UNIT1_ FIRST AID INEMERGENCIES Structure 10 Objectives LI Introduction 12 Conceptsand Principlesof First Aid and Emergency 124 Meaning of Fist Aid 1.22. Objectivesof Fist Aid 423. Principles of First Aid 13 Cardio-pulmonaryResuseitation 41341 Definition and Indications 432 Signsand Assessment of CR 133 ABCCECPR 134 Techniquesof CPR 134 CPR for Children 14 SelectedEmergency Situations 144 Haemomage 142 Shock 143 Wands 144 Bumsond Scalds 14. Poisons 148 Choking 447 Fractures 148 Injuries 15 Inseet Bites and Animal Bites 45 Bocand Wasp Stings 2 Scorpion Sting 2) SnakeBite “454 Dg Bie 44g Emergencies Caused by Heat and Cold 16.1 Heat Cramps 1.6.2 Heat Stroke (Sun stoke) 1.63 Hest Exhaustion 164 Hypothermia 165 Frostbite 17 Other Emergency Situations 4174 Angina Pectorisand Heat Atak 17.2 cardiac Arrest (Cardio-pulmonary Amest) 18 LetUsSumUp 19 Model Answers 1.0_ OBJECTIVES A ficrstdying this unit, you should be able to © explainmeaning of firstaid and emergencies © describe the objectives and principlesof frstaid explain the lif saving techniques commonly useg during gmergencies; and provide first aid in certain emergencies which arise in communityCare of Minor Allments. and Emergencies Ld ‘TRODUCT! In Block | you have leamtabout concepts and principles of community and family health, ‘While working with family orn community, you may comne across many emergency situations. An'emergency isthe unforseen medical condition which calls for promptand quick action to save te life ofa person or to prevent severe damage. If you happen to be at thesite when an emergency arises you may have to deal with it promply with knowledge, skilland confidence. The main aim of providing prompt and proper first aid treatment in any emergency situations to save life, provide relict from immediate danger and prevent further injuryor impairment Inthis unit you will lear aboutproviding frst aid in certain common conditions which may ‘occuraccidentally inthe family or in community. Let us begin with definition, meaning and principles of firstaid, 1.2 CONCEPTS AND PRINCIPLES OF FIRST AID AND EMERGENCY Asa health worker you should understand what are the principles and objectives of first aid and what do you mean by first aid? All these are described in the following subsections 1.2.1 Meaningof First Aid First aid isan immediate temporary assistance given to a person who is injured or has suddenly become ill (using facilities or materials available), atthe site before regular medical help ismade available, First aid includes assessing the victim forlife threatening conditions, performing appropriate interventions to sustain life and keeping the person in the best possible physical and mental state until he'she is brought tothe emergency or casualty unit in the hospital to save life and prevent further injury or damage 1.2.2 Objectives of First Aid ‘The objectives ofthe frst aid are to preserve life prevent further injury and deterioration of the condition, prevent complications related to injury or illness. ‘make the victim as comfortable as possible to conserve strength, peeee help the injured person to be able to reach for professional medics ad at the earliest. 1.2.3 Principlesof First Aid ‘When you come across a seriously injured person you should follow the below mentioned principles ‘4. Make sure that victim's airway is not blocked by the tongue, secretions or some foreign body. (© Make sure thatthe person is breathing, ifnot administer artifical respiration— restore respitation. ‘© Make sue that patent has a pulse ino pulse is felt, administer cardio pulmonary resuscittion(CPR). (Thisis discussed in Section 3.) ‘© Check fot bleeding ~ take measures to control and stop bleeding ‘© Act fast ifthe victim is bleeding severely or he hasswallowed poison or his heart beat corbreathing hasstopped "Every second isimportant”. @ Arrange without delay for shifting the victim to hospital for medical attention. Although most injured persons can safely be moved, itis mportan¢ not to move person with serious neck or back injuries unless you save him from further danger (© Keep the victim’patent lying down. If he has vomited and there is no danger of his neck being broken turn him on hisside to prevent choking. Keep himwarm withblanketsorcoats.