Tromas First Aid Presentation

8/3/2019 Tromas First Aid Presentation

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By

Prof. Dr. Ali El-ShewyProf. of General Surgery

Faculty of Medicine

Zagazig University


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Definition of the first aid measures:

Are the measures that should be done for traumatized patientor for a patient with urgent disease, till the patient referred tothe hospital

Aims of the first aid measures:

1- Saving the life of the patient arresting of bleeding or

doing artificial respiration for a patient with asphyxia2- Relief of pain splinting of fracture or giving analgesicdrugs

3- Preventing complications that may develop preventingwound infection


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A- Air way care

Air way obstruction may kill thetrauma victum within few minutes.

Evaluation of the patency of the

air way and its protection should

receive top priority

All patients with major traumashould receive supplemental

oxygen by mask till arrival to hospital


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Care of air ways:1- Clear the air ways:Removal of vomit, blood or foreign materials from the mouth

and throat either manually (finger sweep) or using sucker.

2- Chin left & Jaw traction

3- Oro-pharyngeal air way tube : to prevents tongue fromfalling back and occluding the air way. It should be used for

unconscious person only

4- Endo-tracheal intubation: Indicated in cases of apnea,

inhalation injuries, maxillofacial trauma, fracture cervicalspine and head injury

5- Crico-thyroidotoy: may be needed if upper airway are

obstructed. It is done by cut and insertion of a tube or a wide

bore needle


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Assessment of air movement, respiratory rate, cyanosis,

stridors, wheezing, chest wounds and asymmetry of

chest wall

Life threatening thoracic conditions should be managed

immediately like:

1- Tension pneumothorax: by needle decompression

2

- Open pneumothorax: by occlusive dressing theninsert chest tube

3- Cardiac tamponade by needle aspiration

4-Flail chest by multiple fractures of ribs by positive ventilation

5- Massive haemothorax by chest tube drainage


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C- Circulation:

If there is massive bleeding causinghaemorrhagic shock we should do :

1- Stop external bleeding by direct pressure

on the wound2- insert large intravenous line

3- Take blood sample for typing & cross

matching4- start giving I.V fluids as lactated ringer

5- Blood transfusion, once available


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D- Disability:Detailed neurological assessment (if the patient is

alert or unconscious )

E- Exposure & environment All clothes of the patient should be renoved

Emergency room should kept warm to avoidhypothermia

Insert uretheral catheter an nasogastric tube


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Definition:Escape of blood from a vessel damaged by injury or

by a disease

Causes:1- Traumatic: as in wounds, fractures and operations

2- Pathological : injury of blood vessel by ulcer ormalignant tumour

3- Abnormal bleeding tendency: as haemophilia,purpera and vitamin K-deficiency.


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a- Primary haemorrhage:

at the time of trauma or operationb- Reactionary haemorrhage :

during first 24 hours after trauma or operation due to

slipping of ligature or dislodgement of blood clot

c- Secondary haemorrhage:within 7-10 days after trauma or operation due to erosion of

blood vessels with sepsis. Is usually serious


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a External haemorrhage:-Escape of the blood to outside the body, as bleeding wound,

epistaxis, haemoptysis, haematemesis and rectal or vaginalbleeding

b- internal haemorrhage : -Bleeding into the body cavities e.g., peritoneal cavity, pleural cavity

and intracranial

c- interstitial haemorrhage :

Bleeding in between tissues as haematoma


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A- Arterial bleeding

B- Venous bleeding

C- Capillary bleeding


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1- Shock :-due to massive loss of blood in short time may lead torapid death

2- Anaemia :-In minor and recurrent bleeding (chronic blood loss) as in

bleeding piles


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1- Compression on the site of bleeding by pressure bandage

2- Elevation of the bleeding limb above the level of the heart

3- Pressure over the artery proximal to the site of bleeding

by a tourniquet or by a pressure bandage -- better to be

avoided because it may lead to ischaemia or gangrene

4- Application of local haemostatic dugs as a piece of gauzesoaked with adrenaline in the nose in case of epistaxis

5- compression of the bleeding surface with moist hot

packs ( as during surgical operation)


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Definition:

Shock is a state of peripheral circulatoryfailure characterized by :

1- hypotension

2- impaired tissue perfusion3- disordered cellular metabolism


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causesa- haemorrhage due to trauma or operationb- burn -- loss of plasmac- excessive vomiting - fluid loss

Clinical picture:a- pallor of the faceb- cold sweaty skinc- rapid pulse and low blood pressured- decrease of urine volume (oliguria)

First aid measures:a- patient lie flat with his limbs elevatedb- maintain open air wayc- arrest bleedingd- sedation by morphia IVe-rapid transport of the patient to hospital to receive the life saving as, fluids,

blood transfusion and oxygen therapy


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Cause :Seeing blood , sever pain , emotional excitation leads to reflex vasomotor paralysis (vasodilatation)

