First Aid

First AidLearning Objectives:After the lecture the members of the group will be able to:Discuss some medical and non-medical conditions that needs first aidDefine first aid, different first aid procedures and explains its importance to the nursing professionDemonstrate good skills of a first aiderDiscuss the importance of first aid and basic life supportProperly perform first aid procedures such as cardiopulmonary resuscitation and artificial respiration for infant, child and adult and the like

Different First Aid ProceduresTrauma Management and Casualty HandlingBasic ExtricationWound ManagementAnimal Bites, Snake Bites, Insect Bites, etc.Basic Life Support/ Cardiopulmonary ResuscitationRescue BreathingForeign Body Airway Obstruction Management

Basic Life Support (BLS)Is the foundation for saving lives following cardiac arrest.Fundamental aspects of which are:Immediate recognition of sudden cardiac arrest and activation of emergency response systemEarly cardiopulmonary resuscitationRapid defibrillationInitial recognition and response to heart attack and stroke are also considered to be part of BLS

Sudden Cardiac Arrest (SCA)Despite important advances in prevention, SCA continues to be a leading cause of death in many parts of the world.A single approach to resuscitation is not practical, but a core set of actions provides a universal strategy for achieving successful resuscitation.

Key Principles in Resuscitation: Strengthening the links in the Chain of SurvivalThese set of actions are terms the Links in the Chain of Survival

6The links includes (RACDAP):Immediate RECOGNITION of cardiac arrest and ACTIVATION of the emergency response systemEarly CPR with an emphasis on chest compressionRapid DEFIBRILLATIONEffective ADVANCED LIFE SUPPORTIntegrated POST-CARDIAC ARREST CAREWhen links are implemented:Survival rates can approach 50% following witnessed out-of-hospital ventricular fibrillation (VF)

For laypersons, recognition of cardiac arrest is not always straightforwardAny confusion on the part of the rescuer can result in a delay or failure to activate the emergency response system or to start CPR.Precious time is lost if bystanders are too confused to act.

Therefore, CPR guidelines focus on recognition of cardiac arrest with appropriate set of rescuer actions We will only discuss the first 3 links:

Activating the Emergency Response SystemEmergency medical dispatch is an integral component of the EMS.Bystanders should immediately call their local emergency to initiate a response anytime they find an unresponsive victim.

Cardiopulmonary Resuscitation (CPR)Is a series of life-saving actions that improve the chance of survival following cardiac arrest.Although CPR may vary, depending on the rescuer, the victim, and the available resources, the fundamental challenge remains:

How to achieve early recognition of arrest and prompt action by the rescuer.

DefibrillationAn AED is a device which correctly assesses heart rhythm, enabling a rescuer who is not trained in heart rhythm interpretation to accurately provide a potentially lifesaving shock to a victim of SCA.Rapid defibrillation is a powerful predictor of successful resuscitation following VF SCA.

When will you do CPR?AS SOON AS POSSIBLE!

Brain cells begin to die after 4-6 minutes without oxygen.CPR must be started as soon as possible after the heart stops beating or if breathing either stops or is ineffective. Any delay in starting CPR reduces the chances of survival. In addition, the brain cells begin to die after 4-6 minutes without oxygen.

15Who may learn about CPR?CPR is an easy and life saving procedure and can be learned by anyone.

One does not need to be a doctor to learn how to do CPR.THE TECHNIQUE AND STEPS IN CPRIF YOU WITNESS A CARDIAC ARRESTHow to Perform Adult CPR

CHECK AREA SAFETY.Survey the scene.See if the scene is safe to do CPR.Get an idea of what happened.CHECK UNRESPONSIVENESS.

Tap or gently shake the victimRescuer shouts Are you OK?Quick check for normal breathingIf the victim is unconscious, rescuer calls for help.CALL FOR HELP:Ambulance, Emergency Services, DoctorRescuer ACTIVATES the EMERGENCY MEDICAL SERVICES.Get AED/Defibrillator!123You find a person lying on the ground, not moving. You should survey the scene to see if it is safe and to get some idea of what happened. Thenbegin doing a primary survey by checking for unresponsiveness.

20NON-RESPONSIVE,NO NORMAL BREATHINGGet a Defibrillator!A E D !PULSE CHECKPalpate for Carotid Pulse within 10 seconds(at the same time CHECK FOR BREATHING)For trained healthcare providers only

Do Mouth to MouthBreathingGive one breath every 5-6 secs (about 12 breaths/min)Recheck pulse every 2 minutes

If with definite pulse but no breathing MOUTH TO MOUTH BREATHING and PULSE CHECKDeemphasized in the new guidelinesFor trained healthcare providers onlyAs short and quick as possiblePulse check not more than 10 secondsIf unsure, proceed directly to CHEST COMPRESSIONS!C A B C. COMPRESSION Do chest compressions firstAIRWAYDoes the victim have an open airway (air passage that allows the victim to breathe)?B. BREATHING Is the victim breathing?After determining unconsciousness, After determining unconsciousness and calling for help, proceed immediately to doCHEST COMPRESSIONS!C COMPRESSION (to assist CIRCULATION)Chest Compressions

