Importance of First Aid it’s better to know it and not need it than to need and not know everyone should be able to perform first aid, you are going to need it What is First Aid? the immediate care doesn’t take the place of proper medical care temporary help difference between life or death First Aid and the Law can be sued Minimize Risk of Suite get consent follow guidelines explain what you will do once you start, you can’t leave until proper help comes Consent Must Have before helping Touching them without permission is unlawful (called battery) Levels of Consent Expressed Consent – must be obtained by alert victim of legal age Implied Consent * – unresponsive victim with life-threatening condition Children and Mentally Incompetent Adults * – Guardian permission and consent Refusing Help some may refuse help reason: * religion * avoid pain * prefer doctor. . . What do you do? try to persuade have a witness consider calling law enforcement Abandonment once you start, you can’t leave until help comes and you are dismissed Negligence not following accepted standards of care this involves: * having a duty to act * breaching that duty * causing injury * exceeding your level Duty to ActNot required unless legal duty to act: * employment * licensed * preexisting responsibility (parent-kid) * type of rescue Breach of Duty Act of Omission * – not doing something simple like putting a band aid on Act of Commission * doing too much like trying to stitches on with out experience Confidentiality cautious about revealing info when caring for a victim (keep secret) some states require you to report rape, abuse, gunshots * * NJ requires gunshots, stabbings, and dog bites. . . but not rape (unless the victim wants it reported) Good Samaritan Laws law to protect docs and others from providing care ncourages people to assist others in distress * 1. Acting during emergency * 2. Acting in good faith * 3. Not guilty of malicious misconduct Chapter 2 Emergencies dangerous rare different unforeseen Bystander Actions vital link between EMS and victim: * – severity physical distance: * – the closer, the more notice relationship: * – knowing them, notice more time exposed: * – arriving later, different stories Factors that Influence Whether a Bystander Helps decide if there is an emergency put off by physical characteristics: * – blood * – vomit * – alcohol on breath attention on HIV & AIDS arriving after the event: – not seeing what happened To Help or Not to Help Deciding to help: * 1. Appreciate the importance of help * 2. Feeling confident * 3. Be willing to help * 4. Comfortable with taking charge * 5. Bodily fluids Why NOT Help? * harmful * injury * sued * getting a disease * helping doesn’t matter: victim gets what they deserves * obstacles When Calling EMS be prepared with info: *1. Location * 2. Phone number * 3. What happened * 4. Number of people * 5. Victims condition Never Hang Up Until Told To Do SO Second Size- Up a 10-second glance: * hazards * cause * number of victims Disease Precautions ange from mild to life threatening prevention: * hand-washing * protective equipment Stages of Grieving Five Stages: * 1. Denial * 2. Anger * 3. Bargaining * 4. Depression * 5. Acceptance * * Avra Mendelaw Shock What is Shock? a state of collapse and failure of the cardiovascular system leads to cellular death;gt; organ failure;gt; body failure;gt; death Causes heart pump fails, reduced pressure of the circulating blood develop as a result of a reduction in the fluid circulation Ex. External/internal bleeding Respiratory Insufficiency: * – wind knocked out; not breathing properly Anaphylactic shock: * allergic reactions: edications food insect stings plant pollen Perfusion when adequate blood and oxygen are provided to all cells Types of Shock Cardiogenic Shock: * – poor pump function; most common is before/ after heart attack Hemorrhagic Shock: * – not enough blood in the body; traumatic injury Neurogenic Shock: * – widespread vessel dilation; swelling in the head, spinal cord or head injury Recognizing Shock rapid pulse pale, grey skin sweating, and cold, clammy Shock Develops weakness and giddiness nausea, and sometimes vomiting thirst rapid, shallow breathing weak, ‘thready’ pulse Progression of Shock agitation anxiety estlessness feeling of impending