Clinical pictures:a- pallor of the faceb- cold sweaty skin

c- slow pulse and low blood pressure

d- drowsiness, fainting attack and fall on the ground

First aid measures:a- patient lie flat with his limbs elevatedb- warm the patient by blankets

c- splinting of traumatized limb and give sedation to relief pain

d- give the patient IV fluids, atropine and vasopressors


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causesAnaphylaxis (hypersensitivity) causes capillary paralysis (dilatationand pooling) due to histamin. The beast example is penicillininjection in a sensitized patient

Clinical pictures:1- skin eruption, swelling in the face

2- difficult breathing

3- low blood pressure

First aid measures:-1- stop further injection of the drug causing hypersensitivity

2- give the patient, antihistamincs, corticosteroid and adrenaline

3- refer to the hospital to take IV fluids and O2


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causes

1- myocardial infarction2- cardiac arrest

3- arrhythmias

Clinical pictures:1- patient looks ill

2- irregular week pulse


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Due to vasomotor paralysis causedby bacterial toxins as in case ofperitonitis and postoperative

infection


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First aid includes the assessment andtreatments that can be performed by aperson with minimal or no medicalequipment.

First aid should not delay the activation ofthe emergency services (EMS)


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Causes: Bronchial asthma & Allergic reaction

This is a serious emergency and requiresimmediate emergency medical care

First aid :

1- help the patient to take his medications

2- allow the patient to sit upright

3- help him to reach to take his medical care


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Most cases of convulsion stop spontaneously within seconds

It is usually due to neurological diseases

First aid:

1- open air way2- prevent tongue injury by putting air way in his mouth

early during the attack

3-move furniture away or place soft objects (pillow) to

protect the head4- after convulsion the patient may be unconscious or

confused, so must be placed on his side to allow oral

secretion to drain out

5- call for EMS


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stroke means infarction of the brain by blood clot or

intracerebral haemorrhage

Clinical pictures:

1- drop of the angle of the mouth when smile

2- inability to close the eyes completely

3- inability to move upper or lower limb

4- speak with difficultyIt is a serious medical emergency and time is critical so,call of EMS immediately if you believe someone may besuffering from a stroke.


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means ischaemia of the heart and affects males and females but morecommon in smokers and old age and persons under stress.

Clincal pictures:

1- chest discomfort (retrosternal pain) for few minutes , and may relieve

and return back

2- discomfort in other areas as left arm, back, neck, jaw and may be

stomach pain

3- shorting of breathing with or without chest discomfort

4- cold sweaty skin, nausea or headache

first aid:1- call for EMS

2- allow the patient to be in the most comfortable position

3- re-assure the patient


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Causes:1- during anathesia and surgical operation

2- electro-conduction

3- drowning & asphyxia

4- gas poising

5- myocardial infarction

6- sever trauma

Clinical pictures:1- absent carotid pulse2- absent or gasping respiration

3- dilated fixed pupils of the eyes


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First aid:

brain can tolerate 3 min of complete circulatory arrest , if notrestored brain death will occur

External cardiac massage and artificial respiration (mouth to mouthbreathing) should be started immediately and continue whiletransporting the patient to the hospital

External cardiac massage is done as the following

1- the patient is laid flat on a firm surface with elevation of his legs to

increase the venous return to the heart

2- Artificial mouth to mouth respiration is done by one person

3- at the same time a second person apply cardiac massage by

compressing the lower part of the sternum against the spine at a

rate of 60 times per minute


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poisoning may be ingested, inhaled

or absorbed through the skin, eyes ormucous membranes

It usually occurs as industrial

accident or home accident by household agents by accidental, criminal orsuicidal act


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1- heavy metal : as, lead, mercury and arsenic

2-insecticides: as, cholinesterase inhibitor3- corrosives: as stronig acids, alkalines

4- food poisoning : bacterial and botulism

5- carbon monoxide6- drug intoxication

7- poisonous plant


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Each type of poison has its specialmanagement, so there is no generalrecommendation for management of poison

The first step of aid measure is to contact thenearest (poison control center) or local EMS

Do not give the victim any thing to drink or eatto induce vomiting unless directed by thepoison control center


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Asample of toxic material or drug taken bythe victim should be kept to know itsnature to provide the suitable treatment

You must find out the (3Ws) who?, what?And when.

who is the patient ( name , age weigh,

address and telephone number

what type of toxins patient take

when he take the toxin


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Remove the clothes of the patient