Hand LocationKneel facing victims chestPlace the heel of your hand on the center of the victim's chest. Put your other hand on top of the first with your fingers interlaced.

place the heel of the hand on the sternum in the center (middle) of the chest between the nipples and then place the heel of the second hand on top of the first so that the hands are overlapped and parallel. Depress the sternum approximately 1 12 to 2 inches (approximately 4 to 5 cm) and then allow the chest to return to its normal position27

Place the heel of one hand on the sternum in the center of the chest between the nipples and then place the heel of the second hand on top of the first so that the hands are overlapped and parallel. Chest Compressions

Position shoulders over hands with elbows locked and arms straight

Give Chest Compressions at 100 per minuteCompress breastbone at least 2 inches deepCompress at a rate of 100 per minute or moreCompress 30 times initiallyAllow the chest to return to its normal positionCompress down and release pressure smoothly, keeping hand contact with chest at all times

Position shoulders over hands with elbows locked and arms straight

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Give 30 Compressions Compress breastbone at least 2 inches

(30 compressions should take 15-18 sec)

Count aloud 1, 2, 3, 4, 5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29, and ONE!

Minimize interruptions

Allow recoil after each compressionCompress breastbone 1 1/2 to 2 in. (30 compressions should take 15-20 sec) Count aloud 1, 2, 3, 4, 5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29, ONE (Push down as you say the number and come up as you await chest recoil)

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A - AIRWAYOpen the Airway: Use the head tilt/chin lift methodPlace one hand on the victims forehead

Place fingers of other hand under the bony part of lower jaw near chin

Tilt head and lift jaw--avoid closing victims mouth Open the Airway: Use the head tilt/chin lift method

Place one hand on the victims foreheadPlace fingers of other hand under the bony part of lower jaw near chinTilt head and lift jaw--avoid closing victims mouth

31Head Tilt Chin Lift Maneuver

This maneuver prevents airway obstruction by the epiglottis.B - BREATHINGGive 2 one-second breathsMaintain airwayPinch nose shutOpen your mouth wide, take a normal breath, and make a tight seal around outside of victims mouthGive 2 full breaths (1 sec/ breath)Observe chest rise & fall; listen & feel for escaping air

Maintain airwayPinch nose shutOpen your mouth wide, take a deep breath, and make a tight seal around outside of victims mouthGive 2 slow breaths (1 1/2-2 sec/min)Observe chest rise & fall; listen & feel for escaping air

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Repeat cycles of 30 compressions & 2 breathsRepeat the cycle of 30 compressions to 2 breaths for 5 cycles34PULSE CHECKRECHECK PULSE EVERY 2 MINUTES (equivalent to 5 cycles CPR)Very brief pulse check should take less than 10 seconds (at the same time check for normal breathing)In case there is any doubt about the presence or absence of pulse, CONTINUE CHEST COMPRESSIONSFor trained healthcare providers only

UNTILHELP ARRIVES. (Emergency Services, Ambulance, Doctor, AED)

PERSON IS REVIVED.CONTINUE CPRIf the victim is breathingThe unresponsive victim with spontaneous respirations should be placed in the recovery position if no cervical trauma is suspected.Placement in this position consists of rolling the victim onto his or her side to help protect the airway.Maintain open airway & position the victim

THE RECOVERY POSITIONMEMORIZE THE STEPS!Survey the scene.Check responsiveness hey hey are you ok?Call for help! Activate EMS[Quick check pulse within 10 secs]C Chest Compressions: 30 x; 100/min; 2 inches deep; push hard and fastA - Airway: head tilt chin liftB Breathing: 2 breaths (1 second/breath)Chest compressions 30 xContinue cycles 30:2 compression-ventilation[Quick check pulse every 2 mins]Until:EMS arrives (AED, doctor, ambulance)Patient has signs of lifeHow to Do CPR on a ChildStay SafeAlways make sure that the area is safe for you and the victim.Children may be infected with contagious diseases. If you are concerned about possible exposure to contagious disease, practice universal precautions and wear personal protective equipment, if available.

How to Do CPR on a ChildTry to Wake the ChildGently tap or shake the child's shoulders and call out his or her name in a loud voice. Don't hurt the child, but be aggressive -- you're trying to wake her up. If the child does not wake up, have someone call 117 immediately. If no one else is available to call 117 and the child is not breathing, continue to step 3 and do CPR for about 2 minutes before calling 117.

How to Do CPR on a ChildBegin chest compressionsIf the child is not breathing, put one hand on the breastbone directly between the child's nipples. Push straight down about 2 inches or about a third of the thickness of the child's chest -- and then let the chest all the way back up. Do that 30 times, about twice per second. If you've been trained in CPR and you remember how to give rescue breaths, go to step 4. If not, just keep doing chest compressions and go to step 5.

How to Do CPR on a Child* If you've been trained in CPR and you remember how to give rescue breaths, go to step 4. If not, just keep doing chest compressions and go to step 5.