doom altered mental status weak, rapid, or absent pulse clammy paleness, with cyanosis around the lips thirst shallow breathing nausea As Oxygen Supply to the Brain Weakens may become restless, anxious, and aggressive may yawn and gasp for air Treatment of Shock Do Not let them move, eat, drink, or smoke Do Not leave them unattended Treat any cause of shock (extensive bleeding) Lay them low Raise and support the casualty’s legs Loosen tight clothing, braces, straps, or belts Insulate them from the cold; contact the emergency service Check and record breathing; be prepare to perform CPRBleeding Bleeding Externally Arterial Bleeding: * bright red * sprouts from wound with every heart beat * most difficult to control Venous Bleeding: * dark red * flows in steady stream * easier to control Capillary Bleeding: * dark red * oozes from wound * often clots Control of External Bleeding Dressing: * applying directly to wound, prevents contamination Bandage: * hold dressing in place, can provide pressure Applying Direct Pressure Elevate Above the Heart If dressing is soaked: * – keep applying with out removing the first layer Internal Bleeding damage or injury to organs painful, swollen deformed extremitiesSigns and Symptoms: discolored, tender, swollen rapid, shallow breathing rapid, weak pulse pale, cool, sweaty skin nausea, vomiting extreme thirst altered mental status symptoms of shock Managing the Victim comfort, calm, and reassure them manage any extreme bleeding keep them warm, treat for shock position of comfort Avra Mendelaw Soft Tissue Injury 3 Types: Abrasion scrape/ “road rash” tearing away outer most layer of skin very little or no blood Laceration break in skin of varying depth bleeding maybe severe caused by sharp object Penetration/ Puncture caused by sharp pointed object little or no external damage nternal damage may be severe may be entrance or exit wound Management complete patient assessment expose the wound control the bleeding prevent further contamination apply sterile dressing and bandage in place Special Considerations nose bleeds: pinch nostrils closed and have them lean forward impaled objects: removal may lead to uncontrolled profuse bleedings, do not remove object chest injuries: any open wound to the chest or upper back should be sealed with dressing taped on three sides, need to be able to breath Eviscerations: an open injury through which organs are protruding; do not put them back in.Amputation: tearing off a body part Impaled Object do not remove unless it interferes with airway, chest compressions, through facial check if removed, bleeding should be controlled through both sides should be secured in place Eviscerations do not attempt to replace organs cover with a sterile, saline-moistened dressing, followed by a dry dressing taped on all sides Amputations wrap in a sterile, saline-moistened dressing seal in plastic bag place in water and ice do not use ice alone do not use dry ice Chest Injuries seal with dressing taped on three sides corner unsealed to created a flutter-valve f condition deteriorates, ensure the flutter-valve is functioning. Burns Facts: 2million a yr 75,000 hospital/ 3,000 deaths 70% in the home higher risk: under 5yrs old, over 55yrs old 113degrees point were exceeds the bodies ability to Types of Burns: Thermal Burns: Not all caused by flames Other causes: contact with hot objects, flammable vapor that ignites, steam, and hot liquid 3sec. exposed to water at 140deg. Can cause 3rd degree burn. At 156deg. The same burn occurs in 1sec. First Degree: affects outer layer only Characteristics: redness, mild swelling, tenderness and pain heals without scares within a weekSecond-Degree: through entire outer layer and into inner layer characteristics: blisters, swelling, weeping/oozing of fluids severe pain capillary blood vessels in dermis are damaged intact blisters provide a sterile, waterproof covering Third Degree: Severe burns that penetrate all skin layers into the underlying fat and muscle Looks leathery, waxy, or pearly grey and sometimes charred Nerve ends have been damaged or destroyed Any pain from surrounding burns of lesser degrees Requires medical care and removal of dead tissue- often skin graft to heal properly. Evaluating Thermal Burns depth extent body partsOther injuries/ preexisting