Download - Senior First Aid
Level 2 Senior First Aid 1
CONTENTS PRIORITIES OF CARE PATIENT ASSESSMENT
– Vital Signs Survey
– Secondary Survey – Triage (multiple casualties)
SHOCK & FAINTING
– Management of Fainting – Management of Shock
ANAPHYLAXIS
– Management of Anaphylaxis & Auto Injector Use
NEEDLE STICK INJURIES – Management of Needle Stick Injuries
BREATHING EMERGENCIES – ASTHMA & HYPERVENTILATION – Asthma – Hyperventilation
CARDIAC EMERGENCIES – ANGINA & HEART ATTACK – Angina – Heart Attack
TRAUMATIC INJURY
– Bleeding – Management of Minor Wounds
– Nose Bleeds – Management of Major Wounds – Embedded Objects
– Amputations – Crush injury – Internal bleeding
BANDAGING
– Donut – Head Bandage (pirate hat)
– Hand Bandage (glove) – Pressure Immobilisation Technique (P.I.T.)
SLINGS – Collar and Cuff Sling – Elevation Sling (shoulder sling)
– Lower Arm Sling FRACTURES
DISLOCATIONS SOFT TISSUE INJURIES
HEAD, FACIAL AND SPINAL INJURIES – Concussion and fractured skull/Cerebral compression – Eye injuries
– Teeth – Spinal injuries
ILLNESS AFFECTING THE CONSCIOUS STATE
– Diabetes – Hypoglycaemia – Hyperglycaemia
– Stroke – Epilepsy
OVER EXPOSURE TO HEAT AND COLD – Burns – Hypothermia – Heat exhaustion
– Heat stroke POISONING, BITES AND STINGS
– Poisoning – Bites and stings
Level 2 Senior First Aid 2
DEFINITION: Emergency care provided for injury or sudden illness before medical care is
available THE 5 P’s
– Preserve life – Prevent further injury
– Protect the unconscious – Promote recovery
– Procure medical aid (access medical aid)
PRIORITIES OF CARE – Approach to an incident
Primary survey – DRSABCD
Vital signs survey Secondary survey - DOLOR
Vital Signs Survey – monitoring trends in condition at regular intervals HSBC
Heart Rate o Average adult resting 60-90 bpm
o Average child resting 70-110 bpm
o Infants resting up to 150 bpm
Skin colour and skin temperature
Breathing Rate and Depth o Average adult 10-20 breaths per minute
o Average infant 30-50 breaths per minute
Conscious state o Hearing, movement in the eyes
o Able to answer questions, movement from limbs
Secondary Survey (conscious casualty) DOLOR Assessment of Responsive patient
Description Ask the patient to describe the problem
Onset and Duration Ask the patient when the problem arose and how it progressed
Location Ask the patient where on the body the problem is
Other signs and symptoms - Do you notice any other signs? - Is the patient aware of any other symptoms?
Relief Has anything provided relief? Eg: rest, position, medication
Head to Toe Examination
Head o Look and feel for bleeding and bumps
o Check for fluid discharge from ears and nose
o Check the eyes for any signs of injuries
Neck o Look at and feel the back of the neck gently for tenderness & irregularities.
Back/Chest/Abdomen o Ask a responsive victim to inhale deeply and see if it causes discomfort
o Look at & feel the chest, back and abdomen for irregularities & tenderness
Limbs o Look for an injury &/or deformity
o Check from the extremities moving toward the trunk, feeling for irregularities
o Check for altered strength and sensation
*check gloves after each section for bodily fluids may need to change gloves
Signs: things you can see
Symptoms: things the patient can feel
Level 2 Senior First Aid 3
TRIAGE (MULTIPLE CASUALTIES)
Unconscious casualties take priority because they cannot protect their airway or protect themselves from external dangers.
Triage: prioritise casualties in order of urgency of management.
