FIRST AID HANDBOOK CHAPTER 1 INTRODUCTION TO FIRST AID First Aid is an important skill and should be taught to everyone

who has the ability to learn. If more people knew First Aid, more lives would be saved. There is a lot of myth and old fables that people still use because of ignorance. If individuals are properly trained in the skills of First Aid there would be a vast difference between life and death, or being handicapped. WHAT IS FIRST AID? First Aid is the immediate and temporary care/treatment given to someone who is injured or has suddenly taken ill, using facilities and materials available at the time of the accident. WHO IS A FIRST AIDER? A First Aider is someone who has been trained and examined in the skills of First Aid. When you are trained, you feel apprehensive when dealing with the real thing. By facing up to these feelings, the First Aider is better able to cope with the unexpected. RESPONSIBILITY OF A FIRST AIDER A good First Aider must respond quickly in life threatening situations, be prepared at all times, remain calm, assess the situation and consider the following: a. b. c. d. e. Observe if there is any danger to you, the people around and the casualty. Is it medical or trauma? (Is the situation medical or a trauma case) What is the nature of the illness or injury? How many casualties are involved? What are the resources that you need or is available to you?

THE THREE PS OF FIRST AID P P P Preserve Life Prevent condition from becoming worst Promote recovery

THE ABC OF FIRST AID A B C Airway Breathing Circulation

The four steps to know before you treat the casualty are: 1. 2. 3. 4. What is it? What causes it? Signs and symptoms How to treat

HOW DOES A FIRST AIDER WORKS? A First Aider works in a calm, skilful and methodical way and must always be prepared The Fight or Flight Response In an emergency your body responds by releasing certain hormones called adrenalin. Your heart beats faster and your breathing is deeper and more rapid. You must stay calm!. Taking slow, deep breaths will help you to calm down, leaving you better able to remember your First Aid procedures. A First Aider must always protect himself/herself first and try to prevent cross infection by washing his/her hands with soap and water, and wearing protective gloves. GIVING CARE WITH CONFIDENCE Every casualty needs to feel secure and safe in the hands of the First Aider. You can create an air of confidence and assurance by: 1. 2. 3. Being in control - both of your own reactions and of the problem. Working in a calm, skilful, methodical way. Being gentle but firm; speaking to the casualty kindly but in a clear and purposeful way.

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Build up trust. Talk to the casualty; explain what you are going to do, try to answer questions honestly and if you dont know the answer say so. Continue to reassure the casualty even when the treatment is finished, find out about the next of kin, or who should be contacted about the accident. Do not leave the casualty until you are satisfied that s/he is in good hands and is properly being taken care of.

HOW TO TAKE CHARGE AT THE SCENE OF AN ACCIDENT, SUDDEN ILLNESS OR ANY EMERGENCY What you should do at the scene of an accident? Use the three Cs (3Cs) of First Aid.

You should first assess the situation

C. Check the scene for safety, is the scene safe for you? Before you approach the scene you must do (body, substance, isolation) (BSI). Protect yourself from all body fluids by wearing protective gloves, and try to prevent cross infection. Wash your hands with soap and water. At the scene identify yourself, tell them who you are and what you are about. Get the history of what happened and how many persons are involved.

Delegate responsibilities
C. Call for help, call the ambulance, tell them where you are, how many persons are injured and the nature of the incident. You may need to call the police, fire brigade or other mode of transportation to take the casualties to the hospital. Care. It is important to give proper care to the casualty. You need to do a more detailed assessment of the casualty to see what need to be done and to prioritise the care you will give. The care you give will make a difference between life or death.

C.

Mass Casualties Where there are mass casualties, your aim is to try to save as much persons as possible using triage to treat the most critical person/s. Using the BBC approach, that is breathing, bleeding and consciousness - you would use it to give priority treatment to casualties. 1. 2. 3. B Breathing : Give mouth-to-mouth breathing B Bleeding: Treat or arrest the bleeding C Conscious: Put in the recovery position
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RAPID PHYSICAL ASSESSMENT When assessing a casualty you must determine if it is a medical or trauma case. Medical cases involve natural illnesses such as: a. b. c. d. e. Asthma Fainting Seizure Stroke Heart Attack

Trauma cases involve external force upon the body force upon the body: a. b. c. d. e. f. g. h. Laceration Abrasion Burns and scalds Fractures Amputation Stab/puncture Fall Motor vehicle accident

CHAPTER 2 FAINTING AND UNCONSCIOUSNESS Fainting is a temporary loss of consciousness caused by temporary loss of oxygenated blood to the brain. Other causes may be a reaction to pain, exhaustion, lack of food (hunger), emotional stress, physical inactivity, long-standing or sitting, heat stress (dehydration), thirst and low blood sugar. Signs and Symptoms 1. 2. 3. 4. 5. 6. Extreme paleness Perfuse sweating Dizziness Nausea Cold and clammy skin Numbness and tingling of hands and feet

Treatment 1. When treating the unconscious fainting, the aim is to put back blood to the brain. Check the ABC to find out if the casualty is breathing. Loosen tight clothing. Elevate the persons legs 8 to 12 inches to allow the blood to flow to the brain. Give plenty of fresh air.

The casualty should regain consciousness within five minutes. 2. When treating the conscious fainting, the aim is also to put back blood to the brain. Put the casualty on a chair to sit and put her/his head between the legs as far as possible.

The casualty should regain consciousness within five minutes. When the casualty becomes fully conscious, ask if s/he is on medication, is hungry, tired, et cetera. If the casualty is hungry, give her/him something sweet to eat or drink to raise the sugar level. If the casualty is exhausted, allow the casualty to rest.

UNCONSCIOUSNESS Unconsciousness means that the brain is not working properly. An unconscious person is completely unresponsive or unaware of what is happening in his/her surrounding. Causes of Impaired Consciousness The causes of impaired consciousness are lack of nutrients oxygen and glucose sugar reaching the brain, head injury, brain tumour, poisoning, epilepsy, diabetes, shock, fainting, stroke, heart attack and electrical shock. Levels of Consciousness For responsiveness, use the AVPU system. 1. 2. 3. 4.

Alert Is the casualty responsive/aware of his or her surroundings, following

simple commands such as Open your eyes or Squeeze my fingers? Verbally - Are they responding verbally? - Answering questions, making appropriate noises. Pain Are they responding to pain? Trying to withdraw when pinched or crying when injured body part is touched/moved. Unconscious/Unresponsiveness Are they unconscious? Is there no movement to voice, pressure or pain.

Treatment 1. 2. 3. Check the ABC and treat accordingly. Assess the level of response using he AVPU Arrange urgent removal of the casualty to the hospital.

SEIZURES/CONVULSIONS (FITS) A seizure also called a convulsion or fits, consists of involuntary contractions of many of the muscles of the body. The condition is due to a disturbance in the electrical activity of the brain. Seizures usually result in loss or impairment of consciousness. The most common cause is epilepsy. A seizure is not a disease but a sign of an underlying condition. seizures are: a. b. c. d. Drugs, alcohol, or poisons Brain tumours Infections, high fever Diabetic problems e. f. g. h. Trauma, Stroke Heat stroke Epilepsy Unknown Some causes of

Tonic-Clonic or Granmal seizure usually last only a few minutes and consist of dramatic body movement. Absence or Petit Mal) seizures usually only last 10-30 seconds and there are no dramatic body movements. Signs and Symptoms In cases of severe seizures, the following may be present. a. b. Sudden loss of consciousness with casualty falling to the ground, often making a loud cry. An epileptic attack can be caused by bright light or colours, sensation of strong odor or perfumes, exhaustion, hunger, fright, fever, taste. The body will stiffen, breathing may stop, convulsive movements begin, the jaw may be clenched and breathing may be noisy. Saliva at the mouth may be blood-stained if the tough and lips have been bitten. There may be a loss of bladder and bowel control. Muscles and breathing become normal, the casualty recovers consciousness within a few minutes, but is very tired and confused. May complain of headaches.

c.

d. e.

Treatment 1. 2. Check the scene for safety for yourself and the casualty. Protect the casualty from injury, place something soft under the persons head, and loosen restrictive clothing. Remove potentially dangerous items such as hot drinks and sharp objects, please note the time the seizure started. Do not try to hold the casualty still during the convulsions, after the convulsion place the casualty in the recovery position and stay with the person until recovery, which is usually within 5 10 minutes. Do not put anything into or over the persons mouth. Protect the casualty from embarrassment by asking onlookers for some privacy.

