood or fluid. Check the pupils of eyes (equal size ,respond to light ). Check the mouth: foreign body.  Check the torso Chest: deformity, wounds, tenderness , blood. Ask the victim to take deep breath and look for symmetry and pain. Abdomen and pelvis: rigidity, pain, bleeding, stability, wounds.  Check the extremities Bleeding. Temperature. Deformity. Movements. Pain. Sensation. Basic life support Dr Ammar Raiy Faculty of Pharmacy  Basic life support First aid given to a victim with heart or breathing arrest and often called resuscitation. BLS is needed for : Heart attack. Drowning. Choking. Others injuries.  Resuscitation A victim who is not breathing needs CPR (Cardio-pulmonary resuscitation) to move O2 into his body and to circulate oxygenated blood in order to keep vital organs alive. A victim who is choking also needs first aid to clear the airway to allow natural breathing or rescue breaths. In case of ventricular fibrillation an automated electrical defibrillator AED is needed to restore a normal rhythm.  Rescue Breaths Blowing air into a non breathing lungs to oxygenate the blood. Given with first aider own air , when he blows air into victim`s mouth or nose in a manner similar to inspiration and let him do expiration before the second blow. Air around us contains 21% O2, the breath we exhale contains 16% O2 which is enough to increase victim`s blood O2 level to maintain life.  Respiratory Emergency Ineffective breathing is a respiratory emergency because it leads to receive not enough O2. Brain cells are very susceptible to low level of O2 and begin to die 4 minutes after O2 cut off. Within 6 minutes brain damage occurs and death is likely soon after. Two primary types: Respiratory arrest breathing has completely stopped. Respiratory distress breathing is difficult and ineffective, which may occur in different illnesses like asthma and allergic reactions.  Respiratory Emergencies Nervous system depression: o Electrical shock. o Drug overdose. Airway obstruction: (Ex: food blocking the pharynx). Chest trauma: o Chest wall damage. o Lung injuries. Carbon monoxide: fire smoke inhalation. Cardiac problems: can reduce circulation resulting in O2 loss.  Prevention of Respiratory arrest by preventing its common causes: Drowning. sudden infant death syndrome (SIDS). Chocking. cardiac arrest.  Preventing drowning Don’t leave a child alone in bathroom, pools, otherwise supervised by an adult who maintains continuous visual contact. For adults ( up to 50% of drowning death) the use of alcohol before swimming is the first reason, so:  don’t drink and go into or near the water.  never dive into unknown or shallow water.  First aid for drowning Drowning causes: airway obstruction, hypothermia. First aid: Don`t try to rescue the victim if you are not trained to do. If not a good swimmer, try to help victim by throwing a rope, stick, rescue vest. If you are on a boat, pull victim from one end of the boat not from the sides. Hold victim from his wrists to pull him out of water. If you are in deep water don`t begin resuscitation unless arriving to shallow water. Begin by clearing airway from water and other obstructing objects. Do CPR and if victim return breathing put him in recovery position. Cover the victim after taking off his wet clothes. Call EMS.  Preventing SIDS sudden infant death syndrome It occurs in infants under the age of 1 year, most commonly (between 2-4 months) of unexplained causes. Etiology: Congenital differences. Infant Position (lying on stomach with nose covered by soft bedding ).  Preventing sudden infant death syndrome Place infants on their back when sleep. Use a firm flat crib and remove pillows, toys and other soft objects. Don’t cover infant`s head during sleep. Use thin blanket and tuck it under the edges and keep it at chest level. Avoid smoking (during pregnancy, when infant exposed). Maintain normal room temperature. Don’t have the infant sleep with sibling or parents.  Techniques of rescue breaths Victim position on his back. Head tilt- chin lift. Use a barrier device if available. Blow slowly and not forcefully. Give each breath over about one second. Watch the chest rise. After each breath let the air escape and the chest fall. Give two rescue breaths ,if victim still not breathing => begin CPR. Rescue breathes techniques:  Mouth to barrier.  Mouth to mouth.  Mouth to nose.  Mouth to stoma.  Mouth to nose and mouth. Potential problems with rescue breaths :  air enters the stomach( risk of vomiting and aspiration).  lose the dentures( better to let them in place if not loose).  Unresponsive Victim not breathing Tilt head lift chin No breathing Return breathing within 10 sec Recovery Rescue breath position Passes through Doesn't pass the lungs Another breath Choking care Return breathing No breathing Recovery CPR Position Cardio Pulmonary Resuscitation CPR  Cardio Pulmonary Resuscitation A combination of: 1. Rescue breaths. (Artificial respiration) 2. Chest compression. To maintain the flow of oxygenated blood to the brain and heart. Effective CPR delay tissue death and extend the brief window of opportunity for a successful resuscitation without permanent brain damage. Most needed in cardiac arrest resulting from heart attack. Heart attack is usually caused by cardio-vascular disease.  cardiovascular risk factors Unpreventable risk factors Preventable risk factors 1. Increasing age. 1. Smoking. 2. Male gender. 2. High cholesterol levels. 3. Race. 3. Hypertension 4. Heredity. 4. Obesity. 5. Stress. 6. Diabetes mellitus.  Maintaining Cardiovascular Health Life style: Habits typically begin in childhood Good diet: 1. Healthy: fruits, vegetables, whole grains and cereals. 