The general priority for managing a casualty: BBFO 1) Check for breathing 2) Control any severe bleeding
3) Shock 4) Treat burns
5) Treat fractures 6) Attend to any other injuries
Useful Acronyms
Patient history SAMPLE
Signs and symptoms
Allergies
Medication
Previous medical history
Last oral intake
Event
Ambulance call 5 P’s
People
Problem
Position
Progress
Phone number
Ambulance handover EPIC
Event
Problem
Interventions
Current condition
Level 2 Senior First Aid 4
SHOCK & FAINTING
Signs & Symptoms – Tingling (poor circulation)
– Light-headedness, dizziness – Nausea – Pale, cold clammy skin
– Brief period of unresponsiveness (1 to 2 minutes) – Rapid, weak pulse & Rapid, shallow breathing
– Altered responsiveness – Thirst
– Weakness – Collapse
Causes of Fainting
– Prolonged periods of standing – Emotional distress
– Low fluids or food
Causes of Shock
– Heart failure – Inadequate blood volume/blood loss
– External or internal bleeding
Management of Fainting and Shock
Primary survey (DRSABCD)
Lay patient down with legs elevated
Treat cause if possible (i.e. bleeding)
Reassurance
Monitor and record vital signs
Provide oxygen, if available and qualified
Maintain body temperature
Seek urgent medical assistance
If the face is pale raise the tail, If the face is red raise the head,
If the face is blue they’re almost through
Level 2 Senior First Aid 5
ANAPHYLAXIS
Management of Anaphylaxis & Auto Injector Use Management:
Call 000 urgently
Primary survey (DRSABCD)
Position of comfort
Assist with medication:
– Confirm correctness with casualty – Prepare the Epipen for use
– Remove from protective case – Remove end cap
– Grip in fist, thumb away from needle – Quickly press into casualty’s upper thigh
– Listen for click – Hold in for 10 seconds
Loosen clothing, remove jewellery
Provide oxygen, if available and qualified
Be prepared for resuscitation
NEEDLE STICK INJURIES
Management of Needle Stick Injuries Management:
Wash the area thoroughly in warm soapy water
Report the incident and record it in a log book
Refer patient to see a doctor for treatment and counselling
Dispose of needles in sharps container
Level 2 Senior First Aid 6
BREATHING EMERGENCIES – ASTHMA & HYPERVENTILATION
Asthma Asthma is an allergic reaction resulting in the narrowing of the smaller airways. This narrowing is
brought about by three mechanisms: Acute narrowing and spasm of small air passages Swelling of the airway lining
Secretion of mucus in the airway
“Preventer” medications, taken daily, act to prevent the swelling and mucus secretion. “Reliever” medications are taken to open the small airways in the event of an asthma attack.
All blue reliever puffers are safe, when used as directed. The student may experience harmless side effects such as shakiness, headache, a tremor or a ‘racing’ heart.
Management if responsive:
If a severe attack call 000 immediately
Reassure patient and assist them into a comfortable position
Administer oxygen therapy
Prepare the inhaler
– Check with casualty for correctness of inhaler – Shake the blue reliever puffer and remove the cap
– Insert the puffer into the spacer, ensuring that the casualty places their mouth over the mouthpiece and gets a good seal
Demonstrate 4 x 4 x 4 technique – Give 4 separate puffs, breathing each puff 4 times
– Wait 4 minutes before repeating if ineffective.
CPR may be required if the casualty becomes unconscious.
In a severe attack, 6-8 puffs may be given to an adult every 5 minutes
Even if medication appears to be effective, medical advice should be sought
Management if unresponsive:
Call 000 urgently
Conduct Primary Survey and act accordingly
Hyperventilation Management:
Conduct primary survey (DRSABCD)
Reassure a conscious patient and help them into a comfortable position
Remove casualty from the environment contributing to over breathing
Encourage them to breath normally
Seek medical aid as appropriate
Mild Cases More Severe Very Severe Cough Pale Exhaustion
Rapid breathing Distressed, anxious Altered responsiveness Wheeze Fighting for breath Cyanosis (blueness)
Rapid pulse Aspiratory / Expiratory wheeze Difficulty / unable to speak
Chest tightness Severe chest tightness No wheeze at all
Level 2 Senior First Aid 7
CARDIAC EMERGENCIES – ANGINA & HEART ATTACK
Recognition: – Chest pain or tightness
– May be gradual or sudden onset – Often described as heavy, dull or crushing – May radiate to neck, jaw, shoulders and arms
– Nausea or vomiting – Shortness of breath
– Pale, cold & sweaty – May appear distressed
Angina – occurs when the blood flow through a narrowed coronary artery is insufficient to meet
the oxygen requirement of the heart.
