Professional Documents
Culture Documents
HISTORY
In addition to the above measurements, it is vital that we have a clear understanding of what is
happening or has happened to the casualty. The story of the incident is the history we collect and it is
essential that it is accurate.
HISTORY
The history of an incident is the story of the incident and the casualtys role in it. History is one
of the most useful tools available to first-aiders, ambulance and medical staff as they attempt
to determine the specific problems faced by a specific casualty. The unconscious or confused
casualty left in a hospital casualty department is a complete mystery to the medical staff
unless they gain insight through a good history. A good history is of great benefit whether the
casualtys problem is a medical condition or an injury.
HISTORY OF AN ILLNESS
With medical conditions the history of the casualty, and even their family, is of great use in
identifying the possible cause of a casualtys illness. For example, the casualty who develops
crushing, central chest pain which radiates to the left neck and arm may be suffering the first
signs of an acute myocardial infarction (AMI) (a very serious heart attack). If the casualty is
able to tell you that they have had episodes of breathlessness and chest tightness over the
last few weeks, then it adds strongly to the evidence that the casualty is having an AMI. If the
casualty also details a family history that includes a father dying of a heart attack, an uncle
having had heart problems and a brother also having had a heart attack, then the evidence is
overwhelmingly in favour of this casualty having an AMI.
HISTORY OF AN ACCIDENT
In a car accident the history is also of great importance in estimating the way in which the
casualty was injured and thus the injuries that the casualty may have suffered. In accidents, a
good history allows medical staff to quickly focus their attention on areas with a high
probability of injury and this gets the casualty into the operating room faster.
For example, a car runs off the road at around 11:30pm in light rain at a Y intersection and
travels towards an electricity pole approximately 50 metres from the edge of the roadway in a
direct line with the bottom end of the Y. The car was travelling along the stem or bottom part
of the Y and has left the road stopping short of the pole by about 5 metres.
Fig 1.
At first glance, the scene seems simple enough. The car has left the road and stopped just
short of the pole. There is little likelihood that anyone has sustained an injury. However, the
history and the physical evidence tell an interesting story.
On arrival at the scene, the first thing you noticed is that there were no skid marks on the
surface of the road and that the tyre marks on the soft edges and the wet soil leading up to the
tree show tread marks all along their length. This indicates that the driver did not apply the
brakes during the accident (under braking the marks would be smooth, that is true skid
marks). You also note that the wheel ruts are dead straight, indicating that the driver made no
effort to turn the steering wheel. You also note wet mud freshly sprayed over the rear of the
car indicating that the driver was driving the car under power. This tells you that the casualty
was probably conscious throughout.
On arriving at the drivers side door you noticed the driver is sitting up and looking forward at
the pole. Following your knock on the window the driver, the only occupant, winds down his
window and talks to you confirming that he was conscious when he ran off the road.
The indications we have is that the vehicle ran off a wet road in the dark and that the driver did
not attempt to steer away from a pole towards which the car was travelling. We also know
that he did not attempt to brake and that he actually applied power to the car. This indicates a
deliberate attempt to drive the car into the pole and indeed this was the case as the driver in
this case later admitted. The history told a story that indicated no physical injury but a
possibility of a person in distress. That is why the ambulance crew in this case persevered
with questioning the driver until he admitted the truth. This allowed them to ensure that the
police at the scene did not leave him alone and that they arranged further help for him.
In addition to reporting a closely observed history the next set of observations that the firstaider can establish is that of Clinical State. The clinical state of the casualty can also be
defined as being the measurement of how sick, or likely to die, the casualty is. Indeed, once
the first-aider learns to rely on the clinical state most of the doubt is removed from the decision
making process.
EMERGENCY OBSERVATIONS
THE HEALTHY PERSON WITH GOOD PERFUSION
1.
2.
3.
4.
5.
Conscious state:
Skin condition:
Pulse:
Respirations:
Blood Pressure:
These four observations tell you that the heart is pumping blood filled with oxygen, food and water
through the blood vessels to the cells of the body and removing carbon dioxide and waste products
from them. In an emergency the following four observations have real importance:
Conscious state:
Skin condition:
Pulse:
Respirations:
5. Blood Pressure:
Where a casualty has two or more of the above signs get help immediately by calling an
ambulance. Do not wait for the casualty to get worse.
The Sick casualty - A person who is seriously ill or injured will suffer poor perfusion because the body
cannot supply enough oxygen, water and food to the bodys cells and cannot remove carbon dioxide
and waste products quickly. Poor perfusion exists where a casualty has two or more of the following
observations:
MEASURING RESPIRATION
In primary patient assessment observe that the patient has an adequate respiratory rate and depth by
visual observations. Respirations should be regular and inaudible.
Count respirations for one minute by observing the rise and fall of chest.
Assess whether the accessory muscles are being used, as the overuse of accessory muscles could
indicate respiratory distress.
Listen for abnormal/noisy breath sounds e.g. gurgling, sighing, and wheezing.
MEASURING CONSCIOUSNESS
RAPID ASSESSMENT
Initial assessment of a casualtys conscious state is based upon their awareness of their surroundings.
Thus, a casualty who responds to your presence, is able to tell you where they are and when they are
(aware of time and place), and is able to speak clearly is conscious.
DETAILED ASSESSMENT
In order to more accurately track changes in a casualtys conscious state a scale, called the Glasgow
Coma Scale (GCS), is used. The GCS enables us to objectively chart a casualtys level of
consciousness at a given point in time using a standardised measure. The elements of the GCS are
the ability of the casualty to open their eyes, to speak and to use their muscles.
The GCS requires no equipment other than a watch and a pen/pencil and paper.
It is important that you record the best response to the test, even if the casualty cannot immediately
reproduce it.
4
3
2
1
5
4
3
2
1
6
5
4
3
2
1
The importance of the GCS is that over time the carer can track changes (decline or improvement) in
the casualtys condition. The sooner you establish accurate recording of the GCS the closer to an
injury or event you can move treatment. The charts below provide an example of what some
conditions look like.
CHAPTER 2
APPROACH TO THE INCIDENT
Reassuring the casualty is very important in first aid and the best reassurance for both casualty and
bystanders is a confident first aider taking decisive action. In order to treat a casualty you must first
manage the incident and the most important skills in first aid are those that allow you to quickly:
1.
2.
3.
4.
DANGER
All emergency incidents are chaotic and there are many dangers. However, all these dangers come
from the environment, the casualty and the bystanders.
Take your time. Be alert and wary. Approach the incident by identifying potential dangers, then
neutralise or remove them, or move yourself, bystanders and the casualty clear of the danger.
Your job is to reduce chaos and not add to it by allowing others, including yourself, to become victims.
In some situations such as high voltage electrocution or poisonous atmospheres, you may be
powerless to help a casualty. If this is the case you must wait and let the experts handle the rescue of
the casualty.
Always Protect Yourself First - If you are injured you cannot help anyone else. The emergency
services will have an extra casualty, and you may find yourself uninsured and off work.
Protect the Bystanders next - Your next priority is to protect bystanders. If necessary, move
bystanders well back from the incident, but remember they will provide valuable help in managing the
incident so make full use of them. However, if you give a bystander a task you must ensure that:
1.
2.
Protect the casualty Last: If you are to effectively deal with a casualty you must have a safe and
ordered environment so minimise danger for the casualty by removing it or, if absolutely necessary,
moving the casualty.
TRIAGE
Where there is more than one casualty you must decide which casualty is to be treated first. To make
this decision you have to look at all the casualties and prioritise them. This process is called triage,
which is a word derived from the French word for three. It is used in medicine to describe the three
levels of seriousness of a casualtys condition:
1.
2.
life threatening
serious injury
10
3. minor injury
If you are first to arrive at a multi-patient scene you will contribute greatly to the treatment of casualties
if you are able to direct ambulance staff to those most in need of immediate care. Concentrating on a
single seriously injured casualty may allow the unnecessary death of another casualty. By triaging all
of the casualties at a scene you will be able to:
1.
2.
3.
Therefore:
1.
2.
3.
Only after you have organised the incident can you begin to treat individual casualties.
2. at the direct cause of the injuries: inspect the object which caused the injury or
3.
damage. The greater the damage to it, the more serious the injury to the casualty
at the casualty: How old is the casualty? The young or elderly often suffer more
serious injury at lower speeds
11
PATTERN OF INJURY
A useful guide to the possible injuries a casualty may suffer at an accident is the pattern of injuries.
The term Pattern of Injuries describes the most common types of injury caused to a human body by
the forces involved in a particular type of accident. Common patterns of injury are:
1.
2.
3.
4.
5.
1.
2.
3.
4.
5.
6.
7.
8.
1.
2.
3.
SIGNS
Signs are those things on or about the casualty that you can see, hear, touch, smell or taste for
yourself. They are identified by using a systematic examination. Remember the most important set of
Signs in first aid are those which tell you the casualtys perfusion status.
SYMPTOMS
Symptoms are the feelings and sensations (pain, nausea, visual disturbances, dizziness, tingling) that
only the casualty can feel. Only the casualty can tell you about their Symptoms. This means that,
unlike History or Signs, Symptoms cannot be substantiated from other sources.