2. Unhealthy: High fat and sugar food. Exercise: good not only for muscles but also for heart, lungs, and blood vessels. Weight control: healthy diet + adequate physical activity. Blood pressure control: (silent killer) reducing salt intake. Maintain good cholesterol level : cholesterol deposits in the arteries along with other substances as plaque causing atherosclerosis (narrow and hard arteries). Avoid high cholesterol food( animal fat). Exercise. Medication if appropriate. Stress management. Stop smoking. Cardiac Chain of Survival  Cardiac chain of survival To save lives of cardiac arrest victims, CPR foundation created the concept of cardiac chain of survival: 1-Early recognition and access to EMS : Recognize victim whose heart has stopped, call EMS. 2-Early bystander CPR : To keep the brain and other vital organs alive 3-Early defibrillation : AED can help get the heart beating normally after cardiac arrest. 4-Early advanced care : The sooner the victim is treated by emergency care professionals, the better chance for survival.  The need of CPR 1. Heart attack or other heart diseases. 2. Drowning. 3. Suffocation. 4. Stroke. 5. Allergic reaction. 6. Diabetic emergency. 7. Prolonged seizures(like asthma attack ). 8. Drug overdose. 9. Electric shock.  Deference between CPR and rescue breaths (RB) Rescue breaths are given to oxygenate the blood of someone who has respiratory arrest but still has pulse. While CPR is to oxygenate blood and circulate it to vital organs by chest compression(cardiac and respiratory arrest). However, since people often have difficulty detecting the pulse, CPR must be used in both.  CPR Technique 1. Hand position on the chest bone midway between the nipples. 2. Compress the chest hard and fast at a rate of 100 per minute.  1.5-2 inches deep.  in child 1/3-1/2 the depth of the chest. 3. Alternate compression to give rescue breaths by the rate (1/5) if two rescuers and (2/30) if one. 4. If you cannot give rescue breaths, you should still give chest compression. This gives the victim better chance to survive than doing nothing. Check response Shake shoulders gently Ask “Are you all right?” Shout for help Check breathing Look, listen and feel for Normal Breathing Open Airway Open airway and determine if the victim is not breathing normally 2 rescue breaths 1) Pinch the nose. 2) Take a normal breath. 3) Place lips over mouth. 4) Blow until the chest rises. 5) Take about 1 second. 6) Allow chest to fall. 7) Repeat. if the 2 berths doesn't go in , give choking care 30 chest compression Place the heel of one hand in the centre of the chest. Place other hand on top Interlock fingers. Compress the chest – Rate 100 /min. – Depth 4-5 cm. – Equal compression and relaxation When possible change CPR operator every 2 min Continue cycles of 30 compression and 2 breaths 2 30  Continue CPR until … Victim begins to move. AED is brought to the scene and ready to use. Professional help arrives. You are exhausted. IF VICTIM STARTS TO BREATHE NORMALLY PLACE HIM IN RECOVERY POSITION  CPR IN CHILDREN Adult CPR techniques can be used in children. Compressions 1/3 of the depth of the chest. Compressions done with one hand.  Alert… If victim vomits while doing CPR: put him on his side to clear vomiting then continue CPR. Don’t give compressions over the bottom tip of the breastbone. Keep your elbows straight and keep your hand in contact with the chest wall. Compress the chest hard and fast. Basic Life Support Choking Care  Choking The inability to breathe because of airway obstruction. Airway could be blocked by:  Foreign object.  Anatomical structure (tongue).  Fluid or vomit. Immediate care is needed to clear the obstruction.  Preventing choking in adults Choking results from swallowing large pieces of food that have not been chewed sufficiently:  Eating quickly.  Eating while engaged in other activities.  More common in alcoholism.  More likely in those wearing dentures.  In children Choking is a serious threat to infant up to 3-4 years of age and a significant cause of death. Infants may put any small object in thier mouth. Guidelines to prevent choking in infant Don’t leave any small objects within the reach of an infant. Feed infants only soft foods. Never let a child move around while eating. Teach children not to eat too fast or to talk or laugh while eating. Don’t give children under age 3 food like:  Peanuts  Popcorn  Grapes  gums  Airway Obstruction Complete airway obstruction:  victim is getting no air at all and consequently no oxygen in blood. This victim will soon become unresponsive, and the heart will stop. Partial airway obstruction: airway is partially blocked, but victim is still getting some air into the lungs. Victim may get enough air to cough the object out.  Responsive victim Partial obstruction: – victim is coughing forcefully in an attempt to expel the object. – victim may have wheezing or high- patched sounds. – First aid:  Encourage coughing to clear the object.  Ask victim to incline down.  Stay with the victim.  Call 110 if the object is not immediately expelled.  Responsive victim  Total obstruction:  victim may look frantic and be clutching at the throat.  You may notice a pale or bluish coloring around the mouth and nail beds.  victim cannot speak. Incline the victim on your arm. Give five shots on the victim back between the scapulas with the palm of your hand. If that doesn`t work… do Heimlich maneuver.  (Heimlich maneuver) Stand behind the victim with one leg forward between victim`s legs. keep your head slightly to one side. Make a fist with one hand and place the thumb against victim abdomen in the midway between the navel and the xiphoid appendix. Grasp your fist with your other hand and thrust inward and upward into the abdomen with quick jerks. Continue until victim expels the object. If you don’t succeed you may try chest thrust and back blows. With small child kneel behind the child to reach around the abdomen. Heimlich maneuver shouldn't be applied in: Pregnant woman. Very obese victim. Children under one year.  