INTRODUCTION TO EMERGENCY NURSING Respiratory Emergencies and Artificial Respiration: Definitions Respiratory Emergency: Is one in which normal breathing stops or in which breathing is so reduced that oxygen in taken is insufficient to support life. Artificial Respiration Is a procedure for making air to flow in to and out of a lung when his natural breathing is inadequate or ceases. • Causes of Respiratory Failure Anatomic Obstruction ♦ Obstruction by tongue (most common cause) ♦ Other causes that constrict the air passages are:
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♦ ♦ ♦
Asthma, croup Diphtheria Laryngeal spasm Swelling after burns of the face Direct injury caused by blow
B. Mechanical Obstruction Solid foreign objects Accumulation of fluid in the back of the throat Aspiration (inhalation of vomits)
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C. Air depleted of Oxygen or containing toxic gases. ♦ Asphyxia may occur due to decreased oxygen or increased Co or other toxic gases (mining area) ♦ Explosion hazard Combustible gases that accumulate in confined spaces. Additional causes of Respiratory Failure are: ♦ ♦ ♦ ♦ ♦ ♦ ♦ Drowning Circulatory collapse Heart disease Strangulation Compression of the chest Poisoning by alcohol Electrical shock
The Breathing process -Contraction of chest muscles and diaphragm causes enlargement of the chest cavity. Inhalation phase -The muscles of the chest lift the ribs, expanding the chest. -The diaphragm contracts and descends to ward the abdomen. ↑Chest cavity
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Exhalation Phase -The muscle relaxes, allowing the ribs & diaphragm to resume their former positions. -The chest cavity becomes smaller and air flows out wards -Rate of Breathing • • Adult - 12 - 18/ minutes In new born is about 20 times/ minutes
For artificial respiration to be effective, the volume of the air that enters must exceed the amount that is already in the air passage and that is needed for normal respiration. Artificial Respiration and Mgt of Respiratory Accidents Objective:
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To maintain an open air way To restore breathing
General Information -The average person may die in 6 minutes or less if his oxygen supply is cut off. -Recovery is usually rapid except in case of Co, poisoning over dosage of drugs or electrical shock. -When a victim revives, he should be treated for shock. -Artificial respiration (Breathing for the patient.) should always be continued until • The victim begins to breathe for him self • Is pronounced dead by a doctor or
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• He is dead beyond any doubt. MANAGING CARDIOPULMONARY EMERGENCIES General objective: At the end of the instruction the trainee will be able to manage cardiopulmonary emergencies. Managing a patient with air way obstruction Specific objective: At the end of the instruction the trainee will be able to manage an airway obstruction using the appropriate technique and the standard nursing procedure. Airway Obstruction The airway connects the body to the life giving oxygen in the atmosphere. Causes Tongue Foreign body Allergic laryngeal edema Trauma to the airway. Obstruction by the tongue The tongue is the most common source of upper airway obstruction. The tongue dropping back & obstruction the throat. - A patient with partial obstruction from the tongue will have snoring respirations & a patient with complete obstruction will have no respirations at all. Management
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It can be corrected using one of several maneuvers that elevate the base of the tongue away from the back of the throat.
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Head tilt- chin lift maneuver -use one hand to press backward on the victim's forehead (head tilt); at the same time, place the fingers of your other hand under the bony part of the victim's chin & pull the chin forward (chin lift).
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Head tilt- neck lift maneuver- place one hand on the victim's forehead & press backward, at the same time, slip your other hand beneath the victim's neck & lift gently upward
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Triple airway maneuver- place fingers behind the angles of the patient's jaw and Forcefully displace the mandible forward. Tilt the head backward Retract the patient's lower lip with the thumbs.
Obstruction by a Foreign Body (Choking) Choking:A small piece of food or a bone (foreign body) may be inhaled in to the windpipe when eating. Most people on such occasions are able to cough it up at once. Sometimes however, help is needed. • • Don't try hooking the foreign n body out with your fingers.
Signs of choking Victim cannot speak or make any sound. Universal distress signal for choking- victim clutches his neck between his thumb and index finger. Dusky or cyanotic skin. Exaggerated but ineffective breathing movements. Collaps
Management A. For babies 5
Hold the baby up side down by the feet and smack him sharply between his shoulder blades. B. For children Lie the child face down over your knee or arm and smock sharply between shoulder blades. c.For Adults 1. Stand behind the patient & grasp them around the chest just under the sternum and • Give a short sharp bear hug or.
2. Tell the patient to lean over the back of the chair holding on the seat and then bang him sharply 3 or 4 times between his shoulder blades ♦ Whichever method you use the foreign body should be coughed out. - If the victim is conscious Partial obstruction- encourage to cough Complete obstruction- apply manual thrusts: - Four quick back blows between the shoulder blades.- Four quick upward thrusts.
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Repeat the sequence as needed.
- If the victim is unconscious: if you are not getting air exchange, reposition the head & attempt to ventilate, if you still do not get an air exchange, immediately turn the victim on his side toward you, resting his chest against your knees, & administer four sharp blows,
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Place the victim on his /her back & apply up to 4 manual thrusts followed by a finger sweep, reposition the victim's head, & again attempt to ventilate. Repeat the sequence as needed.
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- When the maneuvers have failed & equipment for direct laryngoscopy is not available, Cricothyrotomy (making an opening in to the cricothyroid membrane) may be required as a last resort. Abdominal thrust maneuver (Heimlich Maneuver) For conscious victim 1. Stand behind the person who is choking. 2. Place both arms around the person's waist. 3. Make a fist with one hand with the thumb outside the fist. 4. Place thumb side of first against the person's abdomen above the navel & below the ribs. 5. Grasp fist with other hand. 6. Quickly & forcefully exert pressure against the person's diaphragm, pressing up ward with quick, firm thrusts. 7. Apply thrusts, 6- 10 times until the obstruction is cleared. 8. Pressure will compress the lungs & expel the aspirated object. For unconscious victim
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Place the victim on his back. Place one of your hands on top of the other, with the heel of the bottom hand in the middle of the victim's abdomen, slightly above the navel & below the ribcage.
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Press upward toward the diaphragm with four quick thrusts.
For infants & children
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Place the victim face up on your forearm, with his head down.
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Place two or three finger tips (for infants) or the heel of one hand (for a child) on the middle of the victim's sternum, between the nipples, and press into the victim's chest with four quick inward thrusts.
Treatment sequence for the conscious choking victim. Can the victim speak or breath
No
yes
Manual thrusts
Encourage him to cough
No
Effective
Yes
Stop
Treatment sequence for the choking victim who becomes unconscious
Place the victim supine
OPen the airway 8
Finger sweep
Attempt to ventilate
No Successful?
yes
Manual thrusts
Continue artificial ventilation until the patient is breathing spontaneously
finger sweep
Treatment sequence for the person who is found unconscious & the cause is unknown. Establish unresponsiveness
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Open the airway
No Attempt to ventilate
Breathing?
Yes
Maintain an open airway No Successful? Yes
Reposition head & try again to ventilate
Continue artificial ventilation
Successful?
No
Yes
Manual thrusts
Finger sweep Obstruction from swelling The swelling could be due to swelling of the upper airways component tissues. Causes Edema due to croup
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Epiglottitis Burns to the airway Allergic reactions Management
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Establish an airway Administer oxygen Treatment of the cause Cricothyrotomy Obstruction Secondary to Trauma to the face and neck
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Facial trauma can cause airway obstruction from - Collapse of the mandible - Hemorrhage -Tongue injury - Aspiration of tissue, teeth, or dentures - Associated coma.
-Management will depend on the site of the trauma & the extent of related injuries. In general, Turn the patient to the side- blood will drain out of the patient's mouth. Suction the mouth to remove blood & small particles from the upper airway. Nasopharyngeal airway- if the trauma involves the mandible.
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. Trauma to the neck can result in laryngeal fracture or contusion & may require urgent cricothyrotomy.
Artificial respiration
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It is a procedure for causing air to flow into and out of a person's lungs when his natural breathing is inadequate or ceases.
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It should always be continued until: - The victim begins to breath for himself. - The victim is pronounced dead by a doctor. - The victim is dead beyond any doubt. Mouth to Mouth (Mouth to Nose) Method Steps in mouth to mouth (mouth to mouth and Nose) Respiration • Determine consciousness • Tilt the victim's head back so that his chin is pointing up ward. • Place your cheek and ear close to the victim's mouth & nose. Look at the victim's chest to see if it rises and falls: listen and feel air to be exhaled for about 5 seconds. ♦ If there is no breathing, pinch the victim's nostril shut with the thumb and index finger of your hand. ♦ Open your mouth wide ♦ Take a deep breath ♦ Seal your mouth tightly around the victim's mouth and with your mouth forming a wide open circle and below in to the victim's mouth ♦ Initially give four quick full breaths with out allowing the lungs to fully deflate between each breath.
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♦ Maintain the head tilt and again look, listen, feel for exhalation of air & check the pulse for at least 5 to 7 seconds but not greeter than 7 seconds. ♦ If no pulse and breath do CPR ♦ If there is pulse & no breath provide at least 1 breath every 5 seconds or 12 per minute for adults. ♦ Watch the victim's chest to see when it rises. ♦ Stop blowing when the victim's chest is expanded and check for exhalation ♦ Watch chest to see that it falls. ♦ Repeat the blowing cycle For children & infants: Both the mouth & nose should be sealed off by your mouth (mouth -to-mouth and nose resuscitation). Blow into the infant's (child) 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.
