First Aid Manual for Nurses [Third Edition] 9348385305, 9789348385307

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Third Edition

Sanju Sira  BSc (N), RN, RM Nursing Tutor Government Institute of Nursing Rupnagar, Punjab, India

CBS Publishers & Distributors Pvt Ltd • New Delhi • Bengaluru • Chennai • Kochi • Kolkata • Lucknow • Mumbai • Hyderabad • Jharkhand • Nagpur • Patna • Pune • Uttarakhand

Disclaimer Science and technology are constantly changing fields. New research and experience broaden the scope of information and knowledge. The authors have tried their best in giving information available to them while preparing the material for this book. Although, all efforts have been made to ensure optimum accuracy of the material, yet it is quite possible some errors might have been left uncorrected. The publisher, the printer and the authors will not be held responsible for any inadvertent errors, omissions or inaccuracies.

eISBN: 978-93-483-8530-7 Copyright © Authors and Publisher Third e Book Edition: 2022

All rights reserved. No part of this eBook may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system without permission, in writing, from the authors and the publisher. Published by Satish Kumar Jain and produced by Varun Jain for CBS Publishers & Distributors Pvt. Ltd. Corporate O ice: 204 FIE, Industrial Area, Patparganj, New Delhi-110092 Ph: +91-11-49344934; Fax: +91-11-49344935; Website: www.cbspd.com; www.eduport-global.com; E-mail: [email protected] Head O ice: CBS PLAZA, 4819/XI Prahlad Street, 24 Ansari Road, Daryaganj, New Delhi-110002, India. Ph: +91-11-23289259, 23266861, 23266867; Fax: 011-23243014; Website: www.cbspd.com; E-mail: [email protected]; [email protected].

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Representatives Hyderabad Pune Nagpur Manipal Vijayawada Patna

Preface to the Third Edition The much improved third edition of this First Aid Manual for Nurses shows the popularity of this manual. Plenty of efforts have been made to make it a special edition. The book is designed to teach students in a very simple manner how to handle the first aid emergencies that may arise all of a sudden and anywhere. Valuable information has been added to this edition and most of the additions are intended to offer practical guidance to the students. Beyond these additions, considerable improvements both in the content and the organization of the text have been made. This third edition includes the latest emergency procedures, and attractive colored illustrations, which make this book highly valuable, and easily understandable. The best part of the book is that it is beneficial not only for the nursing students for their first aid training but also for the general readers who can use it to enhance their knowledge. The book incorporates all the topics enlisted by the INC. It has a wide coverage of scientific concepts on selected topics related to our day-to-day life. The approach of the book is in fact activity-based which provides clarity to the concepts, besides it includes those emergency situations, which may arise during students’ learning process. This book has seen the light of day because of the hard work of development team, the valuable efforts of editorial team, who worked day and night on tight deadlines to bring the book close to the shape I dreamt of. I aspire that this book will serve its purpose of simplifying the concepts and fundamentals of first aid for all the students. I sincerely hope you all will enjoy reading this book as much as I have enjoyed revising it. As there is always the scope of improvement, I warmly welcome the meaningful comments and suggestions from readers to make this manual more informative.

Sanju Sira

Preface to the Second Edition Unpleasant though it may be, the fact remains that accidents happen. If an accident happens, one cannot be a helpless witness, since simply standing by can potentially worsen the situation. This is why it is important to have at least a basic knowledge of first aid. First aid is the assistance, given to any person suffering from a sudden illness or injury. THe first aid can be provided to preserve life, prevent the condition from worsening, and/or promote recovery. It includes initial intervention in a serious condition prior to professional medical help being available. While everyone can benefit from first aid training, it may be a more necessary requirement for nurses. With this intention, it gives me immense pleasure to present the book, First Aid Manual for Nurses, 2nd edition with new updates as per the need and wants of nurses. The book includes all topics as enlisted by the INC. It has been written in a simple language and an interactive manner to make it more useful for the readers. This time we have converted whole book in fully colored layout for real-time visualization of the images/photographs. Diagrams and images have been selected cautiously to complement the text well and enhance reading experience with a good retention of facts. I aspire that this book will serve its purpose of simplifying the concepts and fundamentals of first aid for all the nursing students. I sincerely hope you enjoy reading this book as much as I have enjoyed writing it.

Sanju Sira

FIRST AID MANUAL FOR NURSES

Contributor and Reviewers SPECIAL CONTRIBUTION Saumya Srivastava MSN (Oncology Nursing), RN, RM Nursing Tutor Vivekananda College of Nursing Lucknow, Uttar Pradesh

REVIEWERS A Jayasudha RN, RM, PhD (N) Principal PSG College of Nursing Peelamedu, Coimbatore, Tamil Nadu A Vimala RN, RM, MSc (N), MPhil Principal Vijaya College of Nursing Vadapalani, Chennai Anu Gauba MSc (N), PhD (N) (Speciality–Community Health Nursing)  Professor Amity University Gurugram, Haryana Arun Varghese PhD Scholar AlIMS (Speciality–Psychiatric Nursing) Certified Simulation Educator BLS, ACLS, PALS, NALS, ATCN, PHTLS Aeromedical Services Advanced Airway etc., Courses Instructor Nursing Tutor AlIMS, Rishikesh, Uttarakhand Asheesh Kumar Gautam RN, RM, MSc (Mental Health Nursing), PhD (Pursuing)

(Speciality–Mental health Nursing) Assistant Professor (Acting Principal) AKG Institute of Nursing Lucknow, Uttar Pradesh

Betsy Chakraborty MSc (N) (Speciality–Mental Health Nursing) Assistant Professor Panna Dhai Maa Subharti Nursing College Swami Vivekanand Subharti University Meerut, Uttar Pradesh Blessy Varghese BSc, MSc (N) (Speciality–OBG Nursing) Professor cum HOD (OBG) Jaipur Hospital College of Nursing Jaipur, Rajasthan CP Sharma MSc (N), PhD (N) (Speciality–Medical Surgical Nursing) Principal BDM College of Nursing Chhuchhakwas, Jhajjar, Haryana Ex-faculty Member Government College of Nursing Sawai Mansingh Hospital (SMS) Jaipur, Rajasthan Dainy Thomas MSc (N) (AIIMS), PhD Scholar (INC) (Speciality–Medical Surgical Nursing) Nursing Officer Pediatric Cardiology AIIMS, New Delhi Farukh Khan MSc (N), PhD (N) Medical Surgical Nursing Principal The Academy of Nursing Sciences and Hospital Gwalior, Madhya Pradesh

The names of the reviewers are arranged in an alphabetical order.

