The presentation slides contain herein are proprietary to the St.

John Ambulance,
Singapore and are for use only in the FIRST AID training courses conducted by St.
John. Reproduction in any form prohibited. NOT FOR SALE
St. JOHN AMBULANCE ASSOCIATION SINGAPORE

FIRST AID TEACHING SLIDES

Compiled by: T. K. KHOO (2010)

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THE HEART AND BLOOD VESSELS

The heart and blood vessels
make up the circulatory system.
They supply the body with blood
which brings oxygen and
nutrients to the tissues and
carries waste
products away.

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THE HEART AND BLOOD VESSELS contd

The heart pumps blood around the body and
then to the lungs to pick up oxygen.

The blood flows through a network of 3 types of

blood vessels: arteries, veins and capillaries.
Capillaries link arteries and veins within body
tissues. Oxygen and nutrients pass from the
blood into the tissues and waste products pass
from the tissues into blood through them.
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COMPOSITION OF THE BLOOD

Blood
Vessel

Red
Blood Cell

White
Blood Cell

Platelet

Plasma

There are about 6 litres of blood in an average

adult body (1 litre per 13 kg body weight)

Red blood cells carry the oxygen; white

blood
(41%)
cells play a role to defend the body against
infection; platelets help blood to clot.
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TYPES OF BLEEDING
Bleeding (haemorrhage) is classified by the
type of blood vessel that is damaged.

Artery (carries oxygenated blood under pressure):

Profuse bleeding.
Blood spurts out in time with heartbeat.
Volume of circulating blood falls rapidly (main
artery).
Vein (carries deoxygenated blood):
Darker red.
Less pressure than arterial blood.
Gush out profusely (large vein)
Capillary (occurs with any wound):
Brisk initially, but blood loss is usually slight.
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HOW WOUNDS HEAL

Platelets and other cells arrive at injured site.
Platelets form a clot in the blood and bloodclotting protein.
Tissue-forming cells move in to start repair.
A plug of fibrous tissues is formed within the
clot.
The plug hardens forming a scab that drops off
when the skin below is healed.

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TYPES OF WOUNDS
Incised Wound

Caused by a clean cut from a

sharp edge object like razor.
Bleeding may be profuse.
Tendons or nerves may be damaged.
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TYPES OF WOUNDS contd

Laceration

Crushing or ripping forces

cause tears or lacertions.
Bleed less profusely but more
tissue damage than incised wounds.
High risk of infection
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TYPES OF WOUNDS contd

Abrasion (Graze)

Topmost layers of skin are

scraped off leaving raw, tender area.
Caused by sliding fall or friction burn.
Embedded foreign particles may cause infection.
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TYPES OF WOUNDS contd

Contusion (Bruise)

A blunt blow ruptures capillaries beneath the skin.

Blood leaks into the tissues.
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TYPES OF WOUNDS contd

Puncture Wound

Can be caused by nail or needle.

Small entry site but a deep track of internal damage.
High infection risk.
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TYPES OF WOUNDS contd

Stab Wound

Can be caused by long or bladed instrument.

Stab wounds to the trunk have risk of injury to vital
organs and internal bleeding.
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TYPES OF WOUNDS contd

Gunshot Wound

Caused by bullet or missile driven into the body.

Entry wound is small; exit wound large and ragged.

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HEART ATTACK
A heart attack is commonly caused
by a sudden obstruction of blood
supply to part of the heart muscle.

Recognition.
Persistent vice-like central
chest pain, spreading to the
jaw and down the arms.
Pain does not ease when
casualty rests.
Breathlessness; discomfort
high in the abdomen like
severe indigestion.
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HEART ATTACK contd

Collapse without any warning.
Sudden faintness or dizziness.
Ashen skin and blueness of lips.
Rapid, weak, irregular pulse.
Profuse sweating.
Air hunger
gasping for air.

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HEART ATTACK contd

Treatment
Put the casualty in a
half-sitting position with
his head and shoulders
supported and knees bent.
Call 995 for ambulance;
inform that a heart attack is suspected.
Monitor vital signs until ambulance arrives.
If casualty loses consciousness do ABC
check and perform CPR if needed.
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FAINTING
Brief loss of consciousness due to temporary
reduction of blood flow to the brain. May be a
reaction to pain, exhaustion, lack of food,
emotional stress or long physical inactivity.