-For the mouth to nose method maintain the back ward head tilt position with the hand on the victim's mouth. -Mouth to mouth and nose resuscitation are administered for infants and children as described above. Both the mouth and nose of the infant or child should be sealed off by your mouth. -Blow into the infant's mouth and nose once every 3 second (20 times per minute) with less pressure and volume.
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-Initially, give four quick, full breaths without allowing the lungs to fully deflate (empty) between each breath. -Maintain the head tilt and again look, listen, & feel for exhalation of air & check the pulse for 5-10 seconds. If there is no pulse & no breathing, begin CPR. -If there is a pulse & no breathing, provide at least one breath every 5 second for adults. -If the airway is clear, only moderate resistance to blowing will be felt. Mouth - to- Stoma The same general procedure as for mouth -to -mouth, but place your mouth firmly over the victim's stoma Keep the victim's head straight for complete laryngectomy Tilt the victim's head back & close of the mouth & nose for partial laryngectomy. Avoid twisting the victim's head. Ventilation with a Bag- valve- mask Select a mask of the correct size. Position yourself at the patient's vertex. Open the patient's mouth, and insert an Oropharyngeal airway. Tilt the patient's head back. Hold the mask securely to the patient's face. Use your other hand to squeeze the bag. Providing Cardiopulmonary Resuscitation Specific objective: at the end of the instruction the trainee will be able to provide cardiopulmonary resuscitation using the appropriate technique according to the standard nursing procedure. Cardiopulmonary resuscitation (CPR) CPR is the combination of artificial respiration & manual artificial circulation that is recommended for use in cases of cardiac arrest. Cardiac arrest occurs when is the heart stops beating effectively. 14
CPR involves the following steps: A- Airway opening. B- breathing restored. C- Circulation restored. D-Definitive personnel. Instituting an artificial circulation if the pulse is absent. therapyby physicians or authorized paramedic
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Positioning the patient - position the patient supine on a firm surface. If possible elevate the lower extremities. Identification of Landmarks - chest compressions are delivered over the lower half of the sternum. Delivery of cardiac compressions - for adults apply enough
force with each compression to depress the sternum 4-5cm, and then release the pressure completely to allow the heart to refill.
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Combining compressions and ventilations Deliver the compressions at a rate of 80 to 100 per minute. When there is one rescuer - perform 15 chest compressions. Followed by 2 full lung inflations. After four complete cycles, check for the return of a spontaneous pulse for 3 to 5 seconds. If the pulse is absent, resume the entire CPR sequence. In two- rescuer CPR, the ratio of compressions to ventilations is 5:1.
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Basic Life support: one - rescuer CPR. No Conscious? yes Open the Airway
No
Breathing?
yes
2 full inflations NO successful? yes
Reposition victim's head
2 full inflations No yes
successful ?
Manual Thrusts
Pulse Present?
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No
secondary survey
Finger sweep
15 chest compressions
continue artificial ventilation 12- 15/min
Two full lung Inflations
Every few minutes Check for return of spontaneous breathing
Check for a return of pulse pulse No Pulse present?
Breathing No present? yes
yes
stable side position
In the trauma victim, check for bleeding after the first series of compressions, and control profuse bleeding. Complications of CPR
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Rib fracture or costochondral sparation - if you allow the fingers to rest on the victim's ribs during compressions. Laceration of the liver & fatal internal bleeding - if your hand slips down over the xyphoid during compressions.
Preventing respiratory accidents Specific objective: - at the end of the instruction the trainee will be able to prevent respiratory accidents at the appropriate time using the standard nursing procedure.
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Respiratory accidents are accidents, which can block and stop the natural breathing. A large number of accidental deaths occur each year because of blockage & stoppage of natural breathing.
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Drowning accidents Prevention - supervision - Protection - Training
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Ingested and inhaled objects Prevention Keep articles/objects/ raw or uncooked or unchopped foods that may be accidentally swallowed or aspirated out of the each of infants & small children. Prepare food carefully, eat slowly & take special precautions in eating with dentures. Do not go to sleep with objects in your mouth. Mechanical suffocation It is the leading cause or accidental death in infants under 1 yeas of age. Prevention Control shifting & bunching of bed clothing Never give an infant thin plastic material to play with & be certain that plastic mattress covers are securely anchored to the mattress. Do not allow an infant to sleep in a bed alongside a larger person Place an infant's crib away from windows. Gas inhalation & electric current
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Prevention: Avoid conditions that allow carbon monoxide accumulation in closed spaces. Avoid entering or use proper gas mask to enter to enclosed areas where carbon monoxide gas is suspected or known to exist.
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Discard or repair worn- out or damaged tools, appliances & other electrical items. Do not over load electrical circuits. GIVING EMERGENCY CARE FOR DROWNING PATIENT
Specific objective: at the end of the instruction the trainee will be able to give emergency care for drowning patient using appropriate technique according to emergency manual. Drowning - is death from asphyxia during an immersion episode with or without inhalation of the surrounding medium. When there is at least temporary survival after submersion, it is called near drowning. There are two types of drowning: Wet drowning - occurs when fluid is inhaled or aspirated into the lungs. - Usually happens after the vocal cords relax & the lungs become partially flooded with water. Dry drowning - occurs when no fluid has been inhaled or aspirated into the lungs. - There is no aspiration of water because of prolonged laryngospasm.
Sequence of events in a drowning victim Conscious victim Immersion (submersion) Unconscious victim Immersion (submersion)
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Breath holding
Relaxation of Epiglottis & Larynx swallowing of water Spasm of
Panic Epiglottis & larynx Hypoxia
Regurgitation Inhalation of water
Loss of consciousness Relaxation of Epiglottis & Larynx Asphyxia Spasm of epiglottis &larynx "Wet drowning” Asphyxia “Dry drowning” “Dry drowning" Aspiration of water & stomach contents
Management
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Do not enter the water to save a drowning victim if you are not a qualified swimmer. Ensure an open airway & initiate breathing even before the victim is removed from the water. Continue artificial ventilation, and remove the victim from the water. Determine whether the victim has a pulse. If not, start external cardiac compressions. 20
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If you suspect neck injury, support the victim's neck in neutral position. And if you suspect spinal injury, the victim should be floated supine onto some form of back support.
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Keep the patient warm. Avoid initial attempts to drain fluid from the lungs or stomach (including abdominal compression) to begin ventilation. Endotracheal intubation of the unconscious victim, & administration of oxygen. Establish an IV lifeline. Administer Bicarbonate (if there is metabolic acidosis) Provide advanced life support measures as required (if there is cardiac arrest, treat as any other cardiac arrest, with epinephrine, cardiac monitoring, e.t.c as indicated.
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Insert an NG tube in intubated patients. Transport every near -drowning victim to the hospital, even those who seem to recover.
Prevention 1. Supervision - never swim alone, and stay away from or out of the water unless proper supervision is provided. 2. Protection - Protect pools from trespassers or unsuspecting toddlers. - Availability use of simple devices around residential - type pools & swimming ponds. 3. Training - water safety training should begin at a very young age.
Shock
Definition:- Shock is inadequate tissue perfusion - Is inadequate blood flow in and out of the body tissue 21
Mechanism of shock Normal tissue perfusion requires three intact mechanisms
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A functioning pump the heart Adequate fluid volume the blood & body fluids. An intact system of tubing the blood vessels.
If any one of those mechanisms is damaged, tissue perfusion may be disrupted, and shock will ensue. Types of shock:-
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Carcinogenic shock:- when shock comes because of failure of the pump e.g. cardiac arrest
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Hypovolumic shock Caused because of loss of volume from the system e.g. hemorrhage shock . - Burn (plasma) Vomiting & sweating diarrhea (electrolyte solution)
Neurogenic shock a care when these is failure of vasoconstriction - Decrease in peripheral vascular resistance (tubing) e.g. Spinal cord injury Mixed types pump and tubing e.g. Anaphylaxis, sepsis S/S of shock Restlessness and anxiety thirst Nausea & vomiting cold, clammy, pale skin Weak rapid pulse (tachycardia) Shallow rapid breathing (Tachypnea) Change in the stock of consciousness Face in blood pressure (hypo tension)
Management
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Maintain an airway 22
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Give oxygen Control bleeding I.V fluid, NPO Keep the patient worm & recumbent, legs elevated Monitor cardiac rhythm, state of consciousness v/s Don't delay to move the victim
DUTY THREE -EMERGENCY WOUNDS CARE Definition: A wound is a break in the continuity of the tissue of the body either external or internal Common Causes: Accidental falls Handling of sharp objects Machinery Weapons Types of Wound 1. Open wound - a break in the skin or the mucus membrane 2. Close wound - involves injury to underlying tissues with out a break in the skin or mucus membrane Types of open wounds Abrasions - the outer layer of the protective skin damaged - Bleeding is limited - Danger of contamination & infection is high
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Incisions:
- Occur when the skin is broken by sharp instruments (knife, broken glass) - May damage muscles, tendons, & nerves.