3.

4.

5. 6.

Types of Seizures 1. 2. Generalised this involves both sides of the brain and there are different types of generalized seizures. Tonic clonic (grand mal) seizures The patient becomes rigid, falls to the ground and the body goes into violent jerky movements. Breathing is labored and there is excess salivation with cyanosis. The patient may lose continence during the attack. Convulsions usually stop after a few minutes and may be followed by deep sleep. Tonic sudden stiffening of the muscles, the person becomes rigid and fall (no jerking) injuries may occur from the fall. Absences Interruption of consciousness, patient stares blankly with fluttering eyelids and nodding of the head, usually lasting a few seconds (petit mal). Partial seizures (simple) Usually consciousness and awareness is maintained. The persons may have a strange feeling, taste, smell or sensation (aura). There is jerking of the body without changes in consciousness.

3.

4.

5.

Management Ensure an open airway. Protect the patient from injury during the seizure by moving objects out of the way. Loosening any tight clothing, removing spectacles, and supporting the head from injury with a blanket or pillow. Do not force anything in the mouth. Place the patient in the recovery position once movements have stopped. Patients should be allowed to recover in their own time. Treat any injuries that the patient may have received. Do not physically restrain the patient.

TREATMENT FOR UNCONSCIOUS FAINTING SKILL Check the scene Check for responsiveness Call for help Position the casualty Open the airway Check for breathing Loosen tight clothing and elevate feet STEPS Is the scene safe? If the scene is safe BSI and proceed. Tap gentle and shout Are you ok? Shout for help to attract other people. Roll casualty on their back in a single unit as you roll you support the head. Use the head tilt/chin lift method. Look, listen and feel for 3-5 seconds, keep airway open. If the casualty is breathing, loosen tight clothing, elevate feet 8-12 inches, give lots of fresh air, the casualty should revive within 5 minutes. When the casualty revives put the casualty to sit and ask questions i.e Are you on medication? Are you hungry? Observe the surroundings. If the casualty is hungry give something sweet i.e glucose, sugar, chocolate, sweetie, etc.

Put the casualty to sit

Give something sweet

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RECOVERY POSITION Who should you place in the recovery position? Casualties who are unconscious and breathing, and whose hearts are beating. This position ensures the following: 1. 2. 3. 4. An open airway Comfort Stability Draining

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CHAPTER 3 ARTIFICIAL RESUSCITATION (AR) (RESCUE BREATHING) RESPIRATORY ARREST What is respiratory arrest? Respiratory arrest is when breathing stops. So, why does breathing stop? Breathing stops when there is a blockage in the air passage caused by: 1. 2. Choking on objects: food, false teeth, seeds, toys, et cetera Drowning, suffocation, strangulation, asthma, burns, stings, poisons, smoke, fumes, rolling back of the tongue, vomiting, drug or alcohol overdose.

What Should You Do If Breathing Stops? 1. 2. 3. 4. 5. 6. Remove the cause or remove the casualty. Check for breathing if the casualty is not breathing then Start Rescue Breathing at once. If the air passage is blocked, check the position of the hand then check mouth and throat for object/s. When breathing starts, place casualty in the recovery position. Monitor the casualty as breathing may stop.

Note: In an unconscious casualty, all the muscles are relaxed. If lying on back, the tongue will fall back and block the throat. When Do You Apply AR? AR is done when the casualty is not breathing and has a pulse (heartbeat). If there is no breathing and no heartbeat then Cardio Pulmonary Resuscitation or CPR should be applied. There is a difference between Rescue Breathing and Rescue Breath. Rescue Breathing is 1 breath every 5 seconds. If there is a pulse and no breathing you administer Rescue Breathing (breath 1 and 2 and 3 and 4 breath). Rescue Breaths are the first 2 breaths that are given after you open the airway and check for breathing. It there is no breathing you must check the mouth to see if it is clear and then give 2 rescue breaths at a rate of 1 1 seconds, the purpose for Rescue Breaths is to find out if there is a clear air passage and to send oxygen to the lungs. We breath in 21% oxygen but our bodies only use 5%, that leaves 16% which is exhaled from our bodies, this is enough to resuscitate someone who is in need.

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Deprivation of oxygen from the brain for 4-6 minutes will cause brain cells and tissues to die, therefore you have to respond as quickly as possible as you dont know how long the casualty had stopped breathing. After opening the airway (A) by using the head-tilt/chin-lift method, check for breathing (B) by looking, listening and feeling for 3 5 seconds. If the victim is not breathing, gently pinch the nose shut and give two full breaths. Using the thumb and index finger of the hand that is on the victims forehead, pinch the victims nose shut while keeping the heel of the hand in place to maintain head-tilt. Your other hand should remain under the victims chin, lifting up immediately give two full breaths while maintain an airtight seal with your mouth over the victims mouth. After giving two rescue breaths, if breaths go in you check for circulation (c) by feeling the carotid pulse at the neck. If there is a pulse but no breathing, administer rescue breathing i.e. 1 breath every 5 seconds. After the first 5 sets of breath check if breathing starts. 1. 2. 3. 4. The victim begins to breath. Medical help arrives. Another trained first aider comes to take over, or. You are too exhausted to continue.

Rescue Breathing for Adults 1. 2. 3. 4. 5. 6. Kneel next to the casualtys head. Open the airway using the head tilt, chin lift method. Check for breathing: look, listen and feel for five (5) seconds. Check mouth for food or object/s that could block the air passage. Give two (2) rescue breaths seal your lips over the casualtys mouth, pinch the nose and breathe. Check pulse for 10 seconds using the carotid pulse at the neck. Give one (1) rescue breath every five (5) seconds. After the first four (4) sets of breathing, check if breathing starts.

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Rescue Breathing for Child Give one (1) breath every four (4) seconds. Rescue Breathing for Infant A technique using mouth and nose breathing is used for infants. 1. 2. 3. 4. Be careful and gentle with infants. Tilt the head back gently not as far as an adult or an older child. Put your mouth over the babys mouth and nose to form a seal. Give one (1) puff every three (3) seconds.

When to Stop Breathing for the Casualty? 5. 6. 7. 8. When the casualty starts breathing again. When qualified aid arrives. A next First Aider comes to assist. When you are tired and exhausted.

Note: In all cases you must take the casualty to the hospital whenever Rescue Breathing is applied. When the casualty starts breathing, place the casualty in the recovery position.

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SKILLS FOR RESCUE BREATHING SKILL Check for Responsiveness Call for help Position the patient STEPS Tap the patient gently, pinch on ear lobe Are you Ok? Shout for help to attract another person and to call an ambulance. Roll the casualty on back in a single unit. As you roll, support head. Use the head-tilt/chin-tilt method. Look, listen and feel for 3-5 seconds. Keep airway open. At a rate of 1-1 seconds. Maintain open airway. Feel the CAROTID PULSE for 5-10 seconds. Give 1 breath every 5 seconds. Do 5 sets. Then check for breathing, Feel the CAROTID PULSE for 5-10 seconds. RESPIRATORY RATE AGE Infants Toddler Pre-School School age Adults 30-60 24-40 22-34 18-30 12-20 RATE beats per minute beats per minute beats per minute beats per minute beats per minute

Open the airway Check for breathing Give 2 rescue breaths Check for pulse Rescue breathing Recheck pulse

PULSE RATE AGE Infants Toddler Pre-School Adults RATE 120-160 beats per minute 90-140 beats per minute 75-100 beats per minute 60-80 beats per minute

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CHAPTER 4 THE HEART The heart is a muscular organ, which acts like a double pump. It is situated in the chest behind the breastbone and rib cartilages, between the lungs and immediately above the diaphragm. The heart is divided into a right and left side and there is no direct communication. Each side is further divided into an upper or collecting chamber (auricle or atrium) and lower or pumping chamber (ventricle). Between each auricle and ventricle there is a non-return valve. HEARTBEAT The heartbeat may be felt just below and to the inner side of the left nipple. The heart contracts in adults at an average rate of 72 times per minute when sitting or at rest but the rate can vary with excitement, exertion, fear or change of position; hence the importance of considering the patients position in cases of bleeding or shock.