Before we look at life saving it is perhaps worth considering death and first aid.
12
2.
3.
4.
5.
13
CHECK AIRWAY
- Position self at casualtys head and watch reactions
1.
Extend casualtys head:
-place hand nearest top of casualtys head on their forehead
-push casualtys head firmly but gently back
-keep head in that position
2.
Jaw lift:
-take hold of casualtys chin between thumb and forefinger
-and open mouth
3.
Look into mouth:
-check for injury to teeth and gums
-check for missing teeth
-foreign objects
4.
Smell for:
-blood and vomit
Fig. 3-3: Clearing the airway using head extension and jaw lift
CHECK BREATHING
1.
2.
3.
4.
14
15
CHAPTER 3
BASIC ANATOMY AND PHYSIOLOGY
SURFACE ANATOMY
Surface anatomy is the identification of landmarks on the surface of the skin which allows us to
compare our knowledge of our own surface anatomy with that of an injured person.
The best way to learn about surface anatomy is to look at and examine your own body. What you
learn from this will help you find injuries on others.
THE SKELETON
15
The skeleton is made up of bone, which is living tissue that requires a blood supply. The larger bones
in the body, such as the pelvis and the femurs, have a greater blood supply because the blood is
made in their marrow.
The Central Nervous System of the brain, cranial nerves and spinal cord;
Brain
Spinal Cord
2.
The Peripheral Nervous System, which is comprised of motor (voluntary) nerves and
sensory nerves. For example, the brain uses motor (voluntary) nerves to transmit commands
to the muscles so when you wish to pick up a glass the motor nerves tell the muscles of the
hand, arm, shoulder and chest to move.
Sensory Nerve
To Spine
Motor Nerve
Fig.1-6: Peripheral Nervous System including Motor (Voluntary) Nerve and Sensory Nerves
3.
The Autonomic (involuntary) Nervous System controls activity in the body without involving
the conscious mind. Most of the functioning of the body is controlled by the autonomic or
involuntary nervous system.
16
THE AIRWAY
Nasal Cavity
Nasopharynx
Mouth
Larynx
Trachae
Bronchi
Lungs
The airway extends from the lips and nostrils, through the nasal and oral cavities to the naso-pharynx
and pharynx, through the larynx, tracheae, bronchi and down to the surface of the air sacs in the
lungs. The airway can be blocked at any point along its length. The most common causes of such
blockage are our own position, vomit, food, saliva, and blood.
THE LUNGS
The air sacs (alveoli) in the lungs are structures one cell thick. They are thin so as oxygen and other
gasses can easily pass into and out of the blood stream.
Co2
O2
Fig 1-9: Air sac (Alveolus) with walls one cell thick
The lungs themselves are therefore made up of the tubes of the airway and the millions of alveoli that
enable oxygen to move into the blood stream.
17
The lungs are contained within the chest and are protected by the chest wall and a layer of tough
tissue called the pleurae.
THE HEART
The heart is a muscular organ that pumps blood to the body and the lungs. It consists of four
chambers, two collecting chambers (atria) and the pumping chambers (ventricles).
The Heart
Aorta
Superior Vena Cava
Pulmonary Arteries
Left Atrium
Right Atrium
Left ventricle
Right Ventricle
Fig. 1-11: The heart showing the flow of blood from the atria to the ventricles
Fig. 1-12: Cross section of an artery and vein showing the difference in thickness.
Both arteries and veins have three layers of tissue and in both the layers are a tough outer coat, a
middle muscle layer and a smooth lining. The difference between the two is that the muscle layer is
much thicker in the artery than in the vein. The artery requires a thick muscular wall so that it can
assist in pumping blood around the body. The vein is soft so that blood can be squeezed along it by
other muscles.
The capillary is similar to the air sacs in the lungs in that its walls are only one cell thick. This is
because, like the air sacs oxygen and CO2, water and food have to pass through its walls to get to the
cells of the body and to the outside.
Co2
O2
Fig. 1-15: Cross section of a capillary.
18
THE ABDOMEN
The abdomen contains the spleen, stomach, intestines, liver and pancreas, kidneys, bladder, female
reproductive system and the blood vessels which supply them and the legs.
19
THE SKIN
The skin comprises a number of layers and structures which protect the body from temperature
change, damage, fluid loss and infection. What we see as skin is in fact the outermost layer which is
dead.
20
CHAPTER 4
TRANSMISSIBLE DISEASE
Today there is a great deal of concern about transmissible diseases, especially Acquired Immunodeficiency Syndrome (AIDS) due to Human Immuno-deficiency Virus (HIV). However, HIV-AIDS is
only one disease and whilst dangerous, it is not the most dangerous or only infectious disease that the
first aider has to consider. There are a range of other diseases which are more common and more
easily caught and are therefore more dangerous than AIDS. For example, Hepatitis B (which is wide
spread in some communities and is about 240 times more infectious than HIV-AIDS), influenza, colds,
childhood diseases, sexually transmitted diseases, herpes, TB, bacterial infections and infestations
such as scabies, ringworm etc. In order to protect ourselves we must treat all casualties as being
potentially infectious and the procedure for dealing with a potentially infectious casualty is called
Universal Precautions.
21
CHAPTER 5
LIFE SAVING TREATMENTS
At any stage of the approach to the incident or during the examination you may detect an injury or
serious condition. The conditions you detect will fall into three groups:
1. those which threaten life which you can treat,
2. those which threaten life which you cannot do anything about, and
3. those which will not immediately threaten life
There are five areas of life saving activity,
1.
2.
3.
4.
5.
CHECK AIRWAY
-extend head backward
-open mouth and look in
-smell for vomit or blood
-check dentures are fixed and if so leave in place
-listen for noisy breathing
22
CHOKING
Choking is due to the blockage of the casualtys airway with a foreign object or substance. Choking
falls into two categories; partial and complete obstruction.
Adult casualty has often been talking, eating and drinking alcohol
child casualty has often been seen playing with small objects
Elderly and infirm person
Story of sudden violent struggling by casualty
SIGNS
a.
b.
c.
d.
e.
SYMPTOMS
a.
Patient is distressed
COMPLETE OBSTRUCTION
The History will tell you if a casualty has suffered a complete obstruction of their airway. Very few
people, except the very frail or elderly, choke without a struggle. A major indicator of complete
obstruction is that the casualty will not make any sound because the airway is completely blocked.
Fortunately complete obstruction is rare.
Adult casualty has often been talking, eating and drinking alcohol
Child casualty has often been seen playing with small objects
Elderly and infirm person
Story of sudden violent struggling by casualty
SIGNS
a.
b.
c.
d.
e.
SYMPTOMS
a.
None
23
4.
5.
6.
7.
24
7.
8.
25
CHEST COMPRESSIONS
Chest compressions are performed following the start of Assisted Ventilations. CPR is the combined
use of assisted ventilations and External Cardiac Compression (ECC) to maintain the casualty until
the arrival of more advanced medical treatment such as electrical defibrillation or drug therapy. It is
very rare for CPR to restart the heart of a casualty.
8.
9.
26
10.
27
28
5
6.
7.
8.
9.
10.
11.
29
CONSTRICTIVE BANDAGE
As a last resort, in rare circumstances, where direct pressure, elevation and rest does not stop
bleeding it may be necessary to use a constrictive bandage. Constrictive bandages are very
uncomfortable for the casualty and can cause severe distress.
3.
4.
1300hrs
5.
INTERNAL BLEEDING
Internal bleeding into the chest or abdomen is a common injury which presents a major threat to life.
The priority is to get the casualty to a surgical hospital as soon as possible.
a.
b.
c.
Poor perfusion
Guarding of abdomen
Obvious injury or frank blood excreted from body, coughed, vomited
or passed in urine or bowel motion
a.
SIGNS
SYMPTOMS
30
31
CHAPTER 6
HEAD INJURY AND UNCONSCIOUSNESS
BRAIN INJURY
Injury to the brain is one of the more serious outcomes that occur due to injury or illness. The first
aider plays a major role in limiting damage that has already occurred and in preventing damage by
identifying the danger of a potential brain injury.
SIGNS
a.
b.
c.
d.
e.
f.
SYMPTOMS
a.
b.
c.
d.
e.
f.
headache
nausea
confusion
speech disturbance
loss of balance
visual disturbance including a dislike of bright light
Because of the danger of compression it is very important that you are able to accurately identify
potential brain injury and monitor changes in a casualtys level of consciousness. The method of
measuring conscious level is the Glasgow Coma Scale.
32
4
3
2
1
5
4
3
2
1
6
5
4
3
2
1
5
4
3
2
1
1. Jennings B., Teasdale. G., Management of Head Injuries, F.A. Davis Company, Philadelphia.
33
There are three types of fractures involving the bones of the head.
1.
2.
3.
Open - This involves the broken bone and brain being exposed to the air.
Closed -Closed fractures of the skull and face referring to breaks in the bones.
Complicated -Complicated fractures involve damage to the brain or its protective
coverings and blood vessels.