Lacerations - It is jagged, irregular or blunt - Breaking or tearing of the soft tissues - Usually causes when great force is exerted against the body - Bleeding may be rapid & extensive. Puncture - Is produced by an object piercing skin layers, creating a small hall. - External bleeding is usually quite limited - Internal bleeding may occur - Risk of infection is high - Avulsion - results when tissue is forcibly separated or torn off the victim's body - There will be heavy & rapid bleeding - Avulsed body part may be reattached to a victim's body by a surgeon. - First Aid for sever bleeding -Stop bleeding -Treat for shock Techniques to stop sever bleeding Steps: 1. Direct pressure - By placing the palm of the hand over a thick pad
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-Manual pressure the main artery -Apply the pressure bandage & tie 2. Elevation (hand, neck, or leg) about the victim's heart 3. Pressure on the supplying artery -Brachial artery for arm wound -Femoral artery for leg wound 4. Tourniquet Prevention of contamination & infection A. Safe Guards Don't remove the cloth pad initially placed on the wound Don't try to cleanse Watch for sign of shock Immobilize the injured area
-Adjust the victim in lying position so that the affected limb can be elevated. B. Mild Bleeding Wash your hands with soap & water Wash in and around the wound Rinse the wound thoroughly by flushing with clean water Dry with sterile gauze/clean cloth Apply dry bandage or clean dressing Inform the victim to see physician immediately. Removal of foreign Body
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Use tweezers sterilized over a flame or in boiling water -Lift out those objects imbedded just beneath the skin with a tip of a sterilized needle. Deeply embedded foreign objects in the tissues, regardless of size should be left for removal by health personnel Under no circumstance should the victim be pulled loose from the fixed object. Dressing the wound Helps to protect from injury, contamination, and assist in the control of bleeding. Infection If bacteria get inside tissues of the body, serious infection may develop with in hours or days. This results in delay of wound healing S/S Swelling, Redness, Sensation of heat Throbbing pain Fever Pus formation Swelling of lymph nodes Emergency care for Infection -Keep the victim lying down & quiet -Immobilize the entire infected area. -Elevate the affected body part if possible. 26
-Apply heat to the area -Don't delay medical care.
DRESSING & BANDAGES Definition: Dressing:- is the immediate protective cover placed over a wound. - Sterile dressings are those, which are free from germs before use & are preferable to non-sterile dressings. Purpose: To assist in the control of bleeding To absorb the blood & wound secretions To prevent contamination To relieve pain
Clean dressing procedure ♦ To use at home Hand washing Boiling the dressing material for 15 minutes. Bandages Definition: is a strip of woven material used to hold a wound dressing or splint in place. Help to immobilize, support & protect an injured part of the body. Kinds of Bandages Gauze bandages Elastic bandages Triangular bandages A binder of Muslin (rarely used) Elastic Bandages -Are expensive. -Can be laundered & used repeatedly. 27 Drying the dressing materials with out contamination Use ironed clothes if available
-Not stretch too tightly (interfere with circulation). Gauze Bandages ♦ Can be used on any part of the body ♦ Can be used in different ways Circular Spiral Figure of eight (joint areas) Finger tip bandages (recurrent)
Triangular Bandage ♦ Used to cover the entire scalp, foot or any large areas. ♦ Used as a sling for fracture of the arm. Combination Dressing and Bandages ♦ Adhesive strips with attached gauze dressing are available in wide variety of sizes & shapes. ♦ Bandage compresses are the most useful and efficient combination of bandage & dressing. be applied for The dressing portion bulks over which pressure may control of sever bleeding.
Application of Bandages General principles: ♦ A bandage should be snug (not to loose and not to tight) ♦ To ensure that circulation is not interfered with Leave the person's fingertips or toes exposed. Watch for swelling, changes of color & coldness. If the victim complains of numbness or tingling sensation, loosen the bandages immediately Never apply a tight circular bandage about a person's neck.
Methods of Applying Bandages 1. Arm Sling 28
Prepare triangular bandage Place one end of the bandage over the injured shoulder and let the other end hang down in front of the chest Carry the point behind the elbow the injured arm of
Carry the second end of the bandage up over the shoulder and tie the two ends together at the side of the neck. Bring the point of the bandage fore ward and pin it to the front of the slings. Make sure the end of the fingers extend just beyond the base for observation Adjust the sling so that the hand elevated 10 - 12 cm above the level of the elbow of a triangular
2. Triangular bandage folded as cravat Bring the point bandage to the middle of the base
Fold length wise along the middle until you obtain the desired width. the base. Place compress and put dressing in place with the hem on the out side. Place the bandage on the head so that the middle of the base lies on forehead Place the center of cravat over the compress that covers the around. Carry the opposite side & cross them. point. ends around to the Fold a hem about 5 cm wide along
3. Triangular Bandage for the scalp & forehead
4. Cravat bandage for forehead, ear & eyes
Bring them back to the starting
5. Cravat Bandage for cheek or ear Use a wide cravat.
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Carry one end over the top of the head and the other & under the chin. Cross the ends at the opposite side. Large thick layered, bulky pads with an outer water proofed surface area. Often used in the treatment of victims with circular burns. Are sometimes called "burn pads" or general-purpose dressings.
Special Pads
Available in several sizes.
First Aid kits & Supplies There are two general types of first Aid kits. The unit type The Cabinet - Type kits Has a complete assortment of first aid materials in unit size or multiples of the unit size. Contains 16,24,or 32 units 16 and 24 unit kits are the most popular. Are made for a wide variety of uses Range in size from pocket versions to large industrial kits. Made to accept packages in different shapes & size
Unit type kit
Cabinet Type Kits
All kits are satisfactory if the following points are observed in their selection: The kit should be large enough & have proper contents Contents should be arranged so that the desired package can be found quickly.
Material should be wrapped so that unused portions don't become dirty through handling.
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Duty 3 -Giving emergency care for a person with Bites.
General objective: At the end of the instruction the trainee will be able to give emergency care for a person with bites. Giving emergency care for a person with insect bites. Specific objective: At the end of the instruction the trained will be able to give emergency care for a person with insect bites at appropriate time using the standard nursing procedure. Insect Bites and stings Injuries caused by mouthparts and venom of insects and certain related creatures .by Hymenoptera families of insects include bees, wasps, hornets, yellow jacket, and ants. A person may have an extreme sensitivity to the venoms of the hymenoptera. Venom allergy is thought to be an IGC--mediated reaction, which constitutes an acute emergency. Stings of the head and neck are especially serious. Death from a hymenoptera sting is usually the result of anaphylaxis. Clinical manifestation range from generalized urticaria, itching, malaise, and anxiety to laryngeal edema, severe bronchospasm, shock, and death. Generally, the shorter the time between the sting and the onset of severe symptoms, the worse the prognosis. Bee stinginjury caused by the venom of a bee. The diagnosis of a bee sting is usually not very obscure (the patient most often will have made the diagnosis himself. There is almost always an immediate local reaction, consisting of pain, redness, swelling and itching at the site of sting. The barbed stinger and its venom sac may still be attached to the patient's skin.
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Treatment If the stinger is still attached to the skin, remove with tweezers, use , a scalpel blade to scrape the stinger and its scat from the wound. Don't squeeze the striper to prevent pumping more venom in to the wound. Apply cold packs/ compress to the sting for pain relief. Materials Soothing lotion (calamine) Ice bag /pack Soap and water If the patient has no history of allergy to bee stings and shows no signs of a systemic reaction, it is not necessary to transport him to the hospital. He should however be advised of the warning sign of anaphylaxis, and the urgency getting to the hospital if any signs occur. Bee stings in extremities often cause infection. If the patient has history of allergy, send the patient to hospital. Administer epinephrine as directed.
Bites and stings from known as arachnids spiders, scorpions and ticks. Spiders Generally spiders are harmless, with two notable exceptions the black widow spider and brown recluse. Symptoms resulting the black widow spider bite. Sudden sharp prick. Slight local reaction. Severe pain produced by nerve toxin. Profuse sweating. Nausea, vomiting. Painful cramps of abdominal muscles (board like abdomen.) Difficulty in breathing.
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Symptoms resulting from the brown recluse spider bite. Several local reactions, produced by venom. Open ulcer with in 1-2 weeks. Destruction of red blood cells (hemolytic reaction). Chills, fever, joint pain, nausea, and vomiting.
Treatment of black widow spider. Supportive Cold pack over the bite area, if you find it Administer oxygen in respiratory distress Start IV line with 5% D/w Administer calcium gluconate - to relief muscle spasm. Transport to hospital Treatment of brown recluse- spider Pre hospital treatment is supportive Antibiotics to prevent secondary infection. Scorpion’s bites Inject venom through a stinger in the tail, vast majority are relatively harmless, although their bite can be very painful. The one exception is a species called centruroides sculpturatus, or the bark scorpion, which is found principally in Arizona and across the borders in melico. If touched or stepped on, the scorpion releases its venom from the stinger at the end of its whip like tail. Effects In bites from the more dangerous species, there are marked systemic effects with in 1 to 2 hrs . Symptoms Excruciating pain at the site of the sting. Numbness or tingling. Nausea and vomiting 33
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Abdominal pain Shock Possible development of convulsion and coma.
Treatment Mgt- Apply cold pack to the sting - Protect air way - Treat seizures, if they occur. For the bite of a bark scorpion- Administer specific antivenin.
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Bites or stings from fleas, mosquitoes, lice, gnats, chipgontick and others common insects produce local pain and irritation but are not likely to cause severe reactions. Some of these insects may transmit disease to man but are not poisonous in them.
Complications Infection Cellulitis
Prevention of insect bites - Avoid places where stinging insects congregate. Avoid insect feeding areas (flower beds, repel fruit, garbage) Avoid going bare foot out doors (yellow jacket may nest and pollinate on the ground). Avoid perfumes, Scented soaps, and bright colors, which attract bees. Keep car window closed. Spray garbage cans with quick- acting insecticide. Remain motionless if an insect is buzzing around.