FIRST AID MANUAL FOR NURSES G Dhanalakshmi Vice Principal HOD (Medical Surgical Nursing) Billroth College of Nursing Chennai, Tamil Nadu G Karpagam BSc (N), MBA (HM) Principal School of Nursing Government Kilpauk Medical College Chennai, Tamil Nadu G Maheswari MSc (N), PhD (N) Principal Excel Nursing College Pallakkapalayam, Tiruchengode Tamil Nadu Hemavathy J BSc (N), MSc (N), PhD (N), MA (Public Admin), MD (ACU), PG Diploma in Guidance and Counseling

(Speciality–Mental Health Nursing) Professor cum HOD Omayal Achi College of Nursing Chennai, Tamil Nadu

J Jasmine Professor Mother Theresa Post Graduate and Research Institute of Health Sciences (Government of Puducherry) Puducherry Jisa George T MSc (N), PhD (N) (Speciality–Medical Surgical Nursing) Assistant Professor Nursing College, AIIMS Bhopal, Madhya Pradesh

Reviewers

Johny Kutty Joseph MSc (N), RN (Speciality–Mental Health Nursing) PhD Scholar, Amity University Assistant Professor Shri Mata Vaishno Devi College of Nursing Katra, Jammu and Kashmir

Kallappa M Sollapure MSc (N) (Psychiatry) (Speciality–Mental Health Nursing) Assistant Professor Shri JG Co-operative Hospital Society’s Institute of Nursing Ghataprabha, Karnataka Karpagavalli Nageswaran MSc (Mental Health [Psychiatric] Nursing) (Applied Psychology), PhD (N)

Dean–Faculty of Nursing Ganpat University Principal Kumud & Bhupesh Institute of Nursing Ganpat University Mehsana, Gujarat Kavita Choudhary MSc (N) Lecturer College of Nursing Pt. Bhagwat Dayal Sharma University of Health Sciences Rohtak, Haryana Mahuya Dey MSc (N) (Speciality–Community Health Nursing) Woodlands College of Nursing Associate Professor Under West Bengal University of Health Science Kolkata, West Bengal N Gowri MSc (N) (Speciality–Community Health Nursing) HOD & Professor Department of Community Health Nursing Our Lady of Health School and College of Nursing Thanjavur, Tamil Nadu

Jyoti MSc (N) (Oncological Nursing), RN, RM Faculty AIIMS, New Delhi

Nancy Thakur MSc (N) (Speciality–Psychiatry Nursing) Assistant Professor Galgotias School of Nursing Greater Noida, Uttar Pradesh

Jyoti Grace Masih BSc (N), MSc [MHN] (Speciality–Mental Health Nursing) Vice Principal FI College of Nursing Lucknow, Uttar Pradesh

Neeraj Kumar Bansal PhD (N) (Speciality–Medical Surgical Nursing) Professor Jai Institute of Nursing Research (JINR) Gwalior, Madhya Pradesh

viii

The names of the reviewers are arranged in an alphabetical order.

FIRST AID MANUAL FOR NURSES Prakash Palanivelu MBA (HM), PhD (N) (Speciality–Psychiatric Nursing) Assistant Professor College of Applied Medical Sciences Prince Sattam Bin Abdulaziz University Saudi Arabia Praveen Suthar MSc (N) Assistant Professor Bhagyalaxmi Nursing College Modasa, Gujarat R Danasu Principal Sri Manakula Vinayagar Nursing College Puducherry R Naganandini PhD (N) (Speciality–Psychiatric Nursing) HOD & Associate Professor Vinayaka Missions Annapoorana College of Nursing Vinayaka Missions Research Foundation (DU) Salem, Tamil Nadu R Velmurugan MSc (N) (Speciality–Medical Surgical Nursing) (Critical Care Nursing) Assistant Professor Nursing College, AIIMS Bhopal, Madhya Pradesh R Arul Malar Principal Ellen College of Nursing Navakkarai, Coimbatore, Tamil Nadu Ramavatar Singh Tyagi MSc (N) (Speciality–Medical Surgical Nursing) Vice Principal Institute of Nursing and Paramedical Science JS University, Shikohabad Firozabad, Uttar Pradesh

S Tamilselvi MSc (N) (Speciality–Medical & Surgical Nursing) Principal Florence Nightingale School of Nursing Sambanthanur, Tiruvannamalai Tamil Nadu Sambad Jagdish BSc, MSc (N) (Speciality–Medical Surgical Nursing) Nursing Officer Community Health Centre and Referral Hospital Jamkandorna Jamkandorna, Gujarat Sanjna Kumari (Speciality–Child Health Nursing) Assistant Professor School of Nursing Science and Research Sharda University Greater Noida, Uttar Pradesh Santhi N Principal KG School of Nursing KG College of Health Sciences KGISL Campus Saravanampatti, Coimbatore, Tamil Nadu Sarbattama Nayak BSc, MSc (N) (Speciality–Community Health Nursing) Cuttack, Odisha Sathiyakala K MSc (N), PhD (N) (Speciality–Psychiatric Nursing) Nursing Tutor College of Nursing, AIIMS Patna, Bihar Shailaja MJ Mathews MSc (OBG Nursing) Assistant Professor Maharshi Karve Stree Shikshan Samsthas Smt Bakul Tambat Institute of Nursing Education Pune, Maharashtra

The names of the reviewers are arranged in an alphabetical order.

Reviewers

Rita Dutta RN, RM, MSc (CHN) (Speciality–Community Health Nursing) Principal Woodlands College of Nursing Under West Bengal University of Health Science Kolkata, West Bengal

S Chitra MSc (N), PhD (Pursuing) (Speciality–Community Health Nursing) Assistant Lecturer Mother Theresa Post Graduate and Research Institute of Health Sciences (MTPG&RIHS) Puducherry

ix

FIRST AID MANUAL FOR NURSES Shwetha Rani CM MSc (N), PhD (N) (Speciality–OBG Nursing) Associate Professor Ganga Sheel School of Nursing (GSSN) Bareilly, Uttar Pradesh Smriti Arora PhD (N) (Speciality–Pediatric Nursing)  Professor cum Principal College of Nursing, AIIMS Rishikesh, Dehradun, Uttarakhand

T Barani Principal Raak Nursing and Paramedical College Sulthanpet, Puducherry Visala Pandian V MSc (N), MBA, PhD (N) Principal EGS Pillay College of Nursing Nagapattinam, Tamil Nadu

Sukhbir Kaur BSN, MSN (Mental Health Nursing) PhD (N) (Gold Medalist)

Reviewers

Associate Professor Department of Psychiatric Nursing Shri Guru Ram Dass (SGRD) College of Nursing SGRD University of Health Sciences Amritsar, Punjab

x

The names of the reviewers are arranged in an alphabetical order.

