First Aid Treatment

DR. MOHAMED JOWHAR

PEGAWAI PERUBATAN, UKM
PUSAT KESIHATAN
UNIVERSITI KEBANGSAAN MALAYSIA

Being a First Aider

Doing Your Best
A casualty may not respond as you hoped, some
conditions are inevitably fatal, even with the best medical
care.
Assessing Risk
First do no harm,
Calculated risk,
Do not use treatments that are not sure about, just for the
sake of doing something.



YOUR RESPONSIBILITY

Talk to casualty-reassure him and obtain information about
his condition
Treat casualty-in position found,
By stander may able to help in giving first aid

GIVING CARE WITH CONFIDENCE
Being in control both of your own reaction & of the
problem,
Acting calmly &logically,
Being gentle but firm, Speaking to casualty kindly but in
clear& purposeful way.

Building up Trust,
Talking to relatives,
Coping with children


Looking after yourself
Personal safety -Do not put yourself at risk,
The fight or flight response- increase heart rate&
breathing, sweating,
Staying calm-remember first aid procedures.
Feelings after an accident
Satisfaction & pleasure,
Confusion & doubt,
Anger & sadness.

Recording first aid treatment
name, address, occupation, date& time,
place & circumstance of accident,
details concerning & treatment given
Actions at an Emergency
Assess the situation,
Make the area safe,
Give emergency aid,
Get help from others.


Topics for today Discussion
Fever
Common Cold-Upper Respiratory Tract Infection (Flu)
Dyspepsia/Gastritis/Peptic Ulcer
Diarrhea
Dysmenorrhoea (Peroid Pain)
Headache
Back Pain
Sport Injury
Bruising /Abrasions/ Lacerations
Head Injury
Eye injury
Severe Bleeding
Burns
Shocks
observe Unconscious patient
Anxiety /Hyperventilation/Panic Attack
Acute Asthma Attack
Anaphalytic Reaction
Ebola Virus




Confused

Sleepy




Boring

Alert
FEVER

Oral Temperature >37.2.C, Ear drum T >37.7.C,
Is a sign of disease and occurs in response to infection (mainly
viral)
Abrupt onset of fever with chill and rigor is a feature of some
disease.

Treatment
Paracetamol 500mg 2 tablets 3-4x/day
High fever- Tepid sponging for first 30minutes combined with
Paracetamol.
Adequate fluid intake/increased fluid 2-3Litre/day-frequent
small drinks of light fluids/water
Dress in light clothing, do not over heat with too many clothes

Common Cold-Upper Respiratory Tract
Infection (Flu)
Tiredness
Running nose, Sneezing
Sore throat
Slight Fever
OthersHeadache, Hoarseness, Cough

Treatments
Rest
Drink ample amount of Water
Stop Smoking
Steamed Inhalation-with Menthol
Medicines-Paracetamol, cough syrupBena Expectorant


Dyspepsia/Gastritis/Peptic Ulcer
More common in Male, Smoking, Stress, Medication with pain
killers, H.pylori infection
Dyspepsia ( Indigestion)
Pain or discomfort centered at upper abdomen
Heartburn due to acid regurgitation
Water brash
Gastritis
Pain m/b severe, +/- vomiting, related with meal
Peptic Ulcer (Gastric Ulcer/Duodenal Ulcer)
Ulcer in Stomach or in Early part of Small Intestine

Treatment
Stop smoking, alcohol and coffee drinking
avoid unnecessary use of pain killer
Avoid spicy and pickled foods
Small and frequent intake of easily digestable food at the
time of disease
Followed by of regular meals
Antacidseg., gelucil, zellox & relcers syrups


Diarrhea

Frequent passage of loose/watery stools
Bacterial Diarrhoea.Acute Gastroenteritis,
Viral DiarrhoeaRota Virus in children
Antibiotic Reactioneg., Penicillins
Irritable bowel syndrome (Chronic Diarrhoea)spicy food, milk
Awareness for Signs of Dehydration
Sunken eyes, skin turger, peripheral pulse, Blood Pressure
Fluid Replacement
ORS, Increased fluid intakecoconut water, fruit juice,
Health Education

Dysmenorrhea (Period Pain)

Period pain in reproductive age of female
Low midline abdominal pain
Varies from to dull to severe cramping pain
Usually lasts for 24hrs up to 2-3 Ds
Asso with nausea and sometimes vomiting
Period Pain Management


Promote life style-exercise, stopped smoking and alcohol,
relaxation techniques
Place hot water bottle over painful area
Avoid extreme cold
Medicationeg., Ponstan

Headache

Tension Headache
Tension or muscle contraction headache
Lasts for hours and recurs each day
Associated with cervical dysfunction and stress or tension
Migraine
sick headache-10%, > in female
Pain usually half of the head, +/- eye pain
Classic Migraine-Headache, vomiting and aura
Common Migraine- Without aura