Recognition
Loss of consciousness
causes casualty to fall.
Slow pulse.
Pale, cold skin and sweating.

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FAINTING contd
Treatment
Advise casualty who
feels faint to lie down.
Raise the legs supporting the ankles on your
shoulders; ensure plenty of fresh air..
When recovered help casualty to sit up
gradually. Repeat if he feels faint again.
If consciousness is not regained quickly,
open airway, check breathing and do CPR if
needed; call 995 for ambulance.
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INTERNAL BLEEDING
This may follow an injury or occur spontaneously
as in bleeding from a stomach ulcer. Most
obvious sign is a discharge of blood from a body
opening. Main risk is SHOCK. Treat as for Shock.

Recognition
Signs and symptoms of shock.
Possible collapse and unconsciousness.
Bleeding from orifices.
Pattern bruising in cases of violent injury.
Pain.
History of recent injury or illness.
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INTERNAL BLEEDING contd.

Possible Signs of Internal Bleeding
Site

Appearance

Cause of Blood Loss

Mouth

Bright red, frothy, coughed-up

blood.

Bleeding in the lungs.

Vomited blood, red or dark

reddish-brown, resembling
coffee grounds.

Bleeding within the digestive

system.

Fresh, bright-red blood.

Injury to the inner or outer ear.

Perforated ear-drum.

Thin, watery blood.

Leakage of fluid from around

the brain due to head injury.

Ear

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INTERNAL BLEEDING contd.

Site

Appearance

Nose

Thin, watery blood.

Leakage of fluid from around

the brain due to head injury.

Fresh, bright-red blood.

Ruptured blood vessel in the

nostril.

Fresh, bright-red blood.

Piles. Injury to the anus or

lower intestine.

Black, tarry, offensive-smelling

stool.

Disease or injury to the

Intestine.

Urethra

Red or smoky appearance to

urine, occasionally with clots.

Bleeding from the bladder,

kidneys or urethra.

Vagina

Either fresh or dark blood.

Menstruation; miscarriage;
pregnancy; recent childbirth;
assault.

Anus

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Cause of Blood Loss

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SEVERE EXTERNAL BLEEDING

Treatment

Expose the wound.

Apply direct pressure
on the wound with a
sterile dressing or
clean pad and maintain it.
Raise and support the
injured limb.
Secure dressing
with a firm bandage.

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SEVERE EXTERNAL BLEEDING contd

Treatment

Treat for Shock

If blood seeps through the dressing
apply a second one over the first.
If blood again seeps through,
remove both dressings
and apply a new one.
Call 995 for ambulance.
Monitor vital signs and
circulation beyond the
bandage.
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SHOCK
A life-threatening condition occurring when
the circulatory system fails and vital organs,
like the heart and brain, are deprived of
oxygen.
Causes

Severe blood loss (most common).

Loss of other body fluid.
Heart unable to pump blood
around the body.
Other causes severe infection,
anaphylaxis, hypoglycaemia, etc.
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SHOCK contd
Recognition
Initially:
Rapid pulse.
Pale, cold, clammy skin;
sweating.
As shock develops:
Rapid, shallow breathing.
Weak thready pulse.
Grey-blue skin (cyanosis).
Weakness and dizziness.
Nausea, possibly
vomiting.
Thirst.
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As the brains oxygen

supply weakens:
Restlessness and
aggressiveness.
Yawning and gasping
for air.
Unconsciousness.
Finally, the heart will
stop.

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SHOCK contd
Effects of Blood or Fluid Loss (Blood vol: 6 litres)
Approx. Vol. Lost

Effects on the Body

0.5 litre

Little or no effect

Up to 2 litres (1/3)

Pulse quickened; sweating

Over 2 litres (>1/3) Pulse at the wrist may

become undetectable.
Casualty becomes unconscious;
Breathing and heart stop.

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SHOCK contd
Treatment
Treat the cause of shock, e.g.
severe bleeding, serious burns.
Raise and support the legs
above the heart level.
Loosen tight clothing at neck, chest, waist.