From the Publisher’s Desk Dear Reader, Nursing Education has a rich history, often characterized by traditional teaching techniques that have evolved over time. Primarily, teaching took place within classroom settings. Lectures, textbooks, and clinical rotations were the core teaching tools; and students majorly relied on textbooks by local or foreign publishers for quality education. However, today, technology has completely transformed the field of nursing education, making it an integral part of the curriculum. It has evolved to include a range of technological tools that enhance the learning experience and better prepare students for clinical practice. As publishers, we’ve been contributing to the field of Medical Science, Nursing and Allied Sciences and earned the trust of many. By supporting Indian authors, coupled with nursing webinars and conferences, we have paved an easier path for aspiring nurses, empowering them to excel in national and state level exams. With this, we’re not only enhancing the quality of patient care but also enabling future nurses to adapt to new challenges and innovations in the rapidly evolving world of healthcare. Following the ideology of Bringing learning to people instead of people going for learning, so far, we’ve been doing our part by: •  •  •  • 

Developing quality content by qualified and well-versed authors Building a strong community of faculty and students Introducing a smart approach with Digital/Hybrid Books, and Offering simulation Nursing Procedures, etc.

Innovative teaching methodologies, such as modern-age Phygital Books, have sparked the interest of the Next-Gen students in pursuing advanced education. The enhancement of educational standards through Omnipresent Knowledge Sharing Platforms has further facilitated learning, bridging the gap between doctors and nurses. At Nursing Next Live, a sister concern of CBS Publishers & Distributors, we have long recognized the immense potential within the nursing field. Our journey in innovating nursing education has allowed us to make substantial and meaningful contributions. With the vision of strengthening learning at every stage, we have introduced several plans that cater to the specific needs of the students, including but not limited to Plan UG for undergraduates, Plan MSc for postgraduate aspirants, Plan FDP for upskilling faculties, SDL for integrated learning and Plan NP for bridging the gap between theoretical & practical learning. Additionally, we have successfully completed seven series of our Target High Book in a very short period, setting a milestone in the education industry. We have been able to achieve all this just with the sole vision of laying the foundation of diversified knowledge for all. With the rise of a new generation of educated, tech-savvy individuals, we anticipate even more remarkable advancements in the coming years.

We take immense pride in our achievements and eagerly look forward to the future, brimming with new opportunities for innovation, growth and collaborations with experienced minds such as yourself who can contribute to our mission as Authors, Reviewers and/or Faculties. Together, let’s foster a generation of nurses who are confident, competent, and prepared to succeed in a technology-driven healthcare system.

Mr Bhupesh Aarora (Sr Vice President – Publishing & Marketing) [email protected]| +91 95553 53330

Special Features of the Book STEPS TO DO 1 Recognize the type of emergency 2

Check the scene

3

Call EMS system

4

Check the victim

5

Give first aid

This feature helps you in following vital steps at the time of emergency.

Caution This feature makes the readers aware of precautionary measures taken during emergency.

y Don’t Forget to wash your hands to avoid cross infection y Use Sterilize dressing y Apply compression for hemostasis

Basic Rules before Applying Dressing The basic rules before applying dressing are given as follows (Fig. 3.3): œ Thoroughly wash your hands. œ Avoid touching the wound or any part of the dressing that will come in the contact of the wound. œ Do not cough, sneeze or talk over the wound or dressing.

This is highly valuable feature which adds value to the chapters.

Note This special feature gives additional information in case of emergency.

If a barrel bandage is not available, it can be made of handkerchief, necktie or scarf. This is tied around the jaw to immobilize it. The bandage should be tied in such a manner that it can be easily removed in case of vomiting.

FIRST AID MANUAL FOR NURSES

Figures in the book help clarify the concepts.

Fig. 5.10:  Splinting of ankle and foot

TABLE 2.1:  Contents of Small First Aid Kit (6” × 3½ × 2½)

Items

Quantity

Adhesive bandages

2

Roller bandages of all sizes

2 each

Cotton wool

1 pack

Sterile small dressing (burn dressing)

1

Small scissors

1

Betadine ointment

1

Hand sanitizer

1

Special Features of the Book

First aid dressing: small, medium and large

xiv

Tables are included to supplement the text matter.

Contents Preface to the Third Edition......................................................................................................................v Preface to the Second Edition.................................................................................................................vi Contributor and Reviewers....................................................................................................................vii Special Features of the Book.................................................................................................................xiii

Unit  I

Introduction and Basics of First Aid

1–7

1. Introduction............................................................................................................................3

Unit  II

Procedures and Techniques in First Aid

9–81



2. First Aid Kit.............................................................................................................................11



3. Dressing..................................................................................................................................17



4. Bandages................................................................................................................................21



5. Splints and Slings................................................................................................................40



6. Transportation of the Injured..........................................................................................51



7. Stretchers................................................................................................................................59



8. Basic Life Support................................................................................................................64

Unit  III First Aid in Emergencies

83–211



9. First Aid Assessment: Primary and Secondary Survey...........................................85



10. Asphyxia..................................................................................................................................95



11. Drowning................................................................................................................................98



12. Heart Attack........................................................................................................................ 101



13. Shock.....................................................................................................................................103



14. Fainting................................................................................................................................ 105



15. Wound.................................................................................................................................. 108



16. Hemorrhage/Bleeding.................................................................................................... 116



17. Injuries to the Bones, Joints and Muscles................................................................ 127



18. Hanging/Throttling/Strangulation............................................................................. 143



19. Falls........................................................................................................................................145



20. Burns.....................................................................................................................................147



21. Poisoning............................................................................................................................. 156



22. Bites and Stings................................................................................................................. 168



23. Foreign Body in the Eye.................................................................................................. 179

FIRST AID MANUAL FOR NURSES



24. Foreign Body in the Nose.............................................................................................. 181



25. Foreign Body in the Mouth........................................................................................... 183



26. Foreign Body in the Ear.................................................................................................. 189



27. Frostbite............................................................................................................................... 191



28. Heat Exhaustion and Heatstroke................................................................................ 195



29. Abdominal Injuries........................................................................................................... 199



30. Chest Injuries...................................................................................................................... 202



31. Crush Injuries..................................................................................................................... 206



32. Sprain and Strain..............................................................................................................209

Unit  IV Community Emergencies and Resources

213–254



33. Disaster Preparedness or Disaster Management.................................................. 215



34. Fire or Wildfires.................................................................................................................. 217



35. Explosions (Nuclear Warfare, Atom Bombs, Hydrogen Bombs)...................... 219



36. Flood.....................................................................................................................................223



37. Earthquake.......................................................................................................................... 226



38. Tsunami................................................................................................................................ 228



39. First Aid in COVID-19-Related Emergencies............................................................ 230



40. Famine.................................................................................................................................. 235



41. Role of Nurse in Disaster Management.................................................................... 237



42. Psychological First Aid.................................................................................................... 239



43. Rehabilitation..................................................................................................................... 242



44. Voluntary Health Organizations.................................................................................. 243

Contents

Index......................................................................................................................................................... 255

xvi

UNIT

I

Introduction and Basics of First Aid Unit Outline  Introduction

1

4

Introduction This book is designed to save lives. It is that simple, whether on the job, in your home, or in community. Knowing first aid allows you to help someone who is injured or suddenly ill until help arrives or the person seeks a health care provider. Most first aid is reasonably simple and at times does not require ample training or equipment but can be dealt with the basic first aid kit. Properly applied first aid may mean the difference between life and death, rapid recovery and long hospitalization or temporary disability and permanent injury. First aid involves more than doing things for others, it also includes the things that people can do for themselves.