The spine and back may be injured in many ways. The most common injuries are those caused by
damage to the muscles and the discs between the vertebrae. These injuries occur as a result of
dangerous lifting practices and are extremely painful, costly and, unfortunately, very common. Other
injuries include stable and unstable fractures and dislocations of the spine. With stable injuries there
is little danger of the bone damaging the spinal cord, but with unstable injuries damage to the spinal
cord can be easily caused by movement.
Spinal injuries not only result in paralysis but can cause many problems such as poor perfusion and
uncontrolled loss of heat from the body. As well as the spinal injury there may be other injuries,
particularly severe head injury. Remember that all unconscious casualties with severe head injury
have a spinal injury till proven otherwise in hospital.
34
SIGNS
a.
b.
c.
d.
SYMPTOMS
a.
b.
c.
d.
5.
6.
7.
35
NOSE INJURIES
Fractured Nose -Fractures of the nose are painful and disfiguring but not life threatening unless there
is associated uncontrolled bleeding.
Foreign Body in Nose - If it can not be blown out or swallowed send to medical practitioner.
Nose Bleed -Most nose bleeds (epistaxis) are dramatic but not life threatening unless it follows severe
facial injury or the casualty is unconscious or elderly.
36
EYE INJURIES
Foreign Bodies in Eye - The first indication of an eye injury is often the sensation that there is
something in the eye.
37
Foreign Object in Ear - For foreign objects in ear leave them for the medical practitioner. If it is an
insect it can be drowned using warm olive or vegetable oil. Insects, such as moths, can be removed
from ears at night by holding a light a few feet away from the affected ear. The moth will, hopefully,
then fly out from the ear.
FRACTURED JAW
There are two basic types of jaw fracture; stable and unstable. With both types of fracture the major
concern is with the casualtys airway. If the casualty is unconscious, simply place them on their side.
If the casualty is conscious then treat as follows:
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CHAPTER 7
MEDICAL CAUSES OF UNCONSCIOUSNESS
STROKE (CEREBRO-VASCULAR ACCIDENT)
Stroke or Cerebra Vascular Accident (CVA) is the common term used to describe the damage
suffered when there is a sudden interruption in the blood supply to the brain. This damage may range
from minor to severe. CVAs are caused by two mechanisms; the blocking of an artery by a blood clot,
or the bursting of an artery within the skull which causes compression of the brain.
SIGNS
a.
b.
c.
d.
SYMPTOMS
a.
b.
c.
d.
e.
f.
headache
nausea
confusion
speech disturbance
loss of balance
visual disturbance including a dislike of bright light
TREATMENT OF STROKE
1.
2.
3.
4.
5.
6.
39
EPILEPTIC FIT
Epilepsy may be defined as a brief disorder of cerebral function often associated with an altered
conscious state and accompanied by sudden, excessive discharge of cerebral neurones which cause
spasm of the muscles.
SIGNS
a.
b.
c.
d.
e.
f.
SYMPTOMS
a.
b.
c.
loss of consciousness
tonic (spasm)
cry may be heard
convulsions may be seen
patient often incontinent of urine and faeces
patient seems drowsy or very sleepy and confused
Uncommon, and often very vague feeling, that a fit is about to occur.
TONIC STAGE
CLONIC STAGE Strong spasms alternate with relaxation and it is at this point that the
casualty often loses control of the bladder and bowel and froths at the
mouth.
SLEEPINESS
The casualty becomes relaxed and comatose and may even fall asleep
for up to 30 minutes or more before regaining consciousness. The
casualty may remain confused for some time following a return to
consciousness.
40
DIABETES
Diabetes is a systemic disease which prevents the pancreas from producing enough insulin for the
body to metabolise sugar. The problems that affect diabetics are low blood sugar, an emergency and
high blood sugar which is often readily identified and treated by the diabetic casualtys family doctor.
SIGNS
a.
b.
c.
d.
e.
SYMPTOMS
a.
Headaches
4.
5.
6.
41
CHAPTER 8
CARDIAC CONDITIONS
Despite a steady decline the single most frequent cause of death in Australia during 2002 was
1
coronary artery disease which killed 32, 029 people . Because it is such a killer you must be aware of
how to recognise acute cardiac conditions and the best way of doing this is to recognise the
significance of chest pain. All casualties who have chest pain should be considered seriously ill until
the exact cause of the pain is identified. Chest pain is divided into two groups, pain which originates in
the chest wall and chest pain due to heart disease.
ANGINA
Angina is caused by deposits of fat and other substances in the lining of the medium sized arteries of
the heart. This leads to a narrowing of the arteries in the heart and a restriction of blood flow to the
heart muscle. Normally casualties with narrowing of their coronary arteries suffer no discomfort unless
they exert themselves.
patient has been diagnosed as suffering angina and been prescribed angina
medication by their doctor
pain or shortness of breath develops during physical exertion
pain lasts less than 10 minutes
a.
SIGNS
SYMPTOMS
a.
42
Approach casualty
Loosen tight clothing
Rest and reassure casualty
Assist casualty to take their own medication (this may be a spray or tablet placed under the
tongue)
If pain persists for more than 10 minutes or after two doses of medication given 5 minutes
apart, call ambulance immediately and treat casualty for AMI.
SIGNS
a.
b.
SYMPTOMS
a.
b.
c.
d.
e.
f.
If you are in anyway unsure treat any chest pain as an AMI and send the casualty to hospital
Approach casualty
If chest pain is cardiac, immediately call ambulance
Take a careful history
Rest and reassure casualty
Be prepared to perform CPR
43
There may be abnormal impulses in a normal heart like those shown in Fig. 5-2.
Sometimes abnormal beats occur which cause the heart to develop a dangerous rhythm such as that
shown in Fig. 5-3. This rhythm will result in the casualty becoming sick and showing Signs of poor
perfusion (shock).
Fig. 5-3: Ventricular Tachycardia. This rhythm will result in a rapid deterioration of the casualties condition
The ventricular tachycardia shown at Fig. 5-3 above will, if not treated, lead to the electrical conduction
within the casualties heart becoming chaotic. This condition, shown at Fig. 5-4, is called ventricular
fibrillation and the casualty will have no pulse and will be in cardiac arrest. This condition is treated in
first aid with CPR.
44
If the casualty has suffered a large amount of damage to their heart, or if they have been collapsed for
more than about 5 minutes without CPR, the electrical conduction system gradually fails. This
condition, cardiac asystole, is shown at Fig. 5-5 below.
In adults, asystole has a very poor outcome and very few casualties survive. However, effective CPR
quickly applied gives the casualty some chance.
In children, asystole is treated with CPR and the outcomes are better than with adults.
Approach casualty
Call ambulance ASAP
CPR
Obtain Defibrillator
Switch on defibrillator
Attach pads to front of chest - ensure that gel is well spread
Maintain CPR
Check pads correctly connected to defibrillator
Allow time to read electrical rhythm
Order all persons to stand clear
Visually check all clear
Only press fire button when instructed to do so by defibrillator
Fire defibrillator at 150 joules
Check for carotid pulse
Repeat steps 6 to 14 until ambulance arrives
45
CHAPTER 9
RESPIRATORY CONDITIONS
The causes of respiratory distress fall into three main groups; medical conditions, traumatic injury and
poisoning. Amongst the medical conditions you need to be aware of are asthma, pulmonary oedema,
Chronic Obstructive Airways Disease (COAD) and childhood airway problems. Traumatic injuries
include problems such as flail segments, Pneumothorax and haemothorax, hanging, strangulation,
choking, drowning and asphyxiation. But whatever the condition, if the casualty is poorly perfused and
showing Signs of respiratory distress then get help as soon as possible.
MEDICAL CONDITIONS
ASTHMA
Bronchial asthma is a condition that results from the narrowing of the small air tubes
(bronchioles) that lead to the air sacs (alveoli) in the lungs. This narrowing is caused by
muscle spasm in the tubes, swelling of the mucus membrane lining the tubes and/or the
plugging of the tubes with mucus. Asthma may begin at any age but is much more likely to
begin in childhood or early adulthood and there is often a family history of asthma and
other allergic responses. Acute asthma attacks can be brought on by allergic reactions,
infections and psychological or emotional stress.
Asthma can be as frightening an experience for you as it is for the casualty. It is important
that this anxiety and distress be reduced, the casualty helped to use their own medication
and an ambulance called as soon as possible.
Asthma is an easily treatable condition and all asthma sufferers are able to self medicate
themselves using salbutamol (Ventolin) and a variety of other drugs. In first aid one of the
main principles is prevention and if an asthmatic casualty is finding that their medication is
not providing them with the usual level of relief then they should see their doctor. The
continued dependence on self medication and a reluctance to seek early medical
assistance often leads asthmatic casualties to suffer unnecessarily severe attacks.
Asthma is not a problem unless the casualty suffers an acute attack or allows a mild attack
to continue for a prolonged period. The earlier the casualty is treated by a medical
STATUS
ASTHMATICUS
practitioner the less severe the illness. Be aware that if the medication does not relieve the
casualties symptoms within 15 to 30 minutes then it is likely that they will not work at all
Status
asthmaticus
is need
a prolonged
asthmatic
attack
is not responding to treatment and
and the
casualty will
to see their
doctor as
soon that
as possible
the casualty becomes progressively worse until they loose consciousness and die. Status
asthmaticus is a dire emergency and an ambulance must be obtained as soon as possible.