Mechanism of the Circulation

The right side of the heart pumps the blood through the lungs, the pulmonary circulation. The left side is concerned with the SYSTEMIC (or general) circulation of the blood throughout the body. With each contraction of the heart, blood is forced through both of these circulatory systems from the ventricles and with each relaxation of the heart blood pours into the collecting auricles from which the ventricles are refilled.

Pulmonary Circulation
Venous blood is collecting from two large veins draining the upper and lower parts of the body into the right auricle and from this chamber passes through a valve to the right ventricle, whence it is forced by compression through the pulmonary artery to the lungs. In the lungs it gives off carbon dioxide gas and water vapour and picks up oxygen gas from the inspired air. This process is known as the interchange of gases. After being recharged with oxygen the blood returns to the left auricle through the pulmonary veins.

Systemic Circulation
From the left auricle the blood now rich in oxygen passes through a valve to the left ventricle and from there is forced out through the main artery of the body (aorta) which through numerous branches, distributes it to all parts of the body.

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When the right side of the heart begins to fail, blood and fluid back up into the abdomen, legs and ankles. Many people notice tenderness in the upper right part of the abdomen. They may experience a loss of appetite and bloating. They may also feel tired. When the left side of the heart fails, the body holds extra fluid, and blood tends to back up into the lungs. This occurs because the left side of the heart pumps blood away from the heart to the organs of the body. During left heart failure, the kidneys do not get enough blood, and they are fooled into reacting as if the body does not have enough blood. Therefore, they hold on to salt and water to keep it in the blood rather than passing it out into the urine. As a result, excess fluid builds up in the body and puts an additional strain on the heart. The additional strain can make the pumping function of the left side of the heart worse, causing less blood to get to the kidneys and setting up a vicious cycle. On average, the heart beats 60 to 80 times per minute and pumps approximately 5 liters (1.3 gallons) per minute at rest. With activity, the heart may pump as much as 25 liters (6.5 gallons) per minute. In heart failure, the heart is unable to increase the amount of blood it pumps as you exercise. This may make you feel short of breath when you try to walk a long distance or climb a flight of stairs. Most people with heart failure also feel tired.

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ANGINA PECTORIS Angina pectoris is a common symptom of chronic heart disease (C.H.D.). It is a transient pain or discomfort due to a temporary lack of adequate blood supply to the heart muscle. The pain may be located in the center of the chest. It is usually described as being crushing, pressing, constricting, oppressive or heavy. It may spread to (more often the left) or both shoulders and/or arms or to the neck, jaw, back or upper mid-portion of the abdomen (epigastrium). Discomfort occurring primarily in the arms, shoulder, neck, jaw, back or epigastrium without anterior chest discomfort may also be a manifestation of angina. It is a steady discomfort, often brought on by any factor that increases the heart rate, including exercise, unusual exertion and emotional or psychological stress. It commonly lasts from 2 to 15 minutes. The most frequent cause of angina is coronary atherosclerosis. As the severity of the coronary narrowing increases, the amount of exertion needed to bring on angina decreases. Rest or nitro-glycerine usually promptly relieves angina. With severe CHD or a few days or weeks before a heart attack, angina may occur at rest or may even awaken someone from sleep. Angina pectoris that is either new, worsening in severity (e.g. more frequent, lasting longer, responding less to nitro-glycerine or rest), or coming on at rest is called unstable angina. Patients with this form of angina are at high risk for acute myocardial infarction and should be hospitalized immediately.

Characteristics of Angina
Rapid onset usually triggered by exertion or stress. Short duration 3-5 minutes Chest pains radiating down the arms and into the jaw. Dyspnoea (difficulty breathing) Mild to moderate nausea Diaphoresis (profuse sweating) Anxiety Relieved by rest and nitro-glycerine tablets within 10 minutes.

The most frequent cause of angina is coronary atherosclerosis.

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ATHEROSCLEROSIS Atherosclerosis is the condition in which an artery wall thickens, as the result of a building-up of fatty materials such as cholesterol. It is commonly referred to as hardening of the arteries. It is caused by the formation of multiple plaques within the arteries. It can cause strokes, heart attacks, congestive heart failure, and most cardiovascular diseases because it interferes with the coronary circulation supplying the heart or cerebral circulation supplying the brain. CLINICAL MANIFESTATION OF CORONARY HEART DISEASE Persons with coronary artery disease may show no signs or signals of heart disease (asymptomatic) or have signs that do suggest coronary heart disease (symptomatic). In a persons with symptomatic CAD, coronary artery narrowing progresses over

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HEART ATTACK (ACUTE MYOCARDIAL INFARCTION) A heart attack occurs when an area of the heart muscle is deprived of blood (oxygen) for a prolonged period (usually more than 20 to 30 minutes). It usually results from severe narrowing or complete blockage of a diseased coronary artery and result in death of the heart muscle cells supplied by the artery. Blood vessel spasm (either spontaneous or secondary due to the use of drugs such as cocaine) can also result in a heart attack. The heart attack in turn may lead to altered electrical rhythms, including ventricular fibrillation. The usual symptom (signal) of a heart attack is a severe pressure or discomfort in the chest that persists for several minutes (more than 15 to 20 minutes) and is not relieved promptly by rest or nitro-glycerine. In women and older persons, however, such typical symptoms occur less frequently. Embolism Embolism occurs when an object or plaque moves from one part of the body through circulation and causes a blockage of a blood vessel in another part of the body: Coronary Embolism, Pulmonary Embolism and Cranial Embolism. Signals of Heart Attack The most common signal of a heart attack is an uncomfortable pressure, fullness, squeezing or pain in the center of the chest. It usually lasts for 2 or more minutes and may come and go. Other signals may include: Nausea Sweating Shortness of breath A feeling of weakness Many patients do not have a severe pain, look sick or have all the symptoms. Generally, stabbing short twinges of pain (less than 10 seconds) are not signals of a heart attack. The person may not admit that he or she is having a heart attack. The person may say that it was something they ate It must be indigestion or It couldnt happen to me may be common reactions. Prepare to take the casualty to the hospital.

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SUDDEN CARDIAC DEATH (CARDIAC ARREST) Sudden death occurs when heartbeat and breathing stop abruptly or unexpectedly. Sudden cardiac death, or cardiac arrest, may occur as the initial and only manifestation of C.H.D. Sudden cardiac death may occur before any symptom. It may also occur in persons with known C.H.D. and especially during a heart attack. It occurs most commonly within 1 to 2 hours after the beginning of a heart attack. The numerous non-cardiac causes of sudden death occur within seconds after a cardiac arrest, whereby the victim loses consciousness and breathing stops. During this early phase the victim may have a convulsion. The sooner circulation to the brain is restored, the greater the chance for full recovery of brain function. After 4 to 6 minutes of cardiac arrest, significant brain damage usually occurs. Children and victims of cold exposure or barbiturate overdose may recover normal brain function after periods of cardiac arrest. Actions For Survival Know the warning signs. Have the person stop whatever he or she is doing. Have the person sit or lie down comfortably. If prescribe by a physician, nitro-glycerine tablets can be administered to relieve the pain of Angina Pectoris. The patient should not receive more that 3 tablets within 10 minutes. Call your doctor or take the victim to the nearest hospital.

Risk Factors Risk factors are conditions or behaviours that may increase the changes of someone developing a disease. Heart disease develops over a long period of time. You should begin reducing risks at an early age. Risk Factors That Cannot be Changed

Some risk factors cannot be modified or eliminated.

HEREDITY GENDER A history of premature C.H.D. in siblings or parents suggests an increased susceptibility that may be genetic. A woman has a lower incidence of coronary arteriosclerosis before menopause. The incidence increases significantly, however, in postmenopausal women, who also have worse clinical case when compared to men. Men are at a greater risk than women.

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AGE one

The death rate from C.H.D. increases with age. However, nearly in four deaths occurs in persons under age 65.

Risk Factors Than Can Be Changed EXERCISE STRESS DIET Exercising on a regular basis will strengthen the heart and blood vessels. Because of stress, blood vessels may constrict, blood pressure may rise and the liver may be stimulated to produce more cholesterol. Reduce cholesterol intake and maintain an ideal body weight to reduce your risk of heart disease. Every time you smoke, your arteries and heart react. Nicotine constricts blood vessels, increases the heart rate, raises cholesterol levels, lower the ability of blood to carry oxygen and increase blood pressure.

