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FIRST AID

WHAT IS FIRST AID?


First Aid is the immediate assistance or treatment given to someone injured or suddenly
taken ill before the arrival of an ambulance, doctor or other qualified medical personnel.
In minor emergencies, first aid may prevent a victim’s conditions from worsening and
provide relief from pain. First aid must be administered as quickly as possible. In the
case of the critically injured, a few minutes can make the difference between complete
recovery and loss of life.
First Aid is a skill based on knowledge training and experience. The term First Aider is
usually applied to someone who has completed a theoretical and practical instruction
course, and passed a professionally, supervised examination.
A certificate is valid for only three years to keep up to date you must be reexamined
after further training to broaden the scope of your skill.
The treatment is only of an emergency kind and in all cases of serious accident a doctor
should be informed, send to hospital or advice to seek medical aid.
AIM OF FIRST AID (WHY DO WE GIVE FIRST AID)

1. To preserve life:-
a) Maintain an open airway
b) Give Artificial Respiration
c) Control bleeding
2. To prevent the condition worsening
a) Dressing of wounds
b) Immobilize of Fracture
3. To promote recovery
a) Re – assure casualty and relieve casualty from pain and discomfort.
b) Handle the casualty with care.
c) Protect the casualty from cold or wet.

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RESPONSIBILTY OF THE FIRST AIDER

1. Assess the situation


2. Identify the disease or condition (diagnosis)
3. Give immediate, appropriate and adequate treatment.
4. Disposal of casualty (send to hospital)

a. Assess the situation without endangering your own life.


b. Identify the disease or condition from which the casualty is suffering.
c. Give immediate appropriate and adequate treatment.

DIAGNOSIS
HISTORY: - This is the full story of how the incident occurred or the illness began and
should be taken directly from the casualty and a responsible by stander or possible
materials around (surrounding) Example
a) I slipped and fell down.
b) I saw the recruit fall and his head hit the wall.
c) Broken bottles and poison container around.
SIGNS: - These are details ascertained by the first aider. Bleeding, wounds, swelling,
deformity, crepitus, tenderness, temperature, pulse.

SYMPTOMS:- These are sensations that the casualty feels and tells you. Pain, Cold,
Heat, Thirst, Nausea, Weakness, Dizziness.

TREATMENT:- Carry out the appropriate treatment for each condition found, gently
and quickly. It is most important that you reassure and encourage the casualty.

AFTER TREATMENT
1. Send casualty to the hospital.
2. Handover to qualified medical personnel.
3. Allow him to go home and advise him to seek medical advice.

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VICTIM ASSESSMENT:-
Do not move the injured or suddenly ill person until you have a clear idea of the injury
or illness and have applied first aid. The exception occurs when the victim is exposed to
further danger at the accident scene.
When making a victim assessment, a first aider will consider what witnesses to the
accident can tell about the accident, what is observed by the first aider and what the
casualty can tell. In order to provide good first aid, a person should be able to identify a
victim’s injury or sudden illness and determine its seriousness.
To find out what is wrong and how extensive it is, the first aider should follow a
systematic approach known as a VICTIM ASSESSMENT.
THE VICTIM ASSESSMENT ATTEMPT:-
a) To gain the victim’s consent.
b) To gain the victim’s confidence.
c) To identify the victim’s problem and determine which of them require immediate
first aid.
A victim assessment of either the injured victim or a medically ill victim is divided into
two steps
a) Primary Survey
b) Secondary Survey

PRIMARY SURVEY
The primary survey covers these areas
A. ------------------------------------- Airway
B. ------------------------------------ Breathing
C. ------------------------------------ Circulation
D. ------------------------------------ Hemorrhage

The primary survey is the first step in assessing a victim. Its purpose is to find and
correct life threatening conditions

AIRWAY: - Does the victim have an open airway? If the person is talking or is conscious,
the airway is open. If it is not open, open it by lifting the chin and thrusting the jaw.
BREATHING: - Is the victim breathing? Conscious victims are breathing. However note
any breathing difficulties. If the victim is unconscious, keep the airway open and look for

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the chest to rise and fall, listen for breathing and feel for expired air out of the victim’s
nose and mouth.
CIRCULATION: - Is the victim’s heart beating? Feel the pulse at the side of the neck
(carotid pulse) if there is a pulse, there is a circulation. If there is no pulse, then there is
no circulation
HAEMORRHAGE:- Is the victim severely bleeding? Look over the victim entire body for
any blood soaked clothing as a sign for severe bleeding.
Having completed the primary survey and attended to life threatening problems it
uncovers, take a closer look at the victim and make a systematic assessment called a
secondary survey.

SECONDARY SURVEY:-

The secondary survey is a clue to discover problems that do not pose an immediate
threat to life but may do so if they remain uncorrected. You look for important signs
and symptoms of injury. The secondary survey is a head to toe examination. Start by
examining the victim’s head, the neck, trunk and extremities, looking for
abnormalities such as swelling, discoloration and tenderness.

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BASIC LIFE SUPPORT
What is CPR? – It means Cardio – Pulmonary Resuscitation. It is the combination of
rescue breathing (mouth to mouth respiration) and external chest compressions.
Cardio refers to the heart.
Pulmonary refers to the lungs
Resuscitation means to revive.

Proper and prompt CPR serves as a holding action by providing oxygen to the brain and
heart.

CPR can save heart attack victim, drowning, suffocation, electrocution or drug over
dose, use CPR any time a victim’s breathing and heart have stopped and use rescue
breathing whenever there is a pulse but no breathing.

WHEN TO START CPR:-


C.P.R is started within the first four minutes of heart stoppage. Advanced cardiac life
support within the next four minutes. Brain damage begins after four to six minutes and
certain after ten (10) minutes when no CPR is given.

WHEN TO STOP CPR:–


Stop resuscitation when
1. Victim revives [regain pulse and breathing]
2. Replaced by another trained rescuer
3. Too exhausted to continue
4. Scene became unsafe
5. A physician tells you to stop.

WHEN NOT TO START CPR


(1) When positive signs of death appear
(2) Severe mutilation
(3) Rigor mortis (Stiffening of the body after death)
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[4] Evidence of tissue decomposition.
[5] Lividity [Purple – reddish color showing on parts of body closet to ground]

HOW DOES CPR WORK?


Chest compression and/or direct heart compressions create enough pressure within the
chest cavity to cause blood to move through the heart and circulatory system.
Chest compressing:- Effectively provided only one-fourth to one third of normal blood
flow.
Rescue Breaths: - Provide 16% oxygen content enough to sustain life.

ADULT RESCUE BREATHING AND CPR:-


(A) If you see a motionless person check responsiveness
Tap or gentle shake victim’s shoulder or shout near victim’s ear
“Are you ok?
(B) Open Airway:-
1. Check for breathing
2. Give 2 slow breaths if there is no breathing.
3. Check for pulse
4. If there is a pulse but no breathing, give rescue breathe every 5 to 6 seconds.
5. If there is no pulse, give C.P.R ( doing the following)
a. Do 30 compressions
b. Give 2 slow breaths
c. Complete 5 cycles of 30 compressions and 2 breaths and check for pulse.

CHOKING
Foreign Body Airway Obstruction
If person is conscious and cannot speak, breathe or cough, give up 5 abdominal thrust.
(a) Stand behind the victim
(b) Wrap your arms around victim’s waist
(c) Make a fist with one hand place the thumb side just above victim’s naval and well
below the tip of the sternum
(d) Grasp fist with your other hand

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(e) Press fist into victim’s abdomen with 5 quick upwards thrusts.
(f) Each thrust should be a separate and distinct effort to dislodge the object.
After every 5 abdominal thrust, check the victim and your technique.
For advance pregnant women and obese victim consider using the chest thrust.
Repeat cycles of up to 5 abdominal thrusts till
(a) Victim coughs up object
(b) Victim starts to breathe or coughs forcefully
(c) Victim becomes unconscious

Reassess victim and your technique after every 5 thrusts.