@ Have someone to call for medical assistance while you giving first aid, The person who Flest Aid In Emergencies ‘summons help should explain the nature of the emergency and ask what should be done pending the arrival of the ambulance. © Examine the victim gently, cut clothing, ifnecessary to avoid abrupt movements which adds pain, Don’t pull clothing away from bums unless itis smoldering ‘@- Reassure the victim, try to remain alm yourself. Your calmness can allay his fear and panic ‘Do not give fluids to an unconscious or semi conscious victim, ‘@ Donot ity to arouse an unconscious person by slaping or shaking. Look for an emergency identification card for medical information related to vietm, for example diabetes, epilepsy or hean diseases Cheek Your Frogress 1 1) List dhree main objectives of first aid ii) List three main principles of frst a by 1.3_ CARDIO-PULMONARY RESUSCIT. 1.3.1 Definition and Indications Cardio-pulmonary resuscitation (CPR) is defined as technique of basi life support for the purpose of oxygenating the brain and heart until appropriate definite medical treatment is ‘made available to restore ventilation and pumping action of heart. Indications ‘The CPR is indicated inthe following situations: 1) Cardiac arrest: Its a condition when heart suddenly stops effective beating ii) Respiratory arrest: Iti a condition when breathing stops ii) Cardio-pulmonary arrest: It is a condition which includes i) and ii) both, 1.3.2 Signs and Assessment of CPR ‘The signs of CPR will include: ‘@ Immédiate loss of consciousness ‘© Cessation of perceptible respiration and arrest after 45 seconds ‘© Absence of carotid pulse © Dilation of pupils ‘Conseiousnesé ‘Shake the shoulders of the victim an ask hwo tel hier name Breathing ak for dest movers, Feel for breath fo seconds by placing the ear shove the eassalty’s mouth and fk ala the chest end abdomen fo se any movement Ifthe casuaif Yas stopped breathing you will nt se any movement Pulse ; Place tee fnges on te Adam's ape and gly move let or © | night side of races o fel for earoridpule inphe hollow between the voles box and adjoining muscle: Count ple for ive soon 7Care of Minor Ailments and Emergencies 1.3.3 ABC of CPR ‘When the victim appears unconscious, o lifeless, the ABC of resuscitation needs to be performed in order to assess his/her most urgent needs. Assessment should be done as quickly as possible, Now let us understand what do we mean by ABC: A= Airway clearance eathing maintenance ireulation maintenance ‘© Therefore, opening an airway will allow passage of fresh air to the lungs. © Breathing will give anificial ventilation by wansferring ait from your own lungs imo ‘casualty’s (mouth to mouth ventilation) ‘© External chest compressions (by applying pressure on the chest) will compress heart ‘and pump the blood to vital organs and thereby maintain circulation, 1.3.4 Techniques of CPR [Now let us see what steps are needed for performing CPR technique. CPR is a life saving technique to be performed with skill and practice. When you come across a victim with cardio-pulmonary arrest, you are expected to do quick assessment because of the critical time factor. The quicker you start CPR the better are the victim's, chances for survival. Now let us see what steps are needed for performing CPR technique as per ABC of CPR. ‘© Gently place the victim on hishher back. Make sure that there is no injury tothe neck ‘because mishandling may cause further damage. ‘© Loosen the necktie, clothes around neck, chest and abdomen. 1) A~dirway Clearance In order to clear the airway following steps are necessary to be performed in an orderly ‘manner. Follow three major steps as given below: |) Check breathing i) Open the airway iit) Clear the airway ‘Now letus narrow down the steps under each major heading i) Check breathing: Refer to sub-section 1.3.2. 4) Open the airway: To clear the airway, you have to "Hove Obstructing substance which could be tongue stepping back, saliva, vomit, loose teth etc. Therefore, take following steps to open the airway 1 Hyperextend the neck to open the airway by placing one hand under the nape ofthe neck and the other hand on forehead and tilt the head back. Liftthe chin gently without closing mouth © Check i breathing is restored. If ye, place the casualty in recovery positon. If not, move tonext step. i) Clearing the airway: In an opening airway you willbe able to sce ox fel obstructing substance(s) as mentioned above therefore, Use fit two fingers asthe hook to dislodge any obstructing substance by sweeping round inside the mouth© Check breathing if restored, place the casualty in recovery position or else move on