CIGARETTE SMOKING

How We Can Help to Keep Our Hearts Healthy Keep your weight at an ideal level by eating nutritious diet meals exercising regularly.

Eat fruit, vegetables, cereals, pasta, low-fat dairy products, fish, poultry and lean meats. Ignore the saltshaker and limit the amount of highly-salted, processed foods you can eat.

We dont know everything yet about how our diets influence heart health. Scientists are still asking many questions and making new discoveries to answer these questions. We do know that it makes good sense to develop healthy eating habits early in life and keep the odds on your side. Fats and your Heart Certain fatty foods tend to increase the amount of cholesterol in the blood while other types of fats help to decrease cholesterol. Saturated fats tend to raise the level of cholesterol in the blood. They are fats that harden at room temperature. Polyunsaturated Fats: tend to lower the level of cholesterol in the blood. They are found in liquid oils of vegetable origin. They include oils made from corn, cottonseed, sunflower, sesame seed, soybean and sunflower seed.
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Animal Origin Saturated Fats Fatty cuts of beef, pork and lamb Butter, cream and whole milk Cheese made from cream and whole milk

Vegetable Original Saturated Fats Hydrogenated shortenings Coconut oil Cocoa butter and palm oil used in most commercially prepared cookies Pie fillings and non-diary cream substitutes.

Vegetable original saturated fats may have a lowering effect on blood cholesterol. (More research is needed to confirm this). These fats are found in foods such as peanuts, peanut oil, olive oil, olives and avocados. High-fat foods, which are concentrated sources of calories, include: Fats of all kinds (shortening, oil, butter, margarine) Cheese Salad dressing Fried foods Sauces and gravies, bacon fat Scrapple Sausage Ribs Potato chips and other snack chips

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CARDIO PULMONARY RESUSCITATION (CPR) C.P.R. is administered when someones pulse and breathing stop. When both breathing and pulse have stopped, the victim has suffered sudden death. C.P.R. is never used to restart the heart. There are many causes of sudden death such as; drowning, smoke inhalation, suffocation, poisoning, electrocution and choking. The most common, however, is heart attack. To understand how C.P.R. can sustain life, consider these two definitions of death: a. b. Clinical Death: the heartbeat and breathing have stopped. This is best thought of as near or apparent death, and it may be reversed. Biological Death: This is permanent brain death due to lack of oxygen. This death is final.

During the first few minutes of clinical death, promptly initiate C.P.R. which may turn the victim back to productive life. Without C.P.R. biological death will occur. Everyone should know the risk factors for heart disease, signals of a heart attack and what to do in case someone suffers a heart attack. Decision Making Make a decision about what to do next, based on what the instructor says. Continue to give appropriate care. THE ABCS OF C.P.R. Begin the ABCs of C.P.R. by: A. B. Opening the airway using the head-tilt, chin-lift method. open, place your ear close to the victims mouth. Check for breathing Once the airway is

Look at the chest for movement Listen for sounds of breathing Feel for breath on your cheek

After 3-5 seconds, if none of these signs are present, the victim is not breathing. EXTERNAL CHEST COMPRESSIONS Artificial circulation is provided by external chest compressions. In effect, when you apply rhythmic pressure on the centre of the casualtys breastbone, you are forcing the heart to pump blood.

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How to Perform External Chest Compression To perform external chest compression, kneel at the victims side near the chest. Place the heel of your hand in the middle of the breastbone and the middle of the nipple line. Place your other hand on top of the hand in position. Be sure to keep your fingers up off the chest wall. Bring your shoulders directly over the victims sternum, as you compress downwards, keeping your arms straight. Depress the sternum about 1 1 inches to 2 inches for an adult victim then relax pressure on the sternum completely. Do not remove your hands from the victims sternum, but allo w the chest to return to its normal position between compressions. Relaxation and compressions should be of equal duration. If there is no breathing do external chest compressions (C.P.R.). The proper ratio is 30 compressions to 2 breaths. You must provide 100 compressions per minute. Emergency Action Steps Remember the three basic steps: CHECK, CALL, CARE upon finding a collapsed person. 1. 2. 3. CHECK the scene and victim. CALL for help and send for emergency medical services CARE - give appropriate care. If the victim is not lying flat on his or her back, roll the victim over, moving the entire body at once. Your instructor will demonstrate this.

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SKILLS FOR CPR 1 2 3 4 5 SKILLS Check for scene Check for responsiveness Call for help Position the casualty Observe for breathing STEPS If the scene is safe, BSI and proceed Tap gently, pinch and ask are you ok? Shout for help to attract other persons and call the Ambulance - 112 Roll casualty on back if found face down, in a single unit support head as you roll. Look at chest or abdomen for rise and fall. If there is no breathing, start chest compressions immediately.

C
6 7 Chest compressions Open airway Give 30 compressions

A
Use the head tilt/chin lift method to open the airway. Check the mouth for food, loose dentures and other foreign objects.

B
8 9 Breathing Check pulse Give two (2) breaths at a rate of 1-1 seconds apart. As air goes in, the chest will rise. After the first five (5) sets of 30 compressions to 2 breaths, check the carotid pulse. If there is no pulse, continue to give 30 compressions to 2 breaths. If pulse is present, give rescue breathing, i.e. one (1) breath every five (5) seconds.

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CHAPTER 5 STROKE Stroke (cerebrovascular accident, CVA) is damaged to part of the brain due to obstruction or rupture of a blood vessel. Extensive damages lead to death. Causes of Stroke Stroke occur when a blood vessel is blocked by a blood clot preventing that area of the brain from receiving oxygenated blood, or a blood vessel ruptures and blood pours into or over the brain. 1. 2. 3. 4. Thrombus/Tumor A blood clot. Aneurysm A weakening of an arterial wall which may lead to a rupture due to bulging of the artery. Embolism Movement of a blood clot or foreign body (fat or air) inside a blood vessel. The clot is called bolus. Compression Blood leaks into the surrounding space causing pressure against the artery preventing blood flow.

Signs and Symptoms Headache (may be only the symptom at first) Collapse or fainting (syncope) Weakness or paralysis in one or more limbs (usually the hand) Difficulty speaking and facial weakness Intense dizziness and visual disturbance Seizures Unequal pupils Loss of strength, typically on one side of the body Loss of bowel and bladder control

Treatment Emergency care depends on signs shown. Perform an incident size up (BSI) Call the emergency medical service immediately Maintain an open airway and be prepared to provide CPR Keep the patient at rest Protect all paralyzed parts Provide emotional support Place the patient in the recovery position to allow for drainage.

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Risk Factors for Cardiac Illnesses 1. 2. 3. 4. 5. 6. 7. Hypertension Cigarette smoking Diabetes High cholesterol Lack of exercise Family history of heart disease/stroke History of angina or previous chest pain.

ANEURYSM An aneurysm is a localized, blood-filled dilation (a blood-like bulge) of a blood vessel caused by disease or weakening of the vessel wall. Aneurysm most commonly occur in the arteries in the brain and in the aorta, as the size increases there is a risk of rupture which can result in severe hemorrhage, stroke and other complications including sudden death. Signs and Symptoms No response Abnormal breathing No signs of circulation

Treatment Keep the victim - stop them from doing what they are doing and put them to sit or lie down. Activate the emergency medical service immediately. Stay with the patient and monitor his condition, If an Automated External Defibrillator (A.E.D.) is available, keep it close by. Place the patient in a comfortable position. If the patient has medication you may assist with the prescribed dose. If the pain persists after 5 minutes activate the emergency medical service and be prepared to start C.P.R.

Causes a. b. Atherosclerosis a condition of the arteries in which blood flow is blocked by fatty deposits. Arteriosclerosis Any condition in which the walls of the arteries are thickened and made rigid, making them unable to process an adequate supply of blood.