Management:
Rest and reassure the patient
If this is the first episode the patient has experienced, call 000 immediately
If the patient has their own medication, assist them to take it
Provide supplementary oxygen
Do not leave patient unattended
If no relief from medication and rest, call 000 urgently
Common medications used for the treatment of angina are inserted under the tongue or between the gum and the lip, or sprayed into the mouth.
Heart Attack Management if responsive:
Send for an ambulance urgently
Assist the person into a comfortable position
Rest and reassure
Loosen any tight clothing
If the patient has their own medication, assist them to take it
Provide supplementary oxygen
Do not leave patient unattended
Be prepared for sudden unresponsiveness
Management if unresponsive:
Call 000 urgently
Conduct primary survey (DRSABCD) and act accordingly
Provide supplementary oxygen
Level 2 Senior First Aid 8
TRAUMATIC INJURY Wound Types
Abrasions Scrapes on the surface of the skin with damage to small capillaries
Lacerations Cuts caused by sharp objects that have ragged edges
Incisions Cuts caused by sharp objects that have smooth edges
Avulsions Where a flap of skin/or flesh has been totally or partially removed
Puncture wound Occurs when a sharp, pointy object has penetrated the flesh
Embedded object Wound with an embedded object still in place
Amputation Occurs when a body part has been severed
Management of Minor Wounds
Superficial, small surface area (<2.5cm), bleeding ceases quickly
Wash in clean, running water or saline solution
Dry using sterile gauze
Cover with a clean dressing
Avulsions
Flaps of skin should not be removed unless it is very small
Large flaps of skin or appendages should be returned to normal position before applying the
sterile dressing/bandage Seek medical attention if
o There is any doubt about the severity of the wound o The wound cannot be easily cleaned
o Infection is a concern o Stiches may be required o Tetanus immunization may be necessary
Nose Bleeds Management:
Ask patient to firmly squeeze the fleshy part of the nose, below the bone
Position the patient sitting upright, with their head slightly forward
Ask the patient to breathe through their mouth and avoid swallowing any blood
Seek medical aid if the bleeding exceeds 10mins
It is best not to apply pressure to a suspected broken nose -Apply cold compress to the top of the nose and forehead
Level 2 Senior First Aid 9
Management of Major Wounds PER Pressure / Elevation / Rest
Management:
Conduct Primary survey (DRSABCD) and act accordingly
Apply direct pressure to the wound site
Apply a sterile dressing, followed by a pad and bandage where possible
Elevate injured site if possible
Call ambulance (if required)
Keep patient still and reassure them
Monitor vital signs and treat for shock if required
If bleeding continues through the pad:
Apply another pad and bandage over the original pad and bandage
Remove pad and bandage and re-apply if bleeding continues
Apply pressure near the atery
Embedded Objects Sometimes objects are embedded at the wound site. Where possible, these objects should be left in place. Attempting to remove the object can cause further damage can exacerbate the bleeding.
