Basic Life Support Fall 2018-2019 PDF

Basic Life Support Fall 2018-2019 Page | 1  First Aid Study Guide 1-Scene safety / Primary assessment 2-CPR (compressions, ventilation, defibrillators) 3-Choking( Partial /complete) 4-Shock(Distributive Shock , Hypovolemic Shock, Cardiogenic Shock) 5-Wound (open wound, closed...

Basic Life Support Fall 2018-2019 Page | 1  First Aid Study Guide 1-Scene safety / Primary assessment 2-CPR (compressions, ventilation, defibrillators) 3-Choking( Partial /complete) 4-Shock(Distributive Shock , Hypovolemic Shock, Cardiogenic Shock) 5-Wound (open wound, closed wound) 6-Bleeding( External , internal) 7-Burns (Thermal, Cold exposure, Chemical, Electrical current, Inhalation. Radiation) 8- Injuries (Head, neck, spinal, nose, mouth, Abdominal, chest, pelvic…) 9- Food borne diseases (infections vs. intoxication) 10- Bites and stings( severity, venom, victim…..) Page | 2  Scene Safety Use your senses Recognize that an Form an initial Awake/ moving Scene impression emergency exists (signs and patient ? Unconsciousness ? symptoms) Own safety Arriving Abnormal skin color or Team safety on Scene life-threatening bleeding? Scene Primary Assessment of the Patient safety Size-Up Unresponsive Adult Patient Bystanders’ safety Wearing PPE Circulation Senses using Assessing the (Hearing, sight, smell) level of consciousness Check for: (LOC) Traffic, fire, escaping Responsive Patient steam, downed electrical Breathing * Patient’s consent lines, smoke, extreme * find out what happened weather or even overly emotional /bystanders)/ Silent and not moving patient standard precautions *may be unresponsive *the patient on the shoulder *use the pneumonic AVPU Not move an ill or (Alert /verbal /painful /Unresponsive) seriously injured patient unless there is an immediate danger, such as fire, flood or poisonous gas(quickly and carefully moving) Nature of the illness or Mechanism of injury Never assume there is just one patient. Page | 3  Part I 1* CPR 2* Choking 3* Shock Page | 4 CPR Page | 5  Airway Supine (face-up) position Modified jaw-thrust maneuver Head-tilt /chin-lift (If a head, neck or technique spinal injury is suspected) Once the airway is open, simultaneously check for: Check for breathing and a carotid pulse, for at least 5 but no more than 10 seconds. Check for patient’s chest rises and falls Listen for Escaping air and feel for it against the side of. your cheek Check for agonal breaths Page | 6 Agonal Breaths NOT normal breathing (Infrequent gasping) Unconscious patient Sign of cardiac arrest Occur after the heart has stopped beating Need to Care for the patient Page | 7  Pulse Checking Check The femoral artery For a pulse Or By palpating The Area between The hip and groin Palpate the carotid artery by sliding two fingers Into the groove of the patient’s neck Do not to reach across the neck And Obstruct the airway Page | 8  Respiratory Arrest Patient Patient Has Not breathing A definitive pulse Give ventilations (Technique to supply oxygen) 1 ventilation Each ventilation Every 5 to 6 Lasting about 1 seconds second Making the chest rise Note: Avoid overventilation and hyperventilation (Rate and volume greater than recommended) BECAUSE IT MAY CAUSE : 1* Gastric distension and possible emesis 2* Coronary perfusion pressures by putting pressure on the vena 3* Decrease in coronary filling 4* Increased intrathoracic pressure  Cardiac arrest Electrical/ mechanical system of the heart malfunctions Patient Patient Not breathing Is unresponsive No pulse Complete cessation of the heart’s ability to function and circulate blood efficiently Note: Cardiac arrest is different from myocardial infarction; however, a myocardial infarction can lead to cardiac arrest Page | 10 Myocardial Infarction (Heart attack) Necrosis (death) of heart tissue as a result of a loss of oxygenated blood. Signs and Symptoms of MI 1* Nausea or vomiting 2* Loss of consciousness 3* Dizziness or light-headedness 4* Sweating, (especially on the face) 5* Pale skin (Especially around the face) 6* Pain that comes and goes (Such as angina 7* Chest pain (longer than 3 to 5 min) 8* Pressure or pain in the chest spreading to the shoulder, arm 9* Difficulty breathing (Faster rate than normal or noisy breathing) Page | 11  Adult Cardiac Chain Of Survival Integrated post-cardiac arrest (Optimize ventilation and oxygenation and Treat hypertension) Provide the Proper tools and medication needed Early CPR To keep oxygen-rich blood flowing Early defibrillation with an automated external defibrillator (AED) Page | 12  CPR Patient in cardiac arrest Cardiopulmonary Heart and breathing have stopped resuscitation Circulates blood that contains oxygen to the vital organs Includes chest compressions / ventilations /automated external defibrillator Compressions Ventilations CPR/AED For Adults Defibrillator Note: For adult patients: CPR consists of 30 chest compressions followed by 2 ventilations Page | 13  Compressions 1*Patient is on: a firm, flat surface floor, ground, stretcher or bed. 2*chest is exposed: ensure proper hand placement/ visualize chest recoil 3* The heel of one hand in the center of the chest is positioned on the lower half of sternum with the other hand on top. 4*Straight Arms / shoulders directly over the hands to promote effective compressions 5*Correct rate of Compressions: at least 100 per minute to a maximum of 120 per minute / proper depth of at least 2 inches for an adult 6*Fully recoil chest between each compression (flow back of the blood into the heart following the compression) Page | 14  Ventilations (Supply oxygen to a patient who is not breathing ) Mouth-to mouth Pocket mask Bag-valve-mask (BVM) Ventilations Ventilations resuscitator 1*Unavailability of a pocket 1*Create a barrier between 1*(Handeled device used to mask or BVM your mouth and ventilate patients and administer the patient’s mouth and nose higher concentrations of oxygen 2*Using the head-tilt/chin-lift than a pocket mask) technique 2*Can help to protect you from contact with a 2*One rescuer opens and 3*Shut nose / Make a complete patient’s blood, vomitus and maintains the airway and ensures seal over the patient’s mouth saliva the BVM mask seal with your mouth. 3*Can help to protect you from 3*The second rescuer delivers 4* Ventilations should be given ventilations by squeezing the bag breathing the air that the patient one at a time slowly with both hands exhales - Depress the bag about halfway 5*Need to use mouth-to-nose to deliver between 400 to 700 ml ventilations in case of unability of volume to make the chest rise to make a complete seal over a - Give smooth and effortless patient’s mouth ventilations that last about 1 second Page | 15  Notes Note: 1* with mouth-to-mouth ventilations, the patient receives a concentration of oxygen at approximately 16 percent compared to the oxygen concentration of ambient air at approximately 20 percent. 2* if you do not break the seal and take a breath between ventilations, the second ventilation may contain an oxygen concentration of 0 percent with a high concentration of carbon dioxide (CO2) Note: 1*make sure to use Pocket mask that matches the size of the patient 2*ensure that you position and seal the mask properly before blowing into the mask. Note: 1*BVMs can hold greater than 1000 milliliters of volume *could lead to overventilation and hyperventilation *This difficulty may indicate an increase in intrathoracic pressure Page | 16 Special Considerations: Advanced Airways (Such as a supraglottic airway device or an endotracheal tube) Page | 17  Stopping CPR Once started, continue CPR with 30 compressions followed by 2 ventilations (1 cycle =30:2) until: 1* You see signs of return of spontaneous circulation (ROSC) such as patient movement or breathing 2* An AED is ready to analyze the patient’s heart rhythm 3* Other trained rescuers take over and relieve you from compression or ventilation responsibilities. 