BASIC LIFE SUPPORT

ADULT RESCUE BREATHING AND CPR

(1) If you see a motionless person, check for responsiveness by tap or gently shaking
the victim’s shoulder. Also you can shout near his ear. “Are you ok”
(2) Roll victim onto back; gently roll victims head, body and legs over the same time. Do
this without further injuring the victim.
(3) Open airway by tilting the head or lifting the chin. Do not move victim’s head or
neck, if you suspect a neck injury. Place fingers of hand under bony part of haw near
chin and lift or tilt head backward.
(4) Check for breathing, take only 3 – 5 seconds place your ear over victim’s mouth and
nose while keeping airway open and look at victim’s chest to check for rise and fall,
listen and feel for breathing.
(5) Give 2 slow breaths if victim is not breathing. Open the airway, punch nose shut and
take a deep breath and seal your mouth around victim’s mouth. (Mouth to mouth
respiration) give 2 slow breaths (You should take a breath after each breath given to
victim) watch chest rise to see if your breath go in. Allow for chest deflation after
each breath. (a) If you cannot use victim’s mouth e.g. injured, teeth clenched etc.
Seal your lips around victim’s nose (mouth to nose) and breathe into nose, remove
your mouth to allow exhalation.

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If neither of these 2 breaths went in, re-tilt the head and try 2 more breaths. If
still unsuccessful, suspect choking.

(6) If the breaths went in check for pulse. Still maintain head tilt with one hand nearest
head on forehead, locate Adam’s apple with 2 or 3 fingers of hand nearest victim’s
neck. Slide your fingers down into grove of neck on side closest to you (do not use
your own thumb because you may feel your own pulse) feel the carotid pulse (5 -10
seconds)
(7) IF THERE IS A PULSE BUT NO BREATHING: - Give one breath every 5 to 6 seconds.
Every minute give 10 to 12 breath, stop and check for pulse.
Continue until,
(a) Victim Starts breathing on his or her own
(b) Relieve by another trained rescuer
(c) Completely exhausted

IF THERE IS NO PULSE

Give cardiopulmonary resuscitation CPR


1. Use your fingers to slide up rib cage edge nearest to the notch at the end of
sternum.
2. Place your middle finger on or in the notch and index finger next to it.
3. Put heel of other hand on sternum next to index finger and remove hand from
the notch and put it on top of hand on chest, interlock, hold or extend fingers up.
Do 30 chest compressions.
4. Give 2 slow breaths and complete 5 cycles of 30 compressions and 2 breaths (one
minute) and check the pulse.

If there is no pulse, restart CPR with chest compression, recheck the pulse every few
minutes, if there is a pulse, give 1 rescue breath every 5 to 6 seconds until victim
revives

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INFANT AND CHILD RESCUE BREATHING (CPR)

CHILD
Give 1 breath every 3 seconds instead of 1 breath every 5 to 6 seconds in adult.

Use only one hand to give chest compressions while keeping other hand on the
forehead. Adult require 2 hands on victim’s chest for compressions.

Give one breath after every 5 chest compression.


Look into mouth remove foreign body only if seen with finger sweep – do not perform
blind finger sweeps. In an adult you can perform blind finger sweeps.

INFANT
(a) Check for pulse – feel for pulse location on the inside of the upper arm between
elbow and armpit (Known as the brachial). Press gently with 2 fingers on inside
of arm closest to you.
(b) Place 3 fingers on sternum with index finger touching but below imaginary
nipple line
(c) Give 5 chest compressions at rate of 100 per minutes of count as you push down
one, two, three, four, and five”.
(d)
(e) Give 1 breath, complete 20 cycles of 5 chest compressions and one breathe
(takes about 1 minute) and check the pulse.

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CHOKING
CONSCIOUS ADULT FOREIGN BODY AIRWAY OBSTRUCTION
If a person is conscious and cannot speak breathe or cough, give up to5 abdominal
thrusts

1. Stand behind the victim


2. Wrap your arms around victim’s waist(do not allow your forearms to touch the
ribs)

3. Make a fist with 1 hand and place the thumb side just above victim’s navel and
well below the tip of the sternum.
4. Grasp fist with your other hand.
5. Press fist into victim’s abdomen with 5 quick upwards thrusts.
6. Each thrust should be a separate and distinct effort to dislodge the object.

After every 5 abdominal thrusts, check the victim and your technique, for advanced
pregnant women and obese victims consider using chest thrusts.

Repeat cycles of up to 5 abdominal thrusts until victim coughs up objects, or starts to


breath or coughs forcefully.

Victim becomes unconscious, start methods for an unconscious victim with finger sweep
or you are relieved by other trained person.

UNCONSCIOUS “CHOKING”
If person is unconscious and breaths have not gone in, give up 5 abdominal thrusts.
1. Straddle victim’s thighs.

2. Put heel of one hand against middle of victim’s abdomen slightly above navel
and well below sternum’s notch.
3. Put other hand directly onto first hand.
4. Press in word and upward using both hands with up to 5 quick abdominal
thrusts.

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5. Each thrust should be distinct and real attempt made to relieve the airway
obstruction. Keep heel of hand in contact with abdomen between abdominal
thrust.
Use the chest for advanced pregnant women and obese victims.

PERFORM FINGER SWEEP


(1) Use only on an unconscious victim. On a conscious victim, it may cause gagging or
vomiting.
(2) Use your thumb and fingers to grasp victim’s jaw and tongue and lift upward to pull
tongue away from back of throat and away from foreign object.
(3) If unable to open mouth to perform the tongue – jaw lift, use the crossed-teeth
apart.
(4) With index finger of your other hand, slide finger down along the inside of one cheek
deeply into the mouth and use a hooking action across to other cheek to dislodge
foreign object.
(5) If foreign body comes within reach grab and remove it. Do not force object deeper.
If the above steps are unsuccessfully, give 2 rescue breaths. If unsuccessfully, retilt head
and try 2 more. Do up to 5 abdominal thrusts and do a finger sweep.

CHOKING
INFANT
CONSCIOUS AND UNCONSCIOUS
Give up to 5 back blows
(1) Hold infant’s head and neck with one hand by firmly holding infant’s jaw between
your thumb and fingers.
(2) Lay infant face down over your forearm with head lower than his/ her chest.
Brace your forearm and infant against your thigh.
(3) Give up to 5 distinct and separate back blows between shoulder blades with the
heel of your hand.
Give up to 5 chest thrusts.
1. Support the back of the infant’s head
2. Sandwich infant between your arms and hand, turn on back, with head lower
than his/ her chest. Small rescuers may need to support infant on their lap.
3. Imagine a line connecting infant’s nipples.

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4. Place three fingers on sternum with your ring finger next to imaginary nipple line
on the infant’s feet side.
5. Lift your ring finger of chest if you seal the notch at the end of the sternum

Move your finger up a little and give up to 5 separate and distinct thrusts with index and
middle fingers on sternum in a manner similar to CPR chest compressions but at a
slower rate.
(1) Keep fingers in contact with chest between chest thrusts.

Check mouth for foreign objects.


(a) Grasp both tongue and jaw between your thumb and finger and lift up
(b) If object is seen, remove with a finger sweep by sliding your little finger of the
other hand alongside cheek to base of tongue using a hook action.
(c) Do not try to remove an unseen object (blind finger sweep)
(d) Do not put object deep.

The C P R Cardiopulmonary Resuscitation

There is various first aid procedures that are recommended to perform in cases
of an accidents.one of these procedures is the C PR or cardiopulmonary
resuscitation. This emergency method is performing in reviving victims of cardiac
arrests.

A CPR training and certification would be the most important thing that you
should have before performing CPR to an individual. C PR is a skill that you need to
learn by taking an accredited first aid training course. Someone who is not studying
medical education can still acquire CPR training; it is regardless of your profession.
CPR may be done when a person stops breathing or heart stops breathing ( like
when a person has a heart attack or almost drown ) CPR is life – saving techniques
CPR can help keep oxygenated blood circulating in the body.

HOW TO DO CPR ON AN ADULT

In 2010, the American Heart Association made a radical change to the recommended
CPR process for victim of cardiac arrest. Also victims of choking, drowning,
electrocution, drug overdose and suffocation.

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Before 2010, In your CPR class you will have been told that you always check airway
and then deliver rescue breaths before starting chest compressions,(ABC) these
recommendations have been changed now start chest compression first, if you start
chest compression you can get the heart beating and blooding flowing around the
system quickly (CAB).

A. Check the scenes for immediate danger make sure you and your victim are safe
from impending fire. See to it if you can do something to counteract, and then move
the victim.

B. Assess the victim’s consciousness by gently taping victim’s shoulder and ask are
you ok? In a loud and clear voice. If victim responds, CPR is not required, instead
under take basic First Aid. It is advisable to administer CPR for 2 minutes before
making the call.

If victim is unconscious, call the ambulance or send for transport, if you are alone,
get off and start chest compressions. CPR consist of 2 (two) stages: chest
compression s (forceful pressing on the chest to stimulate the heart) and artificial
respiration (mouth to mouth ventilation).

