First Aid - Prehospital Care

“Welcome”
21-November-2004 Dr. T. R. Bhadran 1

First Aid
 Presented by: Dr. T.R.Bhadran, MBBS; DTM&H; D.Ortho,.
Civil Surgeon & Orthopaedic Surgeon,Taluk Hospital, Cherthala.

Definition
suddenly sick―Firstor injured

aid is the initial care of a
person‖ ,
( pre-hospital care) the aims being
 To preserve life
 To prevent further harm
 To relieve pain

 What to do in an emergency?
 Immediate action
 Don’t panic
 Get help
 Reassurance

Immediate action
 Fix priority
 Remain calm & controlled
 Think before acting
 Actions should be deliberate

Calling for help
 Ambulance/fire/police/doctor/hospital
 Stay on line until the called person gets

the proper message

Information to be conveyed
from remote area
 Exact address or location

 City or town
 Nearest junction or street
 Landmarks
 Distance from
 Callers identity
 Caller’s phone number
 Explain the incidence
 Number and condition of casualties
 Explain aid available & urgency

Explaining aid available &
urgency in a hospital casualty situation
 Type & Time of accident

 Number of casualties, age & sex
 Did they walk in / were carried in?
 First aid given
 Body parts injured
 Has an X-ray been taken?
 Urgency:- Can the case wait until the called person
completes more serious work at hand, while first aid
is being given & an X-ray is being taken?

Methods to call for help…………
 Direct – Call aloud, Clapping, Drumming

 Phone- land/mobile
 Wireless set
 Flag flares
 E-mail
 Personal locator beacons
 Medical alert devices

Reassurance*:-
 Emotional support
 Keep the casualty informed
 Comfort the casualty
 Console relatives of the casualty
 Get the relatives involved in helping
 Explain the situation to the concerned

First aid Kits*
 Adhesive strips
 Hand towels – 3
 Adhesive tape – 1 roll
 Non adhesive dressings
 Alcohol swab
 Plastic bag for amputations

 Combine dressings
 Safety pins, blades, scissors
 Crepe bandages 5 & 7.5 cms
 Splints
 Triangular bandages
 Gauze swab
 Wound dressings
 Gloves disposable
 CPR barrier devices

*Triage*(pronounced „tree-ahz‟)
Sorting and classification of casualties and
establishment of treatment priorities in
mass casualty situations.
Ask 3 questions
 Who can be saved?
 Who will & who won’t benefit?
 If I treat this case will the others suffer?

High priority!!!
 Unconscious casualty on his back!

 Severe bleeding!
 Head & face injury!
 Shock!
 Chest, Abdominal & Pelvic injury!
 Respiratory embarrassment!
 Severe burns!
“Approaching the scene”
 Examine the scene
 Control the scene with help
 Assess the scene
 How many casualties are there?
 Gain access to the casualty
 Assess the casualties
 Triage the casualties
 Attend to the casualty
“GOLDEN HOUR”
 Period during which all efforts are made to

save life before irreversible pathological
changes take place, period from time of
injury to getting definitive treatment

„Platinum minutes‟
 The first 10 minutes of golden hour
 Assessment & injury survey – 1 min
 Resuscitation & stabilization – 5 min
 Immobilization & transport - 4 min

Attending the casualty-assess
 Shock
 Respiration
 Airway
 Bleeding
 Consciousness
 Injuries

Shock
Identify by
 Cold limbs
 Pale skin
 Shallow breathing
 Vomiting
 Shivering
 Lying on back

Shock
What to do
 Keep him lying down

 Elevate the legs
 Stop bleeding from wounds
 IV line

Bleeding from wounds
 Have the injured person lie down
 Remove any obvious dirt or debris from the wound
 Apply pressure directly on the wound
 Maintain pressure until the bleeding stops
 Don't reposition displaced organs
 Don't remove the gauze or bandage
 Squeeze a main artery if necessary
 Bind with tight bandage & immobilize the injured
body part once the bleeding has stopped
Bleeding from nose
Usually stops within a few minutes
 Lean forward
 Pinch the bridge of the nose & mouth-breathe
 Apply a cool wet cloth to the face & nose
 Apply ice covered with cloth on bridge
 Don’t pick or blow nose after bleeding stops
 Decongestant nasal sprays