4* You are alone and too exhausted to continue responsibilities. Page | 18  Recovery Positions Unconscious patient Patient is If the patient is who is breathing and suspected of having a head, neck or spinal an infant has no head, neck or spinal injury injury 1*Place a patient in the modified 1*Place a patient in the modified H.A.IN.E.S(High Arm IN H.A.IN.E.S(High Arm IN 1*Carefully position the infant Endangered Spine) recovery Endangered Spine) recovery face-down along the forearm position position 2* Support the infant’s head and 2* Kneel at the side of the 2* Kneel at the side of the neck with your other hand while patient and roll the patient patient and roll the patient keeping the infant’s mouth and toward the rescuer toward the rescuer nose clear 3* Place the top leg on the other 3* Place the top leg on the other 3* Keep the head and neck with both knees in a bent positio with both knees in a bent slightly lower than the chest position Page | 19  Automated External Defibrillators (AEDs) 1*Portable electronic devices that automatically analyze The patient’s heart rhythm 2*Automatically analyze the patient’s heart rhythm and can provide defibrillation 3* An Electrical shock that may help the heart re- establish a perfusing rhythm. 4*AEDs deliver defibrillation(s) to patients in cardiacarrest with two specific dysrhythmias: ventricular fibrillation (V-fib) and ventricular tachycardia (V-tach) Note: *For each minute CPR and defibrillation are delayed, a patient’s chance for survival is reduced by 7 to 10 percent *If CPR is in progress, continue CPR until the AED is turned on Page | 20 AED Safety Page | 21  Do’s and Don’ts for AED Use (General precautions) Do’s Don’ts 1*Do not use alcohol to wipe the 1*Before shocking a patient with an patient’s chest dry. Alcohol is AED, do make sure that no one is flammable touching or is in contact with the patient or any resuscitation equipment. 2*Do not touch the patient while the AED is analyzing. Touching or moving the patient may affect analysis. 2*Do use an AED if a patient is experiencing cardiac arrest as a result of traumatic injuries. 3*Do not touch the patient while the device is defibrillating. You or someone else could be shocked. 3*Do use an AED for a patient who is pregnant. Defibrillation shocks transfer 4*Do not defibrillate someone when no significant electrical current to the around flammable or combustible fetus. materials, such as gasoline or free- flowing oxygen Page | 22  One-Rescuer and Two-Rescuer CPR—Adult Responsible for conducting the scene size-up One- Responsible for conducting the primary assessment Rescuer CPR Responsible for performing all the steps of CPR including the use of AED if available RESCUER 1 (team leader): performs the scene size-up/primary assessment/begins the process of providing CPR Two- RESCUER 2 (assistant): calls for additional resources / prepare AED if Rescuer available / analyse AED CPR RESCUER 1: should move the patient’s head after analyzing AED / RESCUER 2: provide chest compressions and get into the covering position Note: 1* the rescuers will continue the cycle of chest compressions and ventilations, switching positions about every 2 minutes 2* the rescuer providing compressions should count out loud 3* If a BVM is available, it is prepared by a third rescuer positioned at the top of the head / and used upon completion of a cycle of chest compressions 4* Ensure no one rescuer becomes fatigued Page | 23  High-Performance CPR (Refers to providing high-quality chest compressions as part of a well-organized team response to a cardiac arrest) AED pads are applied / charged Mask or BVM may need to be repositioned Airway may need to be reopened Rescuers switch positions Pulse checks may be done, but unnecessarily Minimizing interruptions in chest compressions, which helps to Maximize the blood flow generated by the compressions Page | 24  Providing CPR/AED For Children and Infants Pediatric Considerations Age: For CPR care: Child between 1 and 12 (onset of puberty) /Infant younger than 1 year of age Consent: obtain consent from the child’s parent or legal guardian *Not present legal guardian: consent is implied in life-threatening situations *Present legal guardian: state who you are /what you observe /what you plan to do / ask permission Note: *Most child-related cardiac arrests occur as a result of a hypoxic (Asthma, airway obstruction or a drowning) * Ventilations and appropriate oxygenation are important for a successful resuscitation Page | 25  CPR/AED Differences Between Children and Adults Use the same head-tilt/chin-lift technique as an adult Airway Only tilt the head slightly past a neutral position, avoiding any hyperextension or flexion in the neck Very similar to an adult Place your hands in the center of the chest on the lower half of the sternum and compress at a rate between 100 to 120 per minute Compressions For a child: compress the chest only ABOUT 2 inches, For an adult: at least 2 inches as you would One rescuer: 30 compressions to 2 ventilations (30:2) same as for an adult Compressions- to-Ventilations Two-rescuer: this ratio changes to 15 compressions to 2 ventilations (15:2). Ratio Same way regardless of the patient’s age pad placement based on the size of the child AEDs For children 8 years of age or younger use pediatric AED pads if available If it appears that the AED pads would touch each other based on the size of the child’s chest/ Apply one pad to the center of the child’s chest on the sternum and one pad to the child’s back between the scapulae Page | 26 CPR /AED Differences: Adult and child Page | 27  CPR/AED Differences for Infants Primary Tap the bottom of the foot rather than the shoulder and shout, “Are you okay?” Assessment Check the brachial pulse with two fingers on the inside of the upper arm Variations: Infant Not to use your thumb because it has its own detectable pulse Tilt the head to a neutral position, taking care to avoid any hyperextension or flexion in the neck Airway Not to place your fingers on the soft tissues under the chin or neck to open the airway Place the infant on firm, flat surface (such a table or Countertop) Compressions Provide compressions from a standing position rather than kneeling at the patient’s side Same rate as for adults and children, that is, between 100 to 120 compressions per minute Only compress the chest ABOUT 1½ inches Place two fingers from your hand in the center of the chest, about 1 finger-width below the nipple line on the sternum One-rescuer The fingers (index finger and middle finger or their middle finger and fourth finger ) should be oriented so that they are parallel, not perpendicular to the sternum CPR The ratio of compressions to ventilations is the same as for an adult or child, that is, 30 compressions to 2 ventilations (30:2) The rescuer performing chest compressions will be positioned at the infant’s feet while the rescuer providing ventilations will be at the infant’s