Chapter 9

First Aid

Secondary Assessment

Warm-up

• What it’s the ratio between chest compressions and breathes for adult, child, and infant two man CPR?

Lesson Objectives….• Demonstrate how to perform a secondary

assessment.

• Recognize and care for a victim of a sudden illness.

• Recognize and care for wounds.

• Recognize how to control external bleeding.

• Recognize and care for shock.

• Recognize and care for heat- and cold-related emergencies.

Secondary Assessment

• After completing the initial assessment and determining that there are no life-threatening conditions, perform a secondary assessment.

• During a secondary assessment , perform a quick head-to-toe examination for an adult

• Toe-to-head exam for an child/infant

Using SAMPLE to take a brief history pp.142-143• S- signs & symptoms

• A - allergies

• M- medications

• P- pertinent past medical history

• L- last oral intake

• E- events leading up to incident

SUDDEN ILLNESS

• Diabetic emergency

• Fainting

• A seizure

• A stroke

• Allergic reaction

• Poisoning

Sudden illness continued…• It is not important to know

the cause or type of sudden illness because the care you provide will be the same with a few exceptions.

• If you think something is wrong, check the victim and look for a medical identification bracelet or necklace.

• The victim’s condition can worsen rapidly if care is not provided.

Diabetic Emergency

• Too much or too little sugar in their blood

• Often, diabetics know what is wrong and will have something to take

• Give sugar, preferably in liquid form

Seizures

• Provide care in the same manner as for an unconscious victim. Protect the victim from being injured, remove nearby objects that might cause injury.

• If there is fluid in the victim’s mouth (saliva, blood or vomit) roll victim on one side so that the fluids drain from the mouth.

Seizures continued…

• If the victim is known to have periodic seizures, there is no need to summon EMS. Unless…

• The seizure last more than 5 minutes

• Multiple seizure• Appears to be injured• Victim is pregnant• Victim is diabetic• Fails to regain

consciousness• Occurs in water

Seizures in the Water

• Summon or have someone summon EMS

• Support the victim with his or head above water until seizure ends.

• Remove the victim from the water ASAP after the seizure.

• Place the victim face-up on the deck and perform an initial assessment and care.

Stroke

• Signs: weakness/numbness of the face, arm or leg (usually on one side)

• To care think FASTFace- weakness on one side

of face

Arm-weakness/numbness in one arm

Speech- slurred or troubled

Time- time to summon EMS

Bites & Stings p. 147

• Spider/scorpion• Snakebites • Marine Life

– Jellyfish– Crabs– Stingray

WOUNDS

• An injury to the body’s soft tissue, such as the skin, fat and muscles.

• Show video…

http://www.youtube.com/watch?v=mjEcj8KpuJw

Cuts, Scrapes, & Bruises

• Blood- 60,000 miles of blood vessels

• Heart

• Arteries

• Veins

• Capillaries

Stitches

• Uncontrollable bleeding

• Wounds that show muscle, bones, joints

• Large and deep puncture wounds

• Embedded objects

• Human / animal bites

Types of Wounds

• Contusion (bruise)

• Abrasion (scrape)

• Incision (cut / laceration)

• Avulsion

• Puncture

Contusion (Bruise)

• Damage to soft tissues & blood vessels causes bleeding under the skin

• At first it may appear red

• Turn purple

Scrape (abrasion)

• Most common type of wound caused by skin that has been rubbed or scrapped away

• Usually painful because scraping away of outer skin exposes nerve endings

Incision (cut / laceration)• May be jagged or

smooth edges• Commonly caused by

sharp objects• Can also be caused by

a blow from a blunt object

Avulsion

• A cut in which a portion of the skin or other soft tissue is partially / completely torn away

• May hang like a flap• Severed (finger)

Puncture

• Caused when a pointed object pieces the skin (nail, tack, bullet)

• An object that remains embedded in the wound is called an impaled object

Caring for Soft Tissue Injuries

• Closed Wound (internal injuries)• Apply something cold to control swelling• Signals of Internal Bleeding

– Tender, swollen, bruised

– Rapid / weak pulse

– Skin (cool, moist, pale, bluish)