46
SIGNS
a.
b.
c.
d.
e.
SYMPTOMS
a.
Patient is extremely anxious and distressed
11.
12.
a.
b.
c.
e.
f.
SIGNS
47
SYMPTOMS
a.
b.
SIGNS
a.
b.
c.
d.
e.
f.
SYMPTOMS
a.
b.
PULMONARY EMBOLISM
Pulmonary embolism is the blocking of a pulmonary artery or one of its branches by a clot of blood, a
globule of fat or other obstruction. The outcome of such a blockage will be the death of lung tissue,
the failure of respiration and even right-sided heart failure, due to the build up of pressure in the lung.
SIGNS
a.
b.
c.
SYMPTOMS
a.
b.
c.
Poor perfusion
Respiratory distress
Jugular veins in neck will be distended
48
HYPERVENTILATION (OVER-BREATHING)
Hyperventilation (over-breathing) is associated with hysteria or excitement. The direct cause is a
lowering of the amount of carbon dioxide in the blood stream by breathing too rapidly and deeply.
Short periods of hyperventilation are not life threatening
SIGNS
a.
b.
c.
d.
SYMPTOMS
a.
b.
c.
TREATMENT OF HYPERVENTILATION
1.
2.
3.
4.
5.
6.
49
PLEURISY
Pleurisy is a condition in which the outer lining of the lungs and the inner lining of the chest wall are
roughened or inflamed by disease. When the casualty breathes the inflamed areas rub causing pain.
Pleurisy is not a medical emergency but because it is caused by an underlying disease casualties
should see their doctors. One of the major problems with pleurisy is that as a chest pain it needs to be
taken seriously until it can be proven not to be the pain of a heart attack.
Pain relief, using aspirin or paracetamol, and treatment of any coughing with pholcodine linctus may
also be useful. Further pain relief can be obtained by placing a warm object close to the site of the
pain.
SIGNS
a.
b.
c.
d.
e.
SYMPTOMS
a.
b.
c.
d.
TREATMENT OF PLEURISY
1.
2.
3.
4.
5.
50
CROUP
Croup is caused by infection in the respiratory tract which leads to swelling of the mucosa. In babies
and younger children, because the diameter of their airway is so small in relation to its lining, even a
small degree of swelling can result in significant obstruction of their airway.
SIGNS
a.
b.
c.
d.
e.
f.
g.
h.
SYMPTOMS
a.
Difficult to obtain
TREATMENT OF CROUP
1.
2.
3.
4.
5.
6.
7.
8.
9.
EPIGLOTTITIS
Epiglottitis is inflammation of the epiglottis situated below the base of the tongue in the pharynx. The
inflammation is caused by a bacterial infection, haemophilus influenza, and the condition is a serious
medical emergency with a high risk of complete airway obstruction. It is absolutely essential that if
epiglottitis is suspected no attempt is made to examine the casualties mouth or throat and no action
taken that may upset casualty. Urgently call for an ambulance.
51
SIGNS
a.
b.
c.
d.
e.
f.
g.
h.
SYMPTOMS
a.
b.
TREATMENT OF EPIGLOTTITIS
Never attempt to examine the airway of a casualty with suspected epiglottitis
1.
Approach the Incident - do not disturb child
2.
Calm and Reassure Mother and Child
3.
Call ambulance immediately
4.
Visually Check Breathing and Circulation
5.
If Child hot, carefully remove any excess clothing
6.
Be prepared to give Assisted Ventilations and CPR
TRAUMATIC INJURY
AIRWAY PROBLEMS
For airway obstruction see page 14 etc.
HANGING
Hanging is a reasonably common cause of death. It is often used by suicides and is used as an autoerotic sexual practice by some. Whatever the reasons for the hanging, the problems faced by the first
aider are not confined to simple asphyxia. As well as asphyxia the hanged casualty can suffer severe
damage to the spinal column and muscles of the neck due to stretching of these structures by the
body weight. This stretching can also cause damage to the carotid sinuses, which are located in the
neck, and this can result in disturbances of heart rhythm and blood pressure.
52
TREATMENT OF HANGING
1.
2.
3.
4.
5.
6.
7.
Approach incident
Check casualties abdomen for warmth
If casualty still warm get help immediately
When help arrives, lift casualty as follows
-first support casualties head and neck
-lift casualty and loosen noose (watch your back!!)
-cut noose or rope
-allow casualty to slip to ground while supporting head and neck
Check and clear airway -ensure cord/rope is cleared from neck
Check breathing Assisted Ventilation if necessary and CPR
Full Examination and treat for spinal injury
You will need help to get the casualty down so first get help. Watch your back and be aware that
some suicides use steel cable and chains to hang themselves and to release the noose you must
undo the knots or use bolt cutters.
STRANGULATION
Strangulation occurs when the tracheae and larynx are compressed or crushed by pressure from
outside. True strangulation is usually the result of criminal assault.
TREATMENT OF STRANGULATION
1.
2.
3.
4.
5.
DROWNING
People drown quietly. In drowning the victim can swallow a lot of air and water which fills their
stomach and oesophagus before flowing over into the windpipe and lungs. In children this can mean
that the stomach can be hyper-inflated so that it distends into the chest cavity and reduces the ability
of the lungs to expand. In adults the stronger body structures prevent this happening.
With both adults and children, vomiting of water and stomach contents increases the danger to the
casualties airway.
Although fresh and salt water drowning lead to differing chemical problems, the first aid treatment
remains the same.
TREATMENT OF DROWNING
1.
2.
3.
4.
53
FRACTURED RIBS
With simple rib fractures, the major problem is pain. This makes breathing difficult and is very
uncomfortable.
Direct blow/trauma
Usually 5th through 9th ribs - these are unprotected by shoulder
SIGNS
a.
b.
c.
d.
SYMPTOMS
a.
Approach incident
Check airway, breathing and circulation
Check for major haemorrhage
Examine chest wall -isolate area of pain
Allow casualty to Find Comfortable Position (usually lying on injured side)
Apply Arm Sling
Take and record observations
Send casualty to hospital
54
FLAIL SEGMENT
A flail segment is where a rib or series of ribs are fractured in two places allowing a segment of the
chest wall to float free from the surrounding chest wall. This reduces the amount of air that can be
taken into the lungs and can lead to asphyxia. Obviously the larger the segment the more dangerous
the injury.
SIGNS
a.
b.
c.
d.
SYMPTOMS
a.
b.
c.
d.
Poor perfusion
Respiratory distress
Chest wall collapses in during inspiration
Site of fracture tender to touch
Pain on attempt to breathe deeply
Shortness of breath
Patient is able to easily localise pain
Conscious state may be reduced
6.
7.
8.
Approach incident
Check airway, breathing and circulation
Examine Chest Wall - isolate area of injury
Call ambulance immediately
Immobilise chest wall with hands and then
-place towel or large pad over flail segment
-bandage pad firmly to chest:
-tie knots on front of uninjured side over pads
-place arm on the injured side in an Arm sling
Allow casualty to find most comfortable position
Take and record observations
Recheck casualty frequently
55
SIGNS
a.
c.
d.
f.
g.
SYMPTOMS
a.
Poor perfusion
Fast and shallow respiration
Distended neck veins
Blood stained froth in mouth or on lips
Wounds to chest wall
7.
8.
9.
10.
Approach incident
Check airway, breathing and circulation
Call ambulance immediately if injury identified
If necessary Assisted Ventilations and CPR
Check for major haemorrhage
Examine chest wall
-look for more than one wound
-isolate all wounds
-leave protruding foreign objects in place
Seal wound during inspiration and release during expiration
If you have time dress wound (This may not be possible on sweaty skin)
-place air-tight (plastic/rubber) dressing on wound
-tape only three sides of dressing
-ensure dressing seals during inspiration and lets air vent during expiration
If Conscious, let casualty find most comfortable position
Take and record observations
SIGNS
a.
b.
c.
SYMPTOMS
a.
b.
56
TREATMENT OF PNEUMOTHORAX
1.
2.
3.
4.
5.
6.
Approach incident
Check airway, breathing and circulation
Call ambulance
Examine neck and chest wall
-look at neck veins
-examine neck, shoulders and chest wall for damage and air in skin
If Conscious, let casualty find most comfortable position
Take and record observations
Pneumothorax and haemothorax are uncomfortable and can cause the casualty some distress.
However, they are not necessarily life threatening, unless air and blood are trapped in the chest cavity
under pressure. This is called Tension Haemo-Pneumothorax and this is a true medical emergency.
SIGNS
a.
b.
c.
d.
e.
SYMPTOMS
a.
c.
Poor perfusion
Respirations get faster and deeper before becoming shallower
Distended neck veins
Air may be felt in the tissues of the chest wall
Windpipe may be pushed to the uninjured side
5.
6.
