First Aid For Lab students.pptx

First aid

1. First aid and accident prevention 5/26/2023 BY: MEAZA LEMA 1

2. Introduction to first aid 5/26/2023 BY: MEAZA LEMA 2 Learning Objectives After studying the material in this chapter, the student will be able to:- 1. Define first aid 2. Describe the reasons why first aid is given 3. Appreciate values of first aid 4. Identify general directions for giving first aid

3. Introduction to first aid 5/26/2023 BY: MEAZA LEMA 3 Definition: First aid is the immediate care given to a person who has been injured or suddenly ill . It includes home care if medical assistance is not available or delayed. It also includes well selected words of encouragement, evidence of willingness to help, and promotion of confidence by demonstration of competence (American red cross, 1998).

4. Definition of important terms Accident: is an unfortunate incident that happens unexpectedly and unintentionally, typically resulting in damage or injury. e.g . crashing of automobiles Casualty : somebody who has a fatal accident or a serious injury Cardiac arrest : is the sudden stopping of the heartbeat. Resuscitation: is a process of correcting physiological disorders in an acutely ill patient. Cardiopulmonary resuscitation : is a procedure performed to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest. 5/26/2023 BY: MEAZA LEMA 4

5. Definition of important terms conti. Breathing : act of taking air in and out of the lung. Respiration: process of supplying oxygen to cells. Artificial respiration:  is the act of assisting or stimulating  respiration  ABC  is  a word  used to remember essential steps when dealing with a patient. It stands for  Airway,  Breathing and Circulation 5/26/2023 BY: MEAZA LEMA 5

6. Reasons why first aid is given 5/26/2023 BY: MEAZA LEMA 6 To preserve life E.g. mouth to mouth respiration when breathing has stopped. To prevent further injury(complication) E.g. -immobilizing the fractured bone. -Cervical spine protection To promote healing and recovery E.g. reassuring the patient, relief pain, protecting from cold and arranging for transfer. NOTE: Protect yourself – don’t be the victims !

7. Values of First Aid Training 5/26/2023 BY: MEAZA LEMA 7 The need for first aid training is greater than ever. Why?

8. Values of First Aid Training 5/26/2023 BY: MEAZA LEMA 8 The need for first aid training is greater than ever because of: Population growth through out the world Increased use of technological products ; such as mechanical and electrical appliances in everyday use at home, working place and play areas which make more people at risk of injury. In Ethiopia, infrastructure is developing like high speed-roads, hotels, universities, dams, etc Thus, there is an ever growing demand for first aid training for personal use and from the demand for certified first- aiders as part of industrial and commercial establishments.

9. General directions to give first aid 5/26/2023 BY: MEAZA LEMA 9 A. Assessment of the situation - scene size up Is the scene is safe? What was the cause? How many victims were involved? The traffic pattern? etc B . Identifying the problem Type - Mechanism of injury Severity

10. General directions to give first aid conti. 5/26/2023 BY: MEAZA LEMA 10 Prioritizing: a casualty may have more than one injury and that some casualties will require more urgent attention than others. Extricating the victims: disentangling the patient from difficulty Giving immediate and adequate treatment Arrangement of transportation for casualty with out delay accompanied with brief written report

11. Extrication 5/26/2023 BY: MEAZA LEMA 11 Definition : the process of safe removal of the patient from source of accident Two primary extrication goals: To obtain safe access to the patients To ensure patient stabilization

12. Keep in mind these basic guidelines Know the limitations of your training, equipment, and skill. Identify any hazards (eg, gasoline, power lines or wires, hazardous materials). Control those hazards for which you are trained and equipped. Gain access to the patients. Provide patient care and stabilization. Move patients only if absolutely necessary. 5/26/2023 BY: MEAZA LEMA 12

13. Emergency patient assessment 5/26/2023 BY: MEAZA LEMA 13 Triage French word “trier”, literally means: “ to sort out ”. A method of ranking sick or injured people. According to the severity of their sickness or injury. A ccording to the capacity of the facility (mass causality or multiple causality.)