DEFINITION OF FIRST AID First aid is an emergency care and treatment of a sick or injured person before more advanced medical assistance in the form of the emergency medical services (EMS) arrives.

AIMS OF FIRST AID y y y y

To preserve life. To prevent the worsening of one’s medical condition. To promote recovery. To help to ensure safe transportation to the nearest health care facility.

CONCEPT OF FIRST AID First aid is the immediate help given to a victim of injury or sudden illness by a bystander until appropriate medical help arrives or the victim is seen by a health care provider. A few definitions of first aid are: y

First aid is the assistance given to any person suffering a sudden illness or injury with care provided to preserve life, prevent the condition from worsening and/or promote recovery.

FIRST AID MANUAL FOR NURSES y

y

First aid can be defined as the emergency treatment of illness or injury in order to maintain life, to ease pain and to prevent deterioration of patient’s condition until professional medical help can be obtained. First aid is provision of initial care for an illness or injury. It is usually performed by nonexperts (or sometimes by experts in case of emergency) but trained personnel to a sick or injured person until definitive medical treatment can be accessed.

However, once the first-aider has started giving first aid, he/she is legally bound to remain with the victim until an EMS arrives. Another concern is taking the victim’s consent. Usually the consent is clear-cut and always a “yes” as an injured person would never refuse any help. But in case a person is injured but has refused helping in such a situation, a call is made to the police so that the injured person is shifted to a safe custody.

PHILOSOPHY OF FIRST AID The essential factors to survival and recovery from disease and injury in the prehospital situation are prompt and effective preservation of the body’s primary functions: y

UNIT I  Introduction and Basics of First Aid

y

Airway Breathing

y y

Circulation Bleeding control

According to medical studies, the most major contribution to excellent outcomes for victims in the prehospital context is effective support of these core activities.

GOLDEN RULES OF FIRST AID The golden rules of first aid are described under the following two headings:

1. What to Do y y y y y y

4

Do first things first quickly, quietly without fuss or panic. Tactfully reassure the casualty as this will lessen anxiety. Avoid crowd as fresh air is essential. Give artificial respiration if breathing has stopped as every second counts, e.g., airway, breathing and circulation (ABC) of emergency. Stop any bleeding (pressing pressure points). Guard against or treat for shock.

FIRST AID MANUAL FOR NURSES y y y y y

Do not move the casualty unnecessarily but handle the casualty gently. Do not remove the clothes of the casualty unnecessarily. Do not do too much instead do the minimum that is essential to save life and prevent the condition from worsening. Give comfortable position to the casualty. Arrange for the removal of the casualty.

2. What Not to Do y y y

Do not let the casualty see his own injury. Do not leave the casualty alone except to get help. Do not assume the casualty obvious injuries are the only one.

FIRST-AIDER A first-aider is a person, who is trained and authorized in providing first aid. Certification in providing first aid is issued by St. John Ambulance Association and the Indian Red Cross Society to the candidates who have attended theoretical and practical course and have cleared the professional examinations.

Responsibilities of a First-Aider First-aider should save lives by providing immediate medical attention and treatment to persons who are sick or injured. y y y

Protect the unconscious. Prevent a casualty’s condition from becoming worse. Promote the recovery of the casualty.

Rapid industrialization and urbanization is the cause of various accidents and emergencies. When an accident takes place, the first thing in everyone’s mind is to help the victim. First aid is the skill of applying common sense in such a way that the victim’s life is saved, recovery begins and complications are prevented until professional medical help arrives.

5

CHAPTER 1  Introduction

CONCEPT OF EMERGENCY

FIRST AID MANUAL FOR NURSES

The concept of emergencies includes actions to be taken in all emergencies including injury or illness. These steps are as follows: STEPS TO DO 1

Recognize the type of emergency

2

Check the scene

3

Call EMS system

4

Check the victim

5

Give first aid

6

Seek medical attention

Recognize the Type of Emergency It is very important to recognize the type of emergency that has occurred, e.g., bleeding, poisoning, electrocution, accidents, etc. in order to manage and provide timely first aid to the victim.

UNIT I  Introduction and Basics of First Aid

Check the Scene When an emergency has occurred, before blindly helping the victim, check the scene for your safety. If the scene is dangerous then do not approach rather call for help instead of becoming a victim yourself. A quick check is to be made for the following: y y y y

Downed electrical wires Chemical spillage Fumes Smokes and flames

y y y

Risk of explosions Building collapse Personal violence

Once the scene is safe, go and help the victim until medical help arrives.

Call EMS Number The EMS number is to be dialed once a life-threatening injury or illness is recognized, always call EMS number when: y y

6

The victim is unresponsive. The victim is bleeding.

FIRST AID MANUAL FOR NURSES y y y y y

The victim is experiencing a life-threatening condition like choking, critical burns, spinal cord injury, poisoning, unresponsive, etc. In case of imminent childbirth. In case of suicidal attempt. All those situations, in which moving a victim could worsen his/her condition. In all cases, where you are in doubt whether it is an emergency situation.

Check the Victim Check the victim closely, observe keenly within seconds for the lifethreatening conditions requiring immediate first aid.

Give First Aid Once the first-aider has checked the scene and condition of the victim, and feels safe, he/she can immediately give the first aid to the victim as per the type of emergency. The act should be time-saving, prompt and skillful. The first-aider is not supposed to give any kind of medication to the victim, e.g., aspirin because of risk of bleeding, allergic reaction or some other untoward complications. However, if the victim is aware of the medication and needs it in that circumstance, first-aider can assist the victim. Above all in life-threatening situations requiring immediate first aid follow ABC of first aid explained in later chapters.

Seek Medical Attention After providing first aid, do not leave the victim alone or if recovered even then advise him or her to seek medical care. CHAPTER 1  Introduction 7

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UNIT

II

Procedures and Techniques in First Aid Unit Outline  First Aid Kit  Dressing  Bandages  Splints and Slings  Transportation of the Injured  Stretchers  Basic Life Support

2

4

First Aid Kit PREPARATION OF FIRST AID KIT A first aid kit is a collection of the instruments and supplies, used for providing first aid either by an individual or by an organization. A well worked first aid kit is a handy thing to have which is used in case of emergencies. It is available in many shapes and sizes but one can make its own. Some kits are designed for specific activities such as hiking, camping or boating. The international standard for first aid kits is that they should be identified with the ISO graphical symbol for first aid (from ISO 7010) which is an equal white cross on a green background, although many kits do not comply with this standard either because they are put together by an individual or they predate the standard.