Management:
Apply pressure around to the wound site
Elevate the affected area
Apply a ring bandage around the object
Dress around the wound without applying pressure to the embedded object
Amputations Management of the stump:
Refer to management of major wounds
Management of the severed part:
Wrap the body part in a clean, sterile, non-adhesive dressing if possible
Place the body part in a sealed plastic bag or container
Place the sealed body part in a container of icy water
Do not allow part to come into direct contact with ice or water
Seek urgent medical assistance
Crush injury Management:
All crushing forces should be removed as soon as possible and an emergency medical team be called immediately
Call 000
Keep the patient comfortable
Do not use a tourniquet
Monitor vital signs
Level 2 Senior First Aid 10
Internal bleeding WHEN TO SUSPECT IT Internal bleeding may be suspected, depending on:
Type of trauma the victim has undergone
Victim’s past medical history (e.g., stomach ulcers) Victim has signs and symptoms of shock
Pain and swelling in the affected area Coughing up blood, ‘dark brown’ blood in vomit or excretion of blood from urinary or
digestive system
Management:
Call 000 urgently
Conduct Primary survey (DRSABCD) and act accordingly
Lay patient down, if possible, and raise legs slightly
Keep still and reassure
Thermoregulation
Provide supplementary oxygen, if available and qualified
Maintain body temperature
Conduct a Secondary Survey (DOLOR)
Give nothing my mouth
Level 2 Senior First Aid 11
BANDAGING
Donut Bandage
Head bandage (pirate hat)
•place bandage over head •tying off at the back
•tucking in loose bit over the tie off •criss-cross over loose bit and bring ends over to front
•criss-cross over to back and tie off ends at the back
Level 2 Senior First Aid 12
Hand bandage (glove)
•fold over the end of the bandage and place over knee •place fist on top of the bandage •bring loose apex end over the fist
•criss-cross the two sides over the fist, bringing the loose end over the fist •tie off the criss-cross again
Pressure Immobilisation Technique (P.I.T.)
•commencing at the bite site work your way down to the fingers •leave fingernails exposed
•work back up the arm covering two-thirds of the bandage at each turn of the bandage •continue bandaging all the way up to the nearest lymph node.
Splint the limb
Check for circulation beyond the bandage
Make the casualty comfortable, instructing them not to move
Note: it is a good idea to mark the bite site on the bandage with a cross to assist medical personnel to locate where the bite is.
Level 2 Senior First Aid 13
SLINGS
Collar and Cuff Sling
Elevation Sling (shoulder sling)
•place bandage with apex pointing to elbow •over the arm •tuck in under the arm
•twist both ends then tie off the two ends on the uninjured side
Level 2 Senior First Aid 14
Lower Arm Sling
•place bandage with apex to elbow over patient’s chest •bring opposite end over patient’s arm
•tie off on injured side •twist remaining bandage at elbow and tuck in.
Level 2 Senior First Aid 15
FRACTURES
Management:
Conduct a Primary Survey and act accordingly
The main aim is to prevent any movement at the site of the fracture o If unsure, keep the patient still and comfortable and call the ambulance
Immobilise the joint above or below the fracture site
Splint in a position of comfort for the patient
Check for a pulse beyond the fracture. o If not, call for urgent medical aid. Refer the patient to the nearest medical care.
Do not attempt to realign a badly deformed limb
Where possible, an immobilized fractured limb should be elevated
Treat for shock
Support a fractured jaw with hands
DISLOCATIONS Management:
Conduct a Primary Survey and act accordingly
Immobilise the dislocated joint in the position found
Patient needs to be comforted and reassured
Check for a pulse below the dislocation
o if not present move the limb while monitoring any return of the pulse
Ambulance transport should be arranged if required
If possible apply ice *Be aware that there is a strong possibility that a fracture could also have occurred.
Level 2 Senior First Aid 16
SOFT TISSUE INJURIES
Sprains: Occur at the joint
Usually occurs as a result of stretching and possibly tearing of the ligaments or other tissues at the joint
Swelling at the site quickly follows the injury to the joint
This acts as a protective mechanism to stop further movement at the site
Strains: Usually associated with muscles & tendons which attach the muscle to the bone.
Can be caused by overuse or putting excessive load on a muscle or muscle group. It can also occur if muscles are not warmed up properly prior to strenuous use.