Unresponsive victim assess breathing victim not breathing Begin CPR  Choking care for unresponsive victim (adult and children) Open the airway and determine whether victim is breathing. Tilt the head, lift the chin. Give 2 rescue breaths. If breaths don’t go in, give 30 chest compression. Continue CPR….  Choking care for responsive infant 1. Support infant head in one hand with the torso on your forearm and your thigh. 2. Give up to 5 back blows between the shoulder blades. 3. Check for expelled object. 4. With other hand on back of infant head, roll the infant to face up position. 5. Give 5 chest thrust with 2 fingers. – Repeat step 1-4 with alternating back blows with chest thrusts and checking the mouth.. – Continue until the object is expelled or the infant becomes unresponsive.. Then give CPR.  Self-treating choking If you are alone give yourself abdominal thrusts to expel the object. you can use your hand or lean over and push your abdomen against the back of a chair. Arab International University Faculty of Pharmacy Bites and Stings ❑Millions of people every year are bitten or stung. ❑Most are not medical emergencies. ❑Treatment is usually for bleeding, wound care or infection. ❑If victim allergic it can be a medical emergency.  Animal Bites ❑About 30 people a year die from dog bites. ❑Serious because of bleeding and risk of infection. Rabies: ▪ Viral disease that causes acute inflammation of the brain. ▪ Spread when an infected animal scratches or bites another animal or human. ▪ Fatal unless vaccination injections given early. ▪ It is safer to assume that all wild animals have rabies.  Rabies Sings and symptoms: Incubation period: 4-12 weeks. 1. Discomfort and itching sensation at the site of bite. 2. Muscle weakness, Fever, Headache. 3. Fear of water( hydrophobia). 4. Excessive salivation. 5. Progressing within days to cerebral dysfunction: anxiety, confusion, agitation. delirium, abnormal behavior, hallucinations, and insomnia. No cure once symptoms develop  First Aid for Animal Bites 1. Clean the wound with large amounts of warm or room- temperature water with or without soap (unless bleeding severely). 2. Control bleeding. 3. Cover wound with sterile dressing and bandage. 4. Call 110. If approached by a dog: ◦ Stop/ Stand still, Do not run past a dog. ◦ Avoid eye contact ◦ Talk softly ◦ Move slowly ◦ Never turn your back on a dog ◦ Always let a dog see and sniff you before you pet the animal. ◦ Use: stick, mace, pepper spray  Snake Bites Treat all bites as poisonous 1. Have victim lie down and stay calm. 2. Keep bitten area immobile and below level of heart. 3. Call 110. 4. Wash wound with large amounts of warm or room- temperature water with or without soap. 5. Wrap extremity with elastic bandage, wrapping away from the body toward end of limb. Pressure is sufficient if bandage is snug but a finger can be slipped under it. 6. Remove constricting items. ◦ Anti-venom available only at hospitals. ◦ Must be given within 4 hours of the bite. ◦ Icing is not helpful. ◦ Avoid mouth suction.  Scorpion Stings Most scorpions are not venomous. Most can be managed safely at home. Seek urgent care for child or elderly person Antivenin available in some areas. Avoid by not walking barefoot or in sandals and shaking out clothing/shoes.  First Aid for Scorpion Stings 1. Call 110 if problem breathing or other severe symptoms. 2. Monitor breathing and be prepared to give CPR if needed. 3. Wash area (water+ soap). 4. Put ice or cold pack on area. 5. Seek urgent medical attention unless symptoms very mild.  Spider Bites Keep bite area below the heart. Clean bite site. Ice. Monitor ABC,s. Seek medical attention immediately.  Marine Stings (Jellyfish) Most are painful but not dangerous (unless allergic) Signs and symptoms include: ◦ Difficulty breathing ◦ Swelling of throat ◦ Shock ◦ Muscle paralysis ◦ Seizures ◦ Unresponsiveness  First Aid for Jellyfish stings Wash sting area with vinegar as soon as possible, for at least 30 seconds or longer. If vinegar is unavailable, use mix of baking soda and water. Remove any remaining tentacles. To reduce pain, immerse area in water as hot as can be tolerated for at least 20 minutes or as long as pain is felt. If pain returns on removal from the hot water, immerse the area again. Emergency child birth AIU – FACULTY OF PHARMACY PROF: Ammar Raiy A situation where mother can not reach medical facilities in time and needs to give birth in place. Warning signs: 1. The mother says, “the baby is coming,” 2. The baby’s head is showing. 3. The contractions are less than two minutes apart. 4. Abundant water (amniotic liquid) comes out the vagina.  First aid  Call 110.  Assure the mother(better to have husband near).  Make the mother comfortable on her back.  Remove any unnecessary clothing but keep her covered to protect her privacy.  Put some clean towels under her.  Ask the mother to push during contractions and rest between them.  support the baby as it comes out.  Hold the head as it is heavy compared to the rest of the body.  Once you can see baby’s throat make sure the umbilical cord is not wrapped around it. If so, use your finger to loosen it and pass it over the head.  First aid  When the baby comes out wrap it in a clean towel.  Clean its mouth and nose.  If it is not breathing massage its back and tickle its feet to stimulate breathing.  If it is still not breathing begin rescue breathing and CPR.  Never hold the baby upside down and slap it.  If the baby is fine give it to the mother to hold.  The umbilical cord The other end of the umbilical cord will be attached to the placenta which is still inside the mother. Do not pull, it will come out on its own in a few minutes in another set of contractions. Do not cut the cord. Simply wrap the placenta in a towel and keep it with the baby. Never put the placenta lower than the baby as blood may drain from the baby back into the placenta. You may tie something around the umbilical cord a few centimeters away from the baby and from the placenta. But do not cut it.  