to the next step. 2) B Breathing Maintenance ‘You are expected to act quickly and restore breathing by giving mouth-to-mouth ventilation as follows: © Pinch and compress nose to close nostrils © Take deep breath, ‘@ Place your mouth around victim's mouth and make an air tight seal ‘© Breath in four times into the victim's mouth as quickly as possible. Figh.J(a.b) ‘© Watch vietim’s chest movements for rise and fall of chest and also check for heart beat ‘© IFbreathing is not yet restored, feel the pulse as mentioned above (sub-section 1.3.2) and proceed as follows, ie. go to step ‘C’ of ABC (chest compression) “Mouth-to-mouth ventilation mast wot be used fa cases where victim} ‘contaminated with polson, im facial Injuries, where vith’ faces ‘ase of recurrent vomiting. ‘mouth jana fa 3)C—Circulation Maintenance Giving compressions on the chest can stimulate heart beat in a non-beating heart. ‘Therefore, providing external chest compressions (ECC) can help restore circulation provided itis done effectively. ‘Always place the casualty on flat and firm surface while carrying ‘and whea there is no heart beat. compression In order to restore circulation proceed as follows: ‘© Givea pericardial thump into mid sternum region with closed fist (except in myocardial infarction (MI). This may result in resuscitation of normal heart beat which is indicated by the carotid pulsation. If not, then start ECC as given below: — Place the victim on hard surface and kneel at victim’s right side atthe evel of the chest, — Lacate the xiphoid process, — Place hee! of one hand at this point on the sternum, — Interlock fingers to keep them off the victim's ribs, — Keep elbows straight and lean forward, — Deliver downward compression by applying steady smooth pressure to depress victim's steruum 1.5 to 2 inches, Make sure not to bend your elbows during compression, — Then relax pressure completely but do not let your hands leave the victim's chest or ‘you may loose correct hand position, First Aid in Emergen Figo(Care of Minor Ailments an Emergencies 10 Repeat and also perform mouth-to-mouth ventilation. © Continue the procedure and check heart beat afte every cycle of ECC. When the heart ‘eat stars, stop ECC and continue mouth-to-mouth ventilation till spontaneous, breathing is restored. Assist the casualty if needed tll hisher normal rate of breathing and heart beat are established. (© Place the casualty in recovery postion © If the casualty does not start with spontaneous circulation and breathing, continue CPR till twenty minutes, and then stop. ‘© Inany instances refer the casualty to nearby health centre, Here itis necessary that you also get familiar with the procedure of CPR when you have got an assistant It is easy and less tiring to do/carry out CPR with an assistant. Given below are the steps of CPR when you have an assistant. ‘© Firstly decide who will do what and accordingly take the charge. First person takes position atthe head end for performing mouth-to-mouth ventilation, Second person kneels along side the casuaity’s right side atthe level of chest ‘© The role of first person is to start mouth-to-mouth ventilation as listed in airway clearance and breathing maintenance above. © The role of second person is to start ECC as listed in circulation maintenance above. © The ratio of mouth-to-mouth ventilations to ECC will differ. First person will give mouth- to-mouth ventilations and second person will give five ECC. This is performed continuously without pause ie. after five ECC, the first person will perform his role to ‘maintain a rhythm, Count 1, 2 and so on. The count of ECC and mouth-to-mouth at this rate will give a heart rate of 60 per minute and 12 breaths per minute, © Check the heartbeat after every cycle of 5 ECC, 1.3.5 CPR for Children ‘The technique of resuscitation for young and older children isthe same as that of adults explained above. The only difference is that CPR is done strictly ata faster rate i.e. 15 ECC to two ventilations (o maintain a rate of 100 heartbeats and 20 breaths and with less pressure of 1 to 1.5 inch. For resuscitation of newbom refer Course 2, Block 3, Unit 1 Cheek Your Progress 4) List ife saving techniques used in first aid i) What is ABC rule of assessment?1.4 SELECTED EMERGENCY SITUATIONS a ee Nets Let us ist understand what do we mean by emergency Emergencies can be defined as all acute criss (life threatening) situations caused by injuries ‘or other medical problems (illness). Asa health worker you should be able to provide first aid in emergencies at your work place before shifting the casualty to appropriate health facility for further treatment. We shall discuss selected emergency situations in following subsections. 