tromas first aid presentation
TRANSCRIPT
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By
Prof. Dr. Ali El-ShewyProf. of General Surgery
Faculty of Medicine
Zagazig University
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Definition of the first aid measures:
Are the measures that should be done for traumatized patientor for a patient with urgent disease, till the patient referred tothe hospital
Aims of the first aid measures:
1- Saving the life of the patient arresting of bleeding or
doing artificial respiration for a patient with asphyxia2- Relief of pain splinting of fracture or giving analgesicdrugs
3- Preventing complications that may develop preventingwound infection
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A- Air way care
Air way obstruction may kill thetrauma victum within few minutes.
Evaluation of the patency of the
air way and its protection should
receive top priority
All patients with major traumashould receive supplemental
oxygen by mask till arrival to hospital
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Care of air ways:1- Clear the air ways:Removal of vomit, blood or foreign materials from the mouth
and throat either manually (finger sweep) or using sucker.
2- Chin left & Jaw traction
3- Oro-pharyngeal air way tube : to prevents tongue fromfalling back and occluding the air way. It should be used for
unconscious person only
4- Endo-tracheal intubation: Indicated in cases of apnea,
inhalation injuries, maxillofacial trauma, fracture cervicalspine and head injury
5- Crico-thyroidotoy: may be needed if upper airway are
obstructed. It is done by cut and insertion of a tube or a wide
bore needle
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Assessment of air movement, respiratory rate, cyanosis,
stridors, wheezing, chest wounds and asymmetry of
chest wall
Life threatening thoracic conditions should be managed
immediately like:
1- Tension pneumothorax: by needle decompression
2
- Open pneumothorax: by occlusive dressing theninsert chest tube
3- Cardiac tamponade by needle aspiration
4-Flail chest by multiple fractures of ribs by positive ventilation
5- Massive haemothorax by chest tube drainage
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C- Circulation:
If there is massive bleeding causinghaemorrhagic shock we should do :
1- Stop external bleeding by direct pressure
on the wound2- insert large intravenous line
3- Take blood sample for typing & cross
matching4- start giving I.V fluids as lactated ringer
5- Blood transfusion, once available
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D- Disability:Detailed neurological assessment (if the patient is
alert or unconscious )
E- Exposure & environment All clothes of the patient should be renoved
Emergency room should kept warm to avoidhypothermia
Insert uretheral catheter an nasogastric tube
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Definition:Escape of blood from a vessel damaged by injury or
by a disease
Causes:1- Traumatic: as in wounds, fractures and operations
2- Pathological : injury of blood vessel by ulcer ormalignant tumour
3- Abnormal bleeding tendency: as haemophilia,purpera and vitamin K-deficiency.
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a- Primary haemorrhage:
at the time of trauma or operationb- Reactionary haemorrhage :
during first 24 hours after trauma or operation due to
slipping of ligature or dislodgement of blood clot
c- Secondary haemorrhage:within 7-10 days after trauma or operation due to erosion of
blood vessels with sepsis. Is usually serious
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a External haemorrhage:-Escape of the blood to outside the body, as bleeding wound,
epistaxis, haemoptysis, haematemesis and rectal or vaginalbleeding
b- internal haemorrhage : -Bleeding into the body cavities e.g., peritoneal cavity, pleural cavity
and intracranial
c- interstitial haemorrhage :
Bleeding in between tissues as haematoma
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A- Arterial bleeding
B- Venous bleeding
C- Capillary bleeding
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1- Shock :-due to massive loss of blood in short time may lead torapid death
2- Anaemia :-In minor and recurrent bleeding (chronic blood loss) as in
bleeding piles
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1- Compression on the site of bleeding by pressure bandage
2- Elevation of the bleeding limb above the level of the heart
3- Pressure over the artery proximal to the site of bleeding
by a tourniquet or by a pressure bandage -- better to be
avoided because it may lead to ischaemia or gangrene
4- Application of local haemostatic dugs as a piece of gauzesoaked with adrenaline in the nose in case of epistaxis
5- compression of the bleeding surface with moist hot
packs ( as during surgical operation)
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Definition:
Shock is a state of peripheral circulatoryfailure characterized by :
1- hypotension
2- impaired tissue perfusion3- disordered cellular metabolism
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causesa- haemorrhage due to trauma or operationb- burn -- loss of plasmac- excessive vomiting - fluid loss
Clinical picture:a- pallor of the faceb- cold sweaty skinc- rapid pulse and low blood pressured- decrease of urine volume (oliguria)
First aid measures:a- patient lie flat with his limbs elevatedb- maintain open air wayc- arrest bleedingd- sedation by morphia IVe-rapid transport of the patient to hospital to receive the life saving as, fluids,
blood transfusion and oxygen therapy
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Cause :Seeing blood , sever pain , emotional excitation leads to reflex vasomotor paralysis (vasodilatation)
Clinical pictures:a- pallor of the faceb- cold sweaty skin
c- slow pulse and low blood pressure
d- drowsiness, fainting attack and fall on the ground
First aid measures:a- patient lie flat with his limbs elevatedb- warm the patient by blankets
c- splinting of traumatized limb and give sedation to relief pain
d- give the patient IV fluids, atropine and vasopressors
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causesAnaphylaxis (hypersensitivity) causes capillary paralysis (dilatationand pooling) due to histamin. The beast example is penicillininjection in a sensitized patient
Clinical pictures:1- skin eruption, swelling in the face
2- difficult breathing
3- low blood pressure
First aid measures:-1- stop further injection of the drug causing hypersensitivity
2- give the patient, antihistamincs, corticosteroid and adrenaline
3- refer to the hospital to take IV fluids and O2
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causes
1- myocardial infarction2- cardiac arrest
3- arrhythmias
Clinical pictures:1- patient looks ill
2- irregular week pulse
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Due to vasomotor paralysis causedby bacterial toxins as in case ofperitonitis and postoperative
infection
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First aid includes the assessment andtreatments that can be performed by aperson with minimal or no medicalequipment.