Baby comes out feet first Instruct the mother not to push. Do not try to push the baby back in. Simply support it any way it comes out. Bleeding Control  Injuries damage blood vessels can cause external or internal bleeding. Bleeding may be minor or life threatening. Most external bleeding can be controlled with first aid techniques. The major role of blood is to transport oxygen.  Effects of blood loss loss off up to 15% of blood Loss of 15% to 30% of blood volume. volume. Body can compensate by constricting blood vessels constricting blood vessels maintain blood flow to to maintain blood vital organs (brain & heart) pressure. while reducing flow to Victim is alert. other areas. BP and pulse are close to Skin is pale or ashen cool normal. and dry. Heart and respiratory rates increase Victim feels restless and confused.  Effects of blood loss loss of 30% to 40% of blood loss of more than 40% of volume blood volume Body can no longer BP falls. compensate. Vital organs begin to fail Blood pressure falls Victim becomes (shock). unresponsive. victim is confused or death occurs if not anxious. immediately corrected.  Body Control of Bleeding When blood vessel is damaged and blood escapes, the body attempts to control bleeding through 3 processes: ❑ Vascular spasm: the vessel constricts to slow bleeding and allow clotting to occur which is enough in small vessels. ❑ Platelets: stick to each other and to the wall of the vessel and form platelet plug. ❑ Clotting (coagulation) blood proteins produce fibrin which clumps with platelets and other cells in a fibrin web.  External Bleeding Typically occurs when skin and other underlying tissues are damaged by trauma. Bleeding flows out through the wound. Bleeding depends on the size and type of the injured vessel. Wounds where some large vessels are close to the skin (wrist or neck) may result in very heavy bleeding.  Types of external bleeding Bleeding from injured arteries: In general serious and difficult to control. Comes out in a discontinuous jet. Bright red. Rapid and abundant, so it needs immediate control. Bleeding from injured veins: Slow and flows steadily. Dark red. Easy to control. Bleeding from capillaries: from shallow cuts or scrapes. often stops soon by itself.  External bleeding control Minor bleeding : Stops by itself or with light pressure. clean and dress.  Serious bleeding: Elevate the injured limb to reduce blood flow. apply direct pressure by your gloved hand on the wound with sterile dressing. ❑Pressure for short time induces clotting event. ❑direct pressure should not be applied on certain wounds such as skull, fracture or implanted object which may cause additional damage.  When fracture or implanted object is suspected: Apply indirect pressure by compressing the artery irrigating the bleeding area to slow down the blood flow. ▪ Brachial (Top of elbow) ▪ Femoral (Inside upper thigh)  Pressure bandages A pressure bandage can be used over the wound in an extremity. Be sure that it is not so tight (not to cut off circulation of the limb). Signs of poor circulation : skin color: pale warmth : cool sensation : tingling or numbness volume : swelling In such cases loosen the bandage  Preventing blood borne infection Wear Gloves or plastic bags or any barrier. If nothing available, use the victim own hand. Clean without contact. Wash your hands when finished. Disinfect all contaminated objects.  EPISTAXIS (Nose Bleeding) Tilt head down to prevent bleeding to the throat. Close victim’s nostrils with the tips of 2 fingers. Ask victim to breath through his mouth. If that doesn’t succeed: Apply a gauze packing into the bleeding nose. Use a cold towel on the nose or if possible bag of ice. If bleeding doesn`t stop within 20 minutes, seek Medical Care Provider.  Internal bleeding Bleeding within the body in which blood does not escape from an open wound. Caused By: o blunt injury: ex car accidents. o can occur without trauma: (bleeding ulcer). Could be: ❑ Serious and life threatening. ❑ Minor bleeding in the skin appearing as bruise.  Signs of internal bleeding ❑ Bruises or contusions of the skin. ❑ Painful, tender, rigid, bruised abdomen. ❑ Vomiting or coughing blood. ❑ Stools that are black or contain bright red blood. Management: Prevent and help the shock. ❑ Monitor ABC’s (Airway Breathing Circulation) ❑ Keep the victim lying on his/her left side. ❑ Treat for shock by raising the victim’s legs 8” – 12”. ❑ Seek immediate medical attention. ❑ Don’t give the victim anything to drink. Shock Faculty of Pharmacy Dr Ammar Raiy  Shock Definition: dangerous condition in which not enough oxygen-rich blood reaches vital organs. Characterized by: 1. low blood pressure. 2. rapid pulse and breathing. 3. decrease blood supply to the brain and other vital organs. Shock is a life threatening emergency  physiology In order to have well oxygenated vital organs : The heart must efficiently pump blood. (Heart rate varies as needed to pump more or less blood). Blood vessels must be intact and function normally. Blood vessels constrict or dilate to ensure enough blood circulation to vital organs at all times. Blood volume must be sufficient to fill blood vessels. The body controls Blood volume by moving fluid in or out blood circulation.  Causes of Shock Hypovolmic shock: sever bleeding( external or internal). Sever burns. Dehydration. Cardiogenic shock: heart attack. Heart failure. ventricular fibrillation. Neurogenic shock: certain spinal cord injuries. Anaphylactic shock: insect sting. Food. Medication.  Signs and symptoms: vary depending on the cause and severity of shock. signs include : not in the same order Feeling of anxiety, restlessness. Confusion. disorientation or sleepiness. Rapid and shallow breathing. Rapid heart beat, low blood pressure. Skin: pale, ashen and cool. Nausea and thirst.  