head Two-rescuer Place both thumbs on the center of the infant’s chest side-by-side about 1 finger- width below the nipple line. CPR Have the other fingers encircling the infant’s chest toward the back, providing support The rescuer providing ventilations will open the airway using 2 hands and seal the mask using the E-C technique (15 compressions to 2 ventilations (15:2) ) Occurs less often than for an adult / use pediatric AED pads if available/ AEDs Place one pad in the center of the anterior chest and the second pad in the posterior position centered between the scapulae Page | 28 CPR /AED Differences: Adult, child and infant Page | 29 (Continued) CPR /AED Differences: Adult, child and infant Page | 30  Providing Care for An Obstructed Airway (For patients who cannot cough, speak, cry or breathe) CHOCKING Page | 31  Universal signs for choking 1*Clutching the throat 2* Patient will just panic 3* Running about 4* Flailing arms 5*Trying to get another’s attention Page | 32  Obstructed Airway Caring for Caring for an Infant An Adult and Child 1* If the patient can cough: Encourage him to continue coughing until the patient is able to breathe normally 1* If infant is choking and awake but unable to cough, cry or breathe : perform a series of 5 2* If the patient can’t breathe or has a weak or back blows and 5 chest thrusts ineffective cough, you will need to perform abdominal thrusts to clear the obstruction 2* Continue this cycle of 5 back blows and 5 3* If a patient who is choking becomes chest thrusts until the object is forced out; the unresponsive: infant can cough, cry or breathe *carefully lower the patient to a firm, flat surface 3* If an infant does become unresponsive while * send someone to get an AED choking: * Immediately begin CPR with chest *carefully lower the infant onto a firm, flat compressions surface 4* give ventilations: *send someone to get an AED *look in the person’s mouth for any visible * Summon additional resources if appropriate object *Immediately begin CPR starting with * If you can see it, use a finger sweep motion to compressions remove it * If you don’t see the object, do not perform a blind finger sweep, but continue CPR * Remember to never try more than 2 ventilations during one cycle of CPR, even if the chest doesn’t rise (30 compressions and 2 ventilations) Page | 33  HEIMLICH’S MANOEUVRE To perform abdominal thrusts: 1*stand behind the patient 2*while maintaining your balance, make a fist with one hand and place it thumb-side against the patient’s abdomen—just above the navel. 3*Cover the fist with your other hand, and give quick, upward thrusts until the object is forced out Unresponsive PATIENT. USE THE AIR IN LUNGS TOOL TO DISLODGE THE F.B Page | 34  BACK BLOWS / CHEST THRUSTS Start with back blows: 1*Hold the infant face-down on one arm using your thigh for support 2*Make sure the infant’s head is lower than his body 3* support the infant’s head and neck 4*With your other arm, give firm back blows with the heel of your hand between the infant’s scapulae. After 5 back blows, start chest thrusts: 1*Turn the infant over onto your other arm using your thigh for support 2* Support the head and neck as you move the infant. 3*Place two fingers in the center of the infant’s chest, about 1 finger-width below the nipple line CHEST THRUST BELOW CHEST THORACIC SPINE 4*Give 5 quick thrusts. Page | 35  COMPLETE OBSTRUCTION IF ALL FAIL BACK BLOW CHEST THRUST ABDOMINAL THRUST AIRWAY NOT ESTB. CRICOTHYROID OTOMY TRACHEOSTOM Y Page | 36  Special Situation Solution Too large person 1* Give chest thrusts instead of abdominal thrusts 2* position yourself behind the person as you would for abdominal thrusts 3*Place the thumb side of your fist against the center of the person’s breastbone 4* cover your fist with your other hand and pull straight back, giving a quick, inward thrust into the person’s chest. pregnant women * Give chest thrusts instead of abdominal thrusts. Person in a wheelchair. 1*Give abdominal thrusts in the same way that you would for a person who is standing 2*kneel behind the wheelchair. If features of the wheelchair make it difficult to give abdominal thrusts 3* give chest thrusts instead. Alone and choking 1* Give yourself abdominal thrusts, using your hands, just as if you were giving abdominal thrusts to another person 2* Alternatively, bend over and press your abdomen against any firm object, such as the back of a chair or a railing 3* Do not bend over anything with a sharp edge or corner that might hurt you, and be careful when leaning on a railing that is elevated. Page | 37  Shock (Failure of the circulation to deliver enough oxygen-rich blood to the body’s tissues and organs) Types Stages Distributive Shock Initial Stage (Result of inadequate vascular tone) - ↓ in CO -reduction in the oxygenation to the cells – Neurogenic shock - ↓ Aerobic metabolism – Septic shock - ↑ anerobic metabolism – Anaphylactic shock – Accumulation of lactic acid Hypovolemic Shock Compensatory Stage (large reduction in the circulating blood - maintains blood flow to the heart and brain; volume) -↓ blood flow to the GI, kidney, lungs, skin - Activation of epinephrine and -loss of blood or fluid norepinephrine -Kidneys release renin into blood Cardiogenic Shock formation of angiotension & release of aldosterone, ADH(retention of water by ( heart is unable to function adequately the kidney) resulting in insufficient blood flow to tissue and organs ) Progressive Stage -Blood pressure below 80 -myocardial infarction -Tachycardia; tachypnea; ↓ urine output; ↓ body temperature; cold, pale clammy skin. -obstruction of blood flow -congestive heart failure Irreversible Stage - Thrombosis of small vessels occurs - Tissue hypoxia and anoxia occur - lactic acid accumulation contributes to cell death Page | 38 Compensatory Stage Page | 39  Shock (Failure of the circulation to deliver enough oxygen-rich blood to the body’s tissues and organs) Common causes Signs and Symptoms First Aid Care 1-Have the person lie flat on his back ( legs elevated 45 degrees) 1-Severe bleeding 1-Restlessness or irritability 2- Control any external bleeding 2- Severe allergic reactions 2- Altered level of (anaphylaxis) consciousness 3- Cover the person with a 3- Nausea or vomiting blanket ( loss of body heat ) 4- Pale, ashen (grayish), cool, 4- Not allowed for Eating or moist skin drinking (risk for vomiting and aspiration ) to avoid pneumonia. 5- Rapid breathing / Rapid, weak 5- Help the person rest 6- Heartbeat comfortably. Anxiety and pain can intensify the body’s stress 7- Excessive thirst and speed 7-Oxygenation : oxygen is administered to protect against hypoxemia (placed on ventilator if needed) 7- Monitor the person’s condition and watch for changes Page | 40  Part II Traumatic Injuries 1* Wounds 2* Internal Bleeding 3* Burns 4* Muscle, Bone and Joint Injuries 5*Head, Neck and Spinal Injuries 6* Nose and Mouth Injuries 7*Chest Injuries 8* Abdominal Injuries 9*Pelvic Injuries Page | 41  Wounds (Damage of the skin or other tissues of the body) Classifications Factors Assessment 1-Skin integrity: open, closed, 1- Skin ; color , temperature acute , chronic 1-Nutrition , turgor , integrity 2-Cause: intentional, 2-Tissue perfusion 2- Risk for pressure ulcers : unintentional 3-Infection Norton and Braden scales 3-Severity of injury: 4-Age superficial, penetrating, 3- Nutritional status perforating 4- Exposure of skin to body 4-cleanliness: clean, clean- fluids contaminated, contaminated, infected, and colonized 5- Pain 4-descriptive qualities: laceration, abrasion, contusion Page | 42  Closed Wounds 1-Intact skin and injured underlying tissues 2-Damage of the small blood vessels under the surface of the skin 3-blood leaks into the surrounding tissues Common Type Signs and Symptoms First Aid Care 1-Applying a cold pack to the  Bruise (contusion) 1-red or purple area bruised area can help to decrease caused by blunt bleeding and reduce pain and trauma. 