Approach incident
Check airway, breathing -CPR if necessary
Call ambulance immediately
Examine neck and chest wall
-look at neck veins:
-examine neck, shoulders and chest wall for damage and air in skin
-examine windpipe and top of breastbone to check they align
If conscious, let casualty find most comfortable position
Take and record observations
57
CHAPTER 10
ABDOMINAL INJURY
ABDOMINAL PAIN
Abdominal pain can be a sign of a vast range of ailments, both major and minor. In fact anything
ranging from internal haemorrhage to flatulence. Any persistent abdominal pain must be assessed by
a medical practitioner.
SIGNS
a.
b.
c.
d.
SYMPTOMS
a.
Poor perfusion
Guarding and rigidity of abdomen
Obvious injury to body
Frank blood excreted from body
58
INTERNAL BLEEDING
Internal bleeding into the abdomen is a common injury which presents a major threat to life and there
is nothing you can do to control the bleeding. It is essential that the bleeding is identified and the
casualty taken to a surgical hospital as soon as possible.
SIGNS
a.
b.
SYMPTOMS
a.
Poor perfusion
Guarding and rigidity of abdomen
Pain and tenderness
SIGNS
a.
b.
c.
SYMPTOMS
a.
b.
c.
1.
G. D. Tacy, Ruptured Abdominal Aortic Aneurysm, Emergency Medicine: The Principles and Practice, 2nd Edition,
Ed. G.W.O. Fulde, Maclennan and Petty, Artarmon, 1994, p.87
59
CHAPTER 11
BURNS
Burns are caused as a result of exposure to heat, chemicals and electricity. A burn is an injury caused
by heat to the skin and its underlying soft tissues. Burns also inspire a great deal of distress to
casualties, bystanders and rescue personnel. Where a casualty has been burned you have to deal
with danger, airway burns, respiratory arrest, poisoning and the burn itself.
Fig: 8-1: Roll casualty with foot keeping hands and face away from rising hot air
60
React quickly
Throw down, push over or trip casualty
Do not stand above casualty as rising hot air can burn your face and hands
Roll the casualty using your foot or smother flames with a blanket
Get water onto casualty ASAP
TYPES OF BURN
Burns are classified into two types, superficial and deep.
Superficial
Deep
SUPERFICIAL BURN
Superficial burns involve injury to the upper layers of the skin only. This leaves the deeper
skin cells, nerves and other structures alive and the skin is able to recover by itself.
DEEP BURN
A deep burn, as the name suggests, extends deep into the skin killing all the skin cells and
underlying structures including nerves. Thus deep burns are painless, although the area
surrounding a deep burn may be painful. Any deep burn is a serious burn.
61
9%
9%
9%
9%
9%
9%
9%
1%
9%
9%
9%
9%
Fig. 8-3: The rule of 9s applied to the adult male
18%
18%
18%
9%
9%
14%
14%
Fig. 8-4: Rule of 9s estimation of Burns on a child
SIGNS
a.
b.
c.
d.
e.
SYMPTOMS
a.
b.
c.
d.
e.
Redness
Inflammation
Swelling
Blisters
Moist appearance
Pain
Tenderness
Gritty feeling
Nausea with large burn
Dizziness with large burn
62
SIGNS
a.
b.
c.
d.
SYMPTOMS
a.
b.
c.
d.
TREATMENT OF BURNS
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
14.
Danger - ensure your own safety and then that of the bystanders
Get casualty out and put water on them as soon as possible
Airway - look for ash, soot, burns, blistering or swelling to airway
Breathing - look for respiratory distress
If not breathing - Be prepared to give CPR
Call ambulance immediately
Remove all clothing unless stuck to burned area
Apply running cool water for up to 10 minutes
-do not over cool the casualty, beware of hypothermia
Find and remove all jewellery from casualties body
Look for other injuries - burned casualties often suffer cuts and fractures during their attempts
to escape the flames
Place a dry, clean sheet over casualty
Reassure casualty and bystanders
Take and record observations
SCALDS
Scalds are burns caused by hot fluids. Scalds can be very serious and it is essential that quick action
be taken to limit the extent of the burn. Scalds can be caused by hot water, hot oil or any hot liquid. In
all scalds it is very important that all clothing be quickly removed.
In scalds the hot water or oil is absorbed into the clothing and held close to the casualtys skin. This
results in the liquid being insulated from any cold water that is applied and the heat being retained
against the skin for a longer period. Young children who are scalded often have the deepest burns in
the groin area due to their nappies absorbing and holding the hot liquid. Treatment is the same as for
other burns.
CHEMICAL BURNS
Chemical burns are treated in exactly the same way as other types of burn with the exception that
water is applied for longer, up to 20 minutes. You should take care to ensure that you do not come
into contact with the chemical or the water being used to remove it from the casualties body.
Chemical burns to the eyes receive special attention. If casualty has chemical or heat burns to eye
immediate action is required in order to save the casualties sight.
63
DRABCD
Get casualty to water or water to casualty
Open eyelids
Flush with large amounts of cool water for 20-30 minutes
Get ambulance immediately
Treat as for severe eye injury
-dressings to both eyes
-stay with casualty
-keep them calm
ELECTRICAL BURNS
Electrical burns can appear to be very small at first but later extend into very large and serious burns.
No matter how minor an electrical burn seems the casualty must be sent to hospital because the
electric shock may cause electrical disruption of the heart.
High tension electrical burns are often associated with explosive injuries with the casualties arms, legs
or other parts of the body being blown off.
64
CHAPTER 12
FRACTURES, DISLOCATIONS AND SOFT TISSUE
INJURIES
The limbs are the most common site of injury. The injuries that you will encounter include bruising,
sprains, strains, dislocations, fractures, avulsions, and crush injuries. Limb injuries, even when
severe, are not directly life threatening unless associated with uncontrolled bleeding, therefore your
priority is the control of bleeding and the prevention of further injury.
BANDAGING
Bandaging in first aid should be kept simple and practical. There is little point in splinting a fractured
leg with triangular bandages and wood if the ambulance service is going to be on the scene within an
hour. They will use traction splints and therefore they will remove any splinting applied by the first
aider.
The most useful bandage in the first aid kit is the triangular bandage. It can be used to make a variety
of slings, it can be used as a bandage to hold splints on the body and it can be used as a pad and
bandage for bleeding. The triangular bandage can be folded as follows:
Semi-broad phase
Semi-cravat phase
Cravat phase
Fig. 10-1: Folding a triangular bandage to create broad and narrow bandages
65
BRUISING
Bruising on a limb may range from a small dark spot to a large area. The extent of the injury depends
on the damage to the tissues and blood vessels within the limb. Severe bruising can also occur where
a small injury occurs but the casualty has a blood clotting disorder or they are taking anti-clotting
medication. These casualties need to be monitored and if the bruise becomes large they should be
taken to hospital or to their medical practitioner
TREATMENT OF BRUISING
1.
2.
3.
4.
5.
6.
SIGNS
a.
b.
c.
SYMPTOMS
a.
b.
Swelling
Bruising
Unable to bear weight or use limb
Pain
Tenderness
Approach incident
Take history and examine injury
Rest the casualty and the limb
Ice compress applied to injury for 20 minutes
Compression bandage
Elevate Injured limb
If you think there may be a fracture/dislocation treat for that injury
66
FRACTURE
THERE ARE THREE GENERAL CAUSES OF FRACTURES
Direct Force: - a blow to the body breaks the bone directly where the blow is made
Indirect Force: - the force of a blow or impact to the body travels along the body
and fractures a bone further away
Abnormal Muscle Action: - severe muscle contraction can sometimes break bone
A fracture is a break in the continuity of a bone and there are three basic types of fracture:
CLOSED
A closed fracture is where the bone is broken and there is no opening to the exterior
through a wound and no injury to other body organs
OPEN
An open fracture is where the ends of broken bone are exposed to the air either
after they are pushed through the skin or a wound leads down to the bone. An
open fracture is serious because of associated bleeding and the increased risk of
infection entering the bone itself
67
COMPLICATED
A complicated fracture is where other body organs are damaged by the fracture
DISLOCATION
Dislocation occurs when a bone is moved out of place by forces twisting or pulling it. The treatment of
dislocations and fractures is the same
SIGNS
a.
b.
c.
d.
e.
f.
SYMPTOMS
a.
b.
c.
Abnormal or no movement
Deformity - (sometimes)
Swelling
bruising
Shortening of limb (Legs)
Crepitus - a coarse grating sound which should be prevented
7.
8.
Approach incident
Take history and examine injury
If necessary call ambulance immediately
Rest the casualty and the limb
Check circulation below injury (pulse and skin)
If ambulance will be some time in arriving apply bandage
-around feet or hand
-above the fracture
-below fracture
-to the joint above the fracture
-to the joint below the fracture
Tie all knots over padding or splints
Check circulation below bandages
68
Fig. 10-6: OHare Traction splint is a special splints used by ambulance officers for lower limb fractures
6.