Respiratory arrest
No voluntary breathing movements
 Clear the airway &/or Heimlich maneuver

 Artificial respiration
 Mouth to mouth
 Intubations & Ambue bag / respirator
 Tracheostomy (in expert hands only)

Choking
Choking is often the result of inadequately chewed
food becoming lodged in the throat or windpipe.
Solid foods such as meat are frequently the cause
 Talking while simultaneously chewing
 Drinking alcohol while eating
 Wearing dentures
 Young children tend to put into their mouths

Choking
 Panic
 An expression of fear or terror
 The victim may turn purple
 The eyes may bulge
 May wheeze or gasp
 Can speak if block is partial / no if not.

Heimlich maneuver
-in a conscious adult
 Stand behind him, wrap your arms around his
waist, bend him slightly forward.
 Make a fist with one hand and place it slightly
above the person's navel, grasp your fist with the
other hand
 Press hard into the abdomen with a quick,
upward thrust
 Repeat this procedure until the object is expelled
from the airway

Heimlich maneuver
-in an unconscious adult
 Position adult on his back, look inside the mouth
 Sweep the area with your finger
 See if you can remove the blockage.
 If not, kneel over the person and apply upward
thrusts to the upper abdomen
 Repeat the process as necessary to remove the
blockage

Heimlich maneuver
-in a choking infant
 Assume a seated position and hold the infant
facedown on your forearm, which is resting on
your thigh
 Thump the infant gently but firmly five times on
the middle of the back using the heel of your hand
 Repeat till breathing resumes
 The combination of gravity and the back blows
should release the blocking object

Heimlich maneuver
-in a pregnant woman & in obese
Position your hands a little bit higher than

with a normal Heimlich maneuver, at the base
of the breastbone, just above the joining of
the lowest ribs

Cardiopulmonary resuscitation
 Combination of mouth to mouth rescue
breathing and chest compression
 Chest compression to move blood to vital organ

like brain,lungs and heart
 Rescue breathing to oxygenate the blood

CPR
 Check signs of life
 Position person on back on hard surface
 Lift chin forward to open airway
 Watch for spontaneous breathing, if nil 
 Pinch his nostrils
 Breath into his mouth @ 12 breaths/min
 Completely refill your lung after each breath
 What if still there are no signs of life?
 No response,movement or breathing??
 Begin chest compressions

 Place heel of both hands on lower end of chest bone
 Keep elbows straight
 Lean forward and press making use of your weight
 Push down 1.5 to 2 inches @ 80 –100 times/min
 Between 15 each compressions breath into him twice
 Check for signs of life after every four cycles of 15
compressions and 2 breaths: namely neck pulse,
spontaneous breathing movement and/or cough.

Head trauma
Signs
 Severe head or facial bleeding
 Changes in level of consciousness
 Blue-black discoloration near eye or ear
 Cessation of breathing
 Confusion
 Loss of balance
 Weakness or inability to use arm or leg

Head injury
What to do
 Keep him lying down

 Hold him still
 Avoid moving the neck
 Stop any bleeding
 Watch out for respiratory &/or cardiac arrest

Chest injury
What to do
 Seal all penetrating wounds with occlusive

dressing & prevent pneumothorax
 Clear the airway
 Take care, avoid chest compression
 Plaster strapping in flail chest

Abdominal injury
What to do
 Care of wounds
 Don't reposition displaced organs
 Abdominal binders

Spine injuries
Assessment
 ? Other associated head injury

 C/o pain in neck or back
 Weakness, numbness or paralysis or loss of
control over a)limbs,
b)bladder
c) bowel

Spine injuries
What to do
 Keep the person still

 Stabilize the neck with a heavy towel
 Never ever move the neck
 Transport on hard board or wooden plank
 Move with help of several people support
 If alone, drag by his clothing, never turn him
 Or, leave him in position he was found
Crush Injury Syndrome
Why serious?
 A casualty trapped by compressing force for

prolonged period
 Collection of large quantities of acid and
electrolytes and toxins in the crushed muscle
 On release of compressing force, the liberated
blood carries the toxin in high quantities to the
vital organs with fatal results