2-swelling swelling 3-The bruised area is often 2-Elevating the injured area may painful help to reduce swelling, but do not elevate the injured area if doing so causes pain. Page | 43  Open Wounds (skin’s surface is broken and blood may come through the tear in the skin, resulting in external bleeding) TYPES Abrasion Laceration Puncture Avulsion wound Abraison Laceration Puncture wound Avulsion 1-occurs when a 1-shallow wounds 1- Cut, commonly pointed object (nail, 1-Torn skin ( do not bleed much) caused by a sharp an animal’s tooth, (partially/completely) object such as pierces the skin) 2-occurs when broken glass or a 2- caused commonly something rubs knife 2- A gunshot by animal bites , by roughly against the wound is also a Fall or other skin, causing damage 2-Occurs when puncture wound trauma (Elderly to the skin’s surface blunt force splits people have fragile the skin 3- do not bleed skin) 3-scraping of the much unless a outer skin layers 3-Deep lacerations blood vessel has 3- Bleeding: Avulsion exposes sensitive may extend through been injured often causes nerve endings layers of fat and significant bleeding. muscle, damaging 4- High risk for. 4- Rinse the abrasion nerves, blood infection thoroughly with vessels and tendons running water To remove the dirt and 4- No pain (If debris, , and then nerves are damaged) wash the area with soap and water to 5-Bleeding may be lower the risk for heavy or there may infection be none at all Page | 44 Page | 45 Types of open wounds include abrasions (A), lacerations (B), avulsions (C) and puncture wounds (D). A (Abraisons) B ( Lacerations) C ( avulsions) D( Punctures) Page | 46  Signs and symptoms of An infected wound 1- Increased pain 2- Swelling 3- Redness or warmth in the area of the wound. 4- Red streaks extending from the area of the wound 5- Pus (a thick yellow or green fluid) draining from the wound. 6- Fever Use advanced wound-care strategies, antibiotics or both to eliminate the infection and promote wound healing. Page | 47 Basic wound care 1* Cut or tear his clothing carefully to: - evaluate for location, type, and size of the injury - avoid further contamination - avoid further injury 2*DO NOT touch the wound; keep it as clean as possible 3*DO NOT REMOVE protective clothing in a chemical environment (Apply dressings over the protective clothing 4*Examine the casualty to determine if there is more than one wound. (A missile may have entered at one point and exited at another point. 5*The EXIT wound is usually LARGER than the entrance wound (All open (or penetrating) wounds should be checked for a point of entry and exit and treated accordingly) 6*Necessary basic lifesaving measures, such as clearing the airway and mouth-to-mouth resuscitation. Page | 48  First Aid Care for Open Wounds Minor Major Open Wounds Open Wounds (Can be cared for effectively using first aid) (Extensive tissue damage or is bleeding heavily or uncontrollably) 1- Apply direct pressure with a 1- Apply direct pressure with a gauze pad gauze pad to stop the bleeding to stop the bleeding (15 min) 2- Wash the area with soap and 2- place another dressing on top of the first warm water (After the bleeding (If blood soaks through the first dressing,) stops) and apply additional hard direct pressure 3-Rinse under warm running 3- Check the skin (When the bleeding water for about 5 minutes until the stops) on the side of the injury farthest wound appears clean and free of away from the heart (e.g., the hand or foot) debris for feeling, warmth and color. 4- dry the area. 4- Apply a roller bandage over the dressing (snug but not too tight ) 5-Apply a small amount of antibiotic 5- Loosen the bandage If there is a change in feeling, warmth or color from your first 6- Cover the area with a sterile check (for example, the skin is cooler or gauze pad and a bandage, or apply paler than it was before, the area is swollen, an adhesive bandage. or the person complains of a numb or tingly 7- wash your hands with soap and feeling) water, even if you wore gloves. 6- immunization with tetanus vaccine (it is usually given during childhood (booster every 10 years) Dressings A dressing is a pad that is placed directly on a wound 7- Suturing a wound (Stitches) speed to absorb blood and other fluids, promote clotting and healing, reduce infection, and minimize prevent infection scarring (first few hours after the injury) 6 -wash your hands with soap and water, Bandages even if you wore gloves. A bandage is a strip (made of gauze or a gauze-like material) used to hold the dressing in place and to control bleeding Page | 49  Tourniquet application. ► Immediate and effective direct pressure to the wound may reduce the need for a tourniquet application. This is an important benefit as tourniquet applications are to be avoided and used only as a last resort. Page | 50  Myth-Information Applying hydrogen peroxide 1* Although applying hydrogen peroxide to a wound will kill germs, it also can harm the tissue and delay healing (it is better to clean with soap and warm , running water or saline) Letting a wound “breathe” 2* Letting a wound “breathe” by exposing it to air helps it to heal. A better strategy to promote wound healing is to keep the wound moist (with an antibiotic ointment, cream or gel) and covered (under a dressing and bandage). Page | 51  Major Open Wounds (Involves extensive tissue damage or is bleeding heavily) 55 Applying Using A Tourniquet Hemostatic Dressings 1*Used in severe, life-threatening bleeding 1* It is a dressing treated with a that cannot be controlled using direct substance that speeds clot formation pressure 2* Used when severe life-threatening bleeding exists and standard first aid 2* Place the tourniquet around the procedures fail or are not practical wounded extremity about 2 inches above the wound, avoiding the joint if possible 3*used on parts of the body where a tourniquet cannot be applied, such as the 3*Secure the tourniquet tightly in place neck or torso according to the manufacturer’s instructions 4*used to control bleeding from an open wound on an arm or a leg if a tourniquet 4* Twist the rod (windlass) to tighten the is ineffective tourniquet until the bright red bleeding stops 5*applied at the site of the bleeding (possibly inside of the wound) and is used 5*Secure the rod in place along with direct pressure. 6*Note and record the time that you applied the tourniquet 7*Be sure to give EMS personnel this information when they arrive 8* Do not remove it until the person reaches a healthcare facility Page | 52  Open Wounds with Embedded Objects 1*Don’t remove the embedded object if it is large (for example, a large piece of glass or metal) 2*place several dressings around the object to begin to control blood loss 3* packbulk dressings or roller bandages around the embedded object to keep it from moving 4* monitor the person for signs and symptoms of shock. 