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SHOCK contd
Treatment
Cover casualtys body
and legs with a blanket.
Call 995 for ambulance.
Monitor vital signs.
If casualty becomes
unconscious, do ABC check and perform
CPR if needed.
Do not allow casualty to eat or drink or
warm him with any direct source of heat.
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IMPALEMENT
Treatment
Call 995 for ambulance explaining the
situation very clearly.
Support the casualtys body until the
ambulance arrive.
DO NOT allow casualty to eat or drink
DO NOT attempt to lift the
casualty off the object.

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AMPUTATION
Treatment
Control bleeding with direct
pressure and elevation.
Place sterile dressing or clean pad on
the wound and secure it with a bandage.
Treat for shock; monitor vital signs.
Call 995 for ambulance.
Put severed part in a plastic bag,
wrap the package in gauze or soft
fabric and place it in a container of crushed ice.
Mark container with the time and name of casualty
and hand it to the ambulance personnel.
DO NOT allow casualty to eat or drink.
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CRUSH INJURY
Two serious complications:
Shock and Crush Syndrome.

Treatment
If crushed for <15 mins.:
Control bleeding; treat fractures
and shock.

If crushed for >15 mins. or unable

to move the cause of injury:
Leave casualty in the position found.
Call 995 for ambulance explaining the incident
clearly.
Monitor vital signs; wait for help to arrive.
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CUTS AND GRAZES

Bleeding is easily controlled by pressure and elevation.
Seek medical help only if there is risk of infection.

Treatment
If wound is dirty clean under running water or
use alcohol-free wipes.
Dry the wound with gauze
swab and cover with
sterile gauze.

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CUTS AND GRAZES contd

Treatment
Clean area around the wound with soap
and water (wipe away from wound).
Pat dry.
Remove wound covering and apply a
sterile dressing.

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BRUISING
Caused by bleeding into the skin
or tissues beneath the skin.

Treatment
Raise and support the injured part.
Apply firm pressure to the bruise with a
cold compress for at least 10 min.
(RICE technique)

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FOREIGN OBJECT IN A WOUND

Remove loose foreign objects , e.g. glass pieces or
grit, from a wound. Pick them out with tweezers or
rinse off with cold water. DO NOT remove those
firmly embedded.

Treatment
Control bleeding with pressure on both sides of
the object and elevation.
Cover the wound and
object with a piece of
gauze.

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FOREIGN OBJECT IN A WOUND contd

Treatment
Build up padding (e.g. rolled bandages)
sufficiently high on both sides of the
object and bandage without pressing the
object into the wound.
If object protrudes above the padding,
bandage on the sides of the object.

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SCALP AND HEAD WOUNDS

Treatment
Replace any displaced
flaps of skin on the wound.
Cover the wound with a
sterile dressing or pad.
Apply firm pressure to
control bleeding.
Bandage to secure the pad
and maintain pressure.
Call 995 for ambulance if casualty feels
faint or is in shock.
If unconscious, do ABC check and
perform CPR if needed.
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NOSEBLEED
Treatment
Ask casualty to sit and tilt his head forward
for blood to drain from nostrils.
Ask him to pinch the soft part of his nose
for 10 min. and breathe through his mouth.
Release after 10 min. and if bleeding has
not stopped, re-apply the pressure.
When bleeding stops ask
him not to blow his nose.
If bleeding is severe or lasts
more than 30 min. send
casualty to hospital.
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WOUND TO THE PALM

A wound to the palm may cause profuse bleeding. If
deep, tendons and nerves may be severed causing
loss of feeling or finger movements.

Treatment
Ask casualty to clench his
fist over a sterile dressing or
pad and elevate it.
Bandage with his fingers clenched over the
pad leaving the thumb free.
Tie the knot over the fingers
to maintain pressure.
Support the arm in an
elevation sling.
Send casualty to hospital.
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ABDOMINAL WOUND
Treatment
Lie casualty down and loosen tight clothing.
Cover wound with a sterile dressing asking
casualty to hold it firmly.
Raise and support his knees to ease strain
on injury.
Call 995 for ambulance.
Treat for shock and
monitor vital signs.

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ABDOMINAL WOUND contd.

Treatment
Do not touch any protruding intestine.
Cover with a clean plastic bag or film to
prevent intestine surface from drying out.
Do not let casualty eat or drink.
If unconscious, check for breathing.
If breathing, turn him to recovery position
while supporting the abdomen.

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