First aid should not delay the activation ofthe emergency services (EMS)
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Causes: Bronchial asthma & Allergic reaction
This is a serious emergency and requiresimmediate emergency medical care
First aid :
1- help the patient to take his medications
2- allow the patient to sit upright
3- help him to reach to take his medical care
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Most cases of convulsion stop spontaneously within seconds
It is usually due to neurological diseases
First aid:
1- open air way2- prevent tongue injury by putting air way in his mouth
early during the attack
3-move furniture away or place soft objects (pillow) to
protect the head4- after convulsion the patient may be unconscious or
confused, so must be placed on his side to allow oral
secretion to drain out
5- call for EMS
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stroke means infarction of the brain by blood clot or
intracerebral haemorrhage
Clinical pictures:
1- drop of the angle of the mouth when smile
2- inability to close the eyes completely
3- inability to move upper or lower limb
4- speak with difficultyIt is a serious medical emergency and time is critical so,call of EMS immediately if you believe someone may besuffering from a stroke.
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means ischaemia of the heart and affects males and females but morecommon in smokers and old age and persons under stress.
Clincal pictures:
1- chest discomfort (retrosternal pain) for few minutes , and may relieve
and return back
2- discomfort in other areas as left arm, back, neck, jaw and may be
stomach pain
3- shorting of breathing with or without chest discomfort
4- cold sweaty skin, nausea or headache
first aid:1- call for EMS
2- allow the patient to be in the most comfortable position
3- re-assure the patient
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Causes:1- during anathesia and surgical operation
2- electro-conduction
3- drowning & asphyxia
4- gas poising
5- myocardial infarction
6- sever trauma
Clinical pictures:1- absent carotid pulse2- absent or gasping respiration
3- dilated fixed pupils of the eyes
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First aid:
brain can tolerate 3 min of complete circulatory arrest , if notrestored brain death will occur
External cardiac massage and artificial respiration (mouth to mouthbreathing) should be started immediately and continue whiletransporting the patient to the hospital
External cardiac massage is done as the following
1- the patient is laid flat on a firm surface with elevation of his legs to
increase the venous return to the heart
2- Artificial mouth to mouth respiration is done by one person
3- at the same time a second person apply cardiac massage by
compressing the lower part of the sternum against the spine at a
rate of 60 times per minute
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poisoning may be ingested, inhaled
or absorbed through the skin, eyes ormucous membranes
It usually occurs as industrial
accident or home accident by household agents by accidental, criminal orsuicidal act
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1- heavy metal : as, lead, mercury and arsenic
2-insecticides: as, cholinesterase inhibitor3- corrosives: as stronig acids, alkalines
4- food poisoning : bacterial and botulism
5- carbon monoxide6- drug intoxication
7- poisonous plant
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Each type of poison has its specialmanagement, so there is no generalrecommendation for management of poison
The first step of aid measure is to contact thenearest (poison control center) or local EMS
Do not give the victim any thing to drink or eatto induce vomiting unless directed by thepoison control center
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Asample of toxic material or drug taken bythe victim should be kept to know itsnature to provide the suitable treatment
You must find out the (3Ws) who?, what?And when.