5* Remove a small partially embedded object with clean tweezers and pull it out 6* provide care as you would for any minor open wound. Hot and Cold Therapy 1*Assessment for temperature tolerance 2*Bodily responses to heat and cold 3*Local effects of heat and cold 4*Factors influencing tolerance 5* choice of moist and dry compresses , packs , soaks , sitz baths , aquathermia pad Page | 53  Bleeding Definition Types 1-Bleeding (hemorrhage) is 1-Capillary bleeding is slow; the escape of blood from the blood "oozes" from the capillaries, veins, and (wound) cut. arteries) 2-Venous bleeding is dark 2-Bleeding can occur inside red or maroon, the blood the body (internal), outside flows in a steady stream. the body (external) or both. 3-Arterial bleeding (life threatening) is bright red, the blood "spurts" from the wound. Page | 54  External Bleeding 1-The adult body contains approximately 5 to 6 quarts of blood (10 to 12 pints). 2-The body can normally lose 1 pint of blood (usual amount given by donors) without harmful effects. 1 Pint ≈ 0,4732 Liters SO 10 pints. 4.4k 2- Most of the major arteries are deep and well protected by tissue and bone 3-Although bleeding can be fatal, you will usually have enough time to think and act calmly Small wounds Larger wounds 1-Only the capillaries are damaged. 1-A loss of 2 pints may cause shock 2- Usually not serious and can 2-A loss of 5 to 6 pints usually results easily be controlled with a Band- in death. Aid. 3- It will be difficult to decide (During 3-Damage to the veins and arteries certain situations) whether the are more serious and can be life bleeding is arterial or venous. The threatening. distinction is not important. 4- Control bleeding as soon as possible by: a-Direct pressure (controlled bleeding) b-Elevation c-Indirect pressure (severe bleeding):applying pressure to the appropriate pressure point d-Use a tourniquet Page | 55  Burns (A burn is a traumatic injury to the skin (and sometimes the underlying tissues as well) Types Dangerous Sites Thermal Face Cold exposure Ears Chemical Eyes Electrical current Hands Inhalation Feet Radiation Genitalia Perineum Major joints Page | 56  Factorsdifferentiating minor from critical burns Depth of Size of the Location Age of the Cause of the burn burn of the burn person the burn Percentage of the s s Depth of the burn Location of Age of the Cause of body’s surface area the burn person the burn 1*Superficial burns that is burned. - involve the epidermis Critical - Painful /Dry/Red/ 1* Estimation of critical burns critical burns Burns caused Blanch with pressure/Do not Percentage of body blister/ Heal 5-7 days/ No by: surface area estimates Burns that Person: scarring a- Electricity affect: hands, Palm method = 1% younger than b-chemicals 2* Superficial Partial- feet , groin , all Rules of Nines the way around 5 years exposure thickness burns Each leg represents 9 x a limb neck, or older c- nuclear - Epidermis and dermis - Painful/Red/Weeping/ 2 = 18% nose, or mouth than 60 years, radiation Each arm 9% or affect the unless it is Blanches with pressure/ d- explosion Heal in 7-21 days/ Anterior and posterior person’s ability very minor. Unlikely scarring, pigment trunk each 9 x 2 = 18% to breathe changes may occur Head 9% Lund-Browder chart 3*Deep Partial Thickness 2* Medical attention - Epidermis and deeper for. a large percentage dermis/Painful to pressure of the person’s total only/Blister/Wet or waxy body surface dry/Mottled colorisation/ Do not blanch with pressure/Heal 3* a superficial burn in 3-9 weeks/Hypertrophic can be a critical burn if scarring it affects a large percentage of the 4* Full-thickness burns person’s total body - All layers of dermis/ Anaesthetic or reduced surface area. sensation/Appearance varies/Dry/Do not blanch with pressure/No vesicles/Severe Page | 57 scarring with contractures/ Usually require grafting Page | 58 Burns Service Referral Criteria Burns with associated inhalation injury Burns greater than 10% total body surface area Burns to special areas – face, hands, major joints, feet and genitals Full thickness burns greater than 5% total body surface area Electrical burns Chemical burns Circumferential burns of limbs or chest Burns with associated trauma Burns in the very young or elderly people Burn injury in patients with pre-existing illness or disability that could adversely affect patient care and outcomes Suspected non-accidental injury in children or the elderly Burns in children under the age of 12 months Small area burns - in patients with social problems, including children at risk Burns occurring in pregnant women Page | 59  First Aid Care for Burns First aid for burns involve three general steps—stop, cool and cover: 1*Stop : stop the burning by removing the source of the injury if it is safe for you to do so. 2*Cool: a-cool the burn and relieve pain using clean, cool or cold water for at least 10 minutes b- Use water that you could drink c- Never use ice or ice water to cool a burn because doing so can cause more damage to the skin d- If clean cool or cold water is not available, you can apply a cool or cold (but not freezing) compress instead e- Cooling a burn over a large area of the body can bring on hypothermia (a body temperature below normal), so be alert to signs and symptoms of this condition. 3*Cover: a- Cover the burn loosely with a sterile dressing ( to avoid infection) b- Monitor the person closely , to avoid the person to go into shock c- Do not remove pieces of clothing that are stuck to the burned area d- Do not attempt to clean a severe burn e- Do not break any blisters. Page | 60  First Aid Care for Burns Minor Major Electrical Chemical Burns Burns Burns Burns History 1*First aid 1*Primary survey 1*Low voltage – Type of agent (1000V) – Site of contact, 3*Beware of swallowed or inhaled 4*Dressings circumferential full 3*First aid thickness burns – Manner and 5*Analgesia – -Turn power off duration of contact 4*Analgesia differentiating 6*Tetanus – -Ensure own safety – Mechanism of action minor 5*NGT insertion from critical burns of chemical 7*Follow up 4*Dysrhythmias 6*Tetanus First aid 5*Compartment 8*Post burn skin care – -Prolonged 7*Prevent hypothermia syndrome irrigation of water 8*Fluid resus 6* Fluid resus -Remove contaminated clothing -Brush off metals and powders -Do not attempt neutralising without Fluid Resus : -Parkland formula specialist advice Amount required in 24hrs = 4 x wt(kg) x BSA(%) Half in first 8hrs Half in next 16hrs Maintenance fluids in addition for children weighing less than 30kg Guided clinically and by urine output Page | 61  Myth-Information Soothe a burn with butter. 1*It is Not a good idea! 2* Putting butter, mayonnaise, petroleum jelly or any other greasy substance on a burn is not effective for relieving pain or promoting healing 3* In fact, applying a greasy substance to the burn can seal in the heat and make the burn worse. Page | 62  Fracture (A break in the continuity of a bone or cartilage) Common causes Signs and smytpmyS  sD iilclrm rp cd c SS  rtoiirh myrora llap  Bruising  rcar ronnld cpS  rtolcr  rwl npreimDr  rssyec SSr  s t plplv rhm n Sr  rgi dlclr  Pathology  g mi crSilcrDlparemc rr rt mp sdlcl  lylpoplmcrm rr scDliilclc SSrpmrymv ror ilye  difficulty breathing Page | 63  Fracture Types Traumatic Pathological According to the Path of the # Line 1*Transverse Fracture 1* Closed fracture: fracture 1* Occurring after a trivial hematoma does not violence in a bone weakened Perpendicula communicate with the outside by some pathological lesion. r to the long axis of the This lesion may be: bone. - Localized disorder 2*Oblique fracture Open fracture: fracture (Secondary malignant deposit) differentiating hematoma communicates with Oblique the outside through an open minor from critical burns angle to the wound. long axis of - Generalized disorder the bone. (Osteoporosis). 