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CHAPTER 6 AIRWAY OBSTRUCTION (CHOKING) Choking is the result of an object in the air passage. A foreign object that is stuck at the back of the throat may block the throat or cause muscular spasm. A casualty with a completely b locked passage will show the following signs. Clutching the throat with the hands. Unable to speak Unable to breath, unable to cough. Will lose consciousness

If the victim can cough, encourage coughing. DO NOT INTERFERE if the air passage is partially obstructed. If the victim cannot cough, speak or is turning blue, eyes are bulging and, is making high-pitched wheezing noises, it is a totally obstructed airway. Give 5 abdominal thrusts until the object becomes dislodged or the victim becomes unconscious. If the victim is pregnant or extremely obese, perform chest thrusts. The Unconscious Choking Victim If the victim becomes unconscious: Turn over on back Perform finger sweep and try to remove the object. Open the air way and attempt to ventilate. Re-tilt head and give 2 full breaths. Perform up to 5 abdominal thrusts. Do finger sweep. Give 2 full breaths. Repeat abdominal thrust, finger sweep and 2 full breaths.

Conscious Choking Determine if patient is choking. Stand behind patient and deliver abdominal thrusts. Repeat until object is expelled or patient loses consciousness.

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SKILLS FOR TREATING UNCONCIOUSNESS CHOKING

1 2 3 4 5 SKILLS Check scene for safety Check for responsiveness Call for help STEPS If the scene is safe, BSI and proceed Tap gently, pinch and ask are you ok? Shout for help to attract other persons and call the Ambulance - 112 Observe for breathing Look at chest or abdomen for rise and fall. If the casualty is not breathing, do chest thrusts. Do five (5) chest thrusts Place the heel of your hand in the middle of the chest, and place your other hand on top of the hand in position and give five (5) thrusts, pressing down the depth of two (2) inches. Roll the casualty on side If the object dislodges, place the near hand across the chest, roll the casualty towards you on the side for drainage and hook sweep with index finger to clear the mouth. If the object is not dislodged, repeat chest thrust. Place the casualty in the Re-position the head. original position Open airway Use head tilt/chin lift method. Give two (2) breaths If breaths dont go in, then re-tilt head. Re-tilt the head Re-tilt the head to make sure that the airway is fully open. If air doesnt go in, repeat chest thrust. If air goes in, check pulse. Check pulse If there is no pulse and no breathing, start chest compression = 30 compressions, 2 breaths. If there is pulse and no breathing, give rescue breathing, i.e. 1 breath every 5 seconds. Recovery position Casualty breathing and unconscious, conscious but weak, if there are no fractures, place the casualty in recovery position. Check for breathing every five (5) minutes.

7 8 9 10 11

12

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CHAPTER 7 ASTHMA In an asthma attack, the muscles of the air passage in the lungs go into spasm and the lining of the airway becomes swollen. This causes the narrowing of the air passage making breathing difficult. Sometimes there is a recognized trigger for an attack such as an allergy, a cold, dust, drugs, carpet, animals, flowers etc. Signs and Symptoms 1. 2. 3. 4. 5. 6. Difficulty in breathing. Wheezing as the casualty breathes out. Difficulty speaking and whispering. Distress and anxiety Coughing Casualty may lose consciousness and stop breathing.

Treatment
S A MP L E -

Keep calm and reassure the casualty, ask the person to sit and lean forward, if lying down prop up the person with 3 to 4 pillows to have them in the sitting position. Ask the person to breathe slowly and deeply to get more oxygen, ask casualty for medication. Allow or assist with the taking of the medication. If the casualty does not respond to the medication, prepare to take to the hospital. Get history from casualty or relatives and friend using acronym S.A.M.P.L.E.
Signs and symptoms (How long has the casualty been wheezing or breathing short?) Allergies (any known allergies to drugs, food, pollens, pet, carpet, smoke, dust) Medications (Does the casualty have his or her medication (inhaler)? Pertinent past history (Did the casualty have a recent cold or respiratory infection?) Last meal (Has he/she had any fluids since this attack started?) Events leading to the attack (What was he doing or exposed to that may have caused the attack?)

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CHAPTER 8 WOUNDS WOUNDS, BLEEDING, SHOCK, DRESSING A wound is an abnormal break in the skin or tissues of the body that allows bleeding and enables germs to enter. A wound is either open or closed. As a First Aider, your priorities are as follows:A. B. C. D. Assess the casualtys condition (ABC). Protect yourself (BSI) put on your gloves. Control bleeding by applying direct pressure and elevation. To prevent shock apply pressure pad. Comfort, reassure and prepare to take the casualty to hospital.

Types of Wounds GLACIAS CAP

GLAC-

Gunshot the entry may be small and neat. Any exit wound may be large and jagged. Laceration jagged or ripping forces resulting in tear or lacerations, rough edges caused by barb wire, band saw. Abrasion (graze) superficial wound, damage to skin surface. Contusion (bruise) closed wound, the skin is not broken, the blood flows between the tissues and is caused by a blunt blow. Otherwise called coco or black and blue. Incision this is a clean cut caused by a sharp edged object such as razor, knife, thread. Avulsion The tearing loose or tearing off of large flaps of skin or flesh eg earring torn from ears. Stab wound caused by knife or long instrument driven forcefully into the body.
33

IAS-

CAP-

Crush occurs on hard/soft tissues of the body, for example an iron dropping on the toes. Amputation the cutting or tearing off the hands, fingers, arms, legs, feet, toes. Puncture caused by knives, nails, ice picks puncturing the body in a straight line. When there is an entry and exit it is called a perforated wound.

Eviscerated protrusion of the intestines. Penetrating Chest Wound The heart, lungs and major blood vessels are protected by 12 pairs of ribs which make up the ribcage. If a sharp object penetrates the chest wall, there will be internal bleeding. Treatment for Wound

Rest Elevate Direct Pressure Clean Use material available to make bandage Tie bandage

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BLEEDING Bleeding is the emission of blood from the circulatory system. The heart pumps blood around the body. The blood is the vehicle in which oxygen travels throughout the body. The blood carries oxygen to the cells and takes away carbon dioxide. Types of Bleeding: Arterial, Venous, Capillaries Blood Vessels Structures and Functions There are three types of blood vessels: Arteries Veins Capillaries

Arteries carry blood away from the heart and they have a strong outer thick muscular layer and run next to the bones. The blood in the artery is bright red in color. When an artery is cut, the blood spurts to the rhythm of the heart beat. Veins carry blood to the heart. This is made possible by the surrounding muscles and the heart suction. The walls are thinner and are provided with valves to prevent blood going in the wrong direction. The smaller arterioles and venules control the blood flow into and out of the capillary bed. They are next to the surface. The blood in the vein is dark red in colour. When a vein is cut, there is a heavy steady stream. Capillaries connect the arteries to the veins. This is where exchange takes place between the bloodstream and the body tissues. They allow for the exchange of gases and transfer nutrients and waste products.

REMEMBER
The typical adult has 6 litres (about 12 pints) of blood. The volume must be maintained for proper circulatory functions.

35

36

BLOOD Blood is a liquid that is required for survival, it is composed of 55% liquid and 45% solid. The main components of blood are: plasma, red cells, white cells and platelets. The blood volume differs according to the size of the person. Functions of Blood Blood carry oxygen and carbon dioxide Carry nutrients and water Carry waste products from the tissues to the excretory organs. Distributes enzymes and hormones. Distribute heat generated by muscular activity and transported to the skin for cooling. Protects the body from infection by means of the white blood cells. Coagulation of wounds by platelets when they come into contact with damaged tissue.

The spleen which lies in the left upper quadrant of the abdomen, is approximately 12cm long, 7 cm wide, 2.5cm thick and weighs approximately 200 grams. The main function of the spleen is to produce new white blood cells, store red blood cells and destroy old red blood cells. Lymphatic System The lymphatic system is a net work of vessels called lymph vessels. These vessels contain fluid similar to plasma, called lymph. Lymph is filtered though bodies known as lymph nodes. The lymphatic system assists in the removal of waste from body tissues, transportation of nutrients and fighting infection. How to Control Bleeding There are two (2) methods used to control bleeding: a. b. Direct pressure Elevation

Direct Pressure Most cases of external bleeding can be controlled by applying direct pressure to the site of the wound, by using a sterile dressing. You can also apply pressure at the pressure points. Pressure points are sites where an artery that is close to the skin surface lies
37

directly over a bone, for example brachial on the inside of the upper arm, femoral in the thigh. Elevation Elevation is to elevate the wound or the affected part above the heart, if there are no suspected fractures. Nose Bleeding The best way to control bleeding is by using direct pressure, or even elevation. Put the casualty to sit, tilt the head forward, pinch the nose shut and breathe through the mouth for 10 15 minutes. Repeat the procedure if bleeding continues.