who is the patient ( name , age weigh,
address and telephone number
what type of toxins patient take
when he take the toxin
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Remove the clothes of the patient
Skin should be cleaned by runningwater
Washing of the eyes with running water
while holding the eye opened
Do not use chemical to wash the eye or
the skin
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Open all doors and windows and carry the
patient out to fresh air immediately
Tight clothes should be loosened
If convulsion occur. Keep the patient in dark
quite room on his side
Watch the respiration of the patient, if
stopped or irregular, artificial respiration
should be started
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Maintain air ways, aspiration of vomitus or secretion
If respiration is irregular start artificial respiration
Induce vomiting (Emesis): touch the patient throat by
finger or blunt end of the spoon, to empty the stomach
N.B: Emesis is contraindicated in unconscious patient
and in case of corrosive poisoning
Activated charcoal could be used as universal antidote,
as it inactivate most of the poison and chemicals,
except cyanides
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1- Simple fracture: fracture of a bone into twofragment
2- Comminuted fracture: fracture of a bone tomany fragments
3- Compound fracture: fracture associated with
wounds, they are liable to infection
4- Pathological fracture: caused by bone diseasesuch as bone cysts and malignancy. It may occurs
spontaneously or after minimal trauma
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1- Swelling and oedema at the side of
the fractures .
2- Severe pain and tenderness .3- Deformity of the injuried limb .
4- Inability to move the injuried limb .
5- Sensation of crepitus at the sit of the
fracture .
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1- Relief of the pain by using of an analgesic
2- Splinting of the fractured bone of the
relief of the pain to prevent furtherdeformity .
3- Care of any associated wound e.g. arrest
of bleeding .
4- Refer the patient to the hospital .
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Special splints, made of rigid materials areavailable in ambulance cars and in emergency units.
If these splints are not available, one couldimmobilize a fracture limb by one of thesesmethods:
1- use of two plates of wood or heavy cardboard
fixed the limb by bandage2-Band the injured limb to the trunk or to the
normal limb
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do not attempt to move or reposition avictim with a serous muscular, bone or joint
injuryApply ice bag to the injured area for 20minutes
If the injury includes open skin, cover thewound with clean dressing
Do not attempt to push protruding bonesof tissue back into the skin
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Definition : It is injury of the skin, muscle, nerves and bloodvessels
Types:1- Contusion (Bruises): Painful swelling due to blow with a blunt
object as, stick or stone. It occurs as a result of injuries of the
soft tissues while the overlying skin remains intact
2- Haematoma : Localized collection of blood in the tissue planes
due to rupture of a blood vessel. It appears as a soft painful
bluish swelling. Small haematoma usually resolvespontaneously.
3- Wounds: injury of the skin with a variable degree of damage of
the underlying tissues
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1- Abrasions :loss of superficial epithelium of the skin due to scratching with a pointedobject or friction with a hard rough surface.
It appears as a bleeding raw surface associated with pain.
Healing of the abrasion is rapid
2- incised wounds: produced by sharp cutting instruments like knives or fragments of glass
they have healthy clean cut edges with little tendency to infection
3- Contused and lacerated wounds: occur as a result of sever violence with blunt hard objects.
their edges are irregular and devitalized
the underlying soft tissues are usually injured
there is a great risk of contamination and infection
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4- Stab and punctured wounds:
caused by pointed instruments such as knives anddraggers
they have small opening but extend deeply
infection and retained foreign bodies are common
complications
5- Penetrating wounds:
Deep stab wound that involves a serous cavity as
(abdomen or thorax) these wounds are very serious as it may involves a
deep organ or an important structure such as liver,
spleen and heart
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1- Haemorrhage:
Which may be sever enough to cause shock
and death2- Contamination and infection:
Such as cellulites, toxaemia, tetanus and gas
gangrene3- Injuries of important structures:
Such as blood vessels, nerves and organs
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1- Arresting of the bleeding
2- Relieve the pain by splinting of the
injured limb or giving analgesia
3- prevention of contamination of thewound by :
avoiding excessive manipulationDressing of the wound
4- Transporting the patient to hospital
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1- Dressing must be done in a suitable clean place
2- Instruments used must be sterile
3- scrub (wash) your hand with water and betadine
4- scrub the skin around the wound then the wound by betadine5- remove any superficial FB and dirties and do not manipulate
deeply
6- irrigate the wound by saline of antiseptic solution
7- cover the wound with a sterile dressing, then apply bandage8- if bleeding persists after bandage, do not disturb the dressing,
but add further sterile cotton and apply another bandage with
pressure
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Antiseptics are used for the disinfection of instruments, hands, and skin. Also it is used for thetreatment of infected wounds.
The most popular antiseptics are:1- Strong antiseptics: as formalin, they are used tosterilize instruments, but should not be used inwound dressing as it causes tissue damage and delay
healing2- Alcoholic antiseptics: such as alcohol 70 % .These are suitable for dressing of sutured wounds(after surgical operations).