Varied severity
Mild discomfort with minor muscle damage
Complete tearing of the muscle resulting in loss of use
Management: RICER + NOHARM
REST
ICE o Apply 10-20 minutes every 1-2 hours
COMPRESSION
ELEVATION
REFERRAL
Advise the casualty to avoid the following for the first 48-72 hours following injury. No:
Heat Alcohol Running
Massage
Level 2 Senior First Aid 17
HEAD, FACIAL AND SPINAL INJURIES
Concussion and fractured skull/Cerebral compression Management: Consider the possibility of a spinal injury
Keep patient still and reassure them
Continually monitor vital signs
Seek medical advice
Eye injuries Management:
Keep patient still and comfortable
Place a sterile pad over the affected eye
Avoid putting any pressure on the affected eye
Encourage the patient not to blink or move either eye
Seek medical advice
Embedded Object
– Do not remove the object
– Try to place a protective cover around and over the injured eye (eg: polystyrene cup), but avoid putting any pressure on eye or object
– Seek urgent medical aid Small Foreign Body
– Encourage patient to blink several times – Flush the affected eye with clean water or saline
– Seek medical aid if problem persists Chemical Injury
– Rinse the affected eye for at least 15 minutes with copious fresh, clean, flowing water
– Seek urgent medical aid
Teeth Management:
Gently clean dirt from tooth using milk, saline, water, or patient’s saliva
Place tooth back in the open socket, if possible
o Otherwise store in milk, saline, patient’s saliva, or water (in that order)
Keep tongue away from hole where tooth was
Refer patient to dentist
Spinal injuries Management:
Conduct Primary Survey, Vital signs and Secondary Surveys accordingly
Call 000 urgently
Keep the patient still and reassure them
Maintain normal body temperature
Minimise any movement of the head and spinal column
Manage any other injuries
Provide oxygen
Continually monitor vital signs
Level 2 Senior First Aid 18
ILLNESS AFFECTING THE CONSCIOUS STATE
Diabetes Type 1 diabetes: insulin dependant Type 2 diabetes: usually regulated by diet, exercise and lifestyle.
Hypoglycaemia (low blood sugar levels)
Management:
Give sweet drinks, sweets or sugar
Do not give diabetic drinks
Seek medical assistance
Hyperglycaemia (high blood sugar levels)
Management:
Seek medical advice
If unresponsive:
Conduct Primary Survey
Call 000 urgently
Provide oxygen
Stroke FAST
Management:
Call 000 urgently
Reassure patient
Help patient into comfortable position
Loosen any tight clothing
Provide oxygen
Epilepsy Management:
Protect patient from external dangers
Do not restrain
Do not place objects in patient’s mouth
When fitting stops, conduct a Primary Survey and act accordingly
If appropriate, conduct Secondary Survey to check for injuries caused by seizure
Call an ambulance if:
– Seizure last for more than 5 minutes – Patient does no become responsive between seizures – There is no history of seizures
– Pregnancy or other medical conditions are involved – The patient is an infant
– There are significant injuries caused by the seizure – The seizure occurs in water
– Recovery appears to be slow
Level 2 Senior First Aid 19
OVER EXPOSURE TO HEAT AND COLD
Burns Ambulance is recommended for:
– A flame burn the size of the casualty’s palm – Any flame or scald burn involving the hands, face, perineum or genitals
– Any chemical burns – Any electrical burns
– Any burns with suspected respiratory tract involvement – Any infant or child with any type of burn
Types of burns:
Superficial Burn o Only the top layer of skin is involved (eg: sunburn)
Partial Thickness Burn o The top layer and part of the next layer have been burnt
Full Thickness Burn o Both outer layers have been damaged, and possibly the subcutaneous tissue being affected
o This can result in damage to fat, muscles, blood vessels and nerve endings
o Tends to have little pain
Management:
Conduct primary survey and act accordingly
Immediately cool the affected area with running/flowing water for 20 minutes
Remove all jewellery