First Aid for Shock In the absence of treatment Shock leads to respiratory and cardiac arrest. Once it develops, shock cannot be reversed without professional medical care. Call 110 immediately because shock will continue to develop. Victim reaching medical care late has lower chance of survival. Call for any infant or child with persistent vomiting or diarrhea before progressed shock signs appear.  First Aid for Shock Ensure that airway is open. If the victim is bleeding, control bleeding immediately. Position : victim on his back with legs raised about 8 to 12 inches unless having spinal injury, head injury or stroke. help victim to maintaining normal body temperature by covering him. Do not let shocked victim eat, drink or smoke.  Anaphylaxis Most common causes of anaphylaxis are : ❖Certain drugs. ❖Certain foods. ❖Insect stings and bites. Wasp sting  Signs and symptoms of anaphylactic shock may begin within minutes and even seconds of the contact with the allergen(substance allergic to individual). The more quickly the reaction occurs, the more serious it is likely to be.  The early signs and symptoms of anaphylaxis ❑Skin flushing, itching or burning and rash. ❑Sneezing and watery eyes or nose. ❑Coughing. ❑Gastrointestinal upset. As symptoms worsen: ❑Victim becomes anxious. ❑Feels that the throat is closing. ❑Fast breathing, coughing, wheezing, hoarseness. ❑Headache, weakness or fainting. ❑Pale ashen skin or cyanosis.  Prevention Medication allergies Maintain a complete history of medication allergy. Read product label carefully. Foods allergies Check food product labels. and avoid that may contain hidden ingredients. Educate a child caretakers , teachers……  Insects allergies Stay away from insect nesting areas. Wear clothes that covers arms and legs. Don`t swat or try to wave insects away. Don`t ware light colors or sweet-smelling perfumes or colognes. If stung don’t pull the stinger with finger, instead scrap it off with something similar in size and rigidity to a credit card.  First Aid for Anaphylaxis Ask about: ❑allergic antecedents. ❑ what the victim has eaten and drunk.. ❑ insect sting. Observe for early and developing signs and symptoms of anaphylaxis. Call for emergencies. Position the victim for easiest breathing. Be prepared to give BLS and put the victim in recovery position. Give Epinephrine for severe allergy.  Wounds An injury to the skin and some times other deeper soft tissues. Types: – Open wounds: Skin is torn or cut , often leads to bleeding. – Closed wounds: Skin is not affected and injury exists in the hypodermis (beneath the skin).  Types of open wounds Abrasions Lacerations Punctures Avulsions Amputations Abrasions: The top layers of skin are scraped off. Skinned elbow and knee are common in children. It’s painful but not serious. Bleeding is limited to capillary that stops by itself. Foreign material may present and cause infection. lacerations (cut): Frequently penetrate the skin and damage the underlying tissues. Are either: ❑ smooth cut with straight edges called : incision, such those caused by knives. ❑ rough cuts. may cause life- threatening bleeding. Punctures: occur when sharp objects penetrate the skin and deeper tissues. May be gunshot. more likely to trap foreign material increasing the risk of infection. Avulsions: area of skin or outer soft tissue torn partially from the body. Amputations: Complete cutting or “tearing off” of all part of an extremity (finger-foot). The amputated party could be reattached.  Cleaning Wounds o The priority is to control bleeding with direct pressure or other means. o Don’t remove dressing to clean the wound (may disturb clotted blood and restart bleeding). o Otherwise the first step in minor wound care is to clean the wound. o Wash your hands first and wear gloves if available. o Remove clothing, avoid contact with wound. o Gently wash the wound with soap and running water (irrigation)for at least 5 minutes, Or until no foreign matter apparent. o If necessary use sterile gauze to remove any dirt. o Carefully dry the wound. o Apply a sterile dressing and bandage.  Dressing and Bandaging Wounds Choose dressing larger than the wound. If blood seeps through, do not remove dressing but add more dressing on it. Apply a bandage firmly but not so tightly (that cuts off circulation) to hold dressing in place. Don’t cover fingers and toes unless injured. Wrap a bandage from the bottom of the limb upward to avoid cutting the circulation.  Alert... Don’t try to clean a major wound after bleeding control. Don’t put antibiotic ointment except in shallow wounds. Don’t use alcohol, or iodine… Avoid breathing and blowing on the wound. Don’t attempt to remove clothing stuck to a wound. Don’t scrub a wound.  Wound Infections May occur in any open wound. Could be local, or pathogens may inter circulation causing systemic disease. Blood borne diseases may be transmitted from one person to another through un open wound. Pathogens may be transmitted into a wound by any substance that comes into contact with the wound , or even by pathogens in the air.  wounds are at greatest risk : A.Wounds resulting from bites. B.Puncture wounds. C.Wounds contaminated with dirt. Signs and symptoms of local infection : Wound is red ,swollen, and worm. Pain. Pus. Fever. Enlarged lymph nodes.  Tetanus Is called lockjaw because a stiff neck and jaw are early symptoms. Tetanus bacteria is found in soil and on skin surface. It enters the body through wounds. Tetanus immunization is included in routine childhood vaccination. Adults need a booster every 10 years. A tetanus shot must be given within 72 hours after being wounded.  