Approach incident
Call ambulance immediately
Check circulation below injury (pulse and skin)
Reassure and talk to casualty constantly
If the casualty experiences severe muscle spasm
- reassure casualty and get them to relax muscles
-take hold of foot of injured limb and
-gently pull on foot and stretch muscles
-straighten limb
-hold limb until ambulance arrives (this is very strenuous and cannot be done for a
prolonged period by one person)
Continuously check circulation below any bandages
Approach incident
Call ambulance immediately
Check circulation below injury (pulse and skin)
Obtain materials for splinting and bandaging
If the casualty experiences severe muscle spasm
-talk to and reassure the casualty constantly
-take hold of foot of injured limb and
-gently pull foot down from hip
-straighten limb
-hold limb
69
6.
Place bandages and then splint between legs and pad heavily
Padding
Padding
Fracture Site
7.
9.
10.
Apply bandages
-figure 8 narrow bandage around feet
-broad bandage above the fracture
-broad bandage below fracture
-broad bandage to the joint above the fracture
-broad bandage to the joint below the fracture
-Tie all knots over padding
Frequently check circulation below bandages
Reassure casualty and treat poor perfusion
8.
9.
10.
11.
12.
Approach incident
Take history and examine injury
Call ambulance immediately
Rest the casualty
Treat for poor perfusion (Shock)
Padding between legs
Apply bandage
-narrow bandage around feet or hand
-broad bandage to the knee joint
Tie all knots over padding
Prop casualty up very slightly
Place rolled blanket or pillow under knees
Check circulation below bandages
Check perfusion status (shock)
Approach incident
Take history and examine injury
Rest the casualty and the limb
Check circulation below injury (pulse and skin)
Find splint -newspaper is good -and pad it well
Apply splint and padding under arm
70
7.
8.
9.
10.
Approach incident
Take history and examine injury
If necessary call ambulance immediately
Rest casualty and the limb
Check circulation below injury (pulse and skin)
6.
7.
8.
9.
71
AVULSION
Avulsion is the non surgical amputation of a limb or other body part. In most avulsion cases the limb
or body part is torn and twisted off the body. Even with apparently clean cuts there is usually some
degree of crushing and tearing of the tissues around the site of the wound. Because of the tearing,
stretching and mashing of tissues and blood vessels, avulsion can sometimes be accompanied with
severe uncontrolled bleeding
TREATMENT OF AVULSION
1.
2.
3.
4.
5.
6.
7.
8.
Approach incident
Take history and examine injury
Rest the casualty and the limb
Immediately call ambulance
Control haemorrhage -pack stump or hole with towels etc
Elevate Injured limb
Find avulsed part and wrap in and seal in plastic, then wrap with a dry towel
Place wrapped part in ice
CRUSH INJURIES
With crush injuries the weight must be left in place until the arrival of the ambulance if casualty has
been trapped for more than an hour. This prevents the chemicals from burst cells from reaching the
heart and stopping it.
Approach incident
Remove weight if possible (Do not remove weight if trapped for more than an hour)
Immediately call ambulance
Control any Haemorrhage
Immobilise limbs
Elevate legs if possible
Rest and reassure the casualty
Treat poor perfusion
72
CHAPTER 13
ACCIDENTAL POISONING
Accidental poisoning can occur at any age but children are nearly always victims of accidental
poisoning.
DELIBERATE POISONING
While deliberate poisoning is most commonly associated with murder by far the most frequent cause
of deliberate poisoning is attempted suicide and substance abuse.
ABSORBED POISON
Poisons such as insecticides can be absorbed through the skin. The treatment should be based on
the History and anyone exposed to a poison capable of being absorbed into the body must be sent to
hospital. The effects of some of these poisons are very dramatic and can be life threatening.
SIGNS
a.
b.
c.
d.
e.
SYMPTOMS
a.
b.
c.
Disorientation
Confusion
Loss of consciousness
73
INGESTED POISON
Ingested poisoning is a common cause of poisoning and must be treated seriously. In all cases
casualties who have drunk or eaten a poisonous substance must be sent to hospital.
SIGNS
a.
SYMPTOMS
a.
b.
c.
Disorientation
Confusion
Loss of consciousness
INHALED POISONS
Inhaled poisons represent a major threat to life and great care should be exercised in attempting to
rescue the casualty. Remember you cannot carry or drag a heavy casualty and hold your breath. The
best option is to wait for the emergency services and leave the rescue to them.
SIGNS
a.
b.
c.
d.
SYMPTOMS
a.
b.
c.
Disorientation
Confusion
Loss of consciousness
74
INJECTED POISON
The most frequent causes of poisoning through injection are substance abuse and envenomation by
insect or animal bite. The most frequent cause of poisoning in drug abuse is heroin and it presents as
follows.
SIGNS
a.
b.
c.
d.
e.
SYMPTOMS
a.
b.
c.
Danger
Airway, Breathing, Compression and Defibrillation
Call ambulance
75
SIGNS
a.
b.
c.
d.
e.
SYMPTOMS
a.
b.
c.
d.
Disorientation
Confusion
Loss of consciousness
Pain in limb moving towards trunk
9.
10.
Danger -ensure that the angry animal has departed the scene and be careful
Airway, Breathing, Compression and Defibrillation
Rest and reassure casualty
Immediately call ambulance
Cut all clothing from affected limb or area
Apply a dressing to bite
Do not wash wound
If bite on a limb apply compression bandage
-apply compression to bite
-then from fingers or toes all the way to the armpit or crotch
The bandage should be firm but not over-tight
Observe the casualty closely
Bandage from the bite to the fingers and then the whole way up to the armpit.
76
Danger
Rest and reassure casualty
Apply cold compress to bite site
Immobilise limb and seek medical assistance
Danger
Airway, Breathing, Compression and Defibrillation
Get casualty onto beach or boat
Rest and reassure
Immediately call ambulance
Cut all clothing from affected limb or area
Gently remove individual stings with tweezers
Wash wounds with vinegar if available
Do not rub sting
Observe the casualty closely
Danger
Check airway, breathing and casualtys perfusion status
Rest and Reassure
Remove obvious sting and clean skin
If required apply a little ice to stung area
Observe casualty
77
ANAPHYLAXIS
Anaphylaxis is a hyper-allergenic response to the introduction of an antigen into a casualtys body.
The most common antigens include shell fish, bee stings, peanuts and some food colourings. The
Signs and Symptoms of anaphylaxis may range from a stuffy nose to acute respiratory and circulatory
collapse and sudden death. Most people who are at risk of anaphylactic reactions are aware of the
risk and may have access to medication to be taken in an emergency.
SIGNS
a.
b.
c.
d.
e.
f.
g.
h.
SYMPTOMS
a.
b.
c.
Disorientation
Confusion
Loss of consciousness
Danger
Airway, Breathing, Compression and Defibrillation
Get ambulance immediately
Rest and reassure
If the casualty has medication help them administer it immediately
Be prepared to commence Assisted Ventilation and CPR
Observe the casualty closely
78
CHAPTER 14
EMERGENCIES DUE TO TEMPERATURE CHANGE
As a first aider there is a good chance that you will be called to deal with an emergency due to
changes in the core temperature of a casualtys body. The core temperature of the human body is
o
maintained at about 37.6 C and changes of three degrees either lower or higher can seriously affect
the health of a casualty.
Temperature within the core of the body however is almost constant, at around 37.6 C. Any large
fluctuations in this temperature will result in problems. These problems occur because to function the
cells of the body require complex chemical reactions and these can only occur within a limited
O
temperature range around 37.6 C. Thus the core temperature of the body is maintained at this level
O
with only a slight variation (5 ) in a 24 hour cycle with the temperature being lower at about 4.00am
and higher at about 6.00pm.
Body heat is created by cell metabolism, the chemical activity we have already mentioned above. Cell
metabolism produces about 292.6Kj of energy (heat) per hour and the controlled loss of this heat is
what maintains the core temperature of the body.
O
To maintain a constant core temperature of 37.6 C the body has to carefully regulate heat production
and loss and anything which interferes with this will result in temperature imbalance. Thus if more
than 292.6Kj of body heat is lost per hour the casualty will become cold (hypothermic). If heat is
O
prevented from leaving the body the core temperature will rise about 1 C every hour leading to death
within four to five hours.
Heat loss from the body is slowed by gaining heat from the environment by eating hot food, sitting in
the sun or in front of a fire, and through the wearing of clothing which insulates the body from the
environment by trapping and warming air in the fibres close to the skin. If the body needs to lose
excess heat then we move away from sources of environmental heat or we take off clothing.
The body also regulates its heat loss by altering the temperature of the skin. When the skin itself is
hot it fills with warm blood which cools before going back to the heart and core organs. Thus the rate
of heat loss from the body increases. When the environment becomes very cold the blood vessels in
the skin contract and little blood can enter the skin and this reduces the speed of heat loss. This is
why on a cold day the skin is pale and blue from lack of blood and a hot day it is flushed and warm.
79
heat is lost from the body in the form of infra-red rays which radiate out
heating objects in their path,
Conduction:
heat is transferred directly from the skin to any solid object which is colder
than the skin until that object reaches skin temperature,
Convection:
air next to the skin is warmed by the processes of radiation and conduction
and it rises away from the body to be replaced by colder air which is then
also warmed,
Evaporation:
sweat is released onto the surface of the skin from the sweat glands and it
then evaporates when air passes over it
Evaporation is the most important process with 2ml of sweat using 4.18 joules of energy to
evaporate. Evaporation of perspiration is the only way the human body can lose heat once
O
the air temperature rises above 37 C. This is why we find very humid environments very
uncomfortable even at low temperatures.