Remember to protect yourself at all times from body fluids.

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CHAPTER 9 SHOCK Circulatory Shock occurs when there is not enough blood to fill the circulatory system needed to supply the vital organs of the body. Hypovolemic Shock means bleeding profusely, vomiting and diarrhoea, severe dehydration and burns caused by the loss of plasma component of the blood. Metabolic Shock is fluid shock caused by loss of blood fluid by way of diarrhoea and/or vomiting (hypovolemic) shock. Cardiogenic Shock is heart shocks caused by the heart failing to pump enough blood to all parts of the body. This is caused by damage to the heart itself. Neurogenic Shock is nerve shock, when something goes wrong with the nervous system such as injury in an accident, when there is not enough blood in the body to fill the new space. Anaphylacatic Shock is allergy shock caused by something to which the casualty is extremely allergic. Psychogenic Shock is fainting caused by fear, grief, exhaustion, hunger, emotional stress, heat, low blood sugar, anaemia. This causes thenervous system to react and dilate the blood vessels. The flow of blood to the brain is interrupted. Septic Shock is bloodstream shock caused by infections. Poisons are released that causes the blood vessels to dilate. Symptoms Signs and Symptoms Altered mental status Anxiety, restlessness Pale, cool clammy skin Nausea, vomiting Rapid breathing, Tachycardia Unresponsiveness Strong thirst Cyanosis Hypotension Causes Internal and external bleeding Crush injuries Burns - plasma Illness-peritonitis, cardiac conditions Severe allergic reaction Severe bleeding Poisoning Heart attack Electrical shock
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Profuse bleeding Diarrhea Shaking and trembling Nausea Thirst Weakness Restlessness Fear Dizziness

Casualty Appearance Cold and clammy skin Breathing rapid and shallow Pulse rapid and weak Pupils dilated

Treatment for Shock Check for breathing and maintain an open airway. Control bleeding, splint major fractures and treat any other cause. Elevate the legs 8-12 inches, if there are no fractures. Loosen tight clothing, monitor and record vital signs. This must be done every 5 minutes. Do not give the casualty anything by mouth, prepare for vomiting. Prepare to take the casualty to the hospital.

OTHER CONDITIONS WHICH MAY CAUSE SHOCK 1. Diarrhoea and vomiting Diarrhoea is the passing of frequent watery stools.

1.2

Treatment
Replace body fluids quickly to prevent dehydration, especially in children. Give oral rehydration salts if it is in the home or can be obtained from the nearest clinic. If not, give coconut water or sweetened water with a pinch of salt.

40

2.

Dehydration Dehydration occurs when there is severe diarrhoea and lots of water and salts are lost from the body. Dehydration caused by diarrhOea can kill.

2.1

Signs and Symptoms

(i) (ii) (iii) (iv) (v) Thirst and dry mouth Small amount of urine is being passed Very dark urine Skin is dry and loose (when pinched it stays peaked up) Sunken eyes and fontanelle (soft place on a babys head)

2.2

Treatment
(i) (ii) Replace fluids give clear fluids to drink Seek medical aid

Simple Danger Signs of Dehydration 1. 2. 3. 3. 3.1 No urine Dry cry Lethargic

Vomiting Treatment (i) (ii) (iii) Replace body fluids Prevent Dehydration If vomiting persists, seek qualified aid.

How to Prepare Oral Rehydration Fluid: (i) (ii) (iii) (iv) Boil and cool one (1) litre water. Add 4 tablespoons of dark sugar. Add 1 teaspoon salt Pour into clean covered bottle.

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CHAPTER 10 BURNS AND SCALDS Burns are injuries resulting from exposure to dry heat, extreme cold, radiation, corrosive substances and friction; while scalds are by (moist) wet heat from hot liquids, vapours teas or hot fat. Burns are usually classified according to depth, size or degree of skin damage as first, second or third degree burns. First Degree Superficial burns: involve the top layer of the skin known as the epidermis. There is redness, swelling, pain and tenderness. Sun burn is a superficial burn. Second Degree Partial thickness: involves both the epidermis and the dermis (the two top layers of the skin). Second degree burns involve intense pain, redden skin that is moist and has blisters (steam burn). Third Degree Full Thickness Burns: involves all dermal layers, nerves, fat tissue, muscle, bone or organs. This can be dry and leathery and may appear white, dark brown, or charred. Since there is often nerve damage present, there may be no sensation of pain present. Treatment If a burn involves the mouth, nose, throat or airway, this is considered critical and requires medical attention. 1) 2) 3) 4) Flush the burned area under cool running water for 15-30 minutes or until cool. Do not break blisters. Remove all jewellry. Monitor ABC and treat for shock.

Classification of Burns Heat (thermal): Chemicals: This includes fire, steam and hot objects. This includes caustics, such as acids and alkalis.

42

Electricity: This includes electrical outlets, frayed wires and faulty circuits. Lightning: This includes electrical burns and injuries during thunder storms. Sunlight:
Rules of Nines

This includes burns to the skin or eyes due to the ultraviolet rays from the sun.

Chemical Burns To care for chemical burns: Wash away the chemical from the body with water, flush the area for 15-30 minutes, remove contaminated clothing, shoes, socks and jewellry during the wash. Apply dry and sterile dressing. Electrical Burns On the scene of an electrical burn, the most serious problem sustained is cardiac arrest. Nervous system damage and injury to internal organs may also occur. Make sure that the source of electricity has been turned off, use dry stick or board and wear rubber sole shoes.

Treatment
1. Prepare for complications involving the airway and heart.
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2. 3. 4. 5.

Evaluate the burn. Look for entrance and exit wound (enter the hand and exit the foot). Apply dry sterile dressing to the burn sites. Monitor ABS and treat for shock. Prepare for removal to the hospital.

Lightning Burns Lightning burns occurs when someone is electrocuted during a thunder storm. Treat as electrical shock. Sunlight (Radiation) This is a superficial burn. Treat have a bath and pat dry. Friction (Brush Burns) Spinning wheel or fast moving rope, cool with plenty of water.

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CHAPTER 11 POISONING, BITES AND STINGS A poison is a toxic substance solid, liquid or gas, if it enters the body may cause harm or death. There are four (4) main ways by which poison may enter the body. 1. Swallowed (ingested) by Mouth Poison swallowed can include various household and industrial chemicals, foods, plants, medication. This will cause severe abdominal pain, nausea and vomiting. Diarrhoea may also occur. 2. Inhalation (breathing) Inhaled poisons take the form of gases, vapours, sprays, smoke and carbon monoxide 3. Absorption (contact) Absorption (contact) poison absorbed through the skin may or may not damage the skin. Many contact poisons may damage the skin and are slowly absorbed into the bloodstream. Some insecticides and chemicals can be absorbed through the skin and then absorbed by the body. 4. Injection (under the skin) Injection includes insect bites and stings, such as scorpions, wasp, bees, snakes, centipedes, spiders and certain marine life as well as drugs injected with a syringe and needle. Poisons may enter directly into the blood stream, accidents producing cuts, puncture and wounds. In all cases of injected poisons, be alert for anaphylactic (allergic) shock. Signs and Symptoms Ingested poison These may include any of the following: 1. 2. 3. Burns or stains around the casualtys mouth. Breath odors, body odors Abnormal breathing and pulse rate.
45

4. 5. 6. 7. 8. 9.

Dilated or constricted pupils, sweating Excessive saliva or foaming at the mouth Pains in the mouth or throat, stomach, abdomen Upset stomach or nausea, vomiting, diarrhoea Convulsion Altered mental status including unconsciousness

Treatment Swallowed Poison 1. 2. Do not give anything by mouth, take the casualty to the hospital at once, take the poison or container with you. Prepare to treat for shock. Cary the casualty in the recover position, should vomiting occur. Give plenty of fresh air and monitor ABC.

3.

Inhaled Poison 1. Look for possible sources that cause inhaled poison before you try to save life, because your life comes first. Make sure it is safe for you to enter any building or area that is contaminated. Remove the casualty from the source, give plenty of fresh air. Maintain an open airway, monitor the casualtys ABC. Prepare for shock and take to the hospital.

2. 3. 4.

Absorbed Poison 1. 2. Remove the casualty from the source, remove clothing, wash the affected area with soap and water. Monitor ABC and prepare to take to hospital, give elixir to prevent allergic reactions.