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3- Bland antiseptics, such as watery
solution of cetavlon (1%), Theseantiseptics are suitable for openwounds (raw surface) as they dont
interfere with the healing wounds.
4- Povidone iodine (Betadine) :
antibacterial , antifungal , used forskin disinfection , open wounds andfor sutured wounds.
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5- Hypochlorite antiseptics , e.g. Eusol,
liberate nascent chlorine which has a strongantiseptic action and hasten separation ofsloughs without tissue injury. They are usedto eradicate infection in infected open
wounds.6- Effervescent antiseptics e.g.Hydrogen peroxide. It liberates gas bubbles
which penetrate pockets and sloughs. It issuitable for irrigation of infected deep
wounds e.g. after drainage of an abscess.
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Definition of Rescue :
it is the act needed to save the live of a victims
and extract them safely from the field of accident
Accident needs rescue may be :
1- for one person like car accident
2- groups of victims : fires, collapse of buildings ormines, earthquakes , trains or airplanes accidents
and floods
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Rescue should be provided by a team of well trainedpersonal provided with suitable tools and
equipments to facilitate their rescue and extractionprocedures like: hammers, axes, saws, cutters ( either
manual or powered)Rescue workers should be well trained to usethese equipments, also they should be well trained toprovide medical first aid measures ant trauma life
support for the victimRescue workers should be also trained how toprotect themselves, as their work is hazardous, andthey are liable to trauma during their work
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The aim of rescue is to get out the trapped victims
away from the field of the accident safely
Priority of extraction is :
1- start with alive hopeful victim first, which could
be easily and quickly saved
2- followed by less hopeful cases3- and then after for hopeless patients
4- lastly the dead person
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Medical care should be started at the site ofthe accident. The emergency medical care that
the patient receives before he arrives thehospital may irreversibly influence hismortality and morbidity
Medical car should be also continued duringtransportation of the patient till he reach thehospital
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1- Ambulance vehicle:
Transportation should be rapid and safe.
Ground, water or air transportation should be
available and effective.Ambulance cars should be wide enough to facilitatemedical care. It should be well equiped with suitableequipments needed for life support like O2 gas,ventilation equipment, i.v f luids, medications . Etc
It should also provide radio- to communicate withthe receiving hospital.
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2- Ambulance workers :
Should be well trained for use of the rescue tools andprocedures
and they should have good knowledge about management ofmedical emergencies and providing life support measures topatient during transport.
They should also have the skill of use of radio-communications
3- Management during transport:
Vital signs and pulse oximetrySupport monitoring of cardio-respiratory system (ventilation)
Blood volume replacement
Use of appropriate medication
keep written records about the case and its progress
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4- Communication :
Referring doctor should first choose thenearest medical emergency care suitable for
his patients condition.Before transport he should communicate(call) the receiving doctor to give him an idea
about the history and condition of thepatient, to make him ready to receive thepatient and to provide the suitable medicalcare.
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1- Definition of :
1- First aid measures
2- Basic life support
3-Bleeding Primary haemorrhage reactionary haemorrhage secondaryhaemorrhage- internal haemorrhage intersitialhaemorrhage
4- Stock or definition of any type of stock
5- Stroke
6-Simple fracture or any other fracture
7- Soft tissue injury or definition of any type of wounds
8-Rescue
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a- Neurogenic shock or oligaemic shock
b-Cardiac arrest
c - Fractures
33-- Complications of:Complications of:
aa-- HaemorrhageHaemorrhagebb-- WoundsWounds
44-- Aim of first aidAim of first aid
55-- Care of air wayCare of air way
66-- What is the life threatening thoracic condition?What is the life threatening thoracic condition?77-- Cause s OR types ofCause s OR types of haemorrhagehaemorrhage
88--First aid measures forFirst aid measures for haemorrhagehaemorrhage
99--types of shocktypes of shock
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1010--first aid measures forfirst aid measures for neurogenicneurogenic & anaphylactic& anaphylactic
shockshock1111--First aid measures for cardiac arrestFirst aid measures for cardiac arrest
1212-- Types of poisoning & first aid for inhalants toxinTypes of poisoning & first aid for inhalants toxin
1313-- First aid measures of fracturesFirst aid measures of fractures
1414-- How to do splints?How to do splints?1515--Types of soft tissue injuries?Types of soft tissue injuries?
1616-- Types & first aid measures of wounds?Types & first aid measures of wounds?
1717-- How to do dressing for wound?How to do dressing for wound?
1818-- Names and mention one example of antisepticsNames and mention one example of antiseptics1919-- Logic sequence of events for rescueLogic sequence of events for rescue
2020-- Requirements for safe transportationRequirements for safe transportation
2121-- management during transportationmanagement during transportation