Unit 15 First Aid

Janet J. Nelson, RN,CMA

DHO FIRST AID & AMERICAN HEART ASSOCIAION FIRST AID

• DHO UNIT 15 covers detailed first aid procedures.• You will be certified in American Heart Association

First Aid in addition to the DHO Unit 15.• Each section in DHO will result in recordable

check-offs. • Am Heart certification will follow the Unit 15. It will

require a $2.00 fee, separate book, viewing of complete DVD and several check-offs.

• CPR is taught just prior to observation

OBJECTIVES for Unit 15

• Analyze principles for basic first aid care.

• Define key terms

• For each condition:

– Describe signs & symptoms

– Demonstrate first aid for each in appropriate order.

– Identify safety/hazards

15:1 Providing First Aid

• Immediate care given to the victim of an accident or illness to minimize the effect of injury or illness until experts can take over

• Be able to say why you provided the care you did.

Basic Principles of Providing First Aid

• Stop and think. Calm, not panic

• Check the scene, evaluate situation thoroughly…make sure you are safe

• Have a reason for anything you do!!

• Treatment you provide will vary. Give examples?

• Use Standard Precautions. How?

First Steps of First Aid (May BE the most important)

• Recognize that an emergency exists (some not so obvious)

• Be observant and use all senses to detect problems

• What to do if not safe?

• Call emergency medical services (EMS) as soon as possible. How?

Call 911 (or direct someone else to call)• What do you say?

– Situation– Actions taken– Exact location– Number of people– Condition of people e.g. Unconscious, hemorrhaging– Phone number

• DO NOT Hang up until dispatcher says to hang up.• In some cases you call first and give care second?

When?

After you determined there is an emergency, & scene is safe…..then what?

• If possible, obtain the victim’s permission before providing any care. What do you do if he says “NO”?

• How do you acquire information about event?

• Reassure the victim. Do not make promises or predictions.

• Triage if necessary

• Check for other injuries.

As a general “rule of thumb”:• Get help? Do not make diagnosis or prognosis.• Avoid any unnecessary movement of

the victim• Use a confident, calm attitude & have a reason for

what you do.• Avoid giving the victim anything to eat or drink.

Why?• Be aware of environment…too cold…to hot????• Give only care you are qualified to give.• Maintain confidentiality.

15:4 Providing First Aid for Shock• Shock: clinical set of signs and symptoms that are

associated with an inadequate supply of blood to vital organs.

Causes of shock:AnaphylacticCardiogenicHemorrhagicMetabolicNeurogenic/PsychogenicRespiratorySeptic

Signs and Symptoms of Shock

What are correct medical terms for:

Excessive perspiration

For ALL First Aid

• Priority of Care:

– Check the scene

– Check for consciousness and breathing

– Always triage with breathing/bleeding etc.

– Provide Care

• Priorities of care are followed with each first aid incident but may not be repeated with each slide.

First Aid for Shock• Treat etiology

• Positioning of victim (special precautions with neck injuries, vomiting, dyspnea etc)

• Maintain body temperature

• Avoid food or drink

• Reassure victim

15:3 BLEEDING AND WOUNDS

• Check off required for Am. Heart F.A. Certification

15:3 Providing First Aid for Bleeding and Wounds

• What is the difference between bleeding and hemorrhaging?

• What is the difference between a closed wound and an open wound?

• What can be the complications of a wound?

NAME THESE WOUNDS

NAME THESE WOUNDS

Minor Wounds• First priority – prevention of infection• Wash your hands and use barrier• Wash the wound with soap and water• Rinse the wound thoroughly• Use sterile supplies (maintain sterility)• Advise to get medical help if any signs of infection

appear.• What are S&S of infection????• American Heart recommends an antibiotic oint.

(Note Allergies)• Tetanus Q 5 Year with injury

Major Wound with Hemorrhage

First Aid for Major Bleeding• First priority because victim can go into shock

and die quickly.

• Apply Direct Pressure (NO PEEKING)

•Apply more dressing if blood soaks through.

•What do you use if a first aid kit is not available?

Controlling Hemorrhaging (cont.)

• Apply Pressure Bandage if cannot keep pressure on wound.

• Apply a covered ice pack.

If severe bleeding continues - Apply pressure to pressure point areas.

The “T” Word• Tourniquet: ONLY USED IN

EXTREME CASES

Other Wounds

• Embedded Objects: if superficial, gently remove. What if it is deep e.g. knife?