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Giving emergency care for a person with animal bites. Specific objective - At the end of the instruction the trainee will be able to give emergency care for a person with animal bites at appropriate time using the standard nursing procedure.
Animal Bite
Defn:- a wound caused by the bite of an animal. Animals may inflict any type of wound: punctures, lacerations or avulsions. Because the bites carry in to the wound germs from the animal and from the skin and clothing of the person, a variety of infections are possible. The greater danger is that of rabies. The common sources of rabies are dogs and cats and many species of wild game such as fox, wolves, bats, raccoons, rabbit etc. Healthy pets may be vaccinated against rabies.
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There is no known cure for rabies in human beings or animal once the symptoms developed. A bite on the face or neck should receive immediate medical attention, because of the proximity to brain. Keep the animal under observation if possible. Do not kill the animal unless absolutely necessary.
If it is necessary to kill the animal in order to protect people, shooting in the head should be avoided, because the brain tissue have to be examined to determine whether the animal war rabid. Dog bite Most of dog bites are not serious, but the ever-present danger of rabies demands that the paramedic take a careful history of the injury. Circumstance of the bite. Owner of the dog
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Where the dog now- the animal may have to be quarantined. Look carefully to see if the bite penetrated the skin. Infection with rabies can occur only if the saliva of a rabid animal enters a person’s body through a break in the skin surface.
Emergency care for animal bites The wound should be washed thoroughly with soap and water to remove the saliva and then rinsed with clean turning water. Apply dressing, don't suture it Remove constricting rings Avid movement of the affected part A physician should be consulted The dog should be caught and confined so that it may be observed for symptoms of rabies. If the Animal is found to be rabid start vaccine, TAT & antibiotics as indicated. Complications of Animal bites. Tetanus Rabies Septicemia Bone & muscle infections
Prevention of animal bites - Destroy ownerless dogs Register, license and vaccinate all dogs Kill infected animals. Destroy immediately unvaccinated dogs or cats bitten by known rabid animals. Encourage reduction in the dog population by castration, Spaying and drugs.
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Educate pet owners and the public that restrictions for dogs & cats are important. Cooperative programs with wild life conservation authorities to reduce for, Skunk, raccoon and other wild life hosts of sylvatic rabies.
Equipment Soap and water Gauze, bandage, plaster, kidney dish, forceps, basin Scissors Antiseptic solutions- Savalon
Giving emergency care for a person with snakebites. Specific objective: At the end of the instruction the trainee will be able to give emergency care for a person with snakebite at the appropriate time using the standard nursing procedure manual. Kinds of snakebites 1. Poisonous snake bites 2. Non poisonous snake bites The vast majority of snakes are not poisonous, however the poisonous varieties are limited to pit vipers (Rattle snake, Copper head, Coral Snake). Venomous Snakes are found in every part of the world. Pit vipers are not naturally aggressive although some are irritable than others, but they still strike in self- defense. When a pit viper does bite, it strikes with lighting speed. Its fangs snap forward and inject a
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variable amount of venom any where from no venom at all to a lethal dose through the victim's skin. If you want to be sure whether the bite was envenomed look for fang (s) marks; no fang marks, no venom, no matter how much it hurts. The size of the snake estimated with distance between the two fang marks. If fang marks are more than 12mm a part, the snake was big, with greater potential envenomation than a small snake. Effects of poisonous snake bites The Course and prognosis of snake bite depends on the Kind and amount of venom injected The size of the victim Location of the bite General health and age of the victim Protection from clothing, including shoes. Specific antivenin therapy as soon as possible.
Signs and Symptoms of venomous snake bite Extremely painful Swelling usually begin at the site of the bite and may spread to the whole extremity Echymosis Hemorrhagic blisters Systemic Symptoms Start to occur as the venom is absorbed is tingling Sensation in the scalp, face or extremities, twitching of muscles, nausea, vomiting, weakness, light -headedness, dimness of vision, and shock. Emergency management of Snake bites. The key to treatment is to start early and limit absorption of the venom. 38
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Keep the victim at rest Immobilize the injured part and keep it below heart level. Calm and reassure the patient more than on victim of snakebite has died of fright, not of the bite itself. Remove constricting items such as rings or bracelets, from a bitten extremity. If the bite has occurred with in 30- 45 minutes apply constricting band 2 to 4 inches a above the bite, the band should be 3/4 to 1 1/2 inches wide. It should not be too tight or too loose. Periodically check the pulse in the extremity beyond the bite to insure the blood flow.
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Ask circumstance of the bite Rarely an incision with sharp sterilize kite through the fang marks. Cuts should made along the long axis of the limb.
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Don't make cuts on the head, neck, or trunk. Transport to hospital for antivenin treatment, better with in 12 hrs. Administer IV line Administer Oxygen Get the description of the snake.
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Do not use ice (cold compress) be cause it increases local tissue destruction. Don't give corticosteroids the first 6 to hrs of bite because it may depress antibody production and hinder the action of antivenin. Don't give heparin, Aspirin, Sedatives alcohol. Constricting bandage Razor blade Shake bite kit if available 39 Equipment
Prevention of Snake Bite -Greatest numbers of bites occur during day light hours in summer months, observation be careful walking on the way. Giving emergency care for a person with human bites Specific objective: At the end of the instruction the trainee will be able to give emergency care for a person with a human bite at the appropriate time using the standard nursing procedure. Human Bite A wound caused by the bite of human beings. Any human bite that penetrates the skin should be considered dangerous because human bite can be contaminated with both aerobic and anaerobic organisms. Injuries produced by human bite may cause punctures, lacerations, or avulsion.
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The most important step in treating a human bite wounds to clean the wound thoroughly with lots of soap and water. Cover with sterile gauze. Transport the patient to hospital for antibiotic treatment. Soap & water. Gauze, cotton, plaster, scissors, forceps, first aid kit if avoid
Equipment -
DUYT 4 - Emergency management person with specific organ injuries Task 1Apply splint for a patient with fracture bone Bone & joint injury Muscloskeltal injuries fall in to three general fractures, dislocations & sprains. - Fracture - is a break or crack in the continuity of bone. Types of fracture
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1. A complete fracture:- involves a break across the entire cross section of the bone and is frequently displaced 2. Incomplete fracture :- is the break occur through only part of the cross section of the bone e.g greenstick fracture 3. A comminuted fracture :- is one that produces several bone fragments. 4. A closed fracture;- ( simple fracture) is one that doesnot cause a break in the skin. 5. Open fracture :- ( compound, or complex, fracture) is one in which the skin or mucous membrane wound extends to the fractured bone Causes of fracture: -Motor vehicle accidents -Accidental falls -Recreational & sport activities S/S - pain, tenderness, deformity, lose of use, swelling, ecchymosis, exposed bone ends (compound) & discoloration. F.A. -Protect against further injury -Maintain an open air way -Call for an ambulance (medical assistance) -Prevent movements of the injured part -Elevate involved extremities -Apply splint (if ambulance is not available) -Remove the victim's clothing -Control hemorrhage -Don't wash & don't insert your finger in the wound -Don't replace any bone fragments Splinting:-are devices applied to arms, legs, or trunk to immobilize the injured part when a fracture is suspected -Protect further injury during transportation -There are many varieties of splints commercially available -Can be made locally from different materials -It should be long enough to pass the joints -It should be padded 41
-Joints must be immobilized above& below the fracture -Inform the victim not to move the affected part -Never test for fracture by moving the victim's broken body part -Straighten & splint a deformed limb as necessary. Fracture of the skull -Profuse bleeding is common -Deep scalp wounds may be complicated by fragment from skull, my 3 contain hair glass or other foreign material. First aid measures: Brain Injury Causes - trauma of the skull tumor F.A measures Call for ambulance for shock. Insure an open airway Control hemorrhage Keep NPO Record the level of consciousness Face & Jaw fracture Causes - automobile accidents -Other violent injuries Immediate problems: Obstruction of the air way F.A measures Swelling & sever hemorrhage Keep the victim lying down & treat -Wound -Open or closed fracture of skull, illnesses, stroke, Don't clean scalp wound Raise the victim's head & shoulder Don't bend the neck Apply sterile dressing & bandage
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Seek immediate medical assistance Maintain an open air way Provide continues support to the head Lean foreword to drain secretion Give artificial respiration Treat for shock Apply protective dressing as necessary
Fracture of the scapula Cause: fall or automobile collision Dislocation of the shoulder joint, sprain and confusions are common. F.A Apply sling & bandage the victim's upper arm to his chest Fracture of Clavicle -Occur at the weakest portion (1/3 of the distance from the tip of the shoulder to the sternum) -Common in children F.A -Applying a sling to elevate the victim’s arm & shoulder -Bind the arm to the victim's chest. Fracture of the Humerus F. Aid Closed fracture: -Place a pad in the victim's armpit -Apply splint -Support his forearm with sling -Bind the victim's upper arm to his chest Open fracture: Cover the wound with large sterile or clean dressing Apply split (don't press the wound) Don't attempt to cleanse the wound.
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Remember that the three places to immobilize a fracture of the upper arm are: Broken bone ends. Shoulder Elbow Forearm & Wrist (Fracture) Bones involved (ulna & radius) Immobilize the broken bone ends, the wrist and the elbow Bend the elbow & apply sling Fracture of Upper leg Result from falls or traffic injuries The limb is shortened Place a blanket between the legs & bind them together Apply board splint (well padded). Cover open wounds. Apply traction if possible. Fracture of Kneecap (patella) Patella - is front of the knee joint. Cause: direct blow F.A Apply pillow splint or padded splints from the victim's heel to his buttocks along the back of the leg. Fracture of lower leg (tibia & fibula) F.A on both sides of leg & foot between the leg & tie them together. Apply well padded splints Insert blankets or towels
Keep the victim's foot pointing upward The best way to detect deformity or any other abnormality in an extremity is to compare it to the extremity on the other side.