3*Spiral fracture Rotates along the Stress fracture: long axis of the bone. Occurring at a site in the bone subject to repeated minor stresses over a period of time 3*Longitudinal Fracture Birth fracture: Parallel to In the new born children the long axis due to injury during delivery. of the bone Page | 64  Anatomical classification Of fractures 1*Comminuted # 2*Stellate fracture 3*Impacted The bone is broken Occurs in the flat fracture: into than two bones of the skull and a vertical force drives fragments. in the patella, (lines the distal fragment of run in various the fracture into the directions from one proximal fragment. point) 4*Depressed fracture: 5*Avulsion fracture: occurs in the skull where This is one, where a chip of bone is avulsed by the a segment of bone gets sudden and unexpected contraction of a powerful depressed into the differentiating muscle from its point of insertion, cranium. minor from critical burns 6*Greenstick 7*Distraction Fracture in the young separation of 8*Plastic bone of children ( fragments that have break is incomplete, been pulled apart Bowing fracture in leaving one cortex children without intact. disruption of cortex.. Page | 65  Terms used In fracture follow-up 1*Position : 2* Healing : Changed or Central or peripheral unchanged bony bridging differentiating minor from critical burns 4*Malunion : 3*Delayed union : The fracture healed in unacceptable position. 5*Non-union : The healing process is slower than normal. The healing stopped before union occurred. Page | 66  Joints Dislocation (Is the total displacement of the articular end of a bone from the joint cavity) Subluxation : Is an incomplete displacement. Reduction : Is the restoration of the normal alignment of the bones Subluxation Elbow joint Dislocation Classification: Dislocations are classified as follows: A. Congenital B. Traumatic C. Pathological D. Paralytic Page | 67  Fracture Healing Factors Complications 1*Enhancing Youth 1*At time of injury (Immediate) Early Immobilization of fracture fragments  Haemorrhage Bone fragments contact  Damage to important Adequate blood supply internal structures (brain , Proper Nutrition heart..) Adequate hormones  Skin loss ,Shock  Growth hormone ,Nerve damage  Thyroxin  calcitonin 2*Later Complications 2* Inhibiting Local: - tissue necrosis Age (e.g. Average # Femur - Local wound infection Healing Time) - Loss of alignment Infant: 4 weeks - Delayed and malunion Teenager: 12 to 16 weeks - Joint stiffness Extensive local soft tissue trauma General: -Deep vein thrombosis Bone loss due to the severity of -pulmonary embolism the fracture -osteoarthritis Inadequate immobilization (motion at the fracture site) Infection Avascular Necrosis Page | 68 Splinting 1* Splinting is a way to prevent movement of an injured bone or joint 2* It can also help reduce pain 3* apply a splint if you must move the person to get medical help, and if splinting does not cause the person more pain or discomfort. 4* Commercial splints are available 5*You can also make a splint using soft materials (such as blankets, towels or pillows) or rigid materials (such as a folded magazine or a board) 6* You can even use an adjacent part of the body as a splint (for example, you can splint an injured finger to the uninjured finger next to it). This is called an anatomic splint 7* A triangular bandage can be used to make a sling (a special kind of splint that is used to hold an injured arm against the chest) and to make ties to hold other kinds of splints in place. 8*A “cravat fold” is used to turn a triangular bandage into a tie ( 9*Check for feeling, warmth and color beyond the site of injury before and after splinting to make sure that the splint is not too tight. Page | 69 Page | 70  Principles of Management Aims : (A)- Safe life (B)-save the limb (C)-save the function 1. Efficient First Aid: relieves pain and prevents complications. 2. Safe transport: minimize complications in injures to the spine, fracture of the lower limbs, ribs etc (all fractures should be immobilized immediately ). 3. Assessment of condition of the patients for shock & other injuries. 4. Assessment of local condition of the injured limb regarding complications like vascular injury, nerve involvement and injury to neighboring joints. 5. Resuscitation. If needed 6. Radiography of the part 7. Reduction of the fracture(correction of displacement of fragments 8. Immobilization of the fragments. External fixation  Cast (plaster) Internal fixation  Screws  Plates A triangular bandage can be folded into a tie using a cravat fold  intramedullary nails and rod  wires & pins 9. Early physiotherapy : for the preservation of function of the limb 10. Rehabilitation : After union of the fracture to restore full muscle power and joint movements and to make the patient fit for his original job. NOTE:  Fractures are treated by reduction (realignment) &immediate immobilization  In most cases, simple fractures heal completely in approximately 6 - 8 weeks  better to deal with it within 6hrs of injury to avoid infection  The accurate diagnosis ( X- ray examination) Page | 71  Traumatic Amputations (Loss of a body part as a result of an injury: May be completely detached from the body, or it may still be partially attached) 1* try to locate the completely detached part from the body because surgeons may be able to reattach it. 2* Wrap the amputated body part in sterile gauze or other clean material 3*Put the wrapped body part in a plastic bag and seal the bag 4*Keep the bag containing the body part cool by placing it in a larger bag or container filled with a mixture of ice and water 5*Do not place the bag containing the body part directly on ice or dry ice. 6*Give the bag containing the body part to EMS personnel so that it can be taken to the hospital along with the person Page | 72  Muscle, Bone and Joint Injuries Common Type Signs and Symptoms First Aid Care 1*have the person rest without 1* A sprain : occurs when a 1* Muscle, bone and joint moving or straightening the body ligament is stretched, torn or injuries can be extremely part damaged (most commonly painful affect the ankle, knee, wrist 2*apply a cold pack wrapped in 2* If a joint is dislocated, you and finger joints ) a thin, dry towel to the area to may see an abnormal bump, 2* A strain occurs when a reduce swelling and pain (If the ridge or hollow formed by tendon or muscle is stretched, person can tolerate it) the displaced end of the bone torn or damaged. Strains often 3* Remember RICE are caused by lifting something 3* signs and symptoms of R stands for rest. heavy or working a muscle too injury may be as swelling or I stands for immobilize. hard. ( involve the muscles in bruising Stabilize the injured body part the neck, back, thigh or the with an elastic bandage to limit back of the lower leg. 4*The person might also motion. report feeling or hearing C stands for cold. Apply a cold 3*A dislocation occurs when “popping” or “snapping” at pack wrapped in a thin, dry the bones that meet at a joint the time of the injury, or