C. If you are not trained, do not check for pulse, you will spend valuable time
looking for a pulse, when you should be doing compressions.

D. Place the victim on his or her back make sure he or she is lying as flat as possible
– this will prevent injury while you are doing chest compressions.

E. Place the heel of your hand on the victim’s breastbone, exactly between the
nipples and position your hands, so that your arms are straight.

F. Perform 30 chest compressions; press down with both hands directly over the
breastbone to perform a compression, which helps the heartbeat. Chest
compressions are more critical for correcting abnormal heart rhythms.

Do the compression in a relatively fast rhythm.

Where someone is not trained in CPR then they should proceed with
chest compression only, CPR as this is better than nothing. If you are trained rescuer
the recommendations to perform rescue breath still stands but you should start with
chest compressions first.

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G. Make sure the airway is open, place your hand on the victim’s fore head and two
fingers on the chin and tilt the back to open the airway. Use jaw thrust when
suspecting spinal injury.

H. Give artificial Respiration – keeping the airway open, take the fingers that were
on the fore head and pinch the victim’s nose more closed. Make a seal with your
mouth over the victim’s mouth and breathe out for about a second. Give two rescue
breaths.

Make sure you breathe slowly; as this will make sure the air goes in the lungs and
not the stomach.

If the breathe does not go in, re – position the head and try again, the victim may be
choking. Do abdominal thrust (Heimlich manoeuvre) to remove the obstruction.

I. Repeat the cycle of 30 chest compression, if you are doing rescue breaths. Keep
doing a cycle of 30 chest compression and 2 rescue breaths.

What happens if CPR is not done?

The person will become unconscious almost immediately and will die in 5 to 10
minutes.

What are benefits of CPR?

Prolong life for patients who have better life status or who are younger. It also
prolongs life if it is done within 5 to 10 minutes of heart stoppage or breathing
stopped.

But for a person who has an advanced life threatening illness and who is dying, there
are really no benefits.

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ASPHYXIA
This is a potentially fatal condition which occurs if there is not enough oxygen available
to the tissues of the body. Such lack may be due to an insufficient amount of oxygen in
the air breathed in or any interference with or injury to the respiratory system.
Without an adequate supply of oxygen, the tissues deteriorate very rapidly. Vital nerve
cells in the brain can die after only three minutes without oxygen.

CAUSES
1. Obstructed airway due to the tongue failing into the back of the throat in an
unconscious casualty.
2. Fluid in the air passage.
3. Compression of the windpipe by hanging or strangulation
4. Injury to the lungs
5. Injury to the chest wall
6. Electrical injury
7. Poisoning
8. Insufficient oxygen in the atmosphere
9. Carbon monoxide poisoning
10. Cyanide poisoning

GENERAL SYMPTOMS & SIGN


1. Difficulty in breathing; the rate depth of breathing increases
2. Breathing may become noisy
3. Possible frothing at the mouth
4. Blueness of face, lips and fingernails
5. Confusion
6. Lowering of level of responsiveness
7. Possible unconsciousness
8. Breathing may stop

AIM
Maintain or restore the casualty’s breathing and seek medical aid.

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TREATMENT
1. Immediately remove any obstruction or remove the casualty to fresh air.
2. If she is conscious and breathing, reassure and observe.
3. If she is unconscious, open her airway and check breathing. (Complete the ABC of
Resuscitation if required and place her in the recovery position).
4. Seek medical aid, if in doubt about her condition, arrange removal to hospital.

HANGING, STRANGLING
1. Remove the construction from around the casualty’s neck immediately,
supporting the weight of her body if she is hanging. (If there is a knot cut below)
2. If the casualty is unconscious open airway and check breathing, complete the
ABC of resuscitation if required.
3. Arrange removal to hospital.

SMOKE INHALATION
1. Remove the casualty to safety without endangering yourself.
2. Extinguish any clothing that is on fire or smouldering.
3. If she is unconscious open her airway and check breathing. Complete the ABC of
Resuscitation if required and place her in recovery position.
4. Treat any burns.
5. Arrange removal to hospital.

CARBON MONOXIDE POISONING


1. Carbon monoxide is a colourless, odourless gas. Its fumes are dangerous because
carbon monoxide replaces the oxygen in the blood. A casualty may require
prolonged artificial ventilation to clear it completely.
2. Open any doors and drag the casualty to safety if possible.
3. If the casualty is unconscious, open his airway and check breathing. Complete the
ABC of Resuscitation if required and place the casualty in a recovery position.
4. Check breathing rate, pulse and level of responsiveness at 10 minutes intervals.
5. Arrange removal to hospital.

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BLEEDING AND WOUNDS
BLOOD AND CIRCULATION
There are approximately six litres (10 pints) of blood in the normal adult circulatory
system. Blood carries oxygen and other nutrients to the tissues and carbon dioxide and
other waste products away from them.
It flows through a network of flexible tubes called blood vessels. There are three
different types namely, Arteries, Capillaries and Veins
Blood flows around the body through arteries, which carry blood away from the heart
and veins which return blood to the heart. The rate at which blood is lost depends on
the size and kind of blood vessel raptured or damaged. The colour of blood is Red,
White and Blue

THE DANGERS OF BLOOD LOSS


The loss of about one third of the total blood volume can be serious because there is
not enough left to provide a sufficient flow around the body. If you do not act quickly to
stop severe bleeding there is danger that shock and even loss of the casualty’s life may
result .If a major artery raptures, a person may bleed to death within a minute. Injuries
to veins and minor arteries bleed more slowly but may also be fatal if left unattended.
Shock usually results from loss of fluids, such as blood, and must be prevented as soon
as the loss of blood has been stopped.

BLEEDING
Bleeding is the escape of blood from the blood vessels. Bleeding is classified according
to the type of blood vessel damaged. There are three types of bleeding.
(a)Arterial (b) Venous (c) Capillary each is named after the type of blood vessel
damage.

Arterial Bleeding-:
Blood carried in the arteries is fully oxygenated and is bright red. It has just come from
the heart. So it is under pressure and often spurts from the wound in time with the
heartbeat.

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Venous Bleeding:-
Having given up its oxygen, It flows at a lower pressure than arterial blood. When major
vein is ruptured, blood gush profusely. The color of venous bleeding is dark red
Capillary Bleeding
This is the most common type of bleeding. It is present in any wound and it may be the
only type in minor wounds where blood oozes from the wound. Blood loss is generally
negligible. The color is red
Kind of bleeding-:
Internal Bleeding and External Bleeding
Internal Bleeding;-
It is concealed in the body, it is not visible
It is more serious than external bleeding
It is lost from the blood circulation but not the body. It may be revealed by the
appearance of discoloration and bruising or by a flow of blood from one or more of the
various openings, (orifices) of the body such as the mouth and anus.
How blood clots
Blood platelets come into contact with the damage vessel wall, become sticky, and
clump at the injury site. The platelets and damage cells react with a blood protein to
create a mesh fibrin filament. The fibrin mesh traps more blood cells at the injury site
form a jelly-like clot within ten minutes. The fibrin contracts and the clot rapidly shrinks,
releasing serum that causes the area to swell, and leaves a scar.

NOSE BLEEDING
This is also known as “epistaxis”, this is common condition usually due to bleeding from
the blood vessels inside the nostrils. It may occur after a blow to the nose or be the
result of sneezing, pricking or blowing the nose or injury to the small veins in the
septum.

TREATMENTS:-
Safeguard the breathing by preventing inhalation of blood and control bleeding, nose
bleeding is not serious and stops in a short time.
a) Sit casualty down with her head well forward and loosen any tight clothing
around her neck and chest.

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b) Advise her to breathe through her mouth and to pinch the soft part of her nose
and apply pressure over the site.
c) Apply cold compress at the back of the head.
d) Release the pressure after 10 minutes. If the bleeding has not stopped, continue
treatment for further 10 minutes as necessary.
e) When the bleeding stops, tell the casualty to avoid exertion and not to blow her
nose for at least four hours so as not to disturb the clot.
f) If after 30 minutes the bleeding persists or reoccurs, seek medical aid.

SIGNS AND SYMPTOMS:-


a) Pain and tenderness
b) Swelling
c) Shock
d) Breathing may be shallow
e) Restless and talkative
f) Thirsty
g) Cold, clammy skin
h) A rapid weak pulse
i) Vision may be blurred
j) Bleeding from the artifices
k) Possible unconsciousness
l) Face and lip become pale
GENERAL TREATMENT:-
1. Direct method – apply pressure directly on the bleeding spot, either with a clean
bandage or apply dressing on the wound. To stop bleeding, apply pressure
directly over the wound and, when possible, elevate the bleeding body part.
2. Indirect method – apply pressure at the pressure point (femoral pressure point
and brachia) pressure point. The pressure point for the femoral artery, which
supplies blood to the legs, is located on the front center of the leg’
3. Apply sterile dressing on the wound
4. Treat for shock if any
5. Send casualty to the hospital.