1.4.1 Haemorrhage Haemorshage means loss of blood due to internal or external bleeding. This causes decreased oxygen supply to the body especialy to vital organs ie., brain heart and kidneys. Deercased blood volume also causes the hypotension. The hoart must pump faster to ‘compensate for the decreased blood volume and blood pressure. Uncontrolled bleeding can result into shock and death. Let us understand the types of haemorrhage. ‘Types of Haemorrhage According to the depth of the wound, bleeding may be caused from all the three types of blood vessels, such as arteries, veins and capillaries. Let us briefly describe these three types of bleeding. Arterial Bleeding: When an artery is severed or punctured the bleeding is characterised by the heavy spurting of bright red blood in the rhythm of heartbeat, The most common arteries that can be affected are femoral, radial, brachial and carotid arteries, Venous Bleeding: Venous bleeding occurs when a vein is severed or punctured and results in slow flow of dark red blood. It may result in shock and embolism. Capittary Bleeding: The most common type of external haemorrhage results from damaged or broken capillaries and is characterised by oozing of minor cuts, scratches and abrasions First Aid Treatment in Haemorrhage External Haemorrhage Itis the bleeding which can be seen eg, bleeding from nose, mouth, open wound. When you come across a person with external bleeding you should follow the measures or actions given below: ‘© Make the vietim lie down to prevent fainting ‘© Apply firm pressure and maintain itover the wound witha pad until bleeding is controlled. ‘© If there is venous bleeding from the limb, apply pressure below the wound. ‘© If there is arterial bleeding, apply tourniquet above the wound. ‘© When bleeding is controlled, apply the dressing and firm bandage. © Treat for shock, © fbleeding is from upper limb, place the limb ina sling @ Ifitis from lower limb, keep the limb raised. . ‘When bleeding is ot controlled or there is arterial bleeding or patient is in shock, you should immediately refer the casualty to health centre or hospital andifpossible accompany the casualty to the hospitaVealth centre, © Look forany bleeding from the nose (epistanis) et. fe Keep the victim quiet in sitting position leaning forward and head erect. ‘© Ifthe victim is unable to sit up he/she should remain in supine position with head and shoulders raised. In case of epistaxis pressure should be applied beneath the nostrils above the upper lip. Ifbleeding continues, refer to the hospital ‘nternal Haemorrhage tis the bleeding within the body cavities which can not be seen outwardly with no extemal nCare of Minor Ailments and Emergencies evidence. ¢.g. bleeding from stomach ulcer. ft may occur associated with or ivthout injury. Internal bleeding isa life-threatening situation. Common causes for internal bleeding include. © Fractures. Knife and bullet wounds. Crushing Injuries. (Organ Injuries. Ruptured Aneurysms. ‘When you come across the victims with internal bleeding you are expected to make a quick assessment. Observe for shock and the type and pattern of internal bleeding. This includes: ‘© Signs and symptoms of shock. (Refer sub-section 1.4.2.) ‘© Hemoptysis expectoration of blood), © Malena (Datk, tary stool ~ blood in stools) (© Hematuria (blood in urine). You have to take following measures to control internal bleeding: ‘© Victim shouldbe placed on flat surface with legs slightly elevated if this isnot contraindicated bby other injuries. Establish an airway and treat shock. A cold comipress orice is placed on the area of suspected injury. Maintain body temperature with blankets and monitor vital signs. “The vietim should not be given anything to eat or drink. Administer oxygen, if available Decrease the victim’s fear and anxiety by giving psychological support and Controlling Bleeding from Wounds and Cuts If there is bleeding from the wound ina leg, take following measures: © Raise the injured part, © Press the wound with clean cloth or hand, if there is no cloth, ‘© Keep pressing until the bleeding stops. ‘This may take 15 minutes or sometimes an hour ‘or more. (Press dire-tly on the wound.) Fig. 1.2