USES OF FIRST AID y y

To save the life of the casualties in case of emergency. Useful at any place during an emergency, i.e., factories, schools, buses, cars, homes and roadside, etc.

CLASSIFICATION OF FIRST AID KIT A first aid kit can be classified into three categories, i.e., small, medium and large (Figs 2.1 to 2.3). It may be made of plastic or metal. The container should be dirt proof.

APPEARANCE OF THE KIT The first aid kits are marked with a red cross on white background in order to make it easily recogonizable for quick use. Some kits are green in color with white cross.

CONTENTS OF THE FIRST AID KIT y y

Adhesive bandage: It includes Band-Aids and sticking plasters. Dressing: It should be present in the kit so that it may be applied directly on the wound or could be used in case of traumatic injuries.

FIRST AID MANUAL FOR NURSES

UNIT II  Procedures and Techniques in First Aid

Fig. 2.1:  Small first aid kit

Fig. 2.2:  Medium first aid kit

12

FIRST AID MANUAL FOR NURSES

Fig. 2.3:  Large first aid kit y y y y y

y y y y

13

CHAPTER 2  First Aid Kit

y

Sterile eye pads Sterile gauge pads Sterile nonadherent pads (with a nonstick Teflon layer) Occlusive (air tight) dressing: Used for sucking chest wound Bandages: Used for secure dressings (not usually sterile) ƒ Gauge roller bandage: Elastic and absorbent ƒ Elastic bandages: For sprain and pressure bandages ƒ Adhesive elastic roller bandage: Used for bandages which are durable and waterproof. ƒ Triangular bandages: These are used as tourniquet to the splints, slings and support to a part. Saline: Used to clean wounds and for washing foreign bodies from eyes. Soaps: Used for cleaning of superficial wounds where bleeding is stopped. Burn dressing: Used on the burnt site. Gloves: Used to protect the individual from infection. Scissors: Used to cut clothes of the casualty in case of emergency or for general use.

FIRST AID MANUAL FOR NURSES y y y y y y y y y y y y y y y y

Tweezers: Used for removing splinters Alcohol: Used to clean equipment. Torch: Flashlight Hand sanitizer or antiseptic hand wipes Cotton swabs Safety pins: Used to hold and pin bandages Povidone iodine: Antiseptic solution and ointment Hydrogen peroxide Medicated antiseptic ointment Burn gel Calamine lotion Antihistamine cream Hydrocortisone cream Antifungal cream Savlon Small pads and pen for recording

Contents of small, medium and large first aid are named in Tables 2.1 to 2.3 respectively.

UNIT II  Procedures and Techniques in First Aid

TABLE 2.1:  Contents of Small First Aid Kit (6” × 3½ × 2½) Items

Quantity

Adhesive bandages

2

Roller bandages of all sizes

2 each

Cotton wool

1 pack

Sterile small dressing (burn dressing)

1

Small scissors

1

Betadine ointment

1

Hand sanitizer

1

First aid dressing: small, medium and large TABLE 2.2:  Contents of Medium First Aid Kit (16” × 7¾ × 4”) (used for homes, schools and motor vehicles)

14

Items

Quantity

First aid dressing: small, medium and large

3 each

Cotton roll

2

Sterile cotton 25 g

1 Contd…

FIRST AID MANUAL FOR NURSES

Items

Quantity

Roller bandages of all sizes

3 each

Burn dressing

3

Triangular bandages

12

Scissors

1

Adhesive plasters

1

Safety pins

1 pack

Wooden splints

1 set

Savlon/Dettol

1

Gauge (24” x 8”)

1

Band-Aid

1

Torch

1

Small notebook and pen

1

Eye ointment

1

Betadine ointment

1

Aspirin tablets

1 pack

TABLE 2.3:  Contents of Large First Aid Kit (used in big institutions and factories) Quantity

Sterile dressing for fingers

6

Sterile dressing for body

4

Sterile dressing for hand and feet

6

Burn dressing: small, medium and large

4

Sterile cotton wool 25 g

6 large, 4 medium, 4 small

Roller bandages of all sizes

10

Triangular bandages

4

Safety pins

20

Scissors

2

Gauge clothes

4

Band-Aid

20 Contd…

15

CHAPTER 2  First Aid Kit

Items

UNIT II  Procedures and Techniques in First Aid

FIRST AID MANUAL FOR NURSES

16

Items

Quantity

Aspirin

1 strip

Notebook and pen

1

Dettol

4

Eye ointment

2

Cotton wool for pads

6

Adhesive plasters

10

First aid book

1

3

4

Dressing

INTRODUCTION Dressing plays a vital role in first aid. It is applied or put on wound to secure it. It is a pad placed directly over a wound to absorb blood and other body fluids and to prevent infection.

DEFINITIONS y y

It is a protective covering put upon a wound or injured part of the body to control bleeding and to prevent infection. Dressing covers an open wound to protect it from infection, control and stop bleeding.

PURPOSES OF DRESSING The purposes of dressing are: y To cover a wound y To prevent an infection y To absorb blood and fluid drainage y To control bleeding y To protect the wound from further injury.

TYPES OF DRESSING y y

Adhesive dressing or strips. Nonadhesive dressing: ƒ Ready-made sterile dressing ƒ Gauge dressing and gauge pads ƒ Improvised dressing.

Adhesive Dressing It consists of a pad of absorbent gauge or cellulose held in place by a layer of adhesive material (Fig. 3.1). They are used for small cuts and abrasions. For example, simple dressing pads or cotton gauge.

UNIT II  Procedures and Techniques in First Aid

FIRST AID MANUAL FOR NURSES

Fig. 3.1:  Adhesive dressing

Nonadhesive Dressing This is of three types: 1.  Ready-made Sterile Dressing

It consists of several layers of gauge covered by a pad or cotton wool which are attached to a roller bandage to hold them in position. 2.  Gauge Dressing and Gauge Pads

Gauge dressing consists of several layers of gauge to cover large wounds (Fig. 3.2). It is very absorbent, soft and pliable. Gauge pads are used for small wounds. These are available in separately wrapped packages of various sizes and are sterile unless the package is broken. Some gauge pads have several coatings to keep them from soaking to the wound and are especially helpful for burns or wound secreting fluids. 18

FIRST AID MANUAL FOR NURSES

Fig. 3.2:  Gauge dressing

3.  Improvised Dressing

Freshly laundered handkerchiefs, towel, or other cloth may be used in emergencies when sterile dressing are not available. These should be used carefully unfolded and a pet that has not been touched should be placed next to the wound. If a clean cloth is not available than take the available cloth (lean one) and sterile it by scorching with a hot iron or over a flame. Basic Rules before Applying Dressing The basic rules before applying dressing are given as follows (Fig. 3.3):

19

CHAPTER 3  Dressing

œ Thoroughly wash your hands. œ Avoid touching the wound or any part of the dressing that will come in the contact of the wound. œ Do not cough, sneeze or talk over the wound or dressing. œ Use large dressing which is large enough to extend beyond the wound’s edges. Hold the dressing by a corner and place it directly over the wound. Do not slide it on. œ Never touch the inner part of the dressing.