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Task 2 Apply bandage for strain or sprain injury Dislocation Is displacement of a bone end from its articular surface (joint). -The principal symptom of dislocation is pain & the principal sign of dislocation is deformity. -Always check the pulses, strength, and sensation distal to musculoskeletal injury. Signs of Dislocation discoloration F.A Splint & immobilize the effected joint Apply a sling if needed, seek medical attention& never attempt to reduce dislocation. Swelling Obvious deformity Pain upon motion Tenderness and
Sprains Are injuries in which ligaments are partially torn. Usually caused by the sudden twisting of a joint beyond its normal range of motion The ankle & the knee are the joints most commonly affected.
It differs from dislocation in that the continuity of the joint is not disrupted in sprain although the structures that support the joint are separated. Pain upon motion Discoloration
Signs:
Swelling Tenderness
N.B treat every sever sprain as if it were a fracture. F.A - Don't allow walking. -Remove or loosen the victim's shoes. -In mild sprains, keep the injured part raised for at least 24 hrs
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-Apply cold. -It swelling persist seek medical assistance. Strains Are soft tissue injuries or muscle spasms around a joint & are characterized by pain on active movement. F.A -Bed rest, heat & use of board under mattress for a person with strained back. -Other strains apply heat & rest. Prevention of Accidents Resulting in skeletal & muscular Injuries: Motor vehicle accidents Good driving skill & judgment. Driver's attitude toward accident prevention. Periodic check up of vehicle condition. Confirmed condition of the driver. Speed & distance b/n vehicles must be adjusted. Special caution near schools, churches. No deformity or swelling.
Eye Injuries Foreign objects are often blown or rubbed into the eyes. Such objects are harmful not only because of the irritating effect but also because of the danger of their scratching the surface or becoming imbedded in the eye.
Signs & Symptoms Redness of the eye 46
Burning sensation Pain Headache Over production of tears Swelling Wound Presence of foreign body
Precautions object Refer the victim if some thing is embedded in the eye. Keep the victim from rubbing his eye Wash your hands thoroughly before examining the victim's eye. Don't attempt to remove a foreign
Removal of a foreign body from the surface of the eyeball from the inner surface of the eye refer to hospital. Pull down the lower lid If the object lies on the inner surface lift it gently with clean handkerchief or paper tissue If the object has not been located, it may be lodged beneath the upper lid. While the victim looks down, grasp the lashes of the upper lid gently. Pull the upper lid foreword & down over the lower lid tears may dislodge the foreign object If not dislodged, depress the victim's upper lid with a match stick or similar object. Flash the eye with water. If not removed, apply a dry dressing &
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If an acid or alkali gets in to the eyes, flood the eyes with running water for several minutes and get medical advice as soon as possible. A contusion occurs from direct blow, such as fist vehicle accident or explosions results in block eye. In serious case, the structure of the eye may be torn or ruptured. Secondary damage may occur by the effect of hemorrhage and later by infection Vision may be lost Bleeding may occur after several days The victim should be seen by the Ophthalmologist
Blunt Injury of the Eye
A dry sterile or clean dressing should be applied and the victim should be transported lying flat. Penetrating Injuries of the Eye Can result in blindness Don't try to remove the object or to wash the eye Cover both eyes loosely with a sterile or clean dressing Secure with tap or bandage & cover both eyes to eliminate movement of the affected eye Keep and transport the victim by stretcher Take the victim to the emergency room of hospital to get quick medical attention. First Aid measures
HEAD INJURIES Scalp Injuries Bleed profusely May be complicated by fragment from skull fractures May contain hair, glass or other foreign material Don't try to clean scalp wounds
First Aid Measures
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Control bleeding by raising the victim's head & shoulder Don't bend the nick Place a sterile dressing on the wound Apply Bandage to hold the dressing in place & to provide pressure.
Brain injury Causes wounds of the scalp Open or closes fracture of the skull Stroke (impaired blood supply to brain) Tumor Clear or blood tinged CSF draining from the nose or ears following skull fracture Temporary loss of consciousness Partial or complete brain paralysis of muscle of the extremities of the opposite side. Facial paralysis on the same side Disturbance of speech Local or generalized convulsions Bleeding from the nose, ear canal or mouth (skull fracture) Pale face Fast & weak pulse Headache & dizziness Vomiting Unequal size of pupils Loss of bowel & bladder control Obtain medical assistance
Signs & symptoms
First Aid Measures quickly (call for ambulance)
Keep the victim down & treat for shock Insure an open air way
Keep the victim NPO Apply dressing & bandage Record the level of
Continuously maintain open air way Call for medical assistance quickly Lean him fore ward to let secretions drain out Support the victim's head & jaw If the victim is unconscious, elevate his head & shoulder & turn his head to the side Apply artificial respiration if necessary
Any torn or detached part of the ear should be saved Obtain medical care Don't insert instruments or any fluid into the ear canal
Place gauze or cotton loosely in the outer ear canal
N.B. Perforation of an eardrum associated skull fracture requires special attention. Don't clean the ear Don't stop the flow of CSF Turn the victim onto his injured side.
Nose Injuries & Nasal Bleeding Causes: injury May or may not include fracture.
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F.A measures
Disease (HPN), cold, Stress full activity Exposure to high altitude
-Keep the victim quite -Keep the victim in sitting position -Apply direct pressure to the bleeding nostril -Apply cold compress to nose & face -If not stop, insert a small clean pad of gauze & apply externally with thumb & index finger. If it doesn't stop obtain medical assistance -Make sure that nasal bone fractures like all other fractures, have medical attention. Neck Injuries A. Blockage of the airway Cause: -Blunt force exerted on the face, mouth or jaw, may produce tissue damage that body fluids draining in to air passage block the way. -Hard blow on the front of the neck -Extensive swelling F.A: artificial respiration -Obtain immediate medical care B. Lacerations or puncture wound -Bleeding from neck around is dangerous & difficult to control. Control Measures -Exert direct pressure over the wound. -Keep the victim's head & shoulder raised & his air way open. - Seek medical attention. -Cover wound by dressing. -Never apply a circular bandage around the neck. Wounds of the Chest A. Sucking wound of the chest
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/open pneumothorax/ is injury in which air passes in & out of the thoracic cavity through a hole in the chest. If the wounding object or instrument is still in place, leave it undisturbed. F.A. Cover the open wound by large pad The palm of the hand may be applied until a suitable bandage is obtained. Maintain open-air way & give artificial respiration transport the victim with his injured side down.
A. Penetrating wounds of the heart or large blood vessels of chest -The penetrating object should be left undisturbed. F.A. -Elevate the victim's head -Give artificial respiration -Seek medical assistance B. Compression of Lung Tissue Causes: blood /other fluids/ air that has escaped in to the chest cavity from air into the chest cavity from air passages through a tear in the surface of the lung F.A Position for mouth-to-mouth respiration Maintain on open air way Give artificial respiratory Seek medical help quickly. Abdominal Injuries -Wound of the abdomen are particularly dangerous because of the risk of damage to internal organs. - An injury to the chest any what below the nipples is also an injury to the abdomen. -A distended, tender abdomen after injury means internal bleeding. Treat for shock, & transport immediately. First Aid Measures: Don't try to replace protruding intestines or abdominal organs but cover with sterile dressings. Hold the dressing in place with a firm bandage.
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Keep the victim NPO. Crenate the victim's head & should to avoid breathing difficulty. Seek medical attention. -Suspect spinal cord Injury -Vehicular trauma -Diving accidents -Jumps or fall from the height -Significant injury above the-clavicles -Crash injuries -Lighting injuries -Gunshot -Unconscious pt after trauma
Back Injuries
Care full handling of the victim -Don't bend back during transportation. -Give artificial respiration in lying position if needed. -The victim shouldn't be mould until an ambulance arrives with a special stretcher and trained personnel. -Before moving to ambulance immobilize the pt on a long backboard.
Injuries to the Genital Organs Causes -Blunt or penetrating trauma -Accompanied by great pain -Marked succeeding & considerable bleeding Injuries to legs & feet -Serious wounds of the legs & feet are obviously incapacitating. F.A Need medical attention Cover wounds of legs feet 53
Elevate an injured part with pillows F.A -Elevate the injured part above the level of heart (most important) except in snakebite & stings. Blisters Cause -friction (from shoes) F.A if all pressure can be relieved until fluid is absorbed blister are best left unbroken. Otherwise, - wash the entire area. -Make a small puncture hole at the base of blister -Apply a sterile dressing. If blister has already broken, treat is as open wound, watch for sign of infection. Self-care for blisters should not be attempted when the blister fluid lies deep in palm of hand or sole of the foot. Duty: 5 REMOVING FOREIGN BODIES FROM SPECIFIC ORGANS General objective : At the end of the instruction the traniee will be able to remove foreign bodies from specific body organs. - Removing foreign bodies / particles/ from eye. Specific objective: At the end of the instruction the trainee will be able to remove foreign bodies ( particles) from eye using appropriate technique according to emergency nursing procedure manual. If the wound is serious, don't cleanse it. Apply pressure to control bleeding. Separate fingers by gauze. Elevate the victim's hand during transportation. Don't allow to walk Remove shoes & examine color of the toes
Hand Injuries
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Removing foreign bodies / particles | from eye. Foreign particles are often blown or rubbed in to the eyes. Such objects are harm full not only because
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of the irritating effect but also because of the danger of their scratching the surface or becoming embedded in the eye. (A) Sign and symptoms of foreign bodies / practice/ in the eye (i) Redness of eyes (ii) Burning sensation (iii) Pain (iv) Head ach (v) Over production of tear (B) Precautions of foreign body removal from the eye (1) Keep the victim from rubbing his eye (2) Wash your hands thoroughly before examining the victim's eye. (3) Don't attempt to remove foreign object by inserting a match, toothpick, or any other instrument. (4) Refer the victim to a physican if some thing is embeded in the eye, or if something is thought to be embeded but cant be located. (C) First aid management of foreign bodies in the eye.