– Vomiting / coughing up blood

– Excessive thirst

– Confused, faint, drowsy or unconscious

Caring for an Open Wound

• Control bleeding (sterile dressing-direct pressure)

• Raise / elevate above heart (if no broken bone is suspected)

• Apply bandage snugly over dressing (if bleeding does not stop apply additional dressing)

• If bleeding cannot be controlled, put pressure to supplying artery

Continued

• Call EMS

• Care for shock

• Wash hands after care

Shock

• Any serious injury or illness can result in shock.• Shock is a natural reaction by the body.• It usually means the victim’s condition is very

serious.• It is a life-threatening condition that occurs when

the body is not getting enough blood flow. This can damage multiple organs. Shock requires IMMEDIATE medical treatment and can get worse very rapidly.

Signals of Shock

• Restlessness / irritability

• Altered consciousness

• Nausea

• Pale, cool, moist skin

• Rapid breathing

• Rapid pulse

Caring for Shock

• Have victim lie down, elevate legs about 12” (unless you suspect head, neck, back injuries)

• Call 9-1-1• Control any external

bleeding• Help victim maintain body

temperature• Do not give food or drink• Reassure victim

Special Situations

• Severed body parts• Embedded objects• Injuries to the mouth• Animal and human

bites• Emergency childbirth

Severed Body Part

• Wrap the part completely in gauze or a clean towel.

• Wet the towel with cool water. • Place the wrapped body part in a plastic bag &

seal it shut.• Place the sealed bag in to another bag or bucket

filled with ice. • Take the bag with the amputated body part to

the hospital with the victim.

Embedded Objects

• Do not remove it• Place several objects

around object to support it

• Eye-cover both eyes

Organs that Break Through the Abdomen• Carefully remove clothing from around the

move

• Cover organs with a moist, sterile / clean dressing

• Cover dressing with plastic wrap

• Place a folded towel / cloth to keep warm

Burns

•

Burns• Are a specific type of soft tissue injury

• You can describe burns by their cause or by their depth (the deeper the burn, the more severe it is)

• A critical burn can be life-threatening

Burns are caused by:• Heat

• Chemicals

• Electrical current

• Radiation

What are Critical Burns?• Burns involving trouble breathing

• Burns covering more than one body part

• Burns to the head, neck, hands, feet or genitals

• Burns (other than very minor) to child/elderly

• Burns resulting from chemicals, explosions or electricity

Critical Burns• Life-threatening

• Seek immediate medical attention

• Often hard to tell how severe a burn is after it has happened

• Problem breathing

Types of Burns

Superficial (First Degree)

• Involve the first layer of skin

• Skin is red & dry & usually painful

• May be swollen

• Most sunburns are superficial

• Heals in 5-6 days without permanent scarring

Partial Thickness (Second Degree)

• Involves top layers of skin

• Skin is red & blistered that may open & seep clear fluid

• Usually painful & often swells

• Usually heals in 3-4 weeks

• Scarring may occur

Full Thickness (Third Degree)

• Destroys all layers of skin & any/all underlying structures (fat, muscle/bones,nerves)

• Burns look brown/black (charred) with tissue underneath appearing white

• Can be either extremely painful or relatively painless (nerve endings destroyed)

Care for Burns• Stop the burning

– Put out flames or remove victim from source of burn

• Call fast-serious burns

• Cool the burn– Use large amounts of water to cool– Do not use ice

Care for Burns Continued

• Cover the burn– Use dry, sterile

dressings– Loosely bandage them

in place (don’t put pressure on burn)

– Do not break blisters (unbroken skin helps prevent infection)

Minor Burns• Wash area with soap & water

• Keep clean

• Apply antibiotic ointment (Neosporin)

• Watch for infection

Severe Burns• Lay victim down-unless trouble breathing

• Raise areas above heart

• Chill easily- cover

Special Kinds of Burns

Chemical Burns• Chemicals (cleansers, lawn & garden

sprays, paint removers, bleach) come in contact with skin or eyes

• May cause severe burns (longer contact)

• Flush with large amounts of cool running water

• Remove clothing

Electrical Burns

• Never go near a victim of an electrical burn until you are sure the power source is turned off