FIRST AID MANUAL FOR NURSES

Fig. 3.3:  Rules for applying dressing

œ If blood oozes or there is mild bleeding from the dressing, do not remove it instead put another dressing over the top. œ Wear gloves if available or necessary.

UNIT II  Procedures and Techniques in First Aid

Caution y Don’t Forget to wash your hands to avoid cross infection y Use Sterilize dressing y Apply compression for hemostasis

20

4 Bandages INTRODUCTION Bandages are the materials which are used to bind, support and secure injuries. These can be of linen, crape, elastic or gauge.

DEFINITIONS y

y

A material used to hold a dressing or splint in order to support a medical device such as a dressing or splints or to restrict the movement of a part of the body. A bandage is a long piece of thin cloth which is applied around an injured part of the body.

USES OF BANDAGES y y y y y y

To prevent contamination of a wound by holding dressing in position. To control bleeding by applying direct pressure over a wound. To prevent or reduce swelling. To provide support and stability to a broken or an injured part. To hold a dressing in place over an open wound. To maintain pressure, e.g., elastic bandage. General Principles to be used while Bandaging

œ The bandage should be of appropriate size, shape and suitable material. œ Bandages should be applied firmly enough to keep dressing and splints in place and should not be so tight as to cause injury to the part or to impede blood circulation. œ Do not bandage so loosely that the dressing will slip. This is the most common bandaging error. Bandaging tend to stretch after a short time. œ Do not cover fingers or toes unless they are injured because they need to be observed for color changes due to impaired circulation. Contd…

FIRST AID MANUAL FOR NURSES

œ Do not bandage so tightly as to restrict blood circulation. Always check the extremity’s pulse and if you cannot feel the pulse, loosen the bandage. œ Never apply elastic bandages over a wound as it may become tight. œ Never apply a circular bandage around a victim’s neck because it may cause strangulation.

TYPES OF BANDAGES Bandages are available in wide range of types from generic cloth strips to specialized shaped bandages for a specific limb or part of the body. The different types of bandages are as below.

UNIT II  Procedures and Techniques in First Aid

Gauge Bandages or Gauge Roller Bandage These are widely used because they are soft, thin, porous and can be easily adjusted and applied (Fig. 4.1). They are available in market with various lengths and type of material. It can be self adhering conforming that are slightly elastic made of gauge like material of various widths. Apart from this, there are gauge roller of cotton material. These are rigid and nonelastic. The another type of roller bandage are used as compression bandage on contusions, sprains and strains. These are not to be applied over a wound.

Fig. 4.1:  Gauge roller bandage

Compression Bandage This is categorized into two types, i.e., 1. Short stretch compression bandage 2. Long stretch compression bandage

22

FIRST AID MANUAL FOR NURSES

Short Stretch Compression Bandage

This type of bandage is applied on the limb. It is basically used as a treatment for lymphederma or venous ulcers. It works on the principle of resting pressure and working pressure, i.e., this type of bandage is capable of shortening around the limb after application and not so exerting ever increasing pressure during inactivity. This is known as resting pressure, this is safe and comfortable for long-term treatment. On the other hand, the stability of the bandage leads to a very high resistance to stretch when pressure is applied through internal muscles contraction and joint movement. This is called working pressure. Long Stretch Compression Bandage

It has a quality of stretching for a longer period that means their high compressive power can be easily adjusted. These compression bandages have a very high resting pressure and are to be removed when the patient is in resting position or during night times.

Triangular Bandage It is also called cravat (French for necktie). Triangular bandage are named so because they are folded in triangular shape. These are commonly used to secure a dressing at one place especially when the dressing is too large. This kind of bandage is the only one that can be used from Head to Toe because of its quality of being folded into any size leading to varying utility. It is widely used. This can be made by cutting it diagonally a square of calico 100 cm. So that we can get two bandages with three borders. Further it has three corners. y One opposite to base is called point y The other two are called ends. Application of Triangular Bandage

1. As a cravat (folded triangular bandage): The point is folded to the center of the base and folded in half again from the top to the base to form a cravat. It is to apply pressure evenly over a dressing, to hold splints in place or used as a binder around a victim’s body to stabilize an injured arm in an arm sling (Figs 4.2A to C). 2. Fully opened (not folded): This is best used in case of an arm sling. 23

CHAPTER 4  Bandages

A triangular bandage may be applied in two ways:

FIRST AID MANUAL FOR NURSES

A

B

C

Figs 4.2A to C:  Triangular bandage as cravat

Uses of Triangular Bandage

UNIT II  Procedures and Techniques in First Aid

y

y

y

y

y y

24

When being folded as a thick rectangular cloth, the cravat can be placed over a large wound. Here, it will act like a trauma pad by controlling and stopping bleeding and absorbing the blood. When there is a traumatic injury, in that case one folded cravat can be used as a trauma pad while the second cravat can be used to wrap the wound and trauma pad. Here, the triangular bandage functions like a first aid tape to hold the trauma pad in place. Triangular bandage are of great importance during an arm injury as it can be used as a sling to support the arm in a bent position over the chest and the second cravat (folded as a long band) can be used around the torso as a swathe (blinder) to immobilize the arm against the chest. This technique is also known as swathe (Figs 4.3A and B). In case of broken leg, triangular bandage can be used to immobilize the leg with a blanket between the legs and a couple of cravat to tie the legs together firmly not too tight to restrict the circulation. If a victim has a sprained ankle or wrist, a cravat can be used like an ice bandage to wrap and support the appendage. If there is a head wound, triangular bandage can be wrapped over the forehead and around the top of the head to cover the wound.

FIRST AID MANUAL FOR NURSES

A

B

Tube Bandage This type of bandages can be applied with the help of an applicator and is woven in a continuous circle. It is used to hold dressings and splints on to the limbs or to provide support to sprains and strains. It also helps to stop the bleeding (Figs 4.4A and B). 25

CHAPTER 4  Bandages

Figs 4.3A and B:  Technique for applying fully opened triangular bandage

FIRST AID MANUAL FOR NURSES

A

B Figs 4.4A and B:  Tube bandage

Larger varieties support joints, hold dressings in place and can be used under a cast. The only drawback is that they are expensive and require an application.