Elevate burn limbs (where feasible)
Cover burn area with a clean, sterile, lint-free dressing burns dressing or wet cloth
Provide oxygen
Continue to cool burned area after covering/dressing
Do not
Peel off adherent clothing
Burst blisters
Apply ointments or lotions
Use ice or ice water
Apply pressure
Superficial Partial Full
Redness Pain
Severe pain Redness
Weeping from the burn Blistering
Painless Cracked and dry appearance
White or charred appearance
Level 2 Senior First Aid 20
Hypothermia Management:
Mild
Conduct primary survey and act accordingly
Change into dry clothes if possible
Protect from elements
Warm, sweet drinks (no alcohol or caffeine)
Seek medical advice
Moderate to Severe If responsive:
Call 000 urgently
Handle patient gently
Lay patient down flat
Insulate from cold environment
Wrap with blankets, clothing
Monitor patient’s vital signs
Provide warm, sweet drinks if patient is responsive, stable and can swallow
Do not rub or massage
Do not expose to excessive heat (eg: fire, heater, hot shower)
If unresponsive:
Call 000 urgently
Handle patient gently
Lay patient down flat
Conduct Primary Survey
Commence CPR if indicated and continue until relieved by medical aid
Insulate from cold environment
Provide oxygen
Heat exhaustion Management:
Conduct primary survey and act accordingly
Lay patient down and protect from the warm environment
Provide sips of cool fluids
Cool patient’s body
Seek medical advice
Heat stroke Management:
Call 000 urgently
Lay patient down
Conduct primary survey and act accordingly
Cool patient’s body rapidly o Wetting the person with cold water and fanning them will increase evaporation heat loss
o Ice/cold packs can be placed under the armpits, in the groin and around the neck
Monitor vital signs
Provide sips of cool fluids if conscious and can swallow
Provide oxygen
Level 2 Senior First Aid 21
POISONING, BITES AND STINGS
Poisoning
Ingested Poisons Management if responsive:
Conduct Primary Survey and act accordingly
Comfort and reassure the patient
Continuously monitor vital signs
Try to identify type and quantity of poison taken
Call Poisons Information Centre on 13 11 26
Seek medical assistance
Do not induce vomiting unless instructed by P.I.C. Management if unresponsive:
Call 000 urgently
Conduct Primary Survey
Continuously monitor vital signs
Provide supplementary oxygen
Try to identify type and quantity of poison taken, and when it was taken
Absorbed Poisons
Consider potential dangers when conducting Primary Survey
Ensure that you are not also affected
Call 000 urgently
Irrigate the affected area with large amounts of water
Inhaled Poisons Consider potential dangers to ensure you are not also affected
o Don’t attempt a rescue if the patient is in a confined space
Call 000 urgently
Patient should be removed from contaminated areas prior to conducting Primary Survey
Provide oxygen
Level 2 Senior First Aid 22
Bites and Stings There are 3 ways to treat envenomation;
Heat [spines and spikes]
Ice [stings] Pressure and Immobilisation [bites]
o Pressure delays the reaction of venoms or renders it inactive o Tourniquet is not used in first aid anymore because of risk of losing a limb
Do not wash bite site helps identify type of venom and appropriate anti-venom.
Types of venom: Cardio-toxins (affect the heart)
Myo-toxins (affect the muscles) Neuro-toxins (affect the brain)
Management:
Conduct Primary Survey and act accordingly
Pressure
Immobilisation
Heat Cold (Ice) Vinegar
Poisonous Snake
Red Back Spider
Funnel Web Spider
Bee
Wasp
Bull ant
Scorpion
Centipede
Non-tropical Jellyfish —
Bluebottle
Box Jellyfish (Irukandji)
Blue Ring Octopus
Cone Shell
Bullrout/Stone Fish
Stingray
Pressure and Immobilisation Technique PIT
– Blue ringed octopus
– Snakes
– Funnel web spiders
– Cone shells
– Allergic reaction
Immense in Hot Water
– Stonefish
– Stingray barb
– Other spiny fish
– Blue bottle
– Box jelly fish
Apply Ice
– Bee
– Wasp
– Red back spider / white tail
– Bull ant
– Centipede
– Scorpions
– Non tropical jelly fish (if hot water is not avaibale)