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WOUNDS
Any break in the external or internal surfaces of the body involving a separation of
tissue. Wounds are classified as open or closed. Open wounds allow blood to escape
from the body. Closed wounds allow blood to escape from the circulator’s system, but
not the body.

TYPES OF WOUND
INCISED WOUND (clean cut wound)
A clean cut from sharp edge, such as a blade, knife or broken glass. Because the blood
vessels at the edges of the wound are cut straight across there may be profuse bleeding.

LACERATION/TORN WOUND
Caused by rough edge instruments such as barbed wire, machinery or the claws of an
animal. The skin may be torn and irregular. These wounds tend to bleed less severely
than incised wounds and are frequently contaminated by germs and risk of infection is
high.

PUNCTURED WOUND (STAB WOUND)


This occurs when the tissues are penetrated by sharp points, e.g. nails needles and
garden forks, railings and teeth may result in serious internal injury. If the wound is
deep, the risk of infection is high because germs, clothing and dirt have been carried
into it.

CONTUSED WOUND
This can be caused by a fall or a blow with a blunt object. These rapture capillaries
beneath the skin.
Blood leaks into the tissues causing bruising; the skin may be split but is often unbroken.
In a contused, wound the risk of damage to underlying structure. (E.g. fracture) should
be considered, Apply cold compress when there is swelling.

ABRASION (GAZE)
A superficial wound in which the top layers of skin are scraped off having a raw tender
area most commonly caused by a sliding, fall or friction burn. Abrasion often contain
embedded foreign particles that may cause infection.

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GUNSHOT WOUNDS/BULLET WOUNDS
A bullet or missile may be driven into or through the body causing serious internal injury
and sucking in contaminants. The wound at the point of entry may be small and near
but the exit wound may be large and ragged.

AIMS
To control bleeding by applying pressure over wound and raising the injured part.
1. To take step to minimize shock which may be caused by extensive blood loss.
2. Protect the wound from infection and promote natural healing by covering it
with a dressing.
3. Since germs can be present in body fluids, pay attention to hygiene both to
protect the casualty and yourself.
4. Send casualty to hospital for further treatment.

Treatment
1. Before treating the wound, wash your hands well in soap and warm water. If possible,
put on gloves.
2. If the wound is dirty, clean it by rinsing lightly under running water, or use an
antiseptic wipe. Temporary cover the wound with sterile gauze.
3. Elevate the wounded part above the level of the heart, if possible. Avoid touching the
wound directly. Support the affected limb with one hand.
4. Clean the surrounding area with soap and water.

Foreign Bodies In Minor Wounds


Treatment
1. Control any bleeding by applying firm pressure on either side of the object, and by
raising the wounded part.
2. Cover the wounded with gauze to minimize the risk of infection.
3. Pad around the object until you can bandage over it without pressing down. Hold the
padding in place while finishing the bandaging.
4. Arrange to take or send the casualty to hospital.

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FRACTURE

BONE, JOINT AND MUSCLE INJURIES


The skeleton is the hard framework around which the body is constructed. The body is
built on the framework of bones – the skeleton – about 206 bones in normal human
being.
The skeleton supports the muscles, blood vessels and nerves of the body and protects
organs such as the heart. It also helps in movement.
AIM
1. Maintain an open airway and prevent blood loss.
2. Steady and support the injured part, if possible
3. Provides more permanent support, with padding and firm bandaging or splinting.
4. An uninjured part of the body is the best form of “Splint”
5. If a broken bone lies within a large bulk of tissue, (i.e. thigh) treat the casualty for
shock.
6. Send or advice casualty to see doctor.
BONES
1. Skull
2. Mandible – Jawbone
3. Clavicle – Collarbone
4. Scapula – Shoulder blade
5. Sternum – Breastbone
6. Humerus – Upper arm bone
7. Ulna – Lower arm bone
8. Radius – Lower arm bone
9. Carpals – Wrist bone
10. Metacarpals – Hand bone
11. Phalanges – Fingers
12. Femur – thigh bone
13. Patella – knee bone
14. Tibia – Shin bone
15. Fibula – Splint bone
16. Tarsal – Ankle bone
17. Phalanges – Toes
18. Pelvic – Waist bone

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19. Vertebras – Spine
20. Rib cage –Ribs

The stapes is the smallest bone in the body, it is found in the inner ear.
There are 12 pairs of ribs in both men and women.
The longest and the strongest bone in the body is the femur.

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35
FRACTURE
A fracture is a break or crack in a bone. Bones are tough and resilient. When struck or
twisted bone bend like the branches of a healthy tree.
Young bones that are still growing are supple and may split, bend, or crack just like a
young sapling.

TYPES
Simple or Closed Fracture.
The bone is break or crack but there is no wound leading to the broken bone. The
injured site may swell. The skin around a broken bone is intact.
Compound or Open Fracture.
The bone is broken and it also the overlying skin it is therefore exposed through the
tissues to contamination by bacteria from the skin surface and from the air.
Complicated Fracture
The bones is broken and damaged to internal organs such as the lungs, kidneys and also
blow vessels, nerves.
Greenstick Fracture
This usually occurs in children, their bones are fresh, they crack, bend or spilt like a
young sapling.

CAUSES 0F FRACTURES
1. Direct Force:-
A bone breaking at the point where the force or blow is applied. For example the direct
impact of a blow to the upper arm can break the humerus.
2. Indirect Force:-
May be produced by a twist or a wrench! A trip or stumble can break a leg bone for
example. Force may travel from the point of impact through the body to break bone
elsewhere.
3. Muscle Contraction:-
Violent muscle contraction can fracture a bone to which the muscle is attached.
Note:- Age and disease can weaken bones, making them brittle and susceptible to
breaking or crumbling when stressed.

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37
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SIGNS AND SYMPTOMS OF FRACTURE:-
1. A recent violent blow or a fall
2. The snapping sound of a broken bone or torn ligament
3. The sharp pain of a muscle tear
4. Difficulty in moving a limb normally or at all (inability to walk)
5. Pain at or near the site of injury, made worse by movement and severe pain
often indicates dislocation.
6. Tenderness – over a bone is gently touched (is a sign of fracture)
7. Distortion, swelling and bruising at the side of the fracture.
8. Crepitus – grating of bone ends
9. Signs of shock – if the fracture is the thigh bone or pelvis
10. A shortening bending or twisting of the affected limb
11.
TREATMENT
OPEN FRACTURE:-
1. Cover the wound and apply pressure to control bleeding
2. Secure the dressing and padding: bandage firmly but not so tightly to impeded
circulation
3. Immobilize the injured part
4. Treat for shock if any.
5. Send to hospital.
CLOSED FRACTURE:-
1. Reassure, steady and support the injured part.
2. Immobilize the injured part by applying splint age.
3. Apply cold compress
4. Treat for shock if any.
5. Send to hospital.

DISLOCATION
This is partial or full displacement of bones at a joint. It can be caused by a strong force
wrench the bone into an abnormal position or by violent muscle contraction.
A severe dislocation at any joint may also fracture the bones involved. Shoulder thumb
jaw and finger often dislocated and never try to manipulate a dislocated joint back into
place as this may cause fatal injury.

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40
SPRAIN
A sprain is an injury to a ligament at or near a joint. It is often the result of sudden or
unexpected wrenching movement at the joint that pulls the bones within the joint too
far apart and tears the tissues surrounding the joint.
TREATMENT:-
1. Rest, steady and support the injured part in the most comfortable position for
the casualty.
2. Apply ice or cold compress gently to the injured part. (this will reduce swelling,
bruising and pain)
3. Raise and support the injured limb to reduce blood flow to the injury and to
minimize bruising.
4. Take casualty to hospital or advise him to rest and see doctor if necessary.
STRAIN
Over stretching of the muscle which may result in partial tearing or pull. This often
occurs at the junction of the muscle and the tendon that joins it to the bone.
AIMS
To prevent blood loss, movement and infection at the site of injury
To prevent movement at the injury site by supporting the injured part.
To reduce swelling and pain.
To keep the airway open
To seek medical aid if necessary
DO NOT:
Do not move the casualty until the injured part is secured and supported. (Unless
he/she is in danger
Do not let the casualty have anything to eat or drink.
Do not try to replace a dislocation bone in to its socket.
Do not press down directly on protruding bone end.