• Caused by:– Power lines– Lightning– Defective electrical

equipment– Electrical outlets

Electrical Burns continued

• Severity depends on how long the victim was in contact with power source & strength & type of current & path it takes

• Often deep

• Two wounds-enter/exit

Radiation• Sun-may blister• Cool the burn• Stay out of the sun• Protective lotion

(SPF-15)• Antibiotic lotion-

prevent infection

Don’ts of Burn Care• Apply ice directly to any burn, unless it’s

very minor• Touch a burn w/ anything except clean

covering• Remove pieces of cloth that stick to

burned area• Try to clean a severe burn• Break blisters• Use any kind of ointment

Injury to Muscles, Bones & Joints

http://www.youtube.com/watch?v=_wxebhExcTk

Skeletal System

• Over 200 bones• Various sizes &

shapes• Protect the body &

help the body move• Hard & dense & have

a rich supply of blood/nerves

Joints

• Consist of 2 or more bones held together by ligaments

• All joints have a normal range of motion

• When joints are forced beyond this range, ligaments stretch/tear

Muscular System• 600 muscles-most

attached by strong tissue called tendons

• The shortening & lengthening of muscle make the body move

• Brain directs muscles to move through the spinal cord

• Injuries/diseases to the brain, spinal cord, or nerves can affect muscle control (stroke, parapalegic, Parkinsons)

Injuries

• Injuries to muscles, bones & joints happen often

• Happen to people of all ages

• Happen at home, at work, and at play

Four Basic Types of Injuries

• Fractures• Dislocations• Strains• Sprains

Fractures

• Complete break, chip or crack

• Closed

• Fractures can be life-threatening if they involve breaks in large bones, sever an artery, affects breathing

Fractures

• Open (compound)-bone breaks through the skin

Dislocations

• Is the movement of a bone at a joint from its normal position

• Usually more obvious than a fracture

• Usually tears ligament away from bone

• Forms a bump, ridge or hallow

Strains

• Stretching and tearing of muscles & tendons

• Usually caused by lifting something heavy or working muscle too hard

• Usually involve neck, back, thigh, calf

Sprain

• Tearing ligaments at a joint

• Mild sprains may swell, but usually heal quickly

• Severe sprain can involve a fracture/dislocation

• Joints easily injured-(ankle, knee, wrist, finger)

How can you tell how bad the injury is?• Pain (most common signal)

• Swollen, red or bruised

• Significant deformity-twisted or strangely bent

• Abnormal lumps or ridges

• Inability to use affected part normally

• Bone fragments sticking out of wound

Continued

• Feel bones grating, felt/heard a snap,pop at the time of injury

• Injured area is cold/numb

• Compare to uninjured leg or arm

• X-ray, MRI, CAT scan

Splinting

• Splint only when victim must be moved

• Only if you can do it without causing more pain

• Splint the injury in the position you find it

• Check circulation

Types of Splints

• Soft splints

• Anatomic splints

• Slings

• Rigid splints

Sprains & Strains

• General care (R.I.C.E.)

• Rest

• Immobilize

• Cold

• Elevate

• Cold then heat-reduces swelling and pain

Special Situations

Head & Spine Injuries

• 2 million each year• Mostly males 15-30

years old• Causes:

– Motor vehicle accidents (44%)

– Falls (22%)– Acts of violence (24%– Sports (8%) 2/3 from

diving

When to Suspect Head, Neck, & Back Injuries• A fall from a height greater than that of the victim

(elderly person)• Any diving mishap• Unconscious person (unknown reason)• Motor vehicle accidents where severe blunt

force to the head, chest, abdomen, or pelvic area (gun shot wound)

• Victim’s helmet is broken (motorcycle, bike, football, industrial helmet)

• Lightning strike or when a victim is thrown

Signals of Head, Neck & Back Injuries• Change in consciousness• Severe pain/pressure in the head, neck or

back• Tingling or loss of sensation (hands,

fingers, feet & toes)• Partial / complete loss of movement• Unusual bumps/depressions on

head/spine• Blood / fluids (ears / nose)

Signals continued

• Heavy external bleeding (head, neck, back)

• Seizures• Impaired breathing / vision• Nausea / vomiting• Persistent headache• Loss of balance• Bruising (head, eyes, behind the ears)