These four processes act on the skin. A much lesser heat loss is produced through the lungs where
heat is lost during respiration. Very small amounts of heat are lost via passing urine and faeces.
SIGNS:
a.
b.
c.
d.
SYMPTOMS:
a.
Impossible to obtain
80
Approach incident
Reassure and relax parents
Get mother to remove childs clothing
Have mother and father sponge the child with cool water
Fan child
Continue until convulsions cease and child is seen to shiver
Dry child and dress lightly
Ensure parents understand that child should be kept cool
Call a doctor or have parents take child to a hospital.
If the child is over 12 months Childrens Paracetamol can be administered.
EXPOSURE TO HEAT
O
As we have noted the body maintains its core temperature at close to 37.6 C through a complex
system of balancing heat production and loss. This system is regulated from the hypothalamus in the
brain. If any part of this system is unable to operate then the body temperature will rise or drop to the
O
environmental temperature and if this temperature is above 37.6 C the casualty will suffer
hyperthermia Hyper = High and thermia = temperature). Hyperthermia is a progression from the
normal body temperature through to a temperature where death occurs. Along the way the casualty
will suffer from heat cramps, heat exhaustion and heat stroke
81
HEAT CRAMPS
Heat cramps are characterised by severe muscle pains and cramps, especially in the lower limbs and
abdomen. Because heat cramps are often ignored by the casualty it is likely that you will be aware of
their onset. However, where a casualty suffers heat cramps it is important to treat them before they
progress to heat exhaustion
SIGNS
a.
b.
SYMPTOMS
a.
b.
Cramping of muscles
Pink, warm and sweaty skin
3.
4.
HEAT EXHAUSTION
This condition results from over-exposure to high temperature and/or high humidity, especially where
the casualty has been exerting themselves. In a hot humid environment heavy work or exercise can
result in the loss of between 8 and 14 litres of water and 28 grams of salt (NaCl) per day (each litre of
sweat contains 2 grams of salt)
Before going to bed drink about a litre of water. This allows the water to be
absorbed into the cells of the body during the cool of the night when you are not
exerting yourself
2.
On rising drink another litre of water. This ensures that water outside of the cells is
available for the body to sweat during work
3.
During the day drink frequent sips of water, one sip every 15 minutes, to provide the
body with water for sweating during the day
82
SIGNS
a.
b.
c.
d.
SYMPTOMS
a.
b.
c.
d.
Cramping of muscles
Pale, warm and sweaty skin
Pulse >100, weak
Respirations >20
HEAT STROKE
Heat stroke occurs when the casualtys body is no longer able to cope with its rising core temperature,
O
O
usually above 41 C. At 42 C the hypothalamus in the brain fails and the casualtys temperature will
O
O
rise even more rapidly. It takes about 15 minutes for the temperature to rise from 41 C to 42 C. Heat
stroke is a medical emergency and rapid, effective treatment must be implemented if the casualty is to
survive. Heat stroke has a mortality of 10-75%, depending upon the duration of the condition and the
1
effectiveness of the treatment. With effective treatment 90% of casualties will recover .
The onset of heat stroke is quite sudden and the casualty often appears to be no more affected by the
heat than everyone else, although they have hot dry skin in a very hot or humid environment. They
may also display the Signs and Symptoms of heat exhaustion.
1.
Sir Stanley Davidson, Davidsons Principles and Practice of Medicine, 17th Edition, Ed by C.R.W. Edwards, I.A.D
Bouchier, C. Haslett and E.R. Chivers, Churchill Livingstone, London, 1995, pp. 53-54.
83
SIGNS
a.
b.
c.
d.
e.
SYMPTOMS
a
b.
Cramping of muscles
Hot, flushed, dry skin
Pulse >100, strong
Respirations >20
Fitting
EXPOSURE TO COLD
Cold by itself is usually not a problem unless you are scantily clad, ill, injured, undernourished,
exhausted, elderly or the cold itself is extreme
84
Mls
Kno
t
s
KP
H
10
-1
-7
-12
-18
-23
-29
-34
-40
-46
-51
10
-1
-7
-12
-18
-23
-29
-34
-40
-46
-51
7.2
-3
-9
-14
-21
-26
-32
-38
-44
-49
-56
18
-2
-9
-20
-23
-29
-36
-43
-50
-57
-64
-71
11
25.2
-6
-13
-21
-28
-38
-43
-50
-58
-65
-73
-80
10
16
36
-8
-16
-23
-32
-39
-47
-55
-63
-71
-79
-87
12
20
43.2
-1
-9
-18
-26
-34
-42
-51
-59
-67
-76
-83
-92
14
24
50.4
-2
-11
-19
-28
-36
-44
-53
-62
-70
-78
-87
-96
17
29
61.2
-3
-12
-20
-29
-37
-45
-55
-63
-72
-81
-89
-98
19
33
68.4
-3
-12
-21
-29
-38
-47
-56
-65
-73
-82
-91
-100
Wind speeds
greater than 3050 Knots have
little effect
Little danger of
hypothermia in fit,
well fed, and properly
clothed persons
Increasing danger
of hypothermia
in fit, well fed,
and properly
clothed persons
Great danger of
hypothermia in fit,
well fed, and properly
clothed persons
Chart: 10-1. Wind Chill (After Survival in Antarctica National Science Foundation, USA)
85
Wind Speed
HYPOTHERMIA
The bodys response to even a slight drop in temperature is to slow the rate of heat loss by
shutting off blood flow to the skin, allowing it to cool so less heat is radiated to the
environment. Extra heat is then generated by muscle activity such as shivering. As the
core temperature falls the body uses these techniques even more and if the core
0
temperature drops to around 34 C the bodys defence mechanisms will begin to fail. If no
action is taken to prevent this heat loss the casualtys conscious state alters and
respiratory depression occurs leading to reduced blood oxygen levels which leads to a
further drop-off in metabolism and heat production. This process rapidly quickens, with the
onset of life threatening cardiac arrhythmias, particularly ventricular tachycardia (VT) and
ventricular fibrillation (VF), develop.
0
Levels of Hypothermia at C
37.6
37
36
35
34
33
32
31
30
29
28
27
26
25
24-21
20
19-18
17
9
There are three types of hypothermia : Acute (immersion), Subacute (exhaustion) and Subchronic
(urban) hypothermia.
E.L. Lloyd, Accidental Hypothermia, Resuscitation, European Resuscitation Council and Elsevier Science, Ireland Ltd,
1996, p.114.
86
SIGNS
a.
b.
c.
d.
e.
f.
SYMPTOMS
a.
b.
c.
d.
E.L. Lloyd, Accidental Hypothermia, Resuscitation, 32 (1996), p. 116 Warm hands and feet reduce the stimulus for heat
production and will allow reduction of vasoconstrictor tone thus increasing heat loss and increasing the risk of vasomotor
collapse.
87
Slurred speech
Aggressive, unreasonable, violent or drunken behaviour
May have violent shivering fits
Respirations 10 per min or less
Patients axilla (armpit) or groin is very cold to touch
Pale, cyanosed, very cold, marble like skin
Hypotension (low pulse pressure)
Stop immediately
Get everyone into shelter from wind
Immediately insulate casualty, especially the head, from the atmosphere and ground
Get tents up and everyone under them
Cook warm drinks and a meal -all food in one pot on one fire
Get group into sleeping bags
Eat meal and sleep until group recovers
Do not try to walk for help, no matter how close it may be
The fundamental rule is to prevent hypothermia at all costs and always treat the group
STRIPPING THE CASUALTY AND PUTTING A RESCUER INSIDE THE SLEEPING BAG
This technique has a number of major flaws:
1.
2.
3.
4.
5.
It requires the casualty be stripped and this may induce cardiac arrest through the need to
roughly handle the casualty, especially if they are unconscious
Most sleeping bags will not take two bodies
No rescue party can carry two people
Surface warming of a severely hypothermic casualty may kill the casualty
The group cannot afford the energy required
88
6.
7.
Because warming the casualty requires the transfer of energy from the other group members
and because you do not know the energy reserves of the individual group members you
cannot leave one person with the casualty for too long. Thus you have to rotate the entire
group through the casualtys sleeping bag leading to dangerous movement and loss of rest to
all members of the group.
You cannot risk leaving one or two individuals to re-warm the casualty as they may also be quite
badly affected themselves and the extra heat loss involved in re-warming the casualty will place
them at serious risk. For these reasons stripping off to warm a hypothermic casualty should be
regarded as rescue fantasy.
ON CPR
If you are unfortunate enough to be a member of a group where a casualty appears to have suffered a
cardiac arrest from the cold, unless professional help arrives quickly, the casualty will die. A group of
cold and tired people cannot perform effective CPR and to make the attempt risks the safety of the
other group members who may be seriously ill themselves.
SIGNS
a.
b.
c.
d.
e.
f.
SYMPTOMS
a.
b.
c.
d.