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Pull down the lower lid to determine whether or not the object lies on the inner surtace.
It the object lies on the inner surface, lift it gently with the corner of a clean handkerchief or paper tissue. Never use dry cotten around the eye. If the object has not been located, it may be lodged beneath the upper lid.
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While the victim looks down, grasp the lashes of the upper lid gently. Pull the upper lid for ward and down ward over the lower lid. Tears may dislodge the foreign object. It the foreign object has not been dislodged dipress the victim's upper lid with a matchstick or similar object placed horizontally on the top of the cartilage and evert the lid , by pulling up ward on the lashes a gainst the matchstick. Lift of the foreign object with the corner of a clean handkerchief and replace the lid by pulling down ward gently on the lashes. Flush the eye with water
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It the object is still not removed and is suspected to be embeded, apply a dry, protective dressing and consult a physician.
Removing small particles from the nose Specific objectives:- At the end of this lesson the trainee will be able to remove foreign bodies from nose using appropriate technique according to emergency nursing procedure manual. Children often insert foreign bodies in their noses. - Sign and symptems of foreign body in the nose
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The child itself calls attention to the fact that the foreign body has become lodged.
The only clue to its presence is an unplesant discharge from the affected nostril. - Techniques of removing foreign bodies from the nose
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Have the person gently blow through the nose
-Precuations when removing foreign bodies from the nose. If the object protrudes, do'not pull it out If it is sharp, it may have penetrated the septum or the tissue high in the nose, carefully transport the person with out disturbing the object. If the object can't be seen, don't probe for it. probing may only force the object higher in to the nose, thus complicating its removal by a physician.
The child should be prevented from touching his nose and should be told to breath through his mouth (to avoid the danger of draing the foreign body fur ther up wards) Removing foreign bodies from the ear Specific objective : At the end of the session the trainee will be able to remove foreign bodies from the ear using appropriate technique according to emergency nusing procedure manual - Foreign bodies in external ear canal are common problem in pediatric age group - Sign and symptoms of foreiqn bodies in the ear.
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Ear ach Dizzines
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Discomfort -Precautions used when removing foreign body from the ear. If a foreign object is lodged with in the ear canal, the ear should be left alone, and the patient should be transported to the hospital . Because an attempt to remove the object in the pre hospital seeting may cause further damage to the ear and may also create a greateter obstruction. -Don't probe the ear with match sticks, hair pins or any thing else. -Don't pour water in to the ear if the foreign body has been present for a long time, the causalty is deaf in that ear or if the foreign body is sharp, in case the eardrum is perorated. -Don't use cold water , which will make the causalty dizzy (to remove insects) - Techniques for removing foreign bodies from the ear The one possible exception to this rule is the situation in which
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The object in the inner ear is hygroscopic ( absorbs water), such as corn ,beans, or peas, and will thus swell rapidly with in the ear canal. It the distance to the hospital is great, the paramedic may wish to try to flush out the foreign objects before transport.
If i is certain that the ear drum has not been perforated , the following maesures can be taken (1) Fill a bulb syring with alcohol. The alcohol should be close to body temprature. (2) Lie the patient down with the affected ear over a basin. In the case of a small child, the paramedic needs assistance to keep the child still. (3) Place the tip of syring near the top of part of the interance to the ear canal, and rapidly flush in the alcohol. (4) Use gentle pressure because of forceful flushing can drive the object deeper in to the ear canal. (5) If the object con't be flushed out easily , tratnsport the patient with out further attempts. (6) All patients with foreign bodies in the ear should go to the hospital to have the tympanic membrane and deep portions of the ear canal examined for injury and checked for other fareign bodies. Apply patches for the injured eye Spessfic objective .At the end of this session the trainee wii be able to apply patches for the emergency nursing procedure manual.
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EYE INGURIES there are few ocular emergences , but when they occur , they tend to be very urgent indeed , and it is important that the paramedic be well enough informed to suspect then in the appropriate settings. TYPE OF EYE INGURIES - eye injuries can be grouped (A) based on the cause of injury - forgin particles - laceration and contusion - blunt injuries - penetrating injurices - chemicals, heat and light burns.
• • •
the most common eye injurice are caused by flying particles that loadge in the outer surface of the eye ball or under the lid . most forgin particles are washed away by tears caused by irritaion of the globe . the tears are one of the body natural defence mechainsms.
in juinces to the soft tissue arounde the eyes take in the form of laceration and contusion . N.B (1) laceration of the eye lid may appear to be serious , but as long a the globe it self is not damagde , persons sight will probably not be lost . (2) laceration of the cornea or the sclera, even with no injury to the eye lid, may cause the loss of vission .
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Blunt injuries to the eye can be identiffied by blood that covers the iris or the pupil. Pentetrating injuries - are extermely serious and can result in blidness chemicals burns ( injuries) are commnly caused by acids and alkalines. heat burns( injuries )are injuries from explosion or fire light injuries - is an injury from the ultraviolent radiation the so called welders burn
B) based on the sight ( injured area ) ( i) injury to the orbitis
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Trauma to the face may result in fracture of one or several of the bones of the skull that form the orbit ( eye socket ) ( ii) lid injuries lid injuries include echymoses / black eyes/ burns and laceration (iii) inguries to the globe injuries to the globe , including contusion, laceration , foregin bodies , and abrations are in general treated in emergencey departmenet. singns and symptoms of injured eye -obvious foreign object protruding from the globe swollen or lacerated globe blood shot sclera scrached cornea distorted pupil profuse bleeging pain double vission massive nasal discharge Managment of eye injurices removing foreign particle particles ) apply direct pressure or pressure dressing to stop bleeding ( mx of lid laceration ) apply loose dressing (mx of corneal laceration ) cover the injured eye and transport the victim to hospital ( blunt injurices) immediate continous irrigation with copious amount of Rationales _ saline 1 To ensure availablity df equipment _ ringers _ tape water but never irrigate the eye with any chemical antidot ( mx of chemical burn ) 2 To decrease anxiety cover the eye with loose , moist , sterile dressing and transport the 3 To decrease the potential for cross victum to hospital (mx of heat burn ) contamination between clients` lightly patch both eyes (mx of light injuries 4 To provide a surface for tape purpose and techniques of appling patches for the injured adherence and decrease the potential for eyes skin irritation 5 To facilitate complet eye lid relaxation interventions 6 To exert slight pressure against the eye lid 7 To hold the patch against the closed eye lid 59 8 to ensure even pressure against the eye lid if it is not embedded ( to mx foreign
(1) assemble equipment - eye patch - skin preparation - non allergic paper tape (2) explain the procedure to the client (3) wash your hands (4) applly skin preparation to the clients for head & cheek (5) instract client to gently close his eyes (6) place apatch over the closed eye lid (7) apply tape from the cheek to the middle of the for head in a digonnal line pull the tape sunugly enough that the cheek is pulled slightly up ward . (8) cover the patch with over lapping pices of tape
DUTY 6 POISONING Definition A poison is any substance solid, liquid or gas that tends to impair health or cause death when introduced in to the body or on to the skin surface. Causes: Over dose of drugs (ASA) Medicine left within reach of children 60
Poisons transferred from the original containers to jars or soft drink bottles Carelessness of the parent& lack of supervision Improper storage & disposal of poisonous substances
Combining drugs & alcohol Examples of poisons around the home Cosmetics, hair preparations Kerosene Strong detergents Bleaches Acids Non edible mushrooms Signs & symptoms of poisoning
Information from the victim from an observer Presence of container known to contain poison Conditions of the victim (sudden illness) Burns around the lips or mouth Breath odor Pupils of the eye contracted to pin point (over dose of morphine) Objectives of treatment by mouth To dilute the poisons quickly as possible To seek medical advice from physician To maintain respiration or circulation To preserve vital functions & seek medical assistance F. Aid measures for swallowed poisons a. Conscious victim -Give him a drink of tepid water with soap. -Repeat the procedure of inducing vomiting -Don't induce vomiting if the poison is: -Corrosives (strong acid or alkalis)
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-Hydrocarbons (kerosene) -Iodides, silver nitrate, & strychnine. Instead, give milk with egg water or a mixture of flour & water. b. Unconscious victim Maintain an open air way Don't give fluid & not induce vomiting If the victim is vomiting position him & turn the head so that the vomits drains out of the mouth Contact with poisonous chemicals need immediate first aid F.A Remove contaminated clothing, wash all contaminated skin, keep the victim air way be open. Contact with poisonous plants Remove contaminated clothing Wash all exposed areas thoroughly Apply calamine lotion Seek medical advice Poisoning through Inhalations E.g. Carbon monoxide (Co) poisoning Move the pt to fresh air Give moth - to - mouth respiration & cardiac massage Turn your mouth a way from the victim's mouth. The vast majority of snakes are not poisonous. Pit vipers are poisonous. Produce chemical burns &
Poisoning through Injection (Snakebites)
Characteristics of snakes
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Poisonous poisonous Vertical pupils Single row of teeth teeth Two erectile fangs marks S/S
non - round pupils - double row of upper - not leave fang
Start instantaneously, with burning pain or numbness at the site of the bite. Swelling Ecchymoses Hemorrhagic blisters Systemic symptoms F.A depression) hospital notify the hospital. Get description of snake & Don't delay transport to Get the pt away from the snake Calm the pt Remove constrictive items Keep the victim recumbent Splint the bitten extremity Don't allow the victim to walk Avoid alcohol (aggravate CNS Tingling sensation, twitching of muscle, signs of shock (nausea, vomiting, sweating weakness, light headiness.)