Management
Explanation and reassurance
Advise stress reduction-relaxation, meditation
Avoid trigger factors-food (chocolate, cheese, nuts, coffee), moving
round, watching TV
Medication

Back Pain

Mechanical back pain 72%
Pain at rest, relieve at activity- Inflammation
Pain provoked by activity, relieved with rest- Mechanical dysfunction
Pain with standing/walking, relieve on sitting- Spondylolisthesis
Stiffness at rest, pain with or after activity, relief with rest-Osteoarthritis
Treatment
No bed rest-normal daily activity in 2 days
Regular simple analgesics (PCM)
Swimming



Sports Injury/MVA
Musculoskeletal Injury/Pain(PRICE)
Protect
Rest
Ice
Compression
Elevation


Bruising /Abrasions/ Lacerations

Bruising (contusion) -caused by a blunt force trauma
that damages tissue under the skin, bleeding in
subcutaneous or deeper tissue while leaving the skin
basically intact.
Abrasions (grazes) -superficial wounds in which the
topmost layer of the skin (the epidermis) is scraped off,
common with motor vehicle accident.
Lacerations - Lacerations, irregular tear-like wounds
caused by some blunt trauma.

Management

RICE- Rest, Ice, Compression, Elevation (large
Bruises/Haematomas)
Clean /remove all ground- in dirt, metal,clothing and other
material(Abrasions/Lacerations)
Scrub out dirt with sterile water
Clean with Acraflavine solution,apply protective
dressing(some wound may left open
Immobilise a joint that may be affected by a deep wound( eg.
Arm sling)
Analgesic- Paracetamol/Ponstan

Head injury

Control bleeding- put glove , replace skin flap,
Non fluffy pad over wound
Secure dressing with bandage
Help casualty to lie down-head & shoulders
slight raise
Dial ambulance

Eye injury

Support casualtys head-hold head on your
knees , Keep eye still
Give eye dressing dressing , keep uninjured
eye close
Send to hospital

Severe bleeding-Eg.MVA

Apply pressure to wound-direct pressure to
wound , pad before bandage
Raise & support injured part-raise above heart
Wound bandage-secure bandage firmly, check
circulation
Dial for Ambulance
Treat for shock , monitor casualty-vital signs-
level of response, pulse, breathing


Burns

Cool Burn-pour cold liquid/water for 10mins
Watch for smoke inhalation- difficult
breathing
Remove any constrictions-put glove, do not
apply lotion, ointment, do not touch , do not
remove sticks to burn
Cover Burn-dressing
Send to Hospital


Unconscious patient
Completely unresponsive to any stimulus.
1.Blackouts{episodic (transient) loss of consciousness}- dizziness, weakness
2.Epilepsy steps-- aura, initial rigid tonic phase, convulsion, drowsy, with tongue
biting, incontinence urine/faeces
3.Syncope transient loss of consciousness but with warning symptoms and rapid
return of alertness following a brief period of unconsciousness(seconds to 3
minutes)
(1) Vasovagal attack- with standing, dizzy, faintness, blurred vision, sweating
4.Chocking- suddenly cyanosed, while eating meat, speechless, grasps throat


5.Drop attack - blackouts, suddenly falls, immediately get up again- middle aged
women, Dx- vertebrobasilar insufficiency, Parkinsons disease and Epilepsy
6.Heart Attack- reduce blood flow to brain
7.Cardiac arrhythmias- elderly, sudden blackout in heart block,sick sinus
syndrome,ventricular tachycardia
8. Vertebrobasilar insufficiency- stroke, TIA-Transient Ischaemic attack(minor
stroke),
Hypoglycemia- lightheadedness,sweating, shaking,on Diabetics with insulin/oral
drugs
9. Head injuries Brain injuries of Concussion, contusion, lacerations, skull fracture
10.Shock- reduce blood flow to brain
11. Poisoning
12.Meningitis

Management
Keep the patient alive by maintaining airway and breathing and circulation(ABC)
Get the History from witness
Examine patient- Assess by checking level of response to stimuli using AVPU cod
A- Alert?, V- respond to Voice?, P- respond to Pain?, U- Unresponsive to any
stimulus
Check for ABC- open Airway using jaw thrust method, check Breathing,
Circulation, prepare to give chest compressions and rescue breaths
Bleeding- Apply direct pressure to the wound
Head injury should be treated as neck injury/spinal injury- use log- roll technique
Arrange removal of casualty to hospital if necessary, call to PK/Ambulance



Level of Response

Eyes- Observe for reaction while testing other responses
Open spontaneously 4
Open to speech 3
Open to painful stimulus 2
No response 1
Speech - When testing responses, speak clearly & directly close to casualty ears
Response sensibly to questions 5
Seems confused 4
Uses inappropriate words 3
Incomprehensible sounds 2
No response 1
Movement -Apply painful stimulus, pinch ear lobe or back of hand
Obey commands 6
Points to pain 5
Withdraws from painful stimulus 4
Bends limbs in response to pain 3
Straighten limbs in response to pain 2
No response 1