• Deep objects or not easily removed should be left and removed by physician

• Closed Wounds: Apply covered cold application to reduce swelling

• Observe for signs of internal bleeding (to be discussed later)

15:6 Providing First Aid for BURNS

• What are the etiologies of burns?• What are the types of burns? (see photos next slide)

• Will victims display pain?....bleeding?....swelling?

• ……potential for infection?

• Anticipate other complications

Objectives of Burn First Aid• Make sure scene is safe!! .e.g. Electrical or

fire

• Remember “Stop-Drop-Roll”

• Remove etiology

• Cool skin only remove clothing or jewelry that is not stuck

• Cover burn

• Watch for S&S of shock

• Do what you can to prevent infection

QUIZTomorrow over

Intro

Shock

Bleeding

Burns

15:9 Providing First Aidfor Bone and Joint Injuries

• Define a fracture?

• Describe a simple fracture? Compound fracture?

• Differentiate a dislocation and a subluxation?

• Explain a sprain? Strain?

• List signs/symptoms.

VARIATIONS OF FIRST AID TREATMENT

• Depth of injury

• Etiology

• Location on body

Bone and Joint Injury

• Which trauma warrants concern of bleeding? Infection? Pain?

• Will you know the diagnosis?

• Following trauma more than one type of injury may occur at the same time.

First Aid for Bone & Joint Injury• Necessary for Certification• Follow Priorities of Care: Do NOT move if there

may be a back or neck injury!!• Do not move area (not even to take off shoe etc)

and apply cold pack• Only splint if absolutely necessary to move

– Rigid splints– Soft splints– Air splints– Anatomical splints

Splints• Need to be long enough to immobilize the joint

above and below the injured area

• Should be padded

• Tied in place, do not try to put bone back in place.

• Apply as not to create pressure on area

• If open wound, control bleeding before applying splint

• Perform neurovascular assessment and loosen if too tight.

Slings • Triangular Bandages come in first

aid kit or can be cut from a sheet.• Support arm, hand or shoulder.• May be appropriate to use only

sling or tied sling as in photo. Why?

• Minimize movement when applying.

• Hand needs to be higher than elbow but comfortable.

NOTICE KNOT

15:10 Providing First Aidfor Specific Injuries

• What do you do?

Eye Injuries

• Always involves danger of vision loss

• DO NOT allow victim to rub eye

• If free floating –Pull down eye lid, use

Clean Q-tip or gauze & if needed flush.

Eye Injury cont.

• If embedded:

NEVER try to remove the object.- Cover the injured eye with gauze pad or cup.- Bandage both eyes.

(This part of check-off is a “do”)

Blows to the eyePenetrating injuries that cut eye tissue

Ear Injuries

• Can result in rupture or perforation of eardrum

• Torn or detached tissue

• Ruptured or perforated eardrum

• Clear fluid or blood-tinged fluid draining from ear

Head, Neck or Spine Injury

• Most dangerous types of injuries involving bones and joints.

• Movement can result in permanent injury resulting in paralysis

• Avoid any movement of victim if at all possible.

• Notice anything abnormal, fluid from ears or nose, nausea, nosebleeds, seizure activity.

Nose Injuries

• Epistaxis are usually more frightening than serious

• What is etiology?

• Here is another time you were taught incorrectly…– Position head leaning forward!!!– Pressure on soft part of nose– Ice Pack to nose– No not insert tissues or paper that can wad-up.

Mouth Injuries

• Can be serious if bleeding blocks airway!• Apply pressure for bleeding• If tooth is loose, have victim bite down on gauze to

keep tooth in place and send to dentist.• If tooth is chipped, gently clean area and call

dentist.• If tooth is out, control bleeding and put tooth in milk

or clean water and immediately send to dentist.

Chest Injuries

• Internal bleeding may collapse lung and/or interfere with heart activity.

• Sucking chest wound….• Penetrating injuries to the

chest….• Crushing injuries to the

chest….• Be prepared to do CPR

Abdominal Injuries• Bleeding, shock, and damage to organs can be

fatal.• Watch for internal bleeding:

– S&S of shock– Tightness in abdomen– Coughing up or spitting up blood– SOB

• If an open wound-cover tissue with moist clean cloth

• NPO

Injuries to Genital Organs

• Can result from falls, blows, or explosions• Can cause severe pain, bleeding,

and shock• First aid care as you would any where else on the body.

SEVERED ORGANS

Rinse with clean water & wrap in clean dressing

If it fits, put in watertight

plastic bag

Place bag in another container with ice or ice and water. Label.

15:5 Providing First Aidfor Poisoning

15:5 Providing First Aidfor Poisoning

• Poison: any substance that causes a harmful reaction when applied or ingested

• How do you know if someone has been exposed to a poison????