Severity Care of First Degree Immerse in cold water Give ibuprofen Have drink water Apple aloe gel Keep burn raised to reduce swelling and pain Care of Second-Degree Same as first Apply thin layer of antibiotic ointment Cover with dry, non-stick sterilized dressing Seek medical care Care of Third-Degree Not necessary to apply cold because pain is absent Cover with dry, non-stick, sterile dressing Treat victim for shock Seek medical care ASAP After-thermal care Wash hands Leave unbroken blisters intact Change dressing 1-2x a day unless told otherwise Sunburn Most common burnBegins 2-8hrs after exposer Symptoms: redness, tenderness, discomfort, possible blistering and swelling Care for Sunburns Cool compress for 45min. Ibuprofen Drink lots of water Apply aloe **first and second-degree can make person feel ill, have chills, and fever Chemical Burns Will continue to cause destruction until removed Three Types of Chemicals: Acids (battery acid) Alkalis- substance includes lye, drain cleaner, metal polish, oven cleaner, cement, lime, and ammonia Organic Compounds Care for Chemical Burns Immediately remove chemical by flushing with water Remove contaminated clothes Flush for 20min or longerCover with dry, non-stick, sterile dressing Electrical Burns Depends on: The type of burn-flame, flash or contact Voltage Area of body exposure Duration of contact Electricity- can induce cardiac arrest, cause respiratory arrest or “freeze” victim (muscle spasms) Victim with low-voltage electrical injuries may not have skin burns, but might have cardiac or respiratory arrest Care for Electrical Burns Make sure the scene is safe. Disconnect/ turn off power source. Never touch wires. Monitor vitals Treat for shock Blanket victim Call 911 and seek medical attention immediately. Treatment at a burn center might be necessary.Avra Mendelaw * Head and Spinal Injuries Scalp Wounds Bleed profusely because scalp has rich blood supply and the blood vessels there do not constrict Severe scalp wounds me be accompanied by: * concussion * skull fracture Care for Scalp Wounds Control bleeding by gently applying direct pressure with dry, sterile dressing If skull fracture- apple pressure around edge Keep head and shoulders slightly elevated to help control bleeding if no spinal injury is suspected Seek medical care Recognizing a Skull Fracture Difficult to determine except by x-ray unless the skull is deformed Signs and symptoms: pain on point of injury. * deformity of the skull. * bleeding from the ears or nose. * clear, pink, watery cerebrospinal fluid leaking from ear or nose. * Discoloration around eyes. * Discoloration around ears. * May expose skull or brain tissue. Care for Skull Fracture Monitor breathing and provide care Stabilize neck Slightly elevate head and shoulders to control bleeding Cover wounds with sterile dressing To control bleeding, apply pressure around edges of the wound Do not: * stop flow of blood from ear or nose, may increase pressure * remove impaled objects * press on fractured area Brain InjuriesCauses short- and long-term problems Most result of motor vehicle crashes 50,000 people die in the US of head trauma and 2x that have brain injuries that leave them with permanent damage difficult first aid emergencies to handle, victims are often confused, or unresponsive making assessment difficult brain will swell from bleeding the brain is confined in the skull interferes with brain function nerve cells of the brain and spinal cord are unable to regenerate once dead and are lost forever 3 Types of Common Brain Injuries Concussion * – Temporary loss of brain function usually without permanent damage Contusion – Bruising of brain tissue Hematoma * – Result of a broken blood vessel: collection of blood in a local area Concussion Temp. loss of brain function No bleeding in brain occurs Can be unconscious or have amnesia The longer unconscious, the more serious the concussion Unlikely but can cause death Grade 1: * no loss of consciousness * symptoms resolve in less than 15 minutes Grade 2: * no loss of consciousness * symptoms last more than 15 minutes Grade 3: * Any loss of consciousness Care for Brain Injury Seek immediate care Stabilize neck- suspect a spinal injury in an unresponsive victim until proven otherwise 1.Grasp head over the ears and