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


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


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


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


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


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


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


Do not leave patient unattended

Be prepared for sudden unresponsiveness

Management if unresponsive:

Call 000 urgently

Conduct primary survey (DRSABCD) and act accordingly



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


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


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


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


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.


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


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.


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.


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


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


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


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


Hypothermia Management:

Mild


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


Commence CPR if indicated and continue until relieved by medical aid

Insulate from cold environment

Provide oxygen

Heat exhaustion Management:


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


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


POISONING, BITES AND STINGS

Poisoning

Ingested Poisons Management if responsive:


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


Continuously monitor vital signs


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


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:


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)

senior first aid

Health & Medicine

signs of injuries neck

available signs

patient aware

medical care

check gloves

spinal injuries concussion

deformity check

bpm average child