UNIT II  Procedures and Techniques in First Aid

Adhesive Bandage This bandage sticks to the skin and do not require tape or other material to hold it onto the body. These are used for covering wounds or cuts, which may get infected if left open, e.g., Band-Aid (Fig. 4.5).

Fig. 4.5:  Adhesive bandage

26

FIRST AID MANUAL FOR NURSES

Tailed Bandage Tailed bandage consists of the T-bandage, the double T-bandage, the four tailed bandage and the many tailed bandage. These bandages are used to secure dressings to part which do not lend themselves to roller bandage applications. y The T-bandage: It is a t-shaped bandage which has a vertical strip of material sewn or pinned to the center of a horizontal strip. This bandage can be used on a scalp, eye, ear, or perineum bandage. y The double T-bandage: It is made by sewing two vertical strips of material to the center of a horizontal strip and about 4 inches apart. The double T-bandage may be used to hold dressings on the chest, back or perineum. y The four tailed bandage: It is a place of material 4–6 inches wide and about 30 inches long with each end cut about 12 or 14 inches down to middle leaving the center piece about 12–14 inches in length. It is used to hold dressings on the jaw, nose, forehead and the back of the head. y The many tailed bandage: It is similar to the construction of four tailed bandage except that the ends are cut into the desired number of tails about 16 inches in the length and uncut portion is about 20 inches in length.

TYPES OF BANDAGING

Spiral Bandaging This type of bandaging is used for the uniform thickness parts, i.e., finger or wrist. In this, each turn of the bandage overlaps the previous turn. This is preferred over the limb (Figs 4.6A to C). STEPS TO DO

CHAPTER 4  Bandages

1 Start from the distal end. 2 Turn the bandage in circular manner and overlap the previous turn. 3 In case of long bandage wrap down to the starting point.

27

FIRST AID MANUAL FOR NURSES

A

B

C

UNIT II  Procedures and Techniques in First Aid

Figs 4.6A to C:  Steps of spiral bandaging

Reverse Spiral It is also a type of spiral bandaging and usually used for the parts where the thickness varies (Fig. 4.7). For example, legs and forearms. STEPS TO DO 1 Start from the distal end. 2 Turn of spiral should overlap the preceding one by about threefourths of the previous and then reversed by placing a thumb in the center. It should be smooth and in between gap should not be there.

28

Fig. 4.7:  Reverse spiral bandaging of leg

FIRST AID MANUAL FOR NURSES

Figure-of-Eight This is basically used for the elbow and knee joints. This is applied in the manner of eight (8). This bandage is made by foaming two loops over a joint. The turns alternately ascend and descend to cover the part (Figs 4.8A and B).

A

B Figs 4.8A and B:  Figure-of-eight at knee

Spica This is also a type of figure-of-eight but here the turn is larger than the other. It is used for joints at right angle to the body. For example, the shoulder, groin and thumb (Fig. 4.9).

CHAPTER 4  Bandages

Fig. 4.9:  Spica bandage

29

FIRST AID MANUAL FOR NURSES

Shoulder Spica

It is also known as shoulder wrap. This immobile the part, provides joint comfort to an unstable shoulder. STEPS TO DO 1 S tand facing to the victim whose shoulder to be wrapped. Wrap the elastic bandage around the top of the biceps twice making or creating an anchor, pull moderately tight but do not take the stretch out of the bandage. 2 Wrap underneath the attempt over the top of the shoulder and the chest pulling tightly. Follow the wrap underneath the unaffected armpit and across the back and tightly over the shoulder, loop underneath the affected armpit and over the shoulder again back across the chest. 3 Overlap the bandage at least one-half width of the previous pattern. Repeat the pattern until the elastic bandage run out.

UNIT II  Procedures and Techniques in First Aid

4 Tape the finished end of the elastic wrap and follow the pattern back to secure around the anchor on the arm for an extra support wrap. It should resemble a figure 8 pattern. Hip Spica STEPS TO DO 1 T ake around 15 cm or 20 cm comfort foam layer. Bandage it with circular windings to cover the thigh as proximal as possible at the inner side of the leg till the thigh get covered. 2 K  eep continue bringing a circular turn around the waist to position the material so the opposite hip is covered. When coming back across the abdomen mold it by applying additional winding for support. 3 E nd the comfort form layer with around the abdomen cut and mold the underlying layer. 4 Complete the turn and secure with tape.

30

FIRST AID MANUAL FOR NURSES

Ankle Bandage STEPS TO DO 1 Anchor and secure the starting end of the bandage (Fig. 4.10). 2 Turn bandage diagonally across the top of the foot and around ankle. 3 Continue with overlapping figure eight turns. 4 Fasten end of bandage with clips, tape or safety pins.

Fig. 4.10:  Ankle bandage

Thumb Bandage STEPS TO DO 1 Wrap two circular turns around the wrist (Figs 4.11A and B)

3 Continue by making a turn around the thumb returning back to the wrist. 4 Use spiral turn to cover the whole thumb and secure it at the wrist.

31

CHAPTER 4  Bandages

2 T urn the bandage moving toward the back of the hand reaching the thumb.

FIRST AID MANUAL FOR NURSES

A

B Figs 4.11A and B:  A. Thumb bandage; B. Thumb spica

Finger Bandage

UNIT II  Procedures and Techniques in First Aid

STEPS TO DO 1 Cover the finger tip laterally with the bandage (Fig. 4.12). 2 From the base of the finger give turns to cover the finger. 3 Secure it properly.

Fig. 4.12:  Finger bandage

32

FIRST AID MANUAL FOR NURSES

Bandaging a Stump STEPS TO DO Above knee stump (Figs 4.13A to C): 1 If possible, make the victim stand on the other leg or the first aider should be kneeling behind the victim. 2 Start bandaging at the contralateral and then take an anchoring turn around the waist. 3 The bandage now reaches the buttocks to the lateral side of the stump. 4 Then further turn around the stump. 5 Spiral turn is taken toward the groin to under the perineum emerging on the buttocks where it crosses the original bandage. 6 Turn it around the waist and until it descends over the buttocks of the amputated side again. Cover it at the end of the stump.

B

A

CHAPTER 4  Bandages

C Figs 4.13A to C:  Steps in bandaging a stump

33

FIRST AID MANUAL FOR NURSES

Single and Double Eye Bandage STEPS TO DO

Single eye bandage (Figs 4.14A and B): 1 Use narrow or broad bandage depending on the side of the wound. 2 A  pply the center of the bandage on the pad and wind the bandage around the part.