SPINAL INJURY
A victim found with the head or body in an unnatural position, a fracture of the spinal
column may have occurred, Severe pains in the back or neck and lack of movement of
lower extremities are signs of a broken spinal column, do not attempt to straighten or
move the victim body as this may cause permanent paralysis or death.

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Treatment for a Conscious Casualty
1. Reassure the casualty, and tell her not to move.
2. Steady and support her head in the neutral position by placing your hands over her
ears. Maintain this support throughout.

Treatment For an Unconscious Casualty


1. Tilt the head back gently, ensuring that the head and neck stay in the neutral position.
Carefully remove any obvious obstruction. Lift the chin.
2. Recheck breathing and circulation. If they have not returned, position casualty using
the log-roll technique so that you can resuscitate him.
3. Combine artificial ventilation with chest compressions until help arrives.
4. If the victim must be transported, his or her body should be immobilized by placing it
on a flat board.

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BURNS AND SCALDS
THE SKIN:-
One of the largest organs of the body is the skin. The skin is made up of two layers of
tissue. The outer epidermis and inner dermis and lesion layer of subcutaneous fat.

The epidermis contains fatty substances that make the skin waterproof. The dermis
contains blood vessels, muscles, oil glands, sweat glands and hair roots. (Follicles)

The main function of the skin is to maintain a constant body temperature. It also
protects the body from injury, bacterial and viral infections and minor burns.

A burn is an injury to the skin caused by exposure to fire, hot liquids or metals, radiation,
chemicals, electricity, or the sun’s ultraviolet rays.
Burns result from dry heat, extreme cold, corrosive substances, friction or radiation,
including the sun’s rays. Scalds are caused by wet heat from hot liquids and vapour.

AIMS:-
1. Establish your own safety before attempting to treat casualty.
2. Deal with airway problems
3. Stop the burning, by rapid cooling to prevent further tissues damaged, reduce
swelling, minimize shock and alleviate pain.
4. Cover the injury to protect it from infection
5. Check for other injuries.

ASSESMENT OF BURN:-
In treating a burn, it is important to consider the extent and depth of the burn, the
cause and whether the airway is affected.

Burns are classified according to the area and depth of the injury. These factors
determine what treatment required and whether a casualty needs hospital attention.
AREA:-
The area of a burn gives rough guides as to whether or not a casualty is likely to suffer
shock, because of greater fluid loss.
DEPTH:-

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There are three levels of burning however it is difficult to distinguish between the
different levels. A large burn will almost certainly contain all the level.

The extent of the burn will tell you whether shock is likely to develop because of
excessive loss of tissue fluid (serum). Burns destroy the skin, the body’s natural barrier
against airborne bacteria, and therefore carry a serious risk of infection: the deeper the
burn, the higher risk.

When the skin is burned, the small blood vessels within the skin leak fluid. This fluid
either gathers in tissue space to form blisters or it leaks through the skin surface. In a
burn over a large surface area, this loss of fluid can lead to a marked drop in the blood
volume and loss of blood proteins, a condition which may result in shock.

TYPES OF BURN
DRY BURN:-
Caused by dry heat (flames), contact with hot objects.

SCALD:-
Caused by steam or hot liquids such as hot tea or hot fat.

ELECTRICAL BURN:-
Caused by electrical current. Low – Voltage as used by domestic.
Appliances High – Voltage as carried in mains
Overhead cable lightening strikes.

COLD INJURY:-
Caused by freezing metals (frostbite and or contact with freezing vapors such as liquid
oxygen or liquid nitrogen,

CHEMICAL BURN:-
Caused by acid and alkaline both industrial and domestic chemicals

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RADIATION BURN:-
Caused by sunburn and over – expose ultra – violet lamp and radioactive such as an x-
ray. Most sunburn is superficial. The skin is lobster red and blistered and the casualty
may suffer heatstroke.

DEPTH OF BURNS:-
There are three degrees of burn injury.
1. Super facial
2. Partial – thickness
3. Full thickness
A casualty may suffer one or more depths of burn in an accident.

SUPERFICIAL BURN:-
This involves only the outermost layer of the skin and is characterized by redness,
swelling and tenderness. It usually heals well if first aid is given promptly and do not
require medical attention unless it is extensive.

PARTIAL – THICKNESS BURN/ INTERMEDIATE BURNS:-


This burn involves the formation of blisters, which may be intact or broken, with an area
of surrounding redness. It may become infected so you seek medical aid.

FULL THICKNESS:-
DEEP BURNS:-
These burns involve all the layers of the skin. The skin may appear pale, waxy and
sometimes charred. Because the nerve endings are damaged, these burns are relatively
pain free. It always requires medical attention. A person suffering third – degree burns
over more than 10 percent of the body surface area should be hospitalized as soon as
possible.

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AIM:-
1. To stop burning and relieve pain and swelling
2. To maintain an open airway
3. To treat associated injuries
4. To minimize the risk of infection
5. To treat for shock
6. To disperse the harmful chemical (chemical burn)
7. To arrange transport to hospital.

DO NOT :-
1. Do not break blisters or otherwise interfere with the injured area.
2. Do not apply adhesive dressings or adhesive tape type on the skin.
3. Do not apply lotion, ointments or fats to the injury: they can further damage the
tissues and increase the risk of infection.
4. Do not remove anything sticking to the burn, you may cause further damage and
introduce infection into the wound.
5. Do not overcool the casualty to “hypothermia” if the burns cover a large part of
the body.
6. Do not approach victim of high – voltage electricity until you are officially
informed that the current has been switched off and isolated.
Do not allow the casualty to touch the injured eye or forcibly remove contact lens.

TREATMENT:-
MINOR BURNS AND SCALDS:-
First aid for burns involves removing the source of the burn as soon as possible
Small, superficial burns are often caused by domestic accident. Most can be treated by a
First Aider and will heal naturally.
a) Flood the injured part with cold water for at least 10 minutes to stop the burning
and relieve the pain (milk or canned drinks) can be used if water is not available.
b) Gently remove any jewelling, watches, belts or constricting clothing from the
injured area before it begins to swell.
c) Apply sterile dressing

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SEVERE BURNS AND SCALD:-
a) Great care must be taken when treating burns that are deep or extend over a
large areas.
b) Lay the casualty down. Protect the burned area from contact with the ground if
possible.
c) Dense the burn with plenty of cold liquid for at least 10 minutes. Do not delay for
removal to hospital.
d) Resuscitate if breathing has stopped
e) Remove all constrictive material – rings, watches and smouldering clothing
before swelling set in. Do not remove sticking clothing.
f) Reassure casualty, treat for shock and seek immediate medical attention.

ELECTRICAL BURNS:-
a) Make sure that contact with the electrical source is broken. If the casualty is
unconscious – apply A. B. C
b) Flood the sites of injury with plenty of cold water to cool the burns.
c) Apply a sterile dressing or some other clean non fluffy material, to protect the
burns from infection.
d) Give her frequent sips of cold water. If the burns are mild, calamine or an after –
sun preparation may soothe them.

CHEMICAL BURN:-
a) First make sure that the area is safe, remove casualty from the area if necessary.
b) Flood the affected area with water to disperse the chemical and to stop the
burning for at least 20 minutes to dilute the substance.
c) Gently remove any contaminated clothing while flooding the injury.
d) Any powder should be carefully brushed off with gloved or protected hands
before washing.
e) Take or send the casualty to hospital watch her airway and breathing closely.

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FAINTING
A faint (also known as SYNCOPE) is a brief loss of consciousness that is caused by
temporary reduction of blood flow to the brain.

The inactivity caused blood to pull in the lower part of the body, reducing the amount of
oxygen available to the brain.

CAUSES:-
1. Fright – seeing a ghost
2. Reaction to pain
3. Emotional upset
4. Exhaustion
5. Lack of food
6. Long period on parade or physical maturity

SIGNS AND SYMPTOMS:-


1. Dizziness – a brief loss of consciousness causing the casualty to fall to the flour
2. A slow pulse
3. Paleness
4. Cold skin
5. Seeing sports
6. Sweating

TREATMENT:-
Your aim is to improve blood flow to the brain and reassure the casualty as she recovers
and make her comfortable
1. Lay the casualty down and raise and support her legs
2. Make sure that she has plenty of fresh air
3. As she recovers, reassure her and help her sit up gradually
4. Look for and treat any injury that has been sustained through falling.
If she does not regain consciousness quickly open the airway and check breathing, be
ready to resuscitate if necessary.