Criteria for assessment:
Large muscle mass involved

Prolonged compression
Compromised blood circulation

Signs and symptoms
 Compression in excess of 60 min
 Large muscle mass
 Absent pulse or capillary distal to crush
 Pale, cool, clammy skin
 Weak rapid pulse
 Absence of pain in the affected limb
 Onset of shock
Care and first aid
 If < 1hr, release the crushing force

 If > 1hr, do not relieve crush
 Tourniquet- to or not to?
 Reassure the casualty
 Treat any other associated injuries

Dislocations
―Injury to joint where the ends of bones are forced
from their normal positions.‖
 Splint the affected joint into its fixed position.

Don't try to move a dislocated joint or force it
back into place. This can damage the joint and
its surrounding muscles, ligaments, nerves or
blood vessels.
 Put ice on the injured joint.

Fractures
Diagnosis
 Pale, cool, clammy skin & rapid, weak pulse
 Pain & Tenderness at the site
 Loss of power to limb
 Associated wound and blood loss
 Associated organ damage
 Deformity &/or Crepitus (never attempt to elicit)
 If doubtful compare with opposite normal limb

Fractures
Immobilize the part- why & how:
 A splint stabilizes & reduces pain

 Include the joints above and below the fracture in
the immobilization technique used & prevent
unwanted movement
 Don't attempt to align the bone back into position
 The splint should be longer than the bone it is
splinting and extend above and below the injury
Fractures
Cont’d
 Use a rigid material such as wood, plastic metal,

tree branches or even rolled paper. Pad the splint
 Fasten the splint to the limb with gauze, strips of
cloth or string, or even a belt. Start wrapping from
the extremity and work toward the body. Splint
the limb firmly to prevent motion but not tight
enough to stop blood flow

Fractures
Ideal equipments
 Arm sling
 Elevated sling
 Collar & cuff (clove hitch) sling
 Triangular bandage
 Thomas splint
 Collars (hard/soft)
 Foldable trolley with body straps
Anatomical immobilization
 Finger to finger
 Forearm & arm to chest (use cuff button)
 Leg-to-leg & Thigh-to-thigh

Sprains
―Injury to a ligament caused by excessive stretching‖
 Protect the injured limb from further injury

 Rest the injured limb.
 Ice the area.
 Compress the area with an elastic wrap or bandage.
 Elevate the injured limb

*PAIN KILLERS*
 ―There is no better painkiller so good as

good immobilization of an injured limb‖

Drowning
 Without placing yourself at risk, remove the
casualty from the water
 Make sure that his/her head is kept low, this will
discourage the threat of inhaling one's vomit
 Once on land/pool-side perform mouth -to-
mouth resuscitation
 Wrap them as quickly as possible with a blanket
 Look/Listen or Feel for signs of breathing
 CPR

Heart attack
Tell-tale symptoms & signs
 Uncomfortable pressure, fullness or squeezing
pain in the center of chest, lasting more than a few
minutes
 Pain spreading to shoulders, neck or arms
 Lightheadedness, fainting, sweating, nausea or
shortness of breath

Heart attack
 Seat the casualty comfortably
 Call for emergency medical assistance
 Open windows and let fresh air in
 Decide on the fastest method of transportation
 Chew aspirin
 IV line
 Monitor breathing and pulse
 CPR if need be

Epilepsy
 Allow the seizure to run its course
 Place a soft padding around his/her head
 Try and move objects away from the individual
 Don’t attempt to put objects into epileptic's mouth
 Don't restrain the epileptic
 Wait for the jerking movements to cease
 Place the casualty in the recovery position
 Offer comfort and reassurance
Stroke
Occurs when there's bleeding into brain, or normal
blood flow to brain is blocked.
Within minutes of being deprived of essential

nutrients, brain cells start dying — a process that
may continue over the next several hours.