COMA SCORE = E+M+V
MINIMUN 3/15 , MAXIMUN 15/15
IF 8-10: TAKE CARE- MONITOR THE AIRWAY


Asthma Attack-Action
Allow Casualty to use reliever(blue) inhaler-S/s-difficulty
breath/speak , wheeze, grey-blue lips & skin, exhaustion
Make casualty comfortable-sitting forwards & supporting
upper body by leaning arms
Encourage casualty to breath slowly if attack not ease within
1-3min,encourage to take another dose inhaler to breath
slowly& deeply
For adults/children > 6 years old- 6-12 puff in every
20minutes(first hour)
One puff actuation at atime,4-5 normal breaths each time

Anaphylactic Shock

Causes - Bee stings, food reactions- peanuts/fish, drugs

Treatment
1.Call Ambulance-pass info.-causes of allergy
2.Help to relieve symptoms-anxiety, puffy eyes, impaired
breathing , shock
3.Monitor Casualty-response , pulse, breath



Ask-

1.any drug allergy previously ?
2.Any disease?

ADR(Adverse drug Reaction)

DRUG SHOULD BE PRESCRIBED ONLY
WHEN THERE IS VERY GOOD
INDICATION FOR ITS USE.
CONFIDENCE &COURAGE TO TELL
PATIENT WHEN A DRUG IS NOT
REQUIRED.
Anxiety /Hyperventilation/Panic Attack

Anxiety-worry about various life circumstances
Hyperventilation-lightheadedness, dizziness, aerophagy,
hand spasm, sweating, palpitation
Panic Attack(Discrete period of intense fear or
discomfort)-SOB, unsteady feeling, palpitation, shaking,
uncontrolled fear of doing something, +/- chest pain and
numbness



For Anxiety and Panic Attack:
Use non-medication methods
Explanation, reassurance
Coping skills, stress management
For Hyperventilation:
breathe in and out of paper bag
Stop excessive taking of coffee and smoking


MANGSA
AHLI BSMM
RAWATAN AWAL DI TEMPAT
KEJADIAN
SERIUS
RAWATAN LANJUT DI
BILIK RAWATAN
YA
MASA
MASA
LAIN
TELEFON DR.
ONCALL
WAKTU
BEKERJA
BAWA KE PUSAT
KESIHATAN UKM
RAWATAN OLEH DOKTOR
TIDAK
Carta Alir Rawatan Di Kolej

PENGGUNAAN UBAT-UBATAN

Zellox suspension - sakit gastric,minum sebanyak 15ml( 2 -3penutup botol) x
3kali/hari.
Tab Actal/ GELUSIL - sakit gastric, 2bijix3 kali/hari,
Panadol - sakit kepala, badan sakit, demam-500mg 2 biji x3-4 kail/hari,
Ponstan 250mg - sakita kepala,badan, senggunggut dan sakit lain-con: terseliuh, 2
biji x 3 kal
Ultracarbon/Eucarbon- Keracunan makanan ringan& cirit- birit, 1 bijix3
kali/hari,
ORS(Oral Rehydration Solution) - 250ml air masak/mineral bagi sebungkus,
Menzza cream -sakit otot, sendi,terseliuh & kekejangan otot- sapukan
Burnol plus cream - luka kecil, ruam,melecet dan gigitan serangga-sapukan
Flavine/Acraflavine lotion - antiseptic,luka sahaja
Calamine lotion - alergi kulit,ruam& kulit gatal

Ebola Virus
Pusat Kesihatan-Bahagian Kecemasan Dan Kemalangan

Kes-Kes Kecemasan bagi perkhidmatan rawatan Kecemasan selepas waktu
Pejabat@Atas Panggilan( Oncall)-Contoh:
Kesukaran bernafas/Lelah/Asma Akut
Tercekik
Sakit Jantung/Dada yang berturusan
Tidak sedarkan diri(koma) atau mengalami renjatan(shock)
Kemalangan jalanraya dengan kecederaan serius
Wanita hamil yang mengalami sakit perut/turun darah
Keracunan Makanan
Overdose Ubat-Ubatan
Luka atau melecur yang teruk akibat kebakaran
Sengatan binatan berbisa(spt: Ular,Lipan,Kain Jenking,Tebuan dan sbg.)
Serangan sawan/epilepsi
Pesakit jiwa yang mengganggu Ketenteraman awam
Kes hendak bunuh diri(Attempt suicide)
Demam panas yang tinggi(>39.5.C)
Sakit yang kuat hingga pesakit tidak bermaya/terlalu lemah



Kes-kes
Kecemasan yg.
Membahayakan
nyawa
&memerlukan
rawatan paling
segera hendaklah
dihantar terus ke
unit Kecemasan
Hospital
Serdang/Kajang