When to seek medical attention o Bleeding not easily controlled. o Deep or large wound. o Significant wounds on the face. o Signs and symptoms of infection. o Animal or human bite. o Puncture wounds. o Wounds may require stitches. Special Wounds closed wounds: 1-Raise the area of the wound. 2-Put ice or cold water on the affected area. 3-check the victim if he has any other injuries. puncture wounds: Remove any small objects. Gently press the area to control bleeding. Don’t put any medicine. wash the wound with running water. Dress the wound and seek medical attention.  Impaled objects: Leave an impaled object in it’s place and use bulky dressing to keep it from moving. Control bleeding by applying pressure at the side of the object. Dress the wound around the object. Support the object while bandaging it in place. Avulsion & Amputation: Wrap the severed part in a dry sterile dressing but don’t wash it. Place the part in a plastic bag and seal it. Place the sealed bag in another bag or container with ice. Don’t let the part in touch with ice. Make sure the severed part is given to the EMS.  Crush injuries& crush syndrome Crush injury: Injury caused by a heavy object pressure on a part of the body. Crush syndrome: The shock-like state following release of the body part after a prolonged period of compression. Causes: Natural disasters such as earthquakes. War. Buildings collapse as a result of explosion. Industrial incidents (mining). Road traffic accidents. Patients’ own body weight, after stroke or intoxication.  Most commonly in traumatic crush, legs are affected, and less frequently arms. Crush injury of the head and torso significant enough to cause the syndrome is incompatible with life due to the internal organ damage.  Compressive force leads to vascular compromise with collapse of blood vessels, nerves and muscle cells. Muscles can withstand approx 4 hours without blood flow before cell death occurs. loss of blood supply to muscular tissue produces toxins from muscle metabolism without oxygen. the cell releases potassium and other toxic substances such as myoglobin, phosphate and urate into the circulation.  hyperkalemia (may precipitate cardiac arrest). metabolic acidosis. acute renal failure: due to myoglobolinuria.  Management Before one hour After one hour Liberate victim asap. Call 110. Elevate limb if possible. Don’t liberate victim if not Control bleeding. controlled with tourniquet. Deal with fractures, Treat any other injuries. dislocations. Reassure victim and rest with Put victim in shock position. him. Call 110. Burns Chapter 12  Burn injury to the skin and potentially deeper structures caused by heat, electricity or chemicals. Functions of the skin: 1) Fluid retention: skin prevents the loss of fluids and electrolytes. 2) Temperature regulation. 3) Sensation. 4) Protection : against the entry of pathogens, specialized cells also have an immune function.  Minor burn (sunburn) damage only the epidermis. Severe burn damage the dermis or the deepest layer (subcutaneous).  Victim with extensive severe burns shouldn’t be cooled with water over much of the body (risk of hypothermia). Burns can be very painful because skin is rich in sensory nerves. Victims with burns caused by fire may also have respiratory damage caused by inhaling smoke.  If fire happens ❖Evacuate everyone, while calling for help. ❖Don’t use the elevator. ❖Feel doors before opening them, and don’t open if its hot. ❖If air is smoky , stay near the floor where there is more oxygen. ❖Don’t throw water on electrical fire. ❖ if you cannot escape a building on fire, stuff clothing or rags in door cracks.  Preventing Heat Burns Don’t use steam vaporizers. Keep hot irons, curling irons, toasters, and similar appliances away from children. Keep children away from barbecues. Never let children use fireworks. In the kitchen: don’t hold an infant when cooking or drinking hot liquid.  Preventing Sunburn Keep infants under age one out of direct sun light as much as possible. Wear a wide-brimmed hat and protective clothing. Limit sun exposure between 10:00am and 4:00pm. Apply sun protecting factor 20min before sun exposure and every 2hours while in sun. Be aware that reflective surfaces like water and snow increase the risk of burning.  Put Out Fire If the victim’s clothing is on fire, use a blanket or water to put out any flames, Or have the victim roll on the ground. Cool the burn area with water immediately, except with very severe burns. Remove victim clothing and jewelry.  Assessing a Burn Assessment involves consideration of several factors: ❖Burn degree: (first, second, or third). ❖Burned body area. ❖Specific body areas. ❖Victim special circumstances(age, health). Assessing Burn Size: A common method used is the role of nine: ❖Each arm is 9%. ❖Each leg is 18%. ❖The front of the torso is 18%. ❖The back of the torso is 18%. ❖The head is 9%. ❖The genital region is 1%.  Classification of Burns: First degree burns (superficial burns) damage only the skin’s outer layer(epidermis), like a typical sunburn. The skin is red, dry and painful. Second degree burns (partial thickness burns) damage the skin’s deeper layer(dermis), skin is red and very painful. Blisters are often present and may be weeping clear fluid. Third degree burns (full-thickness burns) damage the skin all the way through the subcutaneous layer and may burn muscle or other tissues, pain is not present where the skin is burned but in adjacent areas. When to call for emergency Any third degree burn. Second degree burn more than 10% of the body in an adult (5% in a child or older adult). First degree burn over than 50% of the body.  The location of the burn is important, second or third degree burns on face, genitals, hands or feet are considered emergencies. Circumferential burns that wrap around an extremity or finger should receive immediate medical care. Burns around the nose and mouth may affect breathing. Consider victim’s age(5>age>55) and health.  