Skin should be cleaned by runningwater

Washing of the eyes with running water

while holding the eye opened

Do not use chemical to wash the eye or

the skin


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Open all doors and windows and carry the

patient out to fresh air immediately

Tight clothes should be loosened

If convulsion occur. Keep the patient in dark

quite room on his side

Watch the respiration of the patient, if

stopped or irregular, artificial respiration

should be started


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Maintain air ways, aspiration of vomitus or secretion

If respiration is irregular start artificial respiration

Induce vomiting (Emesis): touch the patient throat by

finger or blunt end of the spoon, to empty the stomach

N.B: Emesis is contraindicated in unconscious patient

and in case of corrosive poisoning

Activated charcoal could be used as universal antidote,

as it inactivate most of the poison and chemicals,

except cyanides


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1- Simple fracture: fracture of a bone into twofragment

2- Comminuted fracture: fracture of a bone tomany fragments

3- Compound fracture: fracture associated with

wounds, they are liable to infection

4- Pathological fracture: caused by bone diseasesuch as bone cysts and malignancy. It may occurs

spontaneously or after minimal trauma


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1- Swelling and oedema at the side of

the fractures .

2- Severe pain and tenderness .3- Deformity of the injuried limb .

4- Inability to move the injuried limb .

5- Sensation of crepitus at the sit of the

fracture .


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1- Relief of the pain by using of an analgesic

2- Splinting of the fractured bone of the

relief of the pain to prevent furtherdeformity .

3- Care of any associated wound e.g. arrest

of bleeding .

4- Refer the patient to the hospital .


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Special splints, made of rigid materials areavailable in ambulance cars and in emergency units.

If these splints are not available, one couldimmobilize a fracture limb by one of thesesmethods:

1- use of two plates of wood or heavy cardboard

fixed the limb by bandage2-Band the injured limb to the trunk or to the

normal limb


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do not attempt to move or reposition avictim with a serous muscular, bone or joint

injuryApply ice bag to the injured area for 20minutes

If the injury includes open skin, cover thewound with clean dressing

Do not attempt to push protruding bonesof tissue back into the skin


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Definition : It is injury of the skin, muscle, nerves and bloodvessels

Types:1- Contusion (Bruises): Painful swelling due to blow with a blunt

object as, stick or stone. It occurs as a result of injuries of the

soft tissues while the overlying skin remains intact

2- Haematoma : Localized collection of blood in the tissue planes

due to rupture of a blood vessel. It appears as a soft painful

bluish swelling. Small haematoma usually resolvespontaneously.

3- Wounds: injury of the skin with a variable degree of damage of

the underlying tissues


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1- Abrasions :loss of superficial epithelium of the skin due to scratching with a pointedobject or friction with a hard rough surface.

It appears as a bleeding raw surface associated with pain.

Healing of the abrasion is rapid

2- incised wounds: produced by sharp cutting instruments like knives or fragments of glass

they have healthy clean cut edges with little tendency to infection

3- Contused and lacerated wounds: occur as a result of sever violence with blunt hard objects.

their edges are irregular and devitalized

the underlying soft tissues are usually injured

there is a great risk of contamination and infection


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4- Stab and punctured wounds:

caused by pointed instruments such as knives anddraggers

they have small opening but extend deeply

infection and retained foreign bodies are common

complications

5- Penetrating wounds:

Deep stab wound that involves a serous cavity as

(abdomen or thorax) these wounds are very serious as it may involves a

deep organ or an important structure such as liver,

spleen and heart


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1- Haemorrhage:

Which may be sever enough to cause shock

and death2- Contamination and infection:

Such as cellulites, toxaemia, tetanus and gas

gangrene3- Injuries of important structures:

Such as blood vessels, nerves and organs


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1- Arresting of the bleeding

2- Relieve the pain by splinting of the

injured limb or giving analgesia

3- prevention of contamination of thewound by :

avoiding excessive manipulationDressing of the wound

4- Transporting the patient to hospital


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1- Dressing must be done in a suitable clean place

2- Instruments used must be sterile

3- scrub (wash) your hand with water and betadine

4- scrub the skin around the wound then the wound by betadine5- remove any superficial FB and dirties and do not manipulate

deeply

6- irrigate the wound by saline of antiseptic solution

7- cover the wound with a sterile dressing, then apply bandage8- if bleeding persists after bandage, do not disturb the dressing,

but add further sterile cotton and apply another bandage with

pressure


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Antiseptics are used for the disinfection of instruments, hands, and skin. Also it is used for thetreatment of infected wounds.

The most popular antiseptics are:1- Strong antiseptics: as formalin, they are used tosterilize instruments, but should not be used inwound dressing as it causes tissue damage and delay

healing2- Alcoholic antiseptics: such as alcohol 70 % .These are suitable for dressing of sutured wounds(after surgical operations).