Stroke
Symptoms are sudden like bolt from the blue
 Weakness or numbness in your face, arm or leg on one
side of your body
 Dimness, blurring or loss of vision, particularly in one
eye
 Loss or trouble of speech
 Severe headache, disorientation
 Unexplained dizziness, unsteadiness or fall

Stroke
True emergency
 Seek immediate medical assistance.
 The faster treatment is given, the more likely
damage can be minimized.
 Every moment counts.
 Remember: The longer a stroke goes untreated,
the greater the damage and potential disability.
Success of treatment may depend on how soon
you receive care

Food poisoning
 Avoid milky drinks or anything acidic such as
soft drinks
 Drink plenty of fresh, boiled water constantly

Poison ingested
 Call emergency services immediately
 Do not force the individual to vomit
 If the casualty has taken corrosive poison , it
would be best to give the person sips of water or
milk
 Use the A B C technique and be prepared to
carry out resuscitation
 Be sure to place a conscious or unconscious
individual in the recovery position until help
arrives
Burns
Superficial Burn (First Degree)
 Involves only the top layer of skin.

 The skin is red and dry and usually painful.
 The burned area may also swell.
 The underlying skin is healthy.

Burns
What to do
 Treat immediately with cool water. Keep the burn

under the water until there is little or no pain.
 Then apply a moist dressing, and bandage loosely.
 Where water is not available, apply a clean, dry
dressing.

Burns
Partial-thickness Burn (Second Degree)
 Involves the partial layers of skin

 The skin is red with blisters
 May open and weep clear fluid
 Giving the skin a wet appearance
 The area may also appear mottled
 Usually painful and often swells

Burns
What to do
 Do not break the blisters - this will compound the

injury by causing an open wound.
 If the blisters are not open, place in cool water until
the pain lessens,
 Then apply a moist dressing, and bandage loosely.
 Do not apply creams, ointments, or sprays.

Burns
Full-thickness Burn (Third Degree)
 Destroys all layers of skin

 Destroys any or all of the underlying structures
 The burn appears brown or black (charred) with
the tissues underneath sometimes appearing white.
 Extremely painful or relatively painless if the
burn destroys the nerve endings.
Burns
What to do
 Do not apply creams, ointments, or sprays.

 Wrap a clean sheet around the victim and,
 If the weather is cool, cover them with blankets.
 The victim should be rushed to hospital because
their life is at stake.

Burns
Chemical Burns
 Remove the chemical immediately

 Flush the area with large amounts of cool running
water
 Remove any clothes with chemicals on them
 Be careful not to spread the chemical to other
body parts or to yourself.

Burns
Electrical Burns
 The power source has been turned off.
 If the victim is unconscious, check breathing and pulse.
 Check for other injuries
 Do not move the victim because he may have spinal
injuries.
 Cover an electrical burn with a dry, sterile dressing.
 Do not cool the burn. There may be two wounds, one
where the current entered the body and one where it left,
and they may be deep.
Cuts & scrapes
Wear latex gloves & avoid direct contact
with body fluids
 Stop the bleeding.
 Clean the wound.
 Apply an antibiotic.
 Cover the wound.
 Change the dressing.
 Get stitches for deep wounds.
 Tetanus toxoid
Part of body torn off
 Find the part
 Wrap it in clean dressing
 Put the bag on ice, but don’t freeze
 Take the part to the hospital

Bruise
 Forms when a blow breaks small blood vessels near
the skin's surface
 A small amount of blood leaks out under the skin
 The trapped blood appears as a black-and-blue mark
 Sometimes, there are tiny red dots or red splotches
 The skin isn't broken

Bruise
First aid measures
 Doesn't need a bandage.

 Elevate the injured area.
 Apply ice or a cold pack for 30 to 60 minutes

Muscle cramps
Symptoms & signs
 Painful, involuntary muscle spasms that usually

occur during heavy exercise in hot environments.
Inadequate fluid intake often contributes to this
problem
 Muscles most often affected include calves,
arms, abdomen and back

Muscle cramps
 Rest briefly and cool down
 Drink water or an electrolyte-containing
sports drink
 Practice gentle, range-of-motion
stretching and gentle massage of the
affected muscle group

Foreign object in the skin
If not deeply embedded
 Use tweezers to remove slivers of wood or

fiberglass, small pieces of glass or other foreign
objects projecting from your skin.
 Clean the area well with soap and water and
apply alcohol to the wound.