General principles of burn care Stop burning and cool the area. Protect burned area from additional trauma and pathogens. Provide supportive care. Ensure medical attention.  Care for first-degree Burns 1. Stop burning by removing heat source. 2. Cool burned area with cold water.(Don’t use ice which can cause further damage). 3. Remove clothing and jewelry or any other constricting item before the area swells. 4. Protect the burn from friction or pressure. Do not apply ointment or other oily or greasy substances on the burn.  Care for second-degree Burns 1. Stop burning. 2. Cool burned area 3. Remove clothing and jewelry from the area. Don’t break skin blisters, this could cause infection. Don`t apply ointment or other substances to the burn. Be gentle when covering burned area.  Care for third-degree Burns When You See…… Charred skin or white, leathery skin. Signs and symptoms of shock: clammy, pale, or ashen skin nausea and vomiting fast breathing.  Care for third-degree Burns 1. Stop burning. 2. Cool surrounding first, and second degree Burns only. 3. Remove clothing and jewelry before the area swells. 4. Call for help. 5. Prevent shock: have the victim lie down. Elevate the legs maintain normal body temperature. 6. Carefully cover the burn with a nonstick dressing, don’t apply a cream or ointment.  ALERT With third-degree burns don’t cool more than 20% of the body with water( 10% for a child) because of the risk of hypothermia and shock. Don’t touch the burn or put anything on it. Don’t give victim anything to drink. SMOKE INHALATION  Any victim of fire could have airway or lung injuries from inhaling smoke or other fumes. A. Airway swelling. B. Carbon monoxide poisoning. Signs and Symptoms : may appear within 48 h Difficult breathing. Coughing. Wheezing. Hoarseness. Burns and blackness around the mouth or nose.  Care for smoke inhalation: Get victim to fresh air, or ventilate the area. Call for help. Help victim into a position for easiest breathing. If he becomes unresponsive, position him in recovery position and be prepared to give BLS.  Chemical Burns Acids and Alkalis, liquids or solids can cause serious chemical burns.  Care for chemical burns 1. For dry chemical brush it off victim’s skin with any items available: (clothes, paper…). 2. Then wash the area with running water for at least 30 min. 3. Because of the risk of fumes move the victim or ventilate the area. 4. Remove clothing and jewelry. 5. Cover the burn with a loose dry non stick dressing 6. Call for any chemical burn.  ALERT With a chemical splashed into the eye, flush immediately with running water for at least 20 min. Tilt victim’s head so that water runs away from the face not into the other eye. After flushing, have victim hold dressing over the eye until he receives medical care.  Electric Burns An electrical burn occurs whenever any part of body comes in contact with electricity. When You See…. A source of electricity near the victim, bare wires, power cords, an electrical device. Burned area of skin, possibly both entrance and exit wounds. Changing levels of responsiveness. 1. Don’t touch victim, until you know the area is safe. 2. With an unresponsive victim give BLS. 3. Call for help. 4. Care for the burn: – stop burning – cool the area – remove clothing and jewelry – cover the burn 5. prevent shock by having victim lie down, elevating legs and maintaining normal body temperature. Head and Spinal Injuries  Any trauma to the head, neck or back may result in serious injuries. Even injuries without immediate obvious signs and symptoms may create a potentially life- threatening problem. Causes of Head and Spinal Injuries: Any forceful blow to the head, neck or back. o Motor vehicle crashes. o Falls from height. o Sports : o Diving emergencies. o Skiing emergencies.  Prevention of Head and Spinal Injuries Guidelines of safety: ▪ Always wear seatbelts and shoulder restraints in vehicles. ▪ Use approved car seats for infants. ▪ Wear appropriate helmets, hard hats for bicycling, sports, and work activities. ▪ Avoid risky activities, when you are under the influence of drugs, alcohol or medications. ▪ Don’t dive into shallow water. Assessing Head and Spinal Injuries A head trauma that fractures the skull may also put enough force on cervical vertebrae that a spinal injury occurs. The assessment of a victim with such injuries should look for both head and spinal injuries. Signs and symptoms: ▪ Deformity in the head, neck, or back. ▪ Changing levels of responsiveness, drowsiness, confusion or dizziness. ▪ Unequal pupils. ▪ Headache. ▪ Clear fluid from the nose or ears. ▪ Stiff neck. ▪ Inability to move any part of the body. ▪ Numbness, lack of feeling in feet or hands. ▪ Loss of bowel or bladder control.  During initial assessment, you may have to reposition the victim in order to: – open airway – check breathing – give CPR Victim may have spinal injury take great care when moving him. Maintain victim’s head position to prevent movement. If your examination reveals any problem suggesting head or spinal injury, call and keep victim still until EMS professionals arrive.  Skull Fractures If the victim had a blow to the head, Consider the possibility of skull fracture or brain injury. When you find bleeding from the scalp, check carefully for a possible skull fracture before applying direct pressure to the wound. A skull fracture is a life threatening condition. BRAIN INJURIES  Signs & symptoms of Brain injuries: ▪ Headache. ▪ Nausea and vomiting. ▪ Unresponsiveness, confusion, altered mental status. ▪ Convulsions. ▪ Numbness, loss of sensation. ▪ Paralysis of body areas, weakness. ▪ Unequal pupils.  Signs and symptoms may appear within the next 48 hours. seek medical attention immediately if any of the following late signs: ❑Nausea and vomiting. ❑Severe or persistent headache. ❑Seizure. ❑Changing levels of responsiveness.  