Injected Poison 1. Prepare for (anaphylactic) allergic shock.

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2. 3. 4.

Scrape away bees and wasp stingers and venom sacs. Place an ice-pack over the area to lessen the pain and reduce swelling. An aspirin moistened and applied to the area as a dressing will take away the pain. Give a dose of elixir, observe for symptoms of allergic reactions. Monitor ABCs.

5.

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CHAPTER 12 DRESSING Dressing: Any material used to cover a wound that will help to control bleeding and reduce contamination and infection. Bandage: Any material that is used to hold a dressing in place. Whichever method is used to control bleeding, you must always protect yourself by wearing latex gloves or plastic bags. You must always cover a wound to prevent infection and to aid the blood clotting process by applying pressure over the wound. Rules for Using Dressing 1. 2. 3. 4. Always wear disposable gloves. Place the dressing over the wound. If blood seeps through the dressing, place another over it. Dispose of gloves, used dressing and soiled items properly.

Types of Dressing Non-sterile Adhesive Cold compress

BANDAGING There are a number of different, first aid uses for bandages. Bandages used to secure dressings, control bleeding, support and immobilize limbs and reduce swelling in an injured part. There are three main types of bandages: 1. 2. 3. Roller Bandages Secure dressing and support injured limbs. Tubular Bandages Holds dressing on fingers and toes or support injured events. Triangular Bandages This can be used in many ways, to make a dressing, a pressure pad and immobilize limbs.

The triangular bandage can be tied to make slings and bandages. To tie this bandage, the reef or square knot is used because it is easy to pull and stay flat. To tie this knot, left over right and under, right over left and under. The types of bandages are:

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Round bandage Arm bandage Hand bandage Amputation bandage Chest/back bandage Head bandage Wrist/ankle bandage Knee bandage Foot bandage Arm sling bandage Elevated arm sling bandage Clavicle bandage Dislocation bandage

Point

End

Base

End

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CHAPTER 13 BONES, MUSCLES AND JOINTS Joint Muscles where two or more bones are joined A soft tissue that lengthens and shortens to create movements. There are two types of muscles, voluntary (control movements) and involuntary (control internal organs, heart etc) The stretching and tearing of ligaments and other soft tissue at a joint. This is caused by sudden or awkward wrenching movements. Tough, fibrous tissues that hold bones together at a joint. The stretching and tearing of muscles and tendons caused by sudden or awkward movements. Fibrous bands of tissues that attach muscles to bones.

Sprain Ligament Strain Tendons

Signs And Symptoms Of Sprains And Strains A. B. C. Pain and tenderness Difficulty in moving the injured part Swelling and bruising in the area if the muscles are torn.

Treatment

R I C E

Rest the injured part. Immobilize Cold compress (15-30 minutes) Elevate the injured part

Advise the casualty to go to the doctor.

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FRACTURES A fracture is a cracked, chipped, splintered or broken bone caused by direct or indirect forces, strong twisting forces. Any strong force to the extremities can cause a fracture, a dislocation, a sprain, a strain and damage to soft tissues. Fractures can be opened or closed. If the wound is closed, you cannot tell if the bone is fractures just by looking at it. You need to treat the wound and send the casualty to qualified aid. Types of Fractures Simple (closed) A simple fracture is when the bone is clearly broken. A compound fracture is when the bone is broken in more than one place and into many pieces. An angulated fracture is an injury to an extremity that causes the bone to bend. This is when one end of the bone is pulled or pushed out of the joint. This is when the fractured bone interferes with an organ. Greenstick fractures are commonly associated with infants, toddlers whose bones are soft and bend like a greenstick. A depressed fracture is referred to as a dent. The bones are driven inwards mainly in the skull. This type of fracture mainly occurs in the head. Linear fracture is a crack.

Compound Commuted (Open) Angulated Dislocation Complicated Greenstick Depressed Linear -

Signs and Symptoms of Fractures The three main signs and symptoms to look for in an extremity injury include: a. b. Pain nerves surrounding the injury have been pressed by swelling tissue or broken bone ends. Swelling the injured area begins to swell because blood from ruptured blood vessels is collecting inside the tissues.
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c.

Deformity a part of the limb looks different in size or shape (always compare both arms and legs to one another).

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Splint any hard/rigid material used to immobilize a fracture.

S P
L

I N T S

swelling pain loss of use irregularity numbness tenderness shortening

D D E P

deformity dislocation exposed bone patient heard sound of broken bones

Treatment of Fractures During your initial assessment, do not focus on obvious injuries, but first assess responsiveness, then airway, breathing and circulation. Control all major bleeding, check and correct life-threatening problems as quickly as possible. After correcting and stabilizing life-threatening injuries, first priority is given to possible injury to the spine. A. B. Skull because it protects the brain and contains a portion of the airway. Pelvis because it protects reproductive and urinary organs and major nerves and blood vessels. Thigh because it is the longest, sturdiest bone (femur) in the body, major nerve and blood vessels surround it.

C.

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D.

Rib Cage because it protects the heart and lungs, broken bones may damage these organs and the patient may have difficulty breathing. Extremity injury where no distal pulse is detected during the initial assessment, extremities should be straightened. Injuries to the arm, lower leg and individual ribs are considered and managed last.

E.

F.

Treatment 1. 2. Assess the casualty before you focus on any particular injury. threatening problems first. Prioritize and manage other injuries. Treat life

Apply a dressing if there is an open wound. Check for distal pulse (radial), sensation and motor function. Distal pulse (circulation), sensation (feeling) motor function (ability to move) check before and after splinting. Immobilize the extremity. Tie bandages above and below the injury. Check A B C Prepare casualty for the hospital.

3. 4. 5. 6.

Why Splint Pain A splint can reduce much of the casualty because it immobilizes the broken or dislocated bones in place and prevents them from damaging nerves and tissues. Bleeding Fractured bone ends, dislocated bones and moving bone fragments can damage blood vessels and cause internal and external bleeding. Rules for Splinting 1. 2. 3. Assess and reassure casualty and explain what you plan to do. Expose the injury site. Control bleeding by dressing the wounds.

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4. 5.

Check distal pulse, sensation and motor function before and after splinting. Reposition limb and apply splint if allowed to do so, tie above and below the wound. Firmly secure the splint, and reassess distal pulse and sensation. Monitor casualty ABC and prepare to take to the hospital. The reason for straightening closed angulated fractures is to improve circulation. It makes splinting easier. Make no attempt to straighten angulation. Do not attempt to straighten angulations if the injuries involve the shoulder, pelvis, hip, thigh, wrist, hand, foot or a joint immediately above or below the injury site.

6. 7. 8.

9. 10.

Injuries to the Spine Injuries to the spine can cause one to become paralysed and reduces normal body function and movement. Spinal injuries are caused by forces to the head, neck, back, chest, pelvis or legs. A whiplash is caused by motor vehicle accidents. The spine is a column made up of 33 bones called vertebrates. Cervical spine Thoracic spine Lumbar spine Sacrum Coccyx 7 bones in the neck 12 bones in the upper back 5 bones in the lower back 5 fused bones 4 fused bones

Signs and Symptoms of Spinal Injuries A. B. C. Weakness, numbness or tingling sensation or a loss of feeling in arms or legs. Paralysis to the arms or legs. Painful movements of arms and legs or no pain sensation.

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D. E. F. G. H.

Pain or tenderness along the back of the neck or the backbone. Burning sensation along the spine or an extremity. Deformity of the spine, angle of head and neck. Loss of bladder and bowel control, difficulty breathing. Persistent erection priapism

Treatment for Injuries to the Spine 1. 2. 3. Make certain the airway is open by using the jaw-thrust manoeuvre. Control serious bleeding avoid moving the injured part when applying dressing. Always assume that an unconscious accident patient has spinal injuries. Check distal pulse, check sensation (feeling) motor function (ability to move) Do not attempt to splint fractures if there are indications of spinal injuries. Never move a casualty with spinal injuries unless you must do so to provide A.R. or CPR and to treat severe bleeding. Keep the casualty still, stabilize or immobilize the casualtys head, neck and as much of the body as possible. Monitor casualty with possible spinal injury. These casualties will go into shock. Sometimes their chest muscles will be paralyzed and they will go into respiratory arrest.

4. 5.

6.

7.