14. Emergency patient assessment conti. 5/26/2023 BY: MEAZA LEMA 14 Patients are sorted with a scientific triage scale in order of urgency. The aim is to bring: The greatest good to the greatest number of people. The patient with the greatest need is helped first. to place them in one of the following categories: E= Emergency P= Priority and Q = Queue (non-urgent )

15. Emergency patient assessment conti. EMERGENCY signs: who require immediate emergency treatment PRIORITY signs: who should be given priority in the queue, rapidly assessed and treated without delay NON-URGENT cases: who can wait their turn in the queue. The majority of seen will be non-urgent cases. 5/26/2023 BY: MEAZA LEMA 15

16. Emergency patient assessment conti. 5/26/2023 BY: MEAZA LEMA 16 Life threatening problems are identified and dealt with FIRST . This is done in a strict order of priorities in order to ensure that the most important steps are undertaken in a logical order ensuring nothing is missed.

17. Emergent Severity Index (ESI ) ESI 1- (RED): Emergency signs are sorted in order of priority as: ABCDO A = Airway B = Breathing C = Circulation, Coma, Convulsions D = Dehydration O = Others ( bleeding, trauma with open fracture, Acute poisoning) 5/26/2023 BY: MEAZA LEMA 17

18. Emergent Severity Index (ESI) ESI 1- (RED): Immediately life threatening Respiratory failure, severe respiratory distress facial, neck, chest injuries, severe hemorrhage, unstable vital signs (shock), Coma with airway obstruction, convulsions, chest pain with unstable v/s. 5/26/2023 BY: MEAZA LEMA 18

19. Emergent Severity Index (ESI) ESI 2 – (Orange): Emergent imminently/potentially life threatening if care is not given within 15min p ending respiratory failure altered consciousness with out airway obstruction moderate trauma with stable vital signs Such patients require frequent re-triage until they are seen by the professional and they are the second in priority following the red If any deterioration appears, they may be categorized accordingly 5/26/2023 BY: MEAZA LEMA 19

20. Emergent Severity Index (ESI) ESI 3 - ( Yellow ): less urgent , potentially serious, could be delayed up to 1hr E.g i njuries to the Lower genitourinary tract, peripheral nerves and vessels, splinted fractures soft tissue lesions They also require re triaging until they are assessed by the health professional and if any deterioration appears they may be categorized accordingly. 5/26/2023 BY: MEAZA LEMA 20

21. Emergent Severity Index (ESI) ESI 4 (Green): They will require a professional care in several hours to days but not immediately . May wait for a number of hours or be told to go home and come back the next day, non urgent . Can be send to near by health institution 5/26/2023 BY: MEAZA LEMA 21

22. Emergency patient assessment conti . 5/26/2023 BY: MEAZA LEMA 22 The Primary Survey uses the systematic approach : DR.ABCD. Dangers Response Airway Breathing Compressions Defibrillation if available

23. D- DANGER 5/26/2023 BY: MEAZA LEMA 23 Eliminate/minimize the dangers before you approach . Ensure the safety of yourself , any bystanders and the casualty. If it is too dangerous to approach, keep at a safe distance and call the emergency services. Only move the casualty/casualties if absolutely necessary . Use bystanders to assist you where possible i.e. controlling traffic, phoning for help. Use barrier devices where possible i.e. use a face shield and gloves.

24. R - RESPONSE If you have more than one casualty, always treat the unconscious ones first. Question: If someone is screaming and shouting and one is on their back quiet which one would be your priority? If they are screaming and shouting, they are breathing. Use the touch and talk approach. NEVER SHAKE an unconscious casualty . The best way to see if the casualty responds is to use the 'COWS' method: touch and talk approach C an you hear me? O pen your eyes! W hat's your name? S queeze my hands ! 5/26/2023 BY: MEAZA LEMA 24

25. R – RESPONSE conti. 5/26/2023 BY: MEAZA LEMA 25 If the casualty responds, ask their name and carry out the ‘history, signs & symptoms' assessment principle If the casualty is unconscious, not responding to talk and touch, call your ambulance now and move onto the airway.