Foreign object in the skin
If deeply embedded
 Clean the area well with soap and water.

 Break the skin over the object with the Sterile needle.
 Use tweezers to remove the object. A magnifying
glass may help you see the object better.
 Apply antibiotic ointment to the area.
 If the particles don't come out easily, cover with
sterile pad and seek medical help
Foreign body in ear
 First aid procedures
 Don't probe your ear with a tool.

 Remove the object if possible.
 Try using gravity.
 Try using oil for an insect.
 Don't use oil to remove any object other than an
insect.

Foreign body in nose
 Don't probe at the object with any tool
 Don't try forcefully breathing in & inhale the object
 Breathe through mouth until the object is removed
 Blow nose gently to try to free the object
 If the object is visible and you can easily grasp it with
tweezers, gently remove it
 Or else call for emergency medical assistance

Foreign body in eye
 What to do
 Seat the person in a well-lighted area.
 Try to locate the object
 If the object is floating in the tear film or on the
surface of the eye, you may be able to flush it out
or remove it manually
 If the object is large . Don't remove the object
cover the eye and the object with a paper cup
 Seek emergency medical assistance

Corneal abrasion
 Extremely painful, because the cornea is very

sensitive
 Feeling of sand in eye
 Tears
 Blurred vision
 Increased photo sensitivity
 Redness around the eye
Corneal abrasion
 Rinse the eye with lukewarm clean tap water over
the eye or splash the eye with clean water. This may
wash out the offending foreign body. Blink several
times. This movement may remove small particles
of dust or sand.
 Pull the upper eyelid over the lower eyelid. The
lashes of the lower eyelid can brush the foreign
body from the undersurface of the upper eyelid.

Black eye
 Bleeding beneath the skin around the eye

 Sometimes indicates a more extensive injury,
even a skull fracture, particularly if the area
around both eyes is bruised or if there has been
head trauma.

Black eye
Using gentle pressure, apply ice or a cold pack to the
area around the eye for 10 to 15 minutes
 Do not to press on the eye itself.
 Apply cold as soon as possible after the injury to
reduce swelling.
 Be sure there's no blood in the white and colored
parts of the eye.

Tooth loss
 Handle the tooth by the top only, not the roots.
 Don't rub it or scrape it to remove dirt.
 Gently rinse the tooth in a bowl of tap water
 Try to replace the tooth in the socket. Then bite
down gently on gauze to help keep it in place. If
you can't, immediately place it in milk, or , saline
 Apply sterile gauze in the gap left by lost tooth

Fainting
Occurs when the blood supply to the brain is
momentarily inadequate, causing one to lose
consciousness for a brief spell.
 Position the person on his or her back.

 Watch the airway carefully
 Check for breathing
 Help restore blood flow

Motion Sickness
It can strike suddenly, progressing from a feeling of
restlessness to a cold sweat, dizziness and then
vomiting
 By ship:request a cabin in the middle of the ship,
near the waterline
 By plane:ask for a seat over the front edge of a
wing. Once aboard, direct the air vent to your face
 By train:take a seat near a window and face
forward
 By road:drive or sit in the front passenger's seat
Motion Sickness
 Focus on the horizon or on a distant, stationary
object. Don't read.
 Keep your head still, resting against a seat back.
 Don't smoke or sit near smokers.
 Avoid spicy foods and alcohol. Don't overeat.
 Take anti-emetics on eve of journey

Snake bite
 Poisonous Non-poisonous
Fright & fear + Fright & fear +

Fang marks + Fang marks nil
Local reaction + / -- Local reaction nil
Systemic signs + Systemic signs nil

Snake bite
 Remain calm & don't try to capture the snake
 Immobilize the bitten arm or leg and try to stay
as quiet as possible
 Don't cut the wound or attempt to remove the
venom
 Don't use a tourniquet or apply ice
 Seek medical attention as soon as possible,
especially if the bitten area changes color, begins
to swell or is painful.