• Immediate action is needed

• First aid varies depending on type of poison and the method of contact

Poison Exposure determines treatment

• If it is swallowed?

• If it is ingested?

• If it is splashed on skin? Or from a plant?

• If Inhaling poisonous gases?

• If injecting substances? Like what?

EPI-PEN• Auto-Injected Epinephrine (Adrenalin)

• Must use Patients prescribed Epi-Pen (there are different doses)

• We will practice with American Heart Certification

Listen to Poison Control

• How do you induce vomiting?

• When do you never what to cause vomiting?

* Burns to lips* Patient is not fully conscious

15:8 Providing First Aid for Cold Exposure

• Snow mobile goes through ice at Grand Lake….now what do you do?

• Exposure to cold external temperatures can cause body tissues to freeze and body processes to slow down

• Needs immediate attention• Degree of injury affected by wind velocity,

amount of moisture and length of exposure to cold

Hypothermia

• When body temperature is less than 95 degrees Fahrenheit or 35 degrees Celsius

• Death can occur if body processes become too slowed down

• What are the S&S?

• Why not alcohol?

Frostbite

• Actual freezing of lymph with damage to the skin and underlying tissues

Notice: red color, edema and vesicles. This woman lost several distal fingers .This case of frostbite was severe.

15:7 Providing First Aid for Heat Exposure

• Over exposure to heat occurs when water and salt are lost through perspiration

• Also occurs when body cannot eliminate excess heat

• Progression from heat cramps

heat exhaustion

heat stroke

Heat Cramps

• Muscle pains and spasms• Caused by exposure to heat• Loss of water and salt from perspiration• Apply firm pressure on cramped muscle to provide

relief• Encourage rest and move to cooler area• Small sips of water or electrolyte solution (e.g.,

sports drink)

Heat Exhaustion

• Occurs when exposed to heat and there is loss of fluids through sweating

• Hypothalamus continue to work so skin is diaphoretic and pale, c/o nausea, headache, vertigo, weakness. (body temp is normal)

• First aid care – cool patient with caution of shock

Heat Stroke

• Prolonged exposure to high temperatures (have other stages been ignored?)

• Needs immediate medical emergency • Signs and symptoms of body unable to eliminate

excess heat…hot red dry skin, unconscious or semi-unconscious (body temp over)

• First aid care: Critical to call for help and cool victim

15:11 Providing First Aidfor Sudden Illness

• Remember your goal in first aid is to provide temporary care….and you can not make diagnosis so….the care you give will be based on the S&S.

• Obtain as much information as you can:– from victim if possible– from medical alert bracelets or necklaces or medical

information cards– From observers or family

• .

Heart Attack

• Myocardial Infarction-Ischemia to heart muscle

• Recognize S&S and realize they vary from person to person (gender, DM)

• Be prepared for CPR

From www.familydoctor.org

Cerebrovascular Accident

• Also called stroke, brain attack or cerebral thrombosis

Fainting or Syncope• Temporary reduction in

supply of blood to brain• Goal: prevent/reduce

injuries• Obtain medical help if:

– recovery not prompt,– there are other injuries, o– fainting reoccurs

Convulsion/Seizures

• Many etiologies

• Many types of seizures

• View video - http://conditions.healthguru.com/video/understanding-generalized-seizures

• Goal of first aid care is directed at preventing

self-injury and making observations

Diabetes Mellitus• Metabolic disorder

caused by lack of or insufficient production of insulin

• Etiology:– Does not know he she is

Diabetic – Or Diabetic -Ate too

much– Too low insulin dose– Stress or sick

Hypoglycemia • Etiology:

• Diabetic took too much insulin• Or ate too little for insulin dose• Or exercised too much for insulin dose• Or vomiting post injection• Or pre-diabetic

15:12 What is the difference between a bandage and a dressing?

• Dressings : sterile covering that are held in place with tape or a bandage

• Bandages: hold dressings in place, to secure splints, and to support and protect body parts

• So then what is a Band-Aid?

TYPES OF BANDAGES/DRESSINGS

Apply a triangular bandage to scalp

Folds a cravat

Circular Wrap

Spiral Wrap

Figure-Eight Wrap

Wrap Fingers ALWAYS REMEMBER TO DO NEUROVASCULAR ASSESSMENT AND LOOSEN IF TOO TIGHT!!

Summary

• Proper first aid can save a life

• Provide only care you are qualified to provide

• Always reassure victim and avoid unnecessary stress and movement

• Obtain medical help as quickly as possible