26. A - AIRWAY Assessing the airway of the casualty without turning onto the side. Keeping the head in the position you found it, look in the mouth. If any solid or liquid is found, place the casualty onto their side and clear the airway. If nothing is found but not breathing adequately , open the airway using the head tilt-chin lift technique, head tilt-neck lift technique or jaw thrust method . 5/26/2023 BY: MEAZA LEMA 26

27. A – AIRWAY conti. 5/26/2023 BY: MEAZA LEMA 27 Head tilt-chin lift Place one hand on the casualty's forehead and two fingers under the chin. Tilt the head back and lift chin up opening the airway. The maneuver is performed by tilting the head backwards in unconscious patients, often by applying pressure to the forehead and the chin. What are contraindications?

28. Head tilt-neck lift maneuver 5/26/2023 BY: MEAZA LEMA 28

29. Jaw-thrust maneuver Is performed by placing the index and middle fingers to physically push the posterior aspects of the mandible upwards while their thumbs push down on the chin to open the mouth. When the mandible is displaced forward, it pulls the tongue forward and prevents it from obstructing the entrance to the trachea. Lifting the mandible using both mandible angles and pushing forward and upward . Use jaw thrust especially in patients with suspicion of cervical spine injury (see picture below) 5/26/2023 BY: MEAZA LEMA 29

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31. Advanced airway management 5/26/2023 BY: MEAZA LEMA 31

32. B - BREATHING 5/26/2023 BY: MEAZA LEMA 32 Check the casualty's breathing by placing your ear and cheek near their mouth and nose whilst looking at their chest: Look for movement of their chest and upper abdomen. Listen for normal breathing Feel for breath on the side of your cheek Assess their breathing for no longer than 10 seconds before deciding whether breathing is normal or not.

33. B – BREATHING conti. If the patient has adequate breathing effort place in recovery position , with the patient leant over on their side (see the picture below). this has an effect of clearing the tongue from the pharynx Avoids a common cause of death in unconscious patients, choking on regurgitated stomach contents. It also avoids aspiration. 5/26/2023 BY: MEAZA LEMA 33

34. C – Compressions 5/26/2023 BY: MEAZA LEMA 34 Asses for circulation on the carotid artery for pulse for 9-10sec . If no pulse, start chest compression. Compress the chest 30 times at a rate of 100 compressions per minute and give 2 rescue breathe.

35. C – Compressions conti. 5/26/2023 BY: MEAZA LEMA 35 The goal of resuscitation interventions for a patient in respiratory or cardiac arrest is to: Restore effective oxygenation & ventilation Restore circulation Return of intact neurological functions A compression depth of at least 4 cm in infants and 5 cm in children PUSH HARD

36. C – Compressions conti. Once you have carried out 30 chest compressions, and 2 rescue breaths, Continue at a ratio of 30:2 until either: Professional arrives to relieve you. It becomes too dangerous to continue The casualty begins to breathe normally You become too exhausted to continue Another competent first aider takes over from you The casualty begins to vomit Death is confirmed 5/26/2023 BY: MEAZA LEMA 36

37. Reassurance 5/26/2023 BY: MEAZA LEMA 37 Easing of discomfort and anxiety is a very important process of first aid. Many first aiders forget that they are treating a 'person', as well as the injury/illness. By combining reassurance with good first aid management, and possibly distracting or diverting the casualty's attention to something else, you will, in most circumstances, actually ease the anxiety and pain levels of the casualty.

38. Reassurance conti. By easing anxiety and pain levels you will help to promote recovery of the injured/ill casualty. This will in turn: Decrease blood loss Which will in turn slow down the shock process Decreasing the heart rate 5/26/2023 BY: MEAZA LEMA 38

39. REMEMBER: Any resuscitation is better than no resuscitation at all. If you are unwilling or unable to carry out rescue breaths, then carry out chest compression alone. If you don't do anything they will stay dead 5/26/2023 BY: MEAZA LEMA 39

40. Summary of Emergency patient assessment 5/26/2023 BY: MEAZA LEMA 40

41. CHAPTER TWO RESPIRATORY EMERGENCIES AND ARTIFICIAL RESPIRATION 5/26/2023 BY: MEAZA LEMA 41 Learning Objectives After studying the material in this chapter, the student will be able to:- Define respiratory emergencies and artificial respiration. Explain the breathing process. Identify causes of respiratory failure Give artificial respiration and manage respiratory accident. Demonstrate cardiopulmonary resuscitation

42. Definition of terms 5/26/2023 BY: MEAZA LEMA 42 Respiratory emergency- is one in which normal breathing stops or in which breathing is reduced so that oxygen intake is insufficient to support life. Respiratory failure- is a syndrome in which the respiratory system fails in one or both of its gas exchange functions: oxygenation and carbon dioxide elimination. Artificial respiration- is a procedure for making air to flow into and out of a person’s lungs when natural breathing is inadequate or ceases.