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Duty 7 providing emergency care for burn patient General objective: - At the end of this instruction the trainee will be able to provide emergency care for burn patient. DEFINATION A burn is any injury that results from heat, chemical agents, or radiation. It may vary in depth, size and severity, causing injury to the cell in the affected area. A. Cause Burns are caused mast commonly by 1. Care less ness with matches are in cigarette smoking 2. Scalds from hot liquids 3. Defective heating, cooking and electrical equipment 4. Use of open fires that produce flame burns, especially when flammable clothing in worn. 5. Un safe practices in the home, in the use of flammable liquids for starting fires for cleaning, and for scrubbing wax off floors. 6. Immersion on over heated bath waters. 7. Use of chemicals, such as lye, strong acid and strong detergents. CLASSIFICATION - Burn are usually classified according to depth or degree of skin damage. A. First degree burn B. Second degree burn
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C. Third degree burn D. Fourth degree burn
A. FIRST DEGREE
First- degree burns are those resulting from over exposure to the sun born, light contact with hot objects, or scalding by hot water or steam. The usual signs are 1. Redness or discoloration 2. Mild swelling and pain 3. Rapid healing (3 &7 days) NOTE. Sever sun burn should receive medical care as soon as possible B. SECOND DEGREE Second- degree (partial thickness) burn are those resulting from a very deep sun burn, contact with hot liquids and flash burns form gasoline, kerosene and other products. Second- degree burns are usually more painful than deeper burn in which the nerve endings in the skin are destroyed. The usual signs are 1. Greater depth than First-degree burns 2. Red or mottled appearance 3. Development of blisters 4. Considerable swelling over a period of several days 5. Wet appearance of the surface of the skin, due to the loss of plasma through the damaged layers of the skin.
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C. THIRD DEGREE -Third- degree burn can be caused by flame, ignited clothing, immersion in hot water, contact with hot objects, or electricity. - Temperature and duration of contact are important factors in determining the extent of tissue destruction. The usual signs are 1. Deep tissue are destruction 2. White or charred appearance (at First, the burn may resemble a second-degree burns). 3. Complete loss of all layers, of the skin. D. FOURTH DEGREE BURN. Some sources also refer to an additional category of burns, Fourth-degree burns, to denote involvement of even deeper tissues, such as muscle and bone. FIRST AID MANAGEMANT OF BURN
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The objective of first aid for burns is to relieve pain, prevent contamination, and treat for shock usually, medical treatment is not required. A. First- degree burns 1. Apply cold water application, or sub merge the burned area in cold water2. Apply a dry dressing if it is necessary. B.SECOND-DEGREE BURNS 1.Immerse the burned part in cold water (not ice water) until the pain subsides 2. Apply freshly ironed or laundered cloths that have been wrung out in ice water. 3.Blot dry, gently. 4 Apply dry, sterile gauze or clean cloth as protective bandage. 5. Do not break blisters or remove tissue 6. Do not use an antiseptic preparation, ointment, spray, or home remedy on a sever burn. If the arms or legs are affected, keep them elevated.
C. THIRD - DEGREE BURN 1. Do not remove adhered particles of charred clothing. 2. Cover burns with thick, sterile dressings or a freshly ironed or laundered sheet or other household linen. 3. If the hands are involved, keep than above the level of the victim's heart. 4. Keep burned feet or legs elevated-(The victim should not be allowed to walk).
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5. Have victims with face burns sit up or prop them up & keep them under continuous observation for breathing difficulty. If respiration problems develop, on open air way must be maintained. 6. Do not immerse an extensive burned area or apply ice over it, because cold may intensify the shock reaction. How ever, a cold pack may be applied to the face or to the hands or feet. 7. Arrange transportation to the hospital as quickly as possible. 8. If medical help or trained ambulance personnel will not reach the scene for an hour or more and the victim is conscious and not vomiting. Give him a weak solution of salt and soda at home and en route. I level teaspoonful of salt and 1/2 level teaspoonful of baking soda to each guart of water, neither hot nor cold. Allow the victim to sip slowly. - Give about 4 ounces (a half glass) to an adult over a period of 15minutes. - Give about 2 ounces to a child from 1 to 12 years of ages and about 1 ounce to infant under 1yr of age. Discontinue fluid if vomiting occurs.- If medical help will not be available with in an hour or more, fluids given if hot other wise contraindicated. (Do hot give alcohol). 9. Do not apply ointment, commercial preparation, grease or other home remedy, such substance may cause further complications and interfere with treatment by the physician. For more extensive burns it is customary to use the rule of nine
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Rule of nines Adult Head 18% Front and back of chest Lower extremities Upper extremities 9% Genitalia 1% 1% 18%.18% Left.18 % Right 18% Left 9% Right 9% 18%.18% 14% 14% 9% 9% Infant
Material for first aid management of burn - Gauze - Bandage - Cotton - Plaster -Solutions water - Vaseline Gauze - scissors -ointments -forceps -Basin
First Aid measures when the person's clothes are on fire - Put of out the flames with cold water or sand if either is on hand. - If water is not available, smother suppress the flames by laying the victim down and wrapping a blanket, coat or rug very lightly around him. - Tear off smoldering clothing by seizing the non- burning areas of the material. - Immerse the affected part in cold water. - Remove any clothing, which is soaked in boiling water, oil or other fluid. - Do not remove burn clothing, which has cooled. - Remove any constricting items such as shoes, boots, rings and bracelets before swelling begins. - Cover the area lightly with a sterile or very clean cloth or sheet.
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Fire or burn prevention - Install fire extinguishers in danger spots. - Keep a garden nose near a faucet for use in case of fire. - In stall, adequate insulation at all heating surfaces. - Repair or replace defective or in adequate electrical wiring. - Perform the required maintenance on heating systems. - Dispose of trash immediately. - Use only nonflammable cleaning fluids. - Hang clothes well away from stoves or fire places. - Place curtains so that they not blow in to flames from any stove, candle, etc. - Store flammable materials in a safe place. - Do not over load electrical circuits. - Supervise children playing near an open fire. - Store matches in a metal container and out of reach of children. - Turn pot and pan handles away from the edge of the stove. - Do not leave tubs of hot water where children can fall in to them. - Do not smoke in bed. - Do not smoke if you are sleepy. - Provide adequate ashtrays through out the house. - Install home fire detectors. Giving first aid care fore a person with chemical burns (2hr) Specific objective: - At the end of the instruction the trainee will be able to give first aid care for from the ear chemical burn by applying the appropriate technique and according to standard emergency nursing manual. Chemical Burns Definition: - chemical burns occurs when specific chemicals (gaseous, liquid or solid form) come in to direct contact with skin and epithelial surfaces. 70
Types of Chemical burns Chemicals capable of causing burn injuries are 1. Strong acids such as Hydrochloric acid. Chromic acid or sulfuric acid. 2. Strong bases such as sodium hydroxide N.B. Contact to strong chemicals, almost any chemical can result in a burn injury if it remains in direct contact with the skin for along enough period. Clinical manifestations - Intense pain - Sensitive to light, redness - Watery eye (increase) - Swelling Material - Gauze - Bandage - Water - Vaseline Gauze - Forceps First aid management - Remove the chemical - If it is dry chemical, brush away solid, particles then lavage (in out) with water as soon as possible. - Simply wetting the burn site is not enough. - Continuous flooding of the chemical for at least 20 min -is required. - Remove jeweler, watch - Do not allow the victim to rub eyes. - Irrigate eyes - Water in a bowl, left the victim put the affected eye side of the face in a bowl. - cotton - basin - kidney dish - scissors
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- Cover the affected eye with eye pad. Complication - Difficult to see. - Sever headache. Prevention - Label containers with chemicals - Keep out of the reach of children Giving first aid for a person with cold injure (frost bite) Specific objective: - At the end of the instruction the trainee will be able to give first aid care for a person with cold injury (frost bite) by using to the appropriate standard technique Cold injury and according the
emergency nursing manual.