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3- Bland antiseptics, such as watery

solution of cetavlon (1%), Theseantiseptics are suitable for openwounds (raw surface) as they dont

interfere with the healing wounds.

4- Povidone iodine (Betadine) :

antibacterial , antifungal , used forskin disinfection , open wounds andfor sutured wounds.


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5- Hypochlorite antiseptics , e.g. Eusol,

liberate nascent chlorine which has a strongantiseptic action and hasten separation ofsloughs without tissue injury. They are usedto eradicate infection in infected open

wounds.6- Effervescent antiseptics e.g.Hydrogen peroxide. It liberates gas bubbles

which penetrate pockets and sloughs. It issuitable for irrigation of infected deep

wounds e.g. after drainage of an abscess.


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Definition of Rescue :

it is the act needed to save the live of a victims

and extract them safely from the field of accident

Accident needs rescue may be :

1- for one person like car accident

2- groups of victims : fires, collapse of buildings ormines, earthquakes , trains or airplanes accidents

and floods


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Rescue should be provided by a team of well trainedpersonal provided with suitable tools and

equipments to facilitate their rescue and extractionprocedures like: hammers, axes, saws, cutters ( either

manual or powered)Rescue workers should be well trained to usethese equipments, also they should be well trained toprovide medical first aid measures ant trauma life

support for the victimRescue workers should be also trained how toprotect themselves, as their work is hazardous, andthey are liable to trauma during their work


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The aim of rescue is to get out the trapped victims

away from the field of the accident safely

Priority of extraction is :

1- start with alive hopeful victim first, which could

be easily and quickly saved

2- followed by less hopeful cases3- and then after for hopeless patients

4- lastly the dead person


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Medical care should be started at the site ofthe accident. The emergency medical care that

the patient receives before he arrives thehospital may irreversibly influence hismortality and morbidity

Medical car should be also continued duringtransportation of the patient till he reach thehospital


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1- Ambulance vehicle:

Transportation should be rapid and safe.

Ground, water or air transportation should be

available and effective.Ambulance cars should be wide enough to facilitatemedical care. It should be well equiped with suitableequipments needed for life support like O2 gas,ventilation equipment, i.v f luids, medications . Etc

It should also provide radio- to communicate withthe receiving hospital.


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2- Ambulance workers :

Should be well trained for use of the rescue tools andprocedures

and they should have good knowledge about management ofmedical emergencies and providing life support measures topatient during transport.

They should also have the skill of use of radio-communications

3- Management during transport:

Vital signs and pulse oximetrySupport monitoring of cardio-respiratory system (ventilation)

Blood volume replacement

Use of appropriate medication

keep written records about the case and its progress


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4- Communication :

Referring doctor should first choose thenearest medical emergency care suitable for

his patients condition.Before transport he should communicate(call) the receiving doctor to give him an idea

about the history and condition of thepatient, to make him ready to receive thepatient and to provide the suitable medicalcare.


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1- Definition of :

1- First aid measures

2- Basic life support

3-Bleeding Primary haemorrhage reactionary haemorrhage secondaryhaemorrhage- internal haemorrhage intersitialhaemorrhage

4- Stock or definition of any type of stock

5- Stroke

6-Simple fracture or any other fracture

7- Soft tissue injury or definition of any type of wounds

8-Rescue


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a- Neurogenic shock or oligaemic shock

b-Cardiac arrest

c - Fractures

33-- Complications of:Complications of:

aa-- HaemorrhageHaemorrhagebb-- WoundsWounds

44-- Aim of first aidAim of first aid

55-- Care of air wayCare of air way

66-- What is the life threatening thoracic condition?What is the life threatening thoracic condition?77-- Cause s OR types ofCause s OR types of haemorrhagehaemorrhage

88--First aid measures forFirst aid measures for haemorrhagehaemorrhage

99--types of shocktypes of shock


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1010--first aid measures forfirst aid measures for neurogenicneurogenic & anaphylactic& anaphylactic

shockshock1111--First aid measures for cardiac arrestFirst aid measures for cardiac arrest

1212-- Types of poisoning & first aid for inhalants toxinTypes of poisoning & first aid for inhalants toxin

1313-- First aid measures of fracturesFirst aid measures of fractures

1414-- How to do splints?How to do splints?1515--Types of soft tissue injuries?Types of soft tissue injuries?

1616-- Types & first aid measures of wounds?Types & first aid measures of wounds?

1717-- How to do dressing for wound?How to do dressing for wound?

1818-- Names and mention one example of antisepticsNames and mention one example of antiseptics1919-- Logic sequence of events for rescueLogic sequence of events for rescue

2020-- Requirements for safe transportationRequirements for safe transportation

2121-- management during transportationmanagement during transportation

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Tromas First Aid Presentation

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