43. The breathing process 5/26/2023 BY: MEAZA LEMA 43 Natural breathing is accomplished by increasing and decreasing the capacity of the chest and the lung. During the inhalation phase of breathing The muscles of the chest contracts and lift the ribs, expanding the chest. At the same time, the diaphragm contracts and descends toward the abdomen. In this way, the chest cavities increased in size and air flows in

44. When all muscles relax, the ribs and diaphragm resume their normal position, the chest cavity becomes smaller, and air flows out . In all manual methods of artificial respiration, the objective is to cause an alternate decrease and increase in size of the chest cavity. When this is done, air flows in and out if there is no obstruction 5/26/2023 BY: MEAZA LEMA 44 B reathing process conti…

45. Respiratory physiology 5/26/2023 BY: MEAZA LEMA 45 The act of respiration engages 3 processes: Transfer of oxygen across the alveolus Transport of oxygen to the tissues Removal of carbon dioxide from blood into the alveolus and then into the environment. Any disruption in one or more of these leads to Respiratory failure .

46. Types of respiratory failure 5/26/2023 BY: MEAZA LEMA 46 Hypoxemic respiratory failure (type I) Hypercapnic respiratory failure (type II) 1. Hypoxemic respiratory failure (type I) characterized by: an arterial oxygen tension ( P a O 2 ) lower than 60 mm Hg with a normal or low arterial carbon dioxide tension (P a CO 2 ). T he most common form of respiratory failure.

47. Causes of Respiratory Failure 5/26/2023 BY: MEAZA LEMA 47 A. Anatomical Obstruction The most common cause of respiratory emergency which interfere with breathing caused by the dropping of the tongue back and obstructing the throat . Other causes of obstruction that constrict the air passages are: Asthma Croup Diphtheria Laryngeal spasm Swelling after burns of the face Swallowing of corrosive poisons Direct injury caused by a blow

48. 5/26/2023 BY: MEAZA LEMA 48 B. Mechanical Obstruction Solid foreign objects lodging in the respiratory passage e.g. choking of food Accumulation of fluids in the back of the throat (mucous, blood or saliva) Aspiration (inhalation of any solid or liquid substance) Causes of Respiratory Failure conti.

49. 5/26/2023 BY: MEAZA LEMA 49 C. Air depleted of oxygen or containing toxic gases Asphyxia : Is a condition in which there is a lack of oxygen in the blood T he tissue do not receive an adequate supply of oxygen. It may occur due to decreased oxygen in the air or increased carbon monoxide (CO) or other toxic gases D. Additional causes of Respiratory Failure are:- Drowning – submerging in water Circulatory collapse (shock) Heart disease Poisoning by alcohol, barbiturate, codeine etc Causes of Respiratory Failure conti.

50. Management of Respiratory Accidents 5/26/2023 BY: MEAZA LEMA 50 Artificial Respiration Purpose: To maintain open air way through the mouth and nose . To restore breathing by maintaining an alternating increase and decrease in the expansion of the chest. General Information The average person may die with in 4-6 minutes if his/her oxygen supply is cut off. Recovery is usually rapid except in case of carbon monoxide poisoning, over dosage of drugs or electrical shock. In such cases, it is often necessary to continue artificial respiration for a long time.

51. Recognition of respiratory emergencies 5/26/2023 BY: MEAZA LEMA 51 The underlying problem in most cases of Respiratory Failure is hypoxia and this is recognized by tachypnea tachycardia sweating peripheral vasoconstriction central and peripheral cyanosis restlessness mental confusion b radycardia accompanied by gasping respirations, which warn of the impending cardiac arrest .