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HEAD-TO-TOE EXAMINATION Injuries and illnesses usually manifest themselves as groups of distinctive features. There are two types of features: 1. 2. Sign: Surface of the body, which you may detect. Symptom: what is coming from inside the body.

Whenever possible, examine a conscious casualty in the position in which s/he is found. Be quick and alert but thorough, using your senses look, listen, feel and smell. Once you have taken the history and asked about any symptoms the casualty has, you should carry out a detailed examination of the person. During the procedure, you must be very observant and talk to the casualty. Always start at the head and work down to the toe using DCAP-BTLS or DOTS method.

D CAP-

Deformities Contusion Abrasions Puncture/Penetrations

BTLS-

Burns Tenderness Lacerations Swelling

DOTS-

Deformities Open wounds Tenderness Swelling

When examining an unconscious trauma/casualty, assume there are neck and spinal injuries. Always open the airway by using the jaw-thrust manoeuvre. To begin your assessment: 1. 2. Check the head and scalp for cuts, bruises and depressions. Examine the patients eyes using a penlight. Look for foreign objects and check the size of the pupils. Dilation or constriction may indicate a brain or spinal injury. Inspect the ears and nose for blood, bloody fluid or clear fluid. The clear fluid is called cere-bro spinal fluid and indicates severe head injury. Inspect the mouth for possible airway obstructions: bleeding, broken teeth, bridges, dentures, crowns, chewing gums, food, vomit or other foreign objects. Check the cervical spine bones for tenderness and deformities. Check the neck for injury or deformities. Feel clavicles for tenderness and deformities, inspect the chest for cuts, bruises, penetrations and impaled objects. Check for possible fractures and equal expansion of the chest and rib cages.
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3.

4.

5.

6.

7.

Inspect the abdomen for cuts, bruises, penetrations, distension and impaled objects. Feel abdomen for tenderness and pain. Feel the upper back. Check the thoracic spine 12 bones for point tenderness and deformities. Feel the lower back lumbar spine 5 bones for point tenderness and deformities. Feel the pelvis for possible injuries and incontinence. Examine the legs and feet individually. Do not lift or move the legs or feet. Compare both legs length, shape, swelling or deformities. Check distal pulse for circulation. Check the posterior tubial pulse. Feel behind the ankle or the dorsalis-pedis pulse, locutid lacteral to the large tendons of the big toe. Examine the upper extremities from the shoulders to the fingertips. Feel each hand and note any cuts, bruises, impaled objects, bleeding, deformities, swelling, dislocations, protruding bones or fractures. Check the radial pulse. Check for sensation by the touch of a finger and motor function by asking the casualty to grasp your hand. If there are no injuries to the head, neck, spine or extremities, inspect the back surface.

8.

9.

10. 11.

12.

13.

14.

Rapid Physical Assessment Medical Asthma Fainting Seizure Stroke Heart Attack Cardiac Arrest Neck: Chest: Abdomen: Extremities: Trauma Laceration Abrasion Burns Fractures Amputation Motor Vehicle Accident Fall

Neck vein, distension and medical identification devices. Presence and equality of breathing sound. Distension, firmness or rigidity. Pulse, motor function, sensation and medical alert devices.
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Vital Signs The vital signs include: 1. Pulse

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2. 3. 4. 5.

Respiration Temperature Blood Pressure Skin Colour

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LIFTING AND MOVING CASUALTIES Planning is important before lifting a patient or an object. Know the weight of the patient or object and request additional help if it is needed. It is also important to consider any physical limitations that may make lifting difficult or unsafe for you. Whenever possible, lift with a partner whose strength and height are similar to yours. Communicate with your partner and with the patient when you are ready to lift and continue to communicate throughout the process. When you are ready to lift, follow these rules to prevent injury: a. b.

Position your feet properly -

positioned shoulder-width apart. your knees.

They should be on a firm, level surface and

Use your legs, not your back, to do the lifting - Keep your back straight and bend
Never twist or attempt to make any moves other than the lift Attempts to turn or twist while you are lifting are a major cause of injury.

c.

d.

When lifting with one hand, do not compensate Avoid leaning to either side.
Keep your back straight and locked.

e.

Keep the weight as close to your body as possible This is part of good body

mechanics and allows you to use your legs rather than your back, while lifting. The farther the weight is from your body, the greater your chance of injury. f.

When carrying a patient on stairs, use a stair chair instead of a stretcher whenever possible - Keep your back straight. Flex your knees and lean forward
from the hips, not the waist. If you are walking backwards down stairs, ask a helper to steady your back.

When lifting or moving patients you should: Explain to the patient what you are doing. Not lift, or move too fast or in ways that will make the injury or illness worse. Not grasp the injured area. Move by grasping clothing or specialist equipment. Keep your back straight. Bend your knees and hips in order to make good use of your leg muscles and lift with arms straight. Keep your chin and elbows tucked in and grip shoulder width. Stand with your feet apart to allow a balanced distribution of your body weight.
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Stand close to the patient. The load should be held as close to the body as possible to allow for central gravity. Break down lifting in stages as to allow for rest and proper control during the movement. Lift with your feet straight and one foot slightly forward.

Before you move a casualty, the following must be observed: a. b. c. d. e. f. Prevent conditions from becoming worse. Move casualty only if you have to. Move as little as possible. Move the casualtys body as a single unit. Use proper lifting and moving techniques. The First Aider must stay at the casualtys head and give commands on the 1-2-3 to lift.

Types of Lifts and Carriages Human Chain, Four-handed seat, Three-handed seat, fireman Lift, Two-Person seat (AFT carriage) Power Lift, Chair Lift, Blanket Lift, Diamond Lift, Arm-to-Arm Drag, Removing a casualty from a vehicle, Shoulder Drag, Blanket Drag, Piggy Back.

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LIST FOR FIRST-AID KIT

ANTACID TABLETS & LIQUID PAIN KILLER-ADULT & CHILDREN PANADOL - PAIN AND FEVER - TABLET AND SYRUP ANTIHISTAMINE FOR ALLERGIES ELIXER/DPH DPH CREAM ANTIHISTAMINE CREAM IODINE SPLINTS (ALL SIZES) COUGH SYRUP AMBUBAG BLOOD PRESSURE EQUIPMENT NECKBRACE VENTOLIN INHALER & SPACER ORAL REHYDRATION SALTS GRAVOL GLUCOSE ANTIBIOTIC CREAM MERCUROCHROME RUBBING ALCOHOL TRIANGULAR BANDAGES ROLLER BANDAGES ABSORBENT GAUZE ADHESIVE TAPE BAND-AID PLASTERS STERILE DRESSING (VARIOUS SIZES) COTTON ANTISEPTIC WIPES ANTISEPTIC SOLUTION HYDROGEN PEROXIDE SOLUTION SCISSORS SAFETY PINS LATEX GLOVES CLINICAL THERMOMETER TWEEZER EYE PADS EYE WASH SOLUTIONI5O ML NORMAL SALINE MOUTH MASK FACE SHIELD POCKET MASK SANITARY NAPKINS NOTE PAD AND PENCIL FIRST-AID MANUAL

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JAMAICA RED CROSS ASSIMILATION EXERCISE FOR FIRST AIDERS

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. Treat fainting for the conscious; and the unconscious adult lying face down Treat choking for the conscious and unconscious infant, child or adult Apply mouth-to-mouth to someone who needs it Treat a casualty who suffers from cardiac arrest Give head to toe examination/check motor-function and sensation Treat multiple casualties as to what method should apply Treat asthma Treat a wound; an artery or vein gets damaged. Treat for shock Treat a wound with an impaled object Treat nose bleeding Splint a fractured leg, hand or finger Treat a casualty with a dislocated shoulder Do the following carriages; human crutch, four hand seat, three hand seat, aft, four persons lift, blanket drag, chair lift and fireman lift Remove someone from a car accident with suspected back or neck injury Treat someone with severe spinal injury to the neck or lower back Treat sprains and strains using R.1.C.E. Treat epilepsy Treat gunshot or stab wound to the abdomen Tie the following bandages; arm, amputation, hand, elevated arm sling, arm sling, chest, back, head, wrist, ankle, foot and knee Transfer casualty from one blanket to another using a log roll

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Sources or Bibliography: First Aid Manual Internet Information Google St. John Ambulance British Red Cross BBC.co.ukhealth

Acknowledgements:

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