towel to the area for no more move out of their normal “grating” when moving the than 20 minutes at a time, and position ( caused by a violent injured par wait at least 20 minutes before force that tears the ligaments, applying the cold pack again. allowing the bones to move out 5*The injured area is cold E stands for elevate. Propping of place ) the injured part up may help to and numb. reduce swelling, but do not 4*A fracture is a complete. do this if raising the injured part break, a chip or a crack in a 6*The person is having causes bone. Fractures can be open more pain. difficulty breathing. (the end of the broken bone 4*Splinting breaks through the skin) or closed (the broken bone does not break through the skin). Page | 73  Myth-Information Apply heat to a muscle, bone or joint injury to speed healing 1* relieve pain associated with chronic muscle, bone and joint conditions such as arthritis 2* it is not the best treatment for an acute muscle, bone or joint injury 3*Applying heat causes the blood vessels in the area to dilate (widen), bringing more blood to the area and increasing swelling 4*Cold, on the other hand, causes blood vessels to constrict (narrow), reducing blood flow to the area, helping to reduce swelling 5*In addition, applying cold slows nerve impulses, helping to reduce pain. Page | 74 Head, Neck and Spinal Injuries Causes 1* hit by a vehicle, thrown from a moving vehicle, or was the occupant of a vehicle involved in a motor-vehicle collision. 2* injured as a result of entering shallow water head first. 3* falling from a height greater than his or her own height. 4* sustained a blow to the head or collided with another player, the ground or a piece of equipment. Page | 75 Head Injuries Types 1-Injury to the Scalp 2-Injury to the Brain 3-Injury to the Skull (skull fracture) Page | 76  Head Injuries Signs and Symptoms Closed Open Increased Head Injuries Skull fracture pressure inside Head Injuries the skull 1-altered mental status 1-contusions, 1-altered mental status lacerations, or /responsiveness 2-Irregular breathing 1-contusions, hematomas to the scalp lacerations, or or deformity to the skull 2-Combativeness 3-contusions, hematomas to the behavior lacerations, or scalp 2- leaking Blood or hematomas to the cerebrospinal fluid from 3- Nausea / vomiting scalp or deformity to 2-Deformity to the skull the ears or nose the skull 4- Dilated pupil size that 3- Bruising around the does not react to light 4-leaking Blood or 3- Depression area eyes (raccoon eyes) / (fixed) with altered cerebrospinal fluid detected during behind the ears, or mental status from the ears or nose palpation mastoid process 5-bruising around the (Battle’s sign) 5- Double vision or 4-Brain tissue exposed eyes (raccoon eyes) / other visual disturbances through an open 4-Damage to the skull behind the ears or wound mastoid process visible through 6- Headache (Battle’s sign) lacerations in the scalp 5-Bleeding from an 7- Loss of memory, open bone injury 5-Pain, tenderness, or confusion/disorientation 6-Loss of movement or sensation swelling at the site of 8-. Weakness or loss of injury balance. 7-Nausea / vomiting.. 8-Dilated pupil size 9-seizure that does not react to 10- Evidence of trauma light (fixed) with to the head. altered mental status 11- Slow heart rate. 9-seizures 12- Irregular breathing 10-Unresponsiveness Page | 77  Head Injuries First Aid Care Brain injury Head injury 1-Maintain an open airway with adequate oxygenation 1-Suspect spine injury so stabilize the head and neck 2- Control bleeding with direct pressure. 2- Monitor the victim’s ABCDs; (open airway) 3- Never try to remove a penetrating object 3- Anticipate vomiting; be prepared to keep the victim’s head and neck 4- Place the victim on the left side; stabilized as you roll the victim elevate the head slightly (If the victim on his or her side to prevent aspiration. sustained a medical or nontraumatic injury) 4- Treat the victim for shock; keep the victim warm 5-keep the victim warm, but avoid overheating 5-do not elevate the legs. 6- While waiting for emergency personnel to arrive: a-Dress any facial and scalp wounds that have not been dressed. b- Monitor vital signs. c-Stay alert to the possibility of vomiting or seizures; work quickly to prevent aspiration. d- Continually monitor the airway and the victim’s neurological status... Page | 78  Spinal Injuries Causes Signs and First aid Complications symptoms care 1-Tenderness in the area of the injury; lacerations, 1-Compression (the cuts, punctures, or bruises 1- Maintain in-line 1-Inadequate weight of the body is over or around the spine driven against the stabilization. Breathing Effort indicate forceful injury. head, as in falls) 2- Maintain an open 2-Paralysis 2-Pain associated with 2-Excessive flexion, movement airway and adequate extension, or rotation ventilation 3-Pain independent of 3-Lateral bending movement or palpation along the spinal column or 4-Distraction (a in the lower leg sudden “pulling apart” of the spine that 4-Obvious deformity of stretches and tears the the spine upon palpation spinal cord, as in (not a usual sign). hangings) 5-Soft-tissue injuries associated with trauma in the head and neck (causing cervical spine injury); shoulders, back, or abdomen (causing thoracic or lumbar injury); or the legs (causing lumbar or sacral injury). 6-Numbness, weakness, in the arms or legs 7-Loss of sensation, weakness, or paralysis in the arms or legs 8-Urinary or fecal incontinence 9-Impaired breathing Page | 79..  Helmet Removal 1. Take the victim’s eyeglasses off before you attempt to remove the helmet. 2. One First Aider should stabilize the helmet by placing hands on each side of the helmet, fingers on the mandible (lower jaw) to prevent movement. 3. A second First Aider should loosen the chin strap. 4. The second First Aider should place one hand on the mandible at the angle of the jaw, and the other hand at the back of the head. 5. The First Aider holding the helmet should pull the sides of the helmet apart (to provide clearance for the ears), gently slip the helmet halfway off the victim’s head, then stop. 6. The First Aider who is maintaining stabilization of the neck should reposition, sliding the hand under the victim’s head to secure the head from falling back after the helmet is completely removed. 7. The first First Aider should remove the helmet completely. 