52. Recognition of respiratory emergencies 5/26/2023 BY: MEAZA LEMA 52 S/s of hypercapnia peripheral vasodilatation Sweating dilatation of the pupils d rowsiness: A very sleepy state m uscle twitching c oma

53. Features of obstructed airway 5/26/2023 BY: MEAZA LEMA 53 Upper Airway The most common cause of upper airway obstruction is a state of coma. Loss of tone in the muscle of the tongue causes it to fall back into the pharynx. In both causes, n oisy breathing similar to snoring The clinical picture often includes stridor (noisy breathing particularly on inspiration) .

54. Features of obstructed airway conti. 5/26/2023 BY: MEAZA LEMA 54 Lower Airway The commonest cause is asthma which presents a similar picture to upper airway obstruction except respiratory –wheeze rather than inspiratory stridor. Always consider the possibility of an inhaled foreign body in a child with unexplained dyspnea, stridor, wheeze or pneumonia.

55. Artificial respirations 5/26/2023 BY: MEAZA LEMA 55 Modalities: Mouth to mouth Mouth to nose breathing Mouth to mouth and nose Mouth to mask Bag valve mask Mechanical resuscitator

56. Artificial respirations conti. Mouth to mouth and nose Used on infants (usually up to around 1 year old), as this forms the most effective seal Mouth to mask Most organizations recommend the use of some sort of barrier between rescuer and patient to reduce cross infection risk . One popular type is the 'pocket mask '. This may be able to provide higher tidal volumes than a Bag Valve Mask . 5/26/2023 BY: MEAZA LEMA 56 'pocket mask

57. Artificial respirations conti. Ventilation with a Bag- valve- mask Select a mask of the correct size. Position yourself at the patient's vertex . Tilt the patient's head back. Hold the mask securely to the patient's face. Use your other hand to squeeze the bag Squeezing the bag once every 5–6 seconds for an adult or once every 3 seconds for an infant or child. 5/26/2023 BY: MEAZA LEMA 57 Ambu bag

58. Mouth- to- mouth (mouth- to- nose) method or” kiss of life” 5/26/2023 BY: MEAZA LEMA 58 Steps Determine consciousness by tapping the victim on shoulder and asking loudly ''Are you OK''? Open air way using the head tilt- chin lift or Jaw thrust. Place your cheek and ear close to the victim’s mouth and nose to assess for respiration. If absent/insufficient, pinch the victim’s nostrils shut with the thumb and index finger of your hand i.e. pressing on the victim’s forehead, Blow air in to the victim’s mouth- give 2 rescue breaths given/2 seconds ..

59. Maintain the head tilt and again look, listen, feel for exhalation of air & check the pulse for at least 5-7 sec. but not greeter than 10 sec. If no pulse and no breath do CPR If there is pulse & no breath provide at least 1 breath every 5 sec . or 12 / minute for adults. Watch the victim's chest to see when it rises. Stop blowing when the victim's chest is expands and falls by it self. 5/26/2023 BY: MEAZA LEMA 59 Mouth- to- mouth (mouth- to- nose) method or” kiss of life” cont…

60. 6. If the chest doesn’t rise when you blow air Reopen the airway by tilting the head and lifting the jaw Pinch the nose again Make a better seal around the mouth Try blowing again 7. If the chest still doesn’t rise, give first aid for choking 5/26/2023 BY: MEAZA LEMA 60 Mouth- to- mouth (mouth- to- nose) method or” kiss of life” cont…

61. For children & infant Both the mouth & nose should be sealed off by your mouth (mouth -to-mouth and nose resuscitation). Blow into the infant's mouth & nose once every 3 seconds ( once every 4 seconds for a child ) with less pressure & volume. N.B. The amount of air is determined by the size of the victim. The head tilt should not be as extensive as that for adults. 5/26/2023 BY: MEAZA LEMA 61

62. Mouth to mouth respiration 5/26/2023 BY: MEAZA LEMA 62

63. Mouth to nose respiration 5/26/2023 BY: MEAZA LEMA 63

64. Mouth to mouth and nose 5/26/2023 BY: MEAZA LEMA 64

65. Recognition of choking person 5/26/2023 BY: MEAZA LEMA 65 Ask the person “ Are you choking ?” If the person is able to answer you by speaking, it is a partial airway obstruction. Stay with the person and encourage him or her to cough until the obstruction is cleared. Do not give the person anything to drink because fluids may take up space needed for the passage of air. Someone who cannot answer by speaking and can only nod the head has a complete airway obstruction and needs emergency help .