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49
50
SHOCK
The circulatory system distributes blood round the body. When the circulatory system
fails to deliver oxygenated blood to every part of the shock set in.

If this is not treated swiftly, vital organs such as the heart and brain may fail which can
lead to death.

What causes circulatory shock?


Shock can develop if the heart fails to pump blood through the circulatory system (a
common cause is a heart attack) or if the blood vessels dilate, as in severe infection or
anaphylactic shock, reducing the blood pressure.

Shock may also occur if the blood supply to the body’s vital organs is reduced through
blood loss or loss of other bodily fluids through burns, severe diarrhoea or vomiting. The
body responds to fluid loss initially by diverting the blood supply from the surface to the
vital organs.

SIGNS AND SYMPTOMS:-


At first
a) A rapid pulse
b) Pale, grey-blue skin
c) Sweating and cold, clammy skin

As shock develops
a) Weakness and dizziness
b) Nausea and possible vomiting
c) Thirst
d) Rapid, shallow breathing
e) A weak pulse – when the pulse at the wrist disappears about half the blood
volume will have been lost.
As the brains oxygen supply weakens
1. As the casualty may become restless
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2. May yawn and gasp for air (air hunger)
3. The casualty will become unconscious
4. Finally, the heart will stop.

CAUSES:-
1. Severe burns and Scalds
2. Severe external bleeding
3. Unconsciousness

TREATMENT:
Your aims are to recognize shock and to treat any obvious cause, to improve the blood
supply to the brain, heart and lungs
a) Treat any cause of shock you identify such as external bleeding.
b) Lay the casualty down on a blanket to protect her from the cold ground, keeping
her head low. Constantly reassure the casualty.
c) Raise and support her legs to improve the blood supply to the vital organs, take
care if you suspect a fracture.
d) Loosen tight clothing such as braces or belts to reduce constriction at the neck,
chest and waist
e) Keep the casualty warm by covering her with blankets.
f) Check and record breathing, pulse and level of response. Be prepared resuscitate
if necessary.

CARDIAC ARREST:-
The term cardiac arrest, describes any sudden stoppage of the heart. Causes include
heart attack, severe bleeding, electric shock, anaphylactic shock, drug overdose and
hypothermia.

Cardiac arrest is characterized by the absence of breathing and no signs of circulation.


Resuscitation begins at once.

Without oxygen the heart muscle and brain cells will deteriorate rapidly. Apply A.B.C. of
resuscitation.

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HEART ATTACK:-
A heart attack most commonly occurs when the blood supply to part of the heart
muscle is suddenly obstructed for example a clot in one of the coronary.

The main risk of a heart attack is that the heart will stop. The effect of the heart attack
depend largely on how much of the heart muscle is affected many casualties will
recover completely.

Drugs that aid recovery include special medicines called (thrombolytic) which act to
dissolve the clot and aspirin, which ‘thins’ the blood.

TREATMENT:-
Make the casualty as comfortable as possible to ease the strain of his heart a half –
sitting position with the casualty’s head and shoulder well supported and his knees
bents is often best.
Constantly monitor and record the casualty’s breathing and pulse rates and be prepared
to resuscitate if necessary.
If the casualty has medicine for angina, such as tablets or a “puffer” aerosol, help him to
take it. If the pain persist, and the casualty is fully conscious, give him a full dose
(300mg) aspirin tablet to chew

EPILEPSY:-
This is a condition, which results from a tendency towards brief disruptions in the
normal electrical activity of the brain.

Epileptic fits may vary from momentary in attention without loss of consciousness
(minor epilepsy) to muscular spasm and convulsions (major epilepsy).

MINOR EPILEPSY:-
This type may start in childhood and may persist into adulthood. It can pass unnoticed
because the casualty often appears only to be day dreaming.

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SIGNS AND SYMPTOMS:-
1. Casualty may appear to be in a daydream and be staring ahead blankly.
2. Casualty might start behaving strangely these automatisms include chewing or
smacking lips saying odd things, or fiddling with clothing.
3. Casualty may have lost memory.

TREATMENT:-
Protect the casualty from any dangers such as busy roads. Keep other people away from
him. Talk to him quietly.
Stay with him until you are certain that he has recovered and can get home.
Advise the casualty to see a doctor.

MAJOR EPILEPSY:-
In major epilepsy, a person experiences an aura which serves as a warning that
something more severe is about to happen.

The aura may differ from one person to another. E.g. A strange feeling in the body or a
particular smell or taste.

During an aura a person’s normal mood may be altered although this will not last long.

SIGNS AND SYMPTOMS:-


1. Casualty suddenly loses consciousness and falls to the ground sometimes letting
out a strange cry.
2. He becomes rigid for a few seconds and breathing may cease. Mouth and lips will
turn blue (cyanosis) and there will be congestion about the face and neck.
3. The muscles then relax and begin convulsive or jerking movements. The
convulsions may be quite vigorous.
4. Breathing may be difficult or noisy through the clenched jaw, froth may appear
around the mouth it may be blood stained if lips or tongue have been bitten.
5. There may be loss of control of bladder and occasionally the bowel.
6. Finally the muscles will relax although the casualty will remain unconscious for a
few minutes or more.

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After the fit is over usually no more than five minutes later, breathing will return to
normal and the casualty will regain consciousness but may be dazed and confused and
act strangely.

TREATMENT:-
1. Protect the casualty from injury during the fit and provide care once he or she
has regained consciousness.
2. If the casualty is falling, try to support him or ease his fall and put him down
gently in a safe place if possible.
3. Clear a space around his neck and place something soft under his head.
4. When the convulsions cease, place the casualty until you are certain recovery is
complete.
5. Even if he makes a full quick recovery advice him to inform his doctor about the
latest attack.

DO NOT
Do not move or lift the casualty unless in danger.
Do not forcibly restrain him.
Do not put anything in his mouth or try to open it.
Do not try to wake the casualty.
Do not send for an ambulance unless the casualty has severe fits, has been injured
during the fit or takes longer than 15 minutes to regain consciousness.

CONVULSIONS IN INFANTS AND CHILDREN:-


In children under the age of five a raised temperature caused by the onset of an
infectious disease or a throat or ear infection can cause convulsion despite their
alarming nature, they are rarely dangerous but the signs may persist while the child’s
temperature remains abnormally high.

SIGNS AND SYMPTOMS:-


1. Child has high fever and may be ‘flushed’ and sweating.
2. Twitching of muscles of face and Limbs
3. Occasional squinting upturned eye.
4. There may be stiffness or rigidity, with the head back and spine arched.
5. Child may be holding his or her breath.

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6. Congestion of the face and neck.
7. Forth may appear at the mouth.

TREATMENT:-
1. Ensure a good supply of fresh air.
2. Loosen any constricting clothing around the child’s neck and chest.
3. Clear a space around the child if the convulsion is severe.
4. Carry out the general treatment for the unconscious casualty.
5. Cool the child: first remove any covering bed cloths and/or clothes, and then
sponge him or her with tepid water starting from the head and working
downward.
6. Reassure the child’s parents and advice them to seek medical aid.

HYSTERIA
This is usually caused by an over-reaction to an emotional upset or nervous stress and is
likely to be heightened by the presence of any on lookers.

SIGNS AND SYMPTOMS:-


1. Temporary loss of behavior control with dramatics shouting, screaming, crying
and or wild beating of limbs. Casualty may be rolling around on the ground and or
tearing of hair and cloths.
2. Hysterical over-breathing (hyperventilation) may follow.
3. Casualty may be unwilling to move or be making strange movements.

TREATMENT:-
Reassure the casualty, refrain from showing him or her any sympathy and gently but
firmly escort to a quiet place.
Stay with the casualty and keep under observation until fully recovered.
Advise the casualty to see a doctor
Do not physically restrain or slap the casualty: this may make him or her behave more
violently.

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POISONING
Poison is any substance that if taken into the body in sufficient quantity can cause
temporary or permanent damaged.
Never attempt to make the casualty vomit, it is ineffective and you may worsen the
situation.

HOW THE POISON ENTER THE BODY


Poison can enter the body through the mouth, the lungs and or the skin (either by
injection or absorption). It can be accidentally or intentionally.

Mouth:- Through the mouth by eating or drinking poisonous substances.