Insect stings
 Move to a safe area to avoid more stings
 Scrape off the stinger with a straight-edged object
 Don't try to pull out the stinger doing so may release
more venom.
 To reduce pain and swelling, apply ice or a cold pack
 Apply 0.5 percent or 1 percent hydrocortisone cream,
calamine lotion or a baking soda paste
 Antihistamine

“ All‟s well that ends well ”
The clean up
 Take a break, relax and breathe easy

 Talk about the incidence with peers
 Clean up the scene
 Clean equipment and restock your first aid kit
 Replace all items used
 Complete any documentation needed

“The purpose of life is to serve
and show compassion and the
will to help others”
So,
“Help…………………………”
Thank you

First Aid - Prehospital Care

Caricato da

Informazioni sul documento

Copyright

Formati disponibili

Condividi questo documento

Condividi o incorpora il documento

Opzioni di condivisione

Hai trovato utile questo documento?

Questo contenuto è inappropriato?

Copyright:

Formati disponibili

First Aid - Prehospital Care

Caricato da

Copyright:

Formati disponibili

“Welcome”

21-November-2004 Dr. T. R. Bhadran 1

21-November-2004 Dr. T. R. Bhadran 2

suddenly sick―Firstor injured

21-November-2004 Dr. T. R. Bhadran 3

21-November-2004 Dr. T. R. Bhadran 4

21-November-2004 Dr. T. R. Bhadran 5

 Stay on line until the called person gets

21-November-2004 Dr. T. R. Bhadran 6

 Exact address or location

21-November-2004 Dr. T. R. Bhadran 7

 Type & Time of accident

21-November-2004 Dr. T. R. Bhadran 8

 Direct – Call aloud, Clapping, Drumming

21-November-2004 Dr. T. R. Bhadran 9

21-November-2004 Dr. T. R. Bhadran 10

21-November-2004 Dr. T. R. Bhadran 11

21-November-2004 Dr. T. R. Bhadran 12

21-November-2004 Dr. T. R. Bhadran 13

 Unconscious casualty on his back!

 Period during which all efforts are made to

21-November-2004 Dr. T. R. Bhadran 16

21-November-2004 Dr. T. R. Bhadran 17

21-November-2004 Dr. T. R. Bhadran 18

21-November-2004 Dr. T. R. Bhadran 19

 Keep him lying down

21-November-2004 Dr. T. R. Bhadran 20

21-November-2004 Dr. T. R. Bhadran 22

 Clear the airway &/or Heimlich maneuver

21-November-2004 Dr. T. R. Bhadran 23

21-November-2004 Dr. T. R. Bhadran 24

21-November-2004 Dr. T. R. Bhadran 25

21-November-2004 Dr. T. R. Bhadran 26

21-November-2004 Dr. T. R. Bhadran 27

21-November-2004 Dr. T. R. Bhadran 28

Position your hands a little bit higher than

21-November-2004 Dr. T. R. Bhadran 29

 Chest compression to move blood to vital organ

 Rescue breathing to oxygenate the blood

21-November-2004 Dr. T. R. Bhadran 30

 Begin chest compressions

21-November-2004 Dr. T. R. Bhadran 32

21-November-2004 Dr. T. R. Bhadran 33

 Keep him lying down

21-November-2004 Dr. T. R. Bhadran 34

 Seal all penetrating wounds with occlusive

21-November-2004 Dr. T. R. Bhadran 35

21-November-2004 Dr. T. R. Bhadran 36

 ? Other associated head injury

21-November-2004 Dr. T. R. Bhadran 37

 Keep the person still

 A casualty trapped by compressing force for

21-November-2004 Dr. T. R. Bhadran 39

Large muscle mass involved

21-November-2004 Dr. T. R. Bhadran 40

 If < 1hr, release the crushing force

21-November-2004 Dr. T. R. Bhadran 42

 Splint the affected joint into its fixed position.

21-November-2004 Dr. T. R. Bhadran 43

21-November-2004 Dr. T. R. Bhadran 44

 A splint stabilizes & reduces pain

 Use a rigid material such as wood, plastic metal,

21-November-2004 Dr. T. R. Bhadran 46

21-November-2004 Dr. T. R. Bhadran 48