8. The victim should then be immobilized Page | 80  Myth-Information A person with a concussion who falls asleep could die 1* It is generally considered safe for a person with a concussion to go to sleep 2* However, the person’s healthcare provider may recommend that you wake the person periodically to make sure that his or her condition has not worsened. Page | 81  Nose and Mouth Injuries Facial trauma can range: 1* from minor injuries (cuts and abrasions, bruises, bloody noses and knocked-out teeth) 2* to more severe injuries, such as a bone fracture 3*A person may have a concussion 4* direct pressure and time for bleeding from open wounds on the face and scalp Nose Injuries Mouth Injuries 1* Nosebleeds caused by Traumatic injuries (Falling or getting hit in the 1* make sure the person is able to nose) , by nontraumatic injuries breathe (breathing problems caused by (breathing dry air and changes in blood or loose teeth) altitude) and by medical conditions (such as hypertension, or high blood 2*place the person in a seated position pressure) and the use of certain leaning slightly forward (If the person is medications) bleeding from the mouth and you do not suspect a serious head, neck or spinal 2*stop a nosebleed by having the injury person pinch (for at least 5 minutes before checking ) his nostrils together 3*place the person on his or her side in the recovery position (If this position is 3* keep the head slightly forward (to not possible) avoid choking by swallowed blood ) 4* hold a gauze pad at the site of the 4* If the bleeding has not stopped after bleeding and apply direct pressure to stop 5 minutes, keep pinching the nostrils the bleeding shut for another 5 minutes 5* Applying a cold pack wrapped in a 5* If the bleeding is severe or gushing, dry towel to the lips or tongue can help call the designated emergency number. to reduce swelling and ease pain 6*Teeth injuries: pressure /save tooth (only by the crown) in saline solution ,egg white, milk ,person’s saliva ) , reimplantation should take place within 30 min... Page | 82  Abdominal Injuries 1*result from blunt or penetrating trauma 2* may be accompanied by internal bleeding 3* suspect an abdominal injury in a person who has multiple injuries. 4*check the person for other injuries because abdominal injuries are often accompanied by injuries to the to the chest, pelvis or head. Signs and Symptoms First Aid Care 1*Call the designated emergency number 1* Severe pain for any serious abdominal injury 2* Organs protruding from the 2* Carefully position the person on his back with his knees bent, unless that abdomen position causes the person pain or the person has other injuries. 3* A tender, swollen or rigid abdomen 3*monitor the person’s condition and 4* Bruising over the abdomen. give care for shock, if necessary 5* Nausea 4*Do not push the protruding organs 6*Vomiting (sometimes blood) back in and do not apply direct pressure 7* excessive thirst to try 8* skin (cool, moist, pale or bluish) 5* stop minor bleeding 9* an altered level of consciousness 6* remove clothing from around the 10* rapid, weak heartbeat wound 7* Moisten sterile dressings with clean, warm tap water or saline and apply them loosely over the wound 8* cover the dressings loosely with plastic wrap or aluminum foil, if available. Page | 83..  Chest Injuries (Heart, the lungs, the trachea and most of the esophagus) Causes Signs and First Aid Care Symptoms 1* caused by blunt trauma and 1*Difficulty breathing Rib Fracture Penetrating trauma (e.g., a stab 2* pale, ashen or bluish skin *Give the person a pillow to or gunshot wound) provide support and make 3*Severe pain 2* Rib fractures (blunt trauma) breathing more comfortable. painful. In childrens, ribs are 3*Bruising more flexible and tend to bend *Have the person rest in a rather than break but bruise the 4*Deformity of the chest wall position that will make breathing lung tissue of children, which can easier 5*Unusual movement of the be a life-threatening injury) chest wall (paradoxical *give care for shock, if breathing ) necessary. 3* Flail chest (multiple ribs are broken in more than one place), 6*Coughing up blood breathing problems because the Sucking Chest Wound 7*A “sucking” sound coming injured area is not able to expand * Control the external bleeding from the wound with each breath properly. (Flail chest is also the person takes (caused by air BY applying direct pressure to frequently associated with a lung entering the chest cavity through the wound contusion (bruising of the lung an open chest wound) tissue), which can be life *Do not cover the wound if there threatening 8* excessive thirst is no external bleeding 4* Sucking chest wounds a 9* an altered level of *Avoid sealing an open chest result of penetrating trauma. consciousness wound because doing so could (Air enter the space between the lead to life-threatening lung and the chest wall and puts 10* a rapid, weak heartbeat. complications. pressure on the lung, causing it to collapse (a condition called *While you are waiting for help pneumothorax). bleeding to arrive, monitor the person’s.. breathing and care for shock, if necessary. Page | 84  Pelvic Injuries Causes Signs and First Aid Care Symptoms 1*Call the designated emergency 1* Caused by Blunt trauma –. number if you suspect a pelvic high energy impacts ( pelvic 1* Severe pain injury fractures and damage to the 2* Bruising, swelling internal organs, blood vessels and 2*Avoid moving the person 3* Instability of the pelvic bones unnecessarily nerves ) 4* Blood-tinged urine (movement can make the pelvic 2*Caused by minor trauma or a injury worse/ also injuries to the fall in older adults with 5* Loss of sensation in the legs or lower spine ) an inability to move the legs osteoporosis 6* excessive thirst 3* try to keep the person lying flat 3* May cause severe internal 7* skin (cool, moist, pale or bleeding and are associated with 4* give care for shock if an increased risk for death in bluish) necessary. older adults. 8* an altered level of consciousness 9* rapid, weak heartbeat.. Page | 85  Part III 1*Food borne diseases 2* Bites and stings Page | 86  Food borne Diseases Introduction borne diseases-(intoxications and infections) Covers illnesses acquired through consumption of contaminated food-food poisoning Food borne disease outbreaks- Occurrence of 2 or more cases of similar illness resulting from ingestion of common food OR When observed number of particular disease exceeds expected number Global burden- high morbidity and mortality Infectious diarrhea- 3 to 5 billion cases and 1.8 million deaths annually CDC- 76 million cases of food borne diseases in US annually with appx.5000 deaths In India- Integrated disease surveillance Project (IDSP) - Food poisoning outbreak reporting increased to more than double in 2009 from 2008 (120 in 2009 and 50 in 2008) Page | 87  Food borne diseases infections vs intoxication Infections Intoxications 1* toxins (natural / preformed 1* Bacterial / Viral / parasite bacterial / chemical) 2* Invade and or multiply in 2* No invasion or multiplication lining of intestine 3*Incubation period- minutes to 3* Incubation period-hours to hours days 4* S/s – Vomitting , nausea, 4* S/s – Diarrhoea, nausea, diarrhea , diplopia, weakness, resp. vomiting, abdominal cramps, failure , numbness, sensory/motor fever dysfunction 5* Communicable-spreads from person to person 5* Not communicable 6* Factors-inadequate 6* Factors-inadequate cooking, cooking, cross contamination, improper handling temperatures poor personal hygiene, bare hand contact Page | 88  Some important food-borne Pathogens, toxins and chemicals Pathogens Toxins / chemicals 1* Bacteria - Bacillus cereus , Brucella , Campylobacter, Clostridium 1* Toxins - marine biotoxins , sp , E.coli, Salmonella sp , Listeria , tetrodotoxin (puffer fish), pyrrolizidine Staph aureus , Vibrio cholera and alka (Endemic ascites) , mushroom V.parahemolyticus toxins , shellfish toxins , mycotoxins- (Aflatoxins ,Ergot and Fusarium), plant 2. Viruses - Hepatitis A and E , intoxicants , BOAA (Lathyrism Rotavirus , Norvovirus 3. Protozoa – Cryptosporidium , Cyclospora , Entamoeba , Giardia , T. 2* Chemicals - pesticides (OPP,sb) , gondii radionuclides , nitrites (food preservatives) toxic metals - cd, cu, hg, 4. Trematodes , Cestodes and pb, sn, fluoride , MSG Nematodes Page | 89  Some common bacterial food poisons Incubatio Cause Symptoms Common foods n period 1-6 hours Staph aureus Nausea, vomitting, Milk n