Lungs:- Through the lungs by inhaling – household or industrial gases, chemical vapour
or fumes from fire, gas stoves and petrol – engine exhausts.
The skin:-
A. By injection into the skin as a result of bites from some animals, insects,
poisonous fish or reptile so by hypodermic syringe.
B. By absorption through the skin by contact with poisonous spray such as
pesticides.

HOW POISONS ACT:-


Once in the blood stream, some poisons work on the central nervous system preventing
breathing, heart action and other vital processes.

Other poison act by displacing the oxygen in the blood and preventing its distribution to
the tissues.

Swallowed poisons also react directly on the food passages, resulting in vomiting, pain
and often diarrhoea.

Corrosive poison may severely burn the lips, mouth, gullet and stomach, thus causing
intense pain.

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SIGNS AND SYMPTOMS:-
Information from the casualty, a witness or objects around the scene. Try to ascertain
exactly what was involved and if swallowed when and how much was taken.
a) Objects of poison or poisonous plants
b) Casualty may be delirious and have convulsions.
c) Symptoms and signs of asphyxia
d) Unconsciousness may develop
e) If swallowed – vomiting or suffer from diarrhea
f) Burns around the casualty’s mouth (Corrosive Poisons)

GENERAL TREATMENT:-
1. Quickly ask the conscious casualty what has happened, remember that he may
lose consciousness at any time.
2. If lips or mouth show signs of burning cool them by giving him water or milk to
sip slowly
3. Do not attempt to induce vomiting.
4. Place him in the Recovery Position, even if he is unconscious. (he may vomit)
5. If consciousness is lost, apply A.B.C of resuscitation immediately
6. Take care not to contaminate yourself with any poison that may be around the
casualty’s mouth
7. Arrange urgent removal to hospital said objects around or vomit to hospital

FOOD POISONING:-
This is caused by food becoming contaminated by bacteria and being stored ore cooked
incorrectly. The most common bacteria are:-
Staphylococci:-
These multiply in food and produce a poisonous substance (toxin).
Salmonellae:-
These multiply in the bowel and cause dysentery like illness. Salmonella is infectious and
can be passed through poor personal and kitchen hygiene.

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SIGNS AND SYMPTOMS:-
STAPHYLOCOCCAL POISONING
(a) Casualty will feel nauseated and may already be vomiting
(b) Casualty may be suffering from abdominal pains and may have headache.
(c) Diarrhea may develop at a later stage
(d) Symptoms and signs of stock.

SALMONELLA POISONING
(a) It will appear within a few hours of eating or be delayed for a day or two
(b) Casualty develops a fever
(c) Casualty may feel nauseated and vomit
(d) Casualty will be suffering from diarrhea
(e) Casualty may have abdominal pain
(f) Symptoms and signs of shock.

TREATMENT:-
(a) Follow the general treatment for poisoning
(b) Make sure the casualty rest
(c) Give him plenty of fluid to drink
(d) If in doubt, arrange removal to hospital.

DRUGS POISONING:-
This condition is caused by an accidental overdose or drug abuse. Drug abuse may be
boldly defined as self – administration of a drug in a manner that is not in accordance
with approved medical or social patterns.

Drug can be inhale, injected or swallowed into the body. Drug commonly abused are:-
I. Narcotics (e.g. heroin)
II. Depressants (e.g. barbiturates)
III. Stimulants (e.g. amphetamines)
In addition, there is solvent inhalation (e.g. glue-sniffing)

SIGNS AND SYMPTOMS:-


Narcotics

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These are usually injected but can be taken in tablet form or inhaled.
Breathing becomes difficult and eventually will cease.
Casualty may have injected marks on the front of one or both arms.

DEPRESSANTS:-
(a) Breathing will be shallow
(b) Skin becomes cold and claiming
(c) Pulse will weak and rapid
(d) Possible unconsciousness

STIMULANTS;-
(a) Casualty will be excited and sweating profusely.
(b) Casualty may be suffering from tremors and hall urinations.

TREATMENT:-
1. Quickly ask the conscious casualty what has happened, remember that he may
loss consciousness at any time.
2. If lips or mouth show signs of burning cool them by giving him water or milk to
sip slowly
3. Do not attempt to induce vomiting.
4. Place him in the Recovery Position, even if he is unconscious. (he may vomit)
5. If consciousness is lost, apply A.B.C of resuscitation immediately
6. Take care not to contaminate yourself with any poison that may be around the
casualty’s mouth
7. Arrange urgent removal to hospital said objects around or vomit to hospital.

ALCOHOL POISONING:-
Alcohol is a drug that depresses the central nervous system. It affects different people in
different ways. The drug affects the areas of higher reasoning within the brain – those
that control, restrain and judgment.

As the concentration of alcohol in the blood increases, the behaviour of the drinker
becomes exaggerated and co-ordination will be impaired.

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SIGNS AND SYMPTOMS:-
Casualty’s breath may smell of alcohol
Casualty’s may be vomiting
Casualty’s face will feel dry and look bloated.

ANAPHYLACTIC SHOCK:-
This condition is a massive allergic reaction which can develop within a few seconds or
minutes of and injection of a drug or insect sting to which the casualty is sensitive. More
rarely it follows the injection of an allergen such as penicillin in which case the reaction
will be slower.

SIGNS AND SYMPTOMS:-


(a) Symptoms and signs of shock
(b) Casualty complains that chest feels tight
(c) Difficulty in breathing – wheezing and gasping for air
(d) Casualty may be sneezing especially around the eyes.
(e) Pulse will be rapid
(f) Unconsciousness may develop.
TREATMENT:-
Follow the treatment for shock
Maintain an open airway, if the casualty’s breathing becomes difficult place the casualty
in the recovery position.
If unconscious, complete the A.B.C Resuscitation
Arrange urgent removal to hospital.

BITE AND STINGS


Animals such as snakes, dogs, cats and certain insects may bite humans with
dangerous consequences. Many snakebites are caused by nonvenomous (non-
poisonous) snakes and do not require treatment beyond cleaning the wound.
Bites infected by venomous snakes require immediate first – aid measures. The
victim should be taken as soon as possible to the nearest emergency medical
facility. Do not cut the area around the bite, attempt to suck out the venom, or
apply ice to the wound. The focus of first aid should be to prevent the venom

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from spreading rapidly through the individual’s bloodstream. In addition, the bite
area should be kept at a lower level than the rest of the body. The wound should
be washed thoroughly with soap and water, blotted dry, and loosely covered with
sterile dressing.

DRESSING AND BANDAGES


A dressing is a protective covering which is placed on a wound to help control bleeding
prevent infection and absorb any discharge.

All dressings should be large enough to cover the area of the wound and extend about
2.5m (1m) beyond it. They should, if possible be sterile so as not to introduce germs
(bacteria) which could cause infection.

A dressing should also be absorbent because, if sweat cannot evaporate, the skin
around the wound will become moist and the dressing sodden. This will encourage the
growth of bacteria and prevent healing.

Dressing helps the blood to clot. Although a dressing may slick to a wound, making it
difficult to remove, the benefit of a dressing outweigh any damage done on removal. If a
dressing becomes stained by blood immediately, do not take it off, but cover it with
further dressings, as necessary

TYPES OF DRESSINGt
ADHESIVE DRESSING
Commonly known as “Plasters” these dressing consist of an absorbent gauze or cellulose
pad held in place by an adhesive backing. The best have a water repellent adhesive
backing which allows moisture to evaporate from the skin. Water proof plasters should
always be used by food handlers and where necessary by first Aiders. They should not
be left for more than a few hours.

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STERILE DRESSING
These consist of a dressing made up of layers of fine gauze or lint and a pad of cotton
wool attached to a roller bandage.

Sterile dressings are preferred first aid dressings for large wounds. If available, they
should be used in preference to any other type of combination dressing and/or bandage
on any wound.
GAUZE DRESSING
These consist of layers of gauze which form a soft pliable covering for large wounds or
burns where no sterile dressings are available. If a gauze dressing is used instead of a
sterile dressing, cover the gauze with a pad of cotton wool and secure it with adhesive
strapping or if pressure is required a bandage.

BANDAGES:-
Bandages are used to:-
a) Maintain direct pressure over a dressing in order to control bleeding
b) Hoped dressings or splint in position
c) Prevent swelling
d) Provide support for limb or joint
e) Restrict movement
f) Occasionally to assist in lifting or carrying casualties.

TYPES OF BANDAGES:-
Triangular bandages and roller bandages. In an emergency, bandages can be improvised
from any of the above material or by using tights or stockings, ties carves or belts.