hold head and neck until EMS arrives 2. If long wait, put head between your knees Further Care Several signs appearing within 48hrs for a head injury indicate a need to seek medical care Headache lasting 1 or 2 days or increases in severity Nausea, vomiting Drowsiness Eye Injuries Penetrating sharp object penetrates eye Care Blows to the Eye blood Cuts of the Eye or Lid Signs Cut appearance of the cornea Inner liquid filling of the eye Lid is cut Care If eyeball is cut, do not apply pressure Eye Avulsion Knocking the eye from its socket CareCover eye loosely with sterile dressing that has been moistened Do not try to push back into socket Cover undamaged eye with patch to stop movement Seek medical care Broken Nose Signs Pain, swelling, and possible crooked appearance Bleeding and difficulty breathing through nostrils Black eyes appearing 1-2days after injury Knocked-Out Tooth Common dental emergency To prevent tooth from drying and protect ligament fibers from damage re-implantaion Broken Teeth Frequently broken by falls or direct blows Care Gently clean dirt and blood from injured area Apply ice Spinal InjuriesSpine- column of vertebrae stacked on one another from tailbone to base of the skull Each vertebrae has a hallow center through which spinal cords passes If broken vertebrae Recognizing Spinal Injuries Pain in arms and legs Neck or back pain Numbness, tingling weakness, burning, or lessened sensation in the arms or legs Loss of bowel or bladder control Checking for Spinal Injuries Have victim wiggle fingers Squeeze fingers and ask if they feel it Squeeze hand Ask them to wiggle their toes Have them push their foot against your hand Care for Spinal Injuries Monitor breathing Stabilize to prevent from moving Avra MendelawBone, Joint, Muscle and Extremity Injuries Types of Injuries: Contusions- bruising of the tissue Strains- Sprains- Tendonitis- inflammation of a tendon do to overuse Dislocations- bones are displaced from their normal joint alignment, out of their sockets, or out of their normal posotions Fractures- breaks on bones that may or may not be accompanied by open wound Basic Care Guidelines for Extremity Injuries Use the RICE procedure Apply a splint What is RICE procedure? Rest, Ice, Compression and Elevation Rest the victim does not move or use the injured body part Ice Applied ice pack as soon as possible or 20-30min. nd repeat every 2-3hrs for the first 24-48hrs after injury * Four stages of cold when icing: cold, burning, aching, and numbness Cold constricts the blood vessels Compression Squeezes out the fluid from the injured site. Limits the ability of the skin and reduces internal bleeding Most important step in preventing swelling Elevation Gravity slows the return of blood to heart from the lower parts of the body. Elevating with combination of ice and compression Bone Injuries Fracture * A break or crack in a bone Closed Fractures- skin in tact Open Fractures- skin is broken Transverse- brake straight across the boneGreenstick- incomplete fractures that commonly occur in children Spiral Fracture- results from a twisting injury, and fracture line may have a spiral look Oblique- crosses the bone in a slanted direction Comminuted- fragmented into more than two pieces Impacted- (hair-line fracture) bones are jammed together and bone may work even without acting like a fracture Recognizing Fractures Use D-O-T-S to assess for an injury: Deformity, Open-Wound, Tenderness, Swelling Deformity: may not be odvious, compare to uninjured part Open-Wound: may indicate fracture Tenderness: found at injured siteSwelling: caused by internal bleeding , happens rapidly Care for Fractures Perform initial check for life-threatening conditions Remove clothing covering injured area Examine area with DOTS Check blood flow and nerves Stabilize injured part Do not puch protruding bones, cover wound and exposed bone with dressing Apply ice Seek medical care Dislocations * Occur when a joint comes apart and stays apart with the bone ends no longer in contact Shoulders, elbows, fingers, hips, kneecaps, ankles Recognizing Dislocations Signs and symptoms are similar to fractures Care for Dislocations Check the CSM Use the RICE procedure Use a splint to stabilizeDo not try to put back into place Seek medical care Sprains * Occurs when a joint is twisted or stretched beyond its normal range of motion Bones are held together at joints by Ligaments When sprained, joint are parcially or completely torn Recognizing Sprains Severe pain Pain prevents use Swelling Skim may be discolored because of bleeding Care for Sprains Follow RICE 20min. ice . . . 