89
FROSTBITE
Like burns, frostbite is either superficial or deep. Frostbite occurs at the bodys extremities, such as
the toes and fingers, and exposed skin, particularly the nose, cheeks and ears.
SIGNS
a.
SYMPTOMS
a.
b.
5.
6.
7.
Treat hypothermia
Gently remove clothing from affected area
Remove all constrictions from limbs
Do not re-warm in field unless you can guarantee part will not re-freeze
-if part re-freezes then gangrene will develop
-re-warming is extremely painful
If unable to send casualty to hospital and risk of re-freezing is small rapidly warm the part for
0
20-30 minutes in water with temperature of 41- 45 C
Cover area with dry, sterile dressing
Do not allow casualty to smoke as nicotine reduces the blood flow to extremities
90
CHAPTER 15
PROBLEMS IN PREGNANCY AND CHILDBIRTH
This chapter is divided into two; firstly, the provision of care to a pregnant woman; and secondly, the
delivery of a baby in an uncontrolled environment.
First aid care for the pregnant woman suffering a specific illness or injury is similar to the care
provided to a non pregnant person suffering the same illness or injury. However, consideration has to
be given to the impact of a specific treatment on the baby and the mother. Thus pregnant women are
always put on their left side so that the baby is off their Inferior Vena Cava and blood return to the
heart is not compromised.
Where the casualty is seriously injured or ill the risk to the baby can be extreme and there is little that
you can do other than basic life saving treatment and get help as soon as possible.
MAJOR DISORDERS
BLEEDING IN EARLY PREGNANCY
Vaginal bleeding is an important sign at any stage of pregnancy and must be investigated by the
mothers medical practitioner. Such bleeding may be a sign of a serious complication which could
endanger the mother or foetus. Therefore any pregnant woman who experiences vaginal bleeding
should be taken to her own medical practitioner or to hospital.
ANTEPARTUM HAEMORRHAGE
th
Antepartum haemorrhage is defined as bleeding from the vagina after the 20 week of pregnancy and
before the birth of the baby. This type of bleeding is very serious and is a major cause of death of
mothers and babies.
The causes of antepartum haemorrhage are the premature separation of the placenta from the uterine
wall (Placental Abruption), the implantation of the placenta over the cervical opening (Placenta
praevia) or tearing of the uterus itself. The exact cause of the bleeding is unimportant to you but you
must recognise the danger to the mother and her baby.
91
Patient is pregnant
Unexplained vaginal haemorrhage
SIGNS
a.
b.
c.
Poor perfusion
Vaginal bleeding
Possible guarding and rigidity of abdominal wall
SYMPTOMS
a.
b.
ECTOPIC PREGNANCY
Ectopic pregnancy is where the foetus and placenta are implanted outside of the uterus, either in a
1
fallopian tube (Common-97%) or in the abdominal cavity (Rare-1% of cases) . Tearing of the
Fallopian tube may occur leading to severe internal haemorrhage and the rapid death of the mother.
SIGNS
a.
b.
c.
SYMPTOMS
a.
1.
N.A. Beischer and E.V. Mackay, Care of the Pregnant Woman and Her Baby, W.B. Saunders, Artarmon, NSW, 1978,
p.80.
92
PRE-ECLAMPSIA
Pre-eclampsia is the first stage in the disease process that leads to eclampsia. The causes of
eclampsia are unknown but it is suspected that the substances produced by the placenta cause a
chemical imbalance in the tissues of the body. These changes lead to circulatory and kidney
problems in the casualty leading to increased fluid retention and high blood pressure. Any pregnant
women suffering from excessive fluid retention, swelling of body tissues and/or high blood pressure
must consult their medical practitioner
ECLAMPSIA
Eclampsia is the end stage of the process and is a threat to the life of the mother and her baby. In fact
eclampsia is one of the major causes of maternal death in western countries. The major aim of
treatment is to identify pre-eclampsia and get the casualty to hospital
Patient is pregnant
Discomfort, swollen tissue, headaches
SIGNS
a.
b.
c.
d.
e.
SYMPTOMS
a.
b.
Headaches
Pulse greater than 100
Swelling of face and hands due to fluid retention
Pale, cool, clammy skin
Fitting and convulsions
Abdominal pain
Visual disturbances
TREATMENT OF ECLAMPSIA
1.
2.
3.
4.
5.
93
DELIVERY
When presented with a pregnant women who believes that she is about to deliver you need to know
two things; one, am I going to have to deliver the baby, and if so; two, what possible complications will
I face? If this is the mothers first baby then the chances are that you will not need to deliver the baby.
If it is her second child then the delivery may be very fast indeed.
SIGNS
a.
b.
c.
SYMPTOMS
a.
SIGNS
a.
b.
SYMPTOMS
a.
94
DELIVERY
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
Gently massage the uterus to assist with contractions and have mother breast feed the baby
When placenta is delivered place it in a container and examine it thoroughly to ensure it is
intact and not torn
Clean up and place pad over mothers vagina
95
BREECH DELIVERY
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
PROLAPSED CORD
A prolapsed cord is where the umbilical cord drops into the birth canal ahead of the baby and is
compressed by the baby as it delivers. Prolapsed cord is a serious and life threatening condition and
must be treated quickly
POSTPARTUM HAEMORRHAGE
During the third stage of labour it is normal for there to be about 150ml of blood lost. However, if the
blood loss is excessive or seems to be continuing then you need to treat the casualty for internal
haemorrhage and get an ambulance quickly.
96
APGAR SCORE
SCORE
COLOUR
Blue or pale
Pink but
extremities blue
RESPIRATION
Absent
Slow, irregular
Good or Crying
HEART RATE
Absent
Below 100
Above 100
MUSCLE TONE
Limp
Some flexion
of extremities
Active motion
REFLEX
IRRITABILITY
Nil
Grimace
Vigorous cry,
cough, sneeze
Completely pink
Using the Apgar Score the highest number a baby can get is 10 and the lowest 0. The treatment is as
follows:
97
GLOSSARY OF TERMS
Abdomen -
The belly. The cavity between the diaphragm and the pelvis.
The muscles of the arms, shoulders and chest used to increase the
depth of breathing.
Is the build up of fluid in the lungs due to the failure of the left side of
the heart.
Alveoli -
Angina Pectoris -
Aorta -
Largest artery in body leading from the heart to all body organs
except the lungs.
Artery -
Asphyxia -
No breathing.
Asthma -
Asystole -
Atria -
Avulsion -
Breech Delivery -
Bronchi -
Bronchitis -
Capillary -
Cardiac -
Cardiac Arrest -
Carotid Pulse-
Pulse found between the windpipe and the muscles of the neck.
Cell -
Closed Fracture -
A broken bone where there are no other injuries and where there is
no wound leading down to the ends of the broken bone.
Complicated Fracture -
Compression bandage -
95
Concussion -
Brain injury where small spaces are opened up between the brain
cells.
Constrictive bandage -
A very tight bandage used to stop very severe bleeding where all
else fails.
Contusion -
Croup -
Diabetes -
Dislocation -
Diuretic -
Eclampsia -
Ectopic Pregnancy -
Emphysema -
Epiglottitis -
Epileptic Convulsions -
Eviceration -
Exhaustion Hypothermia -
Femur -
Thigh bone.
Flail Segment -
Fracture -
Frostbite -
Frusemide -
Grand Mal -
Haemorrhage -
Bleeding.
Haemothorax -
Humerus -
Hyperglycaemia -
Hyperthemia -
Hyperventilation -
Hypoglycaemia -
96
Hypothermia -
Immersion Hypothermia -
Infantile Convulsion -
Inflammation -
Intestines -
Ischaemic -
Lack of blood.
Joint -
Nasopharynx -
Open Fracture -
A broken bone where the broken ends are exposed to the air.
Oropharynx
Pancreas -
Pattern of Injury -
Pelvis -
Perfusion -
The ability of the heart and circulatory system to supply the cells
with oxygen, food and water and to remove waste products from
them.
Petite Mal -
Pharynx -
The throat.
Pleurisy -
Inflammation of the pleura lining the lungs and inner chest wall.
Pneumothorax -
Poor Perfusion -
Postpartum Haemorrhage -
Potassium -
Pre-Eclampsia -
Prolapsed Cord -
A prolapsed cord is where the umbilical cord drops into the birth
canal ahead of the baby and is compressed by the baby as it
delivers.
Pulmonary -
Pulmonary Embolism -
Pulmonary Oedema -
Water leaking from the capillaries into the air sacs of the lungs.
97
Radial Pulse -
Radius -
Respiratory Arrest -
No breathing.
Respiratory Distress -
Poor perfusion with cyanosed skin and the use of the accessory
muscles of respiration.
Scalds -
Skull -
Sprain -
Status Asthmaticus -
Status Epiltpticus -
An epileptic fit which continues for longer than two minutes or where
a series of fits is seen.
Sternum -
Strain -
Stroke -
Toxemia -
Tracheae -
Windpipe.
Triage -
A process for sorting injured people into groups based on their need
for or likely benefit from immediate medical treatment.
Ulna -
Urban Hypothermia -
Vein -
Ventricles -
Ventricullar Fibrillation -
Ventricular Tachycardia -
Vertebrae -
98