Concussion Temporary impairment of brain function, usually not permanent damage. Signs and symptoms: ❖Brief loss of responsiveness. ❖Memory loss about the traumatic event. ❖Temporary confusion. ❖Mildly or moderately altered mental status. ❖Headache. SPINAL INJURIES  A fracture of the neck or back is always serious because of a possible damage to the spinal cord. Even a small displacement or fracture of these bones can damage the soft tissue of the spinal cord or nerves. The spinal cord cannot grow back to heal injury, although medical care can improve the condition of a victim with partially damaged nerves.  Its critical to prevent head and neck movement in all victims suspected to have spinal injury. Unless you have to move the victim, support his head in the position you find. Position the Victim: If the victim is lying on his back and vomits, you must roll him onto his side to let the mouth drain and allow breathing. The help of two or three others is necessary to keep the back and neck aligned during movement. Lower Back Injuries : Generally occur as a result of stressful activity rather than traumatic injury. For example lifting or moving a heavy object. Signs and symptoms may include sharp pain in the lower back, stiffness and reduced back movement.  Chest, Abdomen and Pelvis Injuries Faculty of Pharmacy Dr Ammar Raiy  Injuries to the chest, abdomen or pelvis can result from either blunt or penetrating forces. Blunt trauma: motor vehicle crashes, falls, industrial emergencies, fights. Open injuries: gunshots and stab wounds.  Close and open injuries may be life threatening when: 1.Severe bleeding. 2.Internal organs injury. Shock often occurs. Always call for these injuries. CHEST INJURIES  Chest contains many important structures that may be damaged by injury. These wounds can be life threatening if breathing is affected or from severe bleeding. Signs and symptoms: * breathing problems. * severe pain. * bruising, swelling. * deformity of the chest. * bloody coughing.  Closed Chest Injuries Injuries involving the lungs include: Pneumothorax: air escapes from injured lung into the thoracic cavity resulting in respiratory distress. Heamothorax: blood accumulates in the thoracic cavity.  Call and monitor victim’s breathing while waiting for help. Let a responsive victim find the position that is most comfortable and allows for easiest breathing. For unresponsive victim: maintain an open airway and keep checking breathing.  Rib fractures More common in lower ribs and along the side. Usually cause severe pain, discoloration and swelling. Abdominal organs may be injured. Because of the possibility of serious injury that may become worse with movement, always call for rib fracture.  Flail Chest Fracture of two or more ribs in two or more places. With breathing, the flail segment moves in the opposite direction of the remaining chest wall which is called paradoxical movement. First aid for flail chest includes supporting the affected chest area with a bulky dressing, towel or pillow.  Impaled Object Removing an impaled object from the chest could cause additional bleeding, injury and breathing problems. Leave the object in place and use bulky dressing bandaged around it.  Sucking Chest Wound An open wound in the chest caused by penetrating injury that lets air move in and out the chest during breathing. You may hear a gurgling or sucking sound and may see air bubbles in the blood around the wound.  A sucking chest wound can be life threatening. First aid includes sealing the wound from 3 directions to help victim to maintain adequate respiratory function. ABDOMINAL INJURIES  large blood vessels present within the abdomen in addition to many organs. Internal organs may be damaged and organs may protrude from an open wound. injury may cause internal and\or external bleeding. All abdominal wounds should be considered potentially life threatening.  Closed Abdominal injury Can be life threatening if accompanied with serious internal bleeding. Often, the only symptom is pain. Shock may also present. The abdomen may appear very firm, almost rigid.  First aid: Monitor victim breathing and give supportive care. Victim may feel more comfortable with knees slightly bent because this position decreases abdominal muscles tension(unless spinal injury is suspected). Keep victim warm. Don’t give victim anything to eat or drink because emergency surgery may be needed.  Open Abdominal Wounds Usually injure internal organs (intestines, liver, kidneys or stomach). A large abdominal wall wound may allow abdominal organs to protrude through, this is called evisceration. organs can be further damaged by drying, bleeding or infection.  First aid Victim position: as with closed abdominal injury. Providing wound care. Treat shock. If abdominal organs protrude through an open wound, don’t touch them or try to push them back into the abdomen.  Don’t pack the wound with dressings. instead cover the wound with moist sterile dressing, or plastic wrap loosely taped in place to keep organs from drying. PELVIC INJURIES  The most common pelvic injury is pelvic fracture. ❑Common in the elderly and may be caused by little forces, such as falls. ❑In healthy adults are usually caused only by large forces. Pelvic fractures are generally serious. A broken pelvis may cause severe internal bleeding and organs damage.  Victim cannot move and often has severe pain. On physical examination: instability of the pelvis could be found. Victim may bleed from the genitalia or rectum or have urinary leakage.  First aid Consider that victim may also have spinal injury…… support the head and neck. Don’t move the victim or let him move. Take steps to minimize shock including maintaining victim’s body temperature but don’t elevate the legs. Stabilize the pelvis with victim`s belt.