How to Do CPR on a ChildGive the child two breathsAfter pushing on the chest 30 times, cover the child's mouth with your mouth and pinch his nose closed with your fingers. Gently blow until you see his chest rise. Let the air escape the chest will go back down -- and give one more breath. If no air goes in when you try to blow, adjust the child's head and try again. If that doesn't work, then skip it and go back to chest compressions (step 3), you can try rescue breaths again after 30 more compressions.

How to Do CPR on a ChildKeep doing CPR and call 117 after 2 minutesIf you are by yourself, keep doing CPR for 2 minutes (about 5 groups of compressions) before calling 117. If someone else is there or comes along as you are doing CPR, have that person call 117. Even if the child wakes up, you need to call 117 any time you had to do CPR. Once 117 has been called or you have someone else calling, keep doing CPR. Don't stop until help arrives or the child wakes up.How to Do CPR on an InfantUse these steps to provide CPR to infants approximately less than 1 year of age

How to Do CPR on an InfantStay SafeChildren may be infected with contagious diseases. If you are concerned about possible exposure to contagious disease, practice universal precautions and wear personal protective equipment, if available.

How to Do CPR on an InfantTry to wake the infantReally little babies respond well having the soles of their feet rubbed or tapped. For infants more than 2 months old, tap their shoulder or chest. In either case, call out his name in a loud voice. Don't hurt the baby but be aggressive; you're trying to wake him or her up. If the infant does not wake up, have someone call 117 immediately. If no one else is available to call 117 and the baby is not breathing, continue to step 3 and do CPR for about 2 minutes before calling 117.How to Do CPR on an InfantBegin chest compressionsIf the baby is not breathing, put two fingers on the breastbone directly between the baby's nipples. Push straight down about an inch and a half or about a third of the thickness of the baby's chest and then let the chest all the way back up. Do that 30 times, about twice per second.

How to Do CPR on an Infant* If you've been trained in CPR and you remember how to give rescue breaths, go to step 4. If not, just keep doing chest compressions and go to step 5.

How to Do CPR on an InfantGive the baby two breathsAfter pushing on the chest 30 times, cover the baby's entire mouth and nose with your mouth and gently blow until you see his or her chest rise. Let the air escape the chest will go back down and give one more breath.

How to Do CPR on an InfantIf no air goes in when you try to blow, adjust the baby's head and try again. If that doesn't work, then skip it and go back to chest compressions (step 3), you can try rescue breaths again after 30 more compressions.

How to Do CPR on an InfantKeep doing CPR and call 117 after 2 minutesIf you are by yourself, keep doing CPR for 2 minutes (about 5 groups of compressions) before calling 117. If someone else is there or comes along as you are doing CPR, have that person call 117. Even if the baby wakes up, you need to call 117 any time you had to do CPR. Once 117 has been called or you have someone else calling, keep doing CPR. Don't stop until help arrives or the baby wakes up.

Foreign Body Airway ObstructionPrinciples of when to act on a Mild Airway Obstruction: As long as good air exchange continues, encourage the patient to continue spontaneous coughing and breathing efforts. Do not interfere with the patients own attempts to expel the foreign body, but stay with the patient and monitor his or her condition. If this persists, then activate the emergency response system. Signs of Severe Airway Obstruction:Poor or no air exchange Weak, ineffective cough or no cough High pitched noise while inhaling or no noise at all Increased respiratory difficulty Possible cyanosis (turning blue) Unable to speak Clutching the neck with the thumb and fingers (universal choking sign) Universal Choking Sign

Rescuer actions:Ask the patient if he or she is choking. If the patient nods yes and cannot talk, severe airway obstruction is present and you must activate the emergency response system!

Heimlich Maneuver Stand or kneel behind the patient and wrap your arms around the patients waist. Make a fist with one hand. Place the thumb side of your fist against the patients abdomen, in the midline, slightly above the navel and well below the breastbone. Grasp your fist with your other hand and press your fist into the patients abdomen with a quick upward thrust. Repeat the upward thrusts until 1) the object is expelled or 2) the patient becomes unresponsive.Give each thrust with a little different movement to expel the object. Heimlich Maneuver

Heimlich ManeuverIf the patient becomes unresponsive, lay the patient on a firm surface and begin the steps of CPR for an adult or child. The only extra step is to look for a foreign object when opening the airway and remove it if found. DO NOT DO BLIND FINGER SWEEPS ON ANYONE OF ANY AGE. For infants when responsive, provide 5 back slaps and then 5 chest compressions using the 2 finger method. When unresponsive, treat like infant CPR with 1 extra step. Look for a foreign object in the mouth when opening the airway and giving breaths. Heimlich Maneuver

Special Notes:If a patient is pregnant or too large to wrap your arms around the stomach, one would apply chest compressions to relieve the obstruction. This can be done behind the patient or have the patient stand against the wall or lie down and perform chest compressions as if doing CPR.

END OF MY DISCUSSIONThank you for listening again!- MEFLORES