2-3hrs off with compression Strains * Muscle Strain (pull)- occurs when a muscle is stretched beyond its normal range and tears the muscle Recognizing Strains Sudden, sharp pain in affected muscle Extreme tenderness when touched SwellingWeakness and inability to use injured part Stiffness and pain when moved After a few days, skin may be discolored Cramps Cramp- when a muscle goes into an uncontrolled spasm and contraction 2 categories night cramp heat cramp-related to dehydration and Recognizing cramps Care for Cramps Have victim gently stretch affected muscle Relax the muscle by pressing and massaging it Apply ice Pinch upper lip hard to reduce calf-mucle cramping Drink lightly salted water or gatorade (50/50 with water) Contusions Recognize (bruises) Swelling Pain and tenderness Discoloration Caring Follow RICE Avra Mendelaw CPR (Cardio pulmonary respiration)When to use CPR: Choking Poisoning Drowning or suffocation Electric shock Heart attack Check Call Care Check the scene- make sure its safe to help Check the victim- Call for Help Choking Ask if they are choking: if cant cough, speak, or breath, then they need help Tell someone to call 9-1-1 or skip if alone Back Blows Give 5 back blows 5 chest pumps for infants Abdominal Thrust (Heimlich) first ask of they are chocking ask able to cough or speak fist over belly button, hand over fist, thrust up 5 thrusts repeat until it comes out or victim is unconscious Heart Attack Occurs when arteries becomes suddenly blockedBlocks blood supple and muscle dies Cardiac Arrest Person’s heart rate suddenly drops Heart stops beating, no pulse can be found Brain damage begin within 4-6min CPR must be started immediately Steps to CPR Assess the scene Announce your presence Alert EMS0 call 911 Apply personal protective barrier Circulation- chest compression: 1. 5-2in. deep 30 of them Airway Breathing Reasons to Terminate CPR Rescuer becomes exhausted Scene becomes unsafe Person started breathing AED (automated external defibrillation) used to correct electrical abnormalities in the heart cannot detect pulse is used in conjunction with CPR erform CPR after shock is administrated Chest Pain (a complaint of chest pain must always be considered a threat) Common Causes Muscle strain Respiratory related Trauma Angina Heart attack Management Administer oxygen Do not permit any physical activities Comfort, calm, and reassure Heart Attack Occurs when heart muscle tissue dies becayse the blood supply is reduced or stopped Usually clots in coronary artery – Recognizing a Heart Attack Pressure, squeezing, or pain in the center of the chest lasting more than a few minutes Pain spreading to shoulders, neck, or arms Dizziness, sweating, nausea Shortness of breath Care for Heart Attack Call 911 Monitor breathing, give CPR if necessary Put in comfortable position Give aspirin if they are alert, able to swallow, or aren’t allergic Angina Chest pains due to lack of oxygenBrought on: – Treatment Nitroglycerin- drug used to increase blood supply Altered Mental Status Decrease in responsiveness – Common Causes: Fever Infection Poisoning- including drugs or alcohol Low blood sugar Head trauma Psychiatric disorder – Management Calm, comfort, and reassure Maintain scene safety Monitor airway Place in recovery position: lay on left side Seizures A sudden attack, related to malfunction in nerve system Common Causes: Chronic medical conditions Fever Infections Poisonings Alcohol/drugs Low blood sugar Head trauma Shock Brain tumor Complication of pregnancy – Management Do not attempt to restrain Do not put anything in their mouth Protect them from harm Observe and record seizure activity Stroke A sudden interruption of blood flow to a portion of the brain resulting in tissue death – Signs and Symptoms: Severe headache Lack of speech Difficulty swallowing Facial droop Unequal pupils Paralysis/ numbness Loss of bowl or bladder control Unresponsiveness – Management 911 monitor vitals noting in mouth recovery position calm. . .