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Definition - is the extent of injury caused by exposure to abnormally low temperature. Cause of frost bite
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It results when crystals form, either superficially or deeply in the fluids and underlying soft tissue of the skin It is the most common injury resulting from exposure to cold elements The nose, cheeks, ears, fingers and toes are most commonly affected.
clinical Manifestations Skin changes to white or grayish- yellow in appearance Pain is same times felt early but sub sides later (often there is no pain) The affect area (part) feels intensely cold & numb Blisters may appear later The victim frequently is not aware of frostbite until some one tells him or he observes the pale, glossy skin. 72
Material -Blanket -Warm drink -Extra clothing
-Lotion thermometer -Sterile gauze
MANAGEMENT Objectives:The objectives of first aid are i. To protect the frozen area from further injury ii. To warm the affected area rapidly iii. To maintain respiration First aid procedure a) Cover the frozen part b) Provide extra clothing and blankets c) Bring the victim indoors as soon as possible d) Give the victim a warm drink e) Re warm the frozen part by immersing it in water that is warm, but not hot f) Wrap the affected part gently in a sheet or warm blankets if warm water is not available. g) Don’t rub the part, rubbing may cause gangrene (tissue death) h) Don’t apply heat lamp or hot water bottles i) Don’t let the victim bring the affected part near a hot stove j) Don’t break blisters k) Don't allow the victim to walk after the affected part thaws, if his feet are involved . l) Since sever swelling develops very rapidly after thawing discontinue Warming the victim as soon as the affected part flushed m) Once the affected part is re warmed, have the victim exercise it
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n) If fingers or toes are involved, place, dry, sterile gauze between them to keep them separated. o) Do not apply other dressings unless the victim to be is transported for medical aid. p) If travel is necessary, cover the affected part with sterile or clean cloths and keep the injured part elevated. q) Elevate the frost bitten parts and protect them from contact with bedclothes. r) Obtain medical assistance as possible Complications 1. Mental confusion and impairment of judgment 2. The victim staggers 3. Eye sight fails 4. The victim falls and became unconscious 5. Breathing may cease 6. Death, it occurs is usually due to heart failure Preventions I. Avoiding exposure to extreme cold II. Limiting the exposure time as much as possible III. Wearing proper protective covering IV. Avoid personal practice that may actually contribute to freezing of tissue V. Do not drink alcoholic beverages, smoke or bath immediately prior to going out into extremely cold air. VI. Keep moving about in cold air, exercise fingers and toes it necessary, but avoid over exertion. VII. Finally, learn to recognize the symptoms that indicate possible onset of frostbite giving first aid care for a person with electric injury
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Specific objective: - At the end of the session the trainee will be able to give first aid care for a person with electric injury using the appropriate technique and according to the standard emergency nursing manual. Definition electric injury: - when a person comes in contact with electricity. Electric current including lightning, can cause sever damage to the body. The skin is burned where the energy enters the body and where is flows in to a ground. - Along the path of this flow tissues are damaged due to heat Sign and symptoms - Burns where the energy enters and exists the body -Disrupted nerve pathways displayed as paralysis - Muscle tenderness, with or with out muscular twitching - Respiratory difficulties or respiratory arrest - Irregular heartbeat or cardiac arrest - Elevated blood pressure or low blood pressure with the signs and Symptom of shock - Restlessness or irritability if conscious or loss of consciousness - Visual difficulties - Fractured bones and dislocation from severe muscle contractions or from falling. This can include the spinal column. -Seizures (in sever cases) Material -Dry stick -Electric wires -Ambo bag 75
FIRST AID CARE 1. Warning do not touch the victim with bare hands. Don't use metal or wet objects. - Make certain that you and the patients are in a safe zone (not in contact with any electrical source and out side the area where downed or broken wires or other sources of electricity can reach you). 2. Provide air way care- Electrical shock may cause sever swelling the way. 3 Provide basic cardiac life support as required. Since cardiac rhythm disturbances are common, be prepared to Perform defibrillation if necessary. 4. Care for shock and administer high concentration oxygen. 5. Care for spinal injuries, head injuries, and sever fractures. All serious electrical shock patients should be fully immobilized contraction. Also, the patient may have been thrown by high voltage current, in either case; there is the possibility of spinal injury that requires immobilizations. 6. Evaluate electrical burns, looking for at least two external burn sites: contact with the energy source and with aground. 7. Cool the burn areas and smoldering clothing the same as you would for aflame burn. 8. Apply dry sterile dressings to the burn sites. 9. Transport as soon as possible. Some problems have a slow on set. If there are burns, there also may be more serious hidden problems. In any case of electrical shock, heart problem may develop Remember:- The major problem caused by electrical shock is usually not the burn. Respiratory and cardiac arrest are real possibilities. Be prepared to provide basic cardial life support measures with automated defibrillation. COMPLICATION 76 along
- Respiratory arrest - Cardiac arrest -Un conciseness -Titanic muscle construction -Spinal injury -Severe metabolic acidosis -Acute renal tubular necrosis -Damage nerves & blood vessels even death Prevention - Lightening injures safety measures stay out of rain, stay a way from object that project from the ground - Do not stand along side trees, poles or high buildings. - Do not hold on to fishing poles, golf clubs, or any potential lighting rods - Stay low or lie flat on the ground of out in the open field. - Do not run across open areas - If in a car, keep the windows closed -Never go near victim un less the power is switched off.
Duty 8 -SUDDEN ILLNESSES AND UNCONSCIOUSNESS Although sudden illness is not always argent, sometimes it endangers a person's life, especially if associated with a heart attack or massive bleeding. An important F.A measure in such an instance is to secure transportation for the victim to receive medical care as quickly as possible. Heart Attack - Is sudden interference with normal action of the heart Cause: - blood clot in the coronary artery S/S - persistent chest pain (usually under the sternum) - Gasping & shortness of breath
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Extreme pallor or bluish discoloration of the lips, skin & finger nails. Extreme prostration Shock Swelling of ankles
N.B: The two principal symptoms are shortness of breath & chest pain. F.A Measures Place the victim in semi sitting position Don't allow the casualty to move Loosen any constricting clothing around neck If breathing and heart beat stop, begin resuscitation Remove to hospital immediately Don't give liquid to an unconscious victim Stroke: (Apoplexy) (cerbrovascular Accident) (CVA) Is a condition in which the blood supply to part of the brain is suddenly & critically impaired. Rupture of blood vessels (cerebral hemorrhage) Are often fatal Hemiplesia Difficulty in breathing swallowing Loss of bladder & bowel control Unequal size of pupils of the eye Lack of ability to talk Give artificial respiration if Position the victim on his side Keep the victim NPO Transport the pt to hospital immediately needed
Cause -blood clot (cerebral thrombosis) S/S Major Strokes: - Unconsciousness
F.A: -Maintain an open air way
Minor Stroke: 78
Symptoms -
Small blood vessels in the brain are involved Successful recovery is possible Don't produce unconsciousness Can occur during sleep Headache Confusion Slight dizziness & ringing in the ears Other mild complaints Protect the victim against accident or physical exertion Suggest medical attention
F.A Measure
Fainting (syncope) Faint is a brief loss of consciousness (not more than few minutes) Cause: temporary reduction in the flow of blood to the brain E.g. long period of physical inactivity Recovery is rapid and complete S/S - slow and weak pulse Extreme paleness Sweating Dizziness Nausea Disturbance of vision Leave the victim lying down Maintain an open air way Loose any tight clothing Check for and treat any injury Make sure that the casualty has plenty of air Don't give any liquid unless the victim is fully conscious.
F.A Measures
Convulsion, Seizures (or fits)
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Occur when there is a massive discharge of neurons in the brain Stroke head trauma, space occupying lesions Hypoxemia Hypoglycemia Toxin Meningitis Toxemia of pregnancy Sever dehydration. Idiopathic - most epileptics are in this category Bluish discoloration of the face & lips Foaming at the mouth or drooling Gradual improvement Prevent victim from hurting him self Give artificial respiration if indicated Don't restrain him avoid over crowding, reassure & advice to seek medical attention
Causes: Intracranial pathology
S/S - Rigidity of body muscles followed by jerking movement. Epilepsy Is a chronic disease usually of unknown cause characterized by repeated convulsions. F.A. Measures Push away near by objects Don't force blunt object b/n the victim's teeth Lessen clothing around the neck Keep the victim lying down Is a state of un responsiveness roused. from which the pt can't
F.A Measures
Unconsciousness (Comatose)
-Comma depresses the reflexes that normally protect the air way from aspiration & obstruction.
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-Level of consciousness. -Drowsiness, Stupor, Coma. Causes -Trauma, Medical problems (diabetes), HPN, stroke - Drug over dose, alcohol F.A Measures Ensure an open air way Assist ventilations Start I.V line Protect the pt's eyes Check v/s & neurological signs frequently Transport with out delay
. THIRD DEGREE -Third- degree burn can be caused by flame, ignited clothing, immersion in hot water, contact with hot objects, or electricity. - Temperature and duration of contact are important factors in determining the extent of tissue destruction. The usual signs are
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4. Deep tissue are destruction 5. White or charred appearance (at First, the burn may resemble a second-degree burns). 6. Complete loss of all layers, of the skin. D. FOURTH DEGREE BURN. Some sources also refer to an additional category of burns, Fourth-degree burns, to denote involvement of even deeper tissues, such as muscle and bone. FIRST AID MANAGEMANT OF BURN The objective of first aid for burns is to relieve pain, prevent contamination, and treat for shock usually, medical treatment is not required. A. First- degree burns 3. Apply cold water application, or sub merge the burned area in cold water4. Apply a dry dressing if it is necessary. B.SECOND-DEGREE BURNS 1.Immerse the burned part in cold water (not ice water) until the pain subsides 2. Apply freshly ironed or laundered cloths that have been wrung out in ice water. 3.Blot dry, gently. 4 Apply dry, sterile gauze or clean cloth as protective bandage. 5. Do not break blisters or remove tissue 6. Do not use an antiseptic preparation, ointment, spray, or home remedy on a sever burn. If the arms or legs are affected, keep them elevate