66. First Aid for Choking 5/26/2023 BY: MEAZA LEMA 66 The treatment for a choking person varies with the person's age. Abdominal thrusts (“Heimlich maneuver") Used for adults & children older than one year of age . It may be forceful enough to clear the airway. The quick, upward abdominal thrusts force pushes the diaphragm upward very suddenly, making the chest cavity smaller. This has the effect of rapidly compressing the lungs and forcing air out. The rush of air out will hopefully force out whatever is causing the person to choke.

67. First Aid for Choking conti. 5/26/2023 BY: MEAZA LEMA 67 How to perform abdominal thrusts for conscious Lean the person forward slightly and stand behind him or her. Make a fist with one hand. Put your arms around the person and grasp your fist with your other hand in the midline just below the ribs . Make a quick, hard movement inward and upward in an attempt to assist the person in coughing up the object. This maneuver should be repeated until the person is able to breathe or loses consciousness.

68. 5/26/2023 BY: MEAZA LEMA 68

69. Abdominal trust for conscious 5/26/2023 BY: MEAZA LEMA 69

70. Back slab for conscious 5/26/2023 BY: MEAZA LEMA 70

71. First Aid for Choking conti. 5/26/2023 BY: MEAZA LEMA 71 How to perform abdominal thrusts i f the person loses consciousness A. Gently lay him or her flat on their back on the floor. To clear the airway, kneel next to the person & put the heel of your hand against the middle of the abdomen, just below the ribs. Place your other hand on top and press inward and upward five times with both hands. If the airway clears & the person is still unresponsive, begin CPR

72. 5/26/2023 BY: MEAZA LEMA 72 Back slab for unconscious victim

73. 5/26/2023 BY: MEAZA LEMA 73 Abdominal trust for unconscious

74. Clearing a Blocked Airway in an Infant 5/26/2023 BY: MEAZA LEMA 74 Back blows/slap Used for an infant instead of abdominal thrust. The infant is turned face down, the chest resting on the rescuer's forearm, with the head lower than the body. The rescuer then strikes the infant between the shoulder blades 5 times using the heel of the hand. The strikes should be firm but not hard enough to cause injury. The rescuer then checks the mouth, removing any visible objects.

75. Choked infant cont’d… 5/26/2023 BY: MEAZA LEMA 75 If the airway remains blocked , the rescuer turns the infant face up with the head down,\ and using the second and third fingers, thrusts inward and upward on the infant's breastbone 5 times (chest thrusts). The rescuer then checks the mouth again

76. 5/26/2023 BY: MEAZA LEMA 76 Back slap

77. Chest thrusts for babies 5/26/2023 BY: MEAZA LEMA 77

78. Mechanical suffocation (Strangulation) 5/26/2023 BY: MEAZA LEMA 78 If pressure is exerted on the outside of the neck , the air way is squeezed and the flow of air to the lung is cut off. The main causes of such pressure are: Hanging - suspension of the body by rope around the neck or throat. Strangulation - constriction or squeezing around the neck or throat. Hanging may cause a broken neck ; for this reason, a casualty in this situation must be handled very carefully.

79. Recognition (signs ) A constricting article around the neck Marks around the casualty’s neck Rapid, difficult breathing; impaired consciousness, cyanosis. Congestion of the face, with prominent veins and, possibly, tiny red spots on the face or on the whites of the eyes. Caution Do not move the casualty unnecessarily, in case of spinal injury . Do not destroy or interfere with any material that has been constricting the neck, such as knotted rope; police may need it as evidence. 5/26/2023 BY: MEAZA LEMA 79 Mechanical suffocation (Strangulation ) conti.

80. First aid aim and interventions 5/26/2023 BY: MEAZA LEMA 80 The aims are: To restore adequate breathing. To arrange urgent removal to the hospital Interventions/measurements Quickly remove any constriction from around the casualty’s neck. Support the body while you do so; if it is still hanging. Be aware that the body may be very heavy. Lay the casualty on the ground. Open the airway and check breathing. If he/she is not breathing , be prepared to give rescue breaths and chest compressions if necessary. If he/she is breathing, place her in the recovery position.