TRIANGULAR BANDAGES
These can be made by cutting in half diagonally a piece of material (Linen or Calico) not
less than 1m (l yard) square. Alternatively, triangular bandages can be bought, often
wrapped in sterile packages.

Triangular bandages can be used in a number of ways. Open or unfolded, bandages can
be used to form a sling to provide support or protection for the arms or chest or for
securing dressings over area head, hand and foot.

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Alternatively it can be folded according to specific requirements.
Parts of a triangular bandage
Point

Side Side

End End
Base
Broad – Fold Bandages
These folded triangular bandages are used for immobilize limbs during transportation or
for security splints or dressing.
(a) Turn in a narrow hem along the base of the bandages. Fold the point to the base.
(b) Fold the whole bandage in half again in the same direction.

Narrow – Fold Bandages


These are useful for securing a dressing at a joint if no other bandage is available (e.g.
around the ankle or wrist)

CHECKING CIRCULATION:-
Immediately after applying a bandage and at 10 minutes intervals thereafter, it is
important to check that the circulation and/ or nerves have not been interfered with by

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the bandage. This can be check as indicated below, and if any of the symptoms and signs
are present, adjust or remove the bandage as necessary.

METHOD:-
1. Press one of the nails as skin of the bandage limb until it turns white.
2. Release pressure; the part should quickly become pink again, showing that blood
has returned.
 If the nails remains white or blue or the fingers are unnaturally cold, the
bandage is too light.
3. Remove the outer wrapping. Hold the dressing by the edges over the wound; lower
it into place.
4. If necessary, cover the gauze with one or two layers of cotton wool.
5. Secure the pad with a bandage or adhesive strapping.

COLD COMPRESS
Closed injuries such as bruises and sprains must be cooled to minimize swelling and
relieve pain. This is best achieved by placing the injured area under cold running
water of the body, e.g. the head or chest, or prolonged application is required, a
cold compress or an ice bag may have to be used instead.

APPLYING A COLD COMPRESS


1. Soak a pad of cotton wool, towelling or similar cloth or iced water squeeze or
wring it out so that it is damp but not dripping, and place it on the injury.
2. To ensure that the cooling effect is maintained, replace the pad with a fresh
compress or drip more cold water on to the old one. Continue cooling the injury
for 3 minutes.
3. If necessary, cover the compress with an open weave bandage to hold it lightly in
 Place all used dressing or infected material in a plastic bag and seal and label.
Dispose by incineration.
 Place all needless or sharp items in a sealed tin and dispose.

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PLANNED FIRST AID ACTIVITIES
 Remember that in handling a wound, blood or excreta, you yourself may be in
danger of infection. Mop up spills and disinfect using one part of household
bleach to 10 parts or water.
 If you are attending to a casualty who has an infection, use disposable gloves if
possible.

HANDLING AND TRANSPORT:-


When moving a casualty, it is important to be aware of the dangers of yourself and the
casualty. Incorrect handling and transport methods could aggravate the casualty’s
condition and cause you to injure yourself.

You should not move a casualty unless you have received comprehensive training or the
casualty is in imminent danger and it is safe for you to approach him or her.

HANDLING AND TRANSPORT RULES:-


1. Move a casualty only if it is absolutely necessary and you are not putting yourself
in danger.
2. Always explain to a casualty what is happening so that he or she can co-operate
as much as possible
3. Do not attempt to remove a casualty by yourself if help is available. Ensure that
the helper understand what they need to do, so that they can co-operate fully.
4. When more than one person is moving a casualty, always appoint someone to
give verbal commands.
5. Always use the correct lifting technique to avoid injuring your back when lifting
or carrying.

MANUAL MOVES
The method you choose to remove a casualty from immediate danger will depend on
the situation, the casualty’s condition and whether there is any help available.
(a) Type of injury
(b) Weight and size of the casualty

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(c) Number of helpers
(d) Distance of safety

1. The task - is it really necessary? Can the casualty move himself? Is it possible to
get help? Is there any equipment available?
2. The load – how heavy is the casualty? What are his injuries and will the move
aggravate them?
3. The environment – have you made enough space for your move? What sort of
ground will you be crossing? Do you have everything you need?
4. The handlers – are you and any team members properly trained?

CARRIES FOR ONE FIRST AIDER


If no help is available, encourage a casualty to walk a little help from you or a walking
aid. If you are by yourself you should only attempt to move a casualty in an emergency,
when the casualty is in real danger. Only use the cradle and piggyback methods for
lightweight casualties such as children.
(a) Human Crutch method
(b) Cradle Method
(c) Drag Method
(d) Piggyback Method

CARRIES BY TWO FIRST AIDERS


It is easier to control a move with two First Aiders. However, such a carry must still be
undertaken with extreme caution and only in an emergency. Use the two handed seat
to move conscious casualties. Only use the fore - and – aft carry to move casualty on to
a stretcher or carry chair.
(a) The two – handed seat
(b) The fore – and – aft carry
(c) Chairs carry

STRETCHERS
These are used to carry casualties to an ambulance or shelter. The robust standard
stretcher is found at many sports grounds, schools and workplaces. The lighter canvas -
and – poles stretcher is used to lift a casualty on to a stronger stretcher. Orthopaedics
stretchers should be used when you suspect a spinal injury.

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GENERAL RULES FOR STRETCHERS:
(a) Always test stretchers regularly for wear and tear and make sure that they can
support a casualty’s weight.
(b) When loading a stretcher, explain to the casualty what is happening
(c) Always ensure that an unconscious casualty or a casualty, who needs to be
transported to any distance, is securely strapped on to the stretcher.

HUMAN CRUTCH
1. Stand on the casualty’s injured or weaker side. Place his arm in front of him and
grasp his hand with your hand.
2. Pass your other arm around his waist. Grasp his clothes to support him.
3. Move off with your inside foot. Take small step and walk at the casualty’s pace.
Reassure the casualty throughout.

DRAG METHOD
1. Crouch behind the casualty; help her to sit up and cross her arms over her chest.
2. Pass your arms under the casualty’s armpits and grasp her wrists. Carefully pull
her backwards and squat walk. (Do not use this method if there are shoulder,
head or neck injuries).

CRADLE METHOD
1. Squat beside the casualty; pass one of your arms around the casualty’s trunk,
above the waist cross her arms across her body.
2. Pass your other arm under her thighs stand, hugging her towards you.

PIGGYBACK METHOD
1. Crouch in front of the casualty; with your back to her. Ask her to put her arms
over your shoulders and if possible grasp her own hands.
2. Grasp the casualty’s thighs and rise slowly keeping your back straight.

THE TWO HANDED SEAT


1. Squat facing each other on either side of the casualty. Cross arms behind her
back and grasp her waist band.

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2. Pass your hands under the casualty’s knees and grasp each other’s wrists. Bring
your linked arms up to the middle of the casualty’s thighs.
3. Move in close to the casualty, keeping your back straight, rise slowly and move
together.
FORE – AFT CARRY
1. Sit the casualty up and put her arms across her chest
2. Squat behind the casualty, slide your arms under her armpits and firmly grasp her
wrists.
3. Ask your partner to squat beside the casualty and pass his arms under her thighs,
taking hold of her legs.
4. Working together, keeping your backs straight, rise slowly and move off.

FEVER
A sustained body temperature above the normal level of 37oC (98.oF) is known as fever.
It is usually caused by a bacteria or viral infection, and may be associated with influenza,
measles, chicken pox, meningitis, earache, sore throat, or local infection, such as an
abscess.
1 Make the casualty comfortable in cool surroundings, preferably in bed with a light
cover. Allow her to rest.
2 Give the casualty plenty of cool, bland drinks to replace lost fluids.
3 An adult may take two paracetamol tablets. Give a child the recommended dose of
paracetamol syrup.

HEADACHE
A headache may accompany any illness, particularly a feverish ailment such as
‘flu, but it may be the most prominent symptom of a serious condition, such as
meningitis or stroke. Mild “poisoning” caused by a stuffy or fume-filled
atmosphere, or by excess alcohol or any other drug, can induce a headache in an
otherwise healthy person.
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Headache may develop for no apparent reason, but can often be traced to
tiredness, nervous tension, stress or emotional upset, or undue heat or cold.
Headache can range from constant low-grade discomfort to “ blinding” pain that
is completely incapacitating.

TREATMENT
1 Help the casualty to sit or lie down comfortably in a quiet place. If possible,
remedy any likely cause of the headache, such as loud noise, bright light, or lack
of fresh air.
2 An adult may take two paracetamol tablets or her own painkillers. Give a child
the recommended dose of paracetamol syrup.

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