UNIT II  Procedures and Techniques in First Aid

3 Tie in a place which will not cause discomfort to the victim in any position.

A

B Figs 4.14A and B:  Single eye bandage

Double eye bandage 1 A circular turn is made around the head. 2 Cover one eye. 3 The other eye is covered from the back of the head. 4 Give one turn to each eye alternatively. 5 Do not cover the nose. 6 Secure the pads by repeated turns. 7 Each turn should cover two-thirds of the previous turn. 8 Secure the bandage.

34

FIRST AID MANUAL FOR NURSES

Ear Bandaging Single Bandaging

It is same as eye. It requires three or four turns to cover the ear. In the end secure it.

y y y

Double Bandaging STEPS TO DO 1 Put a piece of the tape on the head at the outer corner of each eye in order to secure the bandage (Figs 4.15A and B). 2 The fixing turn round the head is taken in the upper margin of each dressing then passed behind the right ear, up in the front of it and reversed in the corner of the eye. It again crosses the forehead, reverses again and passes down over the front of the left ear and across the occiput. The side tape is secured.

A

B Figs 4.15A and B:  Ear bandage

STEPS TO DO 1 The tail of the bandage is to be kept below the affected breast. 2 A  pply the bandage across the trunk away from the affected side and take a circular turn around the trunk. 3 T ake another circular turn to secure the bandage ending below the affected breast. 35

CHAPTER 4  Bandages

Breast or Breast Binder

FIRST AID MANUAL FOR NURSES

4 Carry the bandage up over the affected breast at the lower border of the dressing to the opposite shoulder and down across the back to the auxilary line. 5 Apply another circular turn round the trunk by leaving one-third of previous turn exposed. 6 Carry over the bandage up over the breast again to the opposite shoulder by leaving one-third of the bandage exposed from the middle line of the body over the affected breast. 7

Bring the bandage down across the back and round the trunk again in the same way.

8 Continue the turns until the dressing is completely covered and fix the bandage at the center of the front of the trunk. 9 The trunk turns should not cover the breast but merely support it from below.

Jaw Bandage (Figs 4.16A and B) STEPS TO DO

UNIT II  Procedures and Techniques in First Aid

1  Barrel bandage is used to immobilize fractured jaw. 2

 one-meter-length of firm bandage is passed under the jaw and tied in A a half knot on the vertex.

3 T he two halves are separated one being pushed behind the occiput and other on the forehead. 4  The two free ends are brought up and tied firmly on the vertex over a pad.

A

B Figs 4.16A and B:  Jaw bandage

36

FIRST AID MANUAL FOR NURSES

Note If a barrel bandage is not available, it can be made of handkerchief, necktie or scarf. This is tied around the jaw to immobilize it. The bandage should be tied in such a manner that it can be easily removed in case of vomiting.

Capeline Bandage (Figs 4.17A to C) A bandage covering the head or an amputation stump like a cap. STEPS TO DO 1 Have two roller bandages and join their ends together. 2 Stand behind the casualty. 3 P  lace the joint in the center of the forehead and carry the bandage round the greatest circumference of head above the ears to occiput. 4  Cross the bandage now and carry one bandage up over the center of the head to forehead meanwhile carry the other straight on around immediately over the previous turn and bring it over the other turn at the forehead. 5 T urn the first bandage again and carry it back over the top of the head slightly to one side of center line to the occiput and carry the other round the head and over it at the back. 6 T urn the first bandage again and carry it back over the top of the head slightly to the opposite side of mid line and catch it by the other bandage at the forehead. 7 C  ontinue applying turns and bring the same bandage to go backward and forward over the head and work outwards leaving a third of the previous turn uncovered.

9 Continue till the whole dressing is complete. 10 T ake a circular turn around the head and pin it up at the center of the forehead.

37

CHAPTER 4  Bandages

8 C  arry the other bandage round and round the head to catch and hold down the backward and forward turns.

FIRST AID MANUAL FOR NURSES

A

B

UNIT II  Procedures and Techniques in First Aid

C Figs 4.17A to C:  Capeline bandage

Abdominal Binder and Bandages STEPS TO DO 1 With the bandage just below the wound, make two turns on the abdomen. 2 Alternatively, move the bandage slightly upward and downward with each of the turn overlapping one another. 3 The overlapping manner should be as such as to cover at least two-thirds of the previous turn. 4 Secure the bandage at the front of the abdomen.

38

FIRST AID MANUAL FOR NURSES

Reef Knot (Figs 4.18A to F) STEPS TO DO It is also called square knot. 1 Hold the end of the bandage one in each hand. 2 Lay the right hand bandage over the other. 3 Cross the ends in the right hand under and then over the left hand bandage to make a first turn. 4 Bring the right hand bandage over the left hand bandage to make the second turn. 5 Bring the original right hand rope over the other rope. 6 The original right hand rope is pulled under the other rope then pull on e both ends firmly to tighten. 7 Check the reef knot for a tidy appearance. 8 This knot is made on the part where the skin is not hurt or cause some discomfort.

B

C

D

E

F

Figs 4.18A to F:  Steps involved in reef knot

Caution y Keep the injured part of the body supported in the position it’ll be in when the bandaging is in process. y Always use the right size bandage – different parts of the body need different sizes of bandage 39

CHAPTER 4  Bandages

A

5 Splints and Slings SPLINTS When a victim has a fracture, the extremity is to be stabilized in order to prevent movement. Splints can be tied in place with bandages or strips of cloth torn from the clothing. This is usually done in the following cases: fracture, sprain in the arm or leg dislocation.

Purposes of Splints Following are the purposes of splints: y It helps to prevent further injury. y It reduces pain. y It helps to prevent damage to muscles, nerves and blood vessels. y It helps to minimize bleeding and swelling. y It prevents a closed fracture from becoming an open fracture.

Types of Splints It is of three types: 1. Soft splints: The soft splints are those which are made up of pillow, towel, folded blanket or a triangular bandage folded into a sling. Splints are usually used for stabilizing fracture of the lower leg or the forearm. 2. Anatomic splints: This type of splints are mostly used and are also known as self splint. In this, injured body part is tied to an uninjured part or splinting fingers together. For example, the legs can be tied together or an injured arm can be tied to the chest or an injured finger can be tied to an adjacent finger. 3. Rigid splints: This type of splints can be made from the piece of metal or plastic or from a padded board or even a rolled newspaper, magazine or thick cardboard can be used as rigid splint. A rigid splint must be long enough so that it can be secured well above and below the fracture site.

FIRST AID MANUAL FOR NURSES

Guidelines for Splinting (Figs 5.1 to 5.10) œ Before splinting the part, cover all the open wound if present with a dry, sterile dressing. œ Check CSM in the extremity. (CSM means circulation, sensation and movement.) œ Splint the part only if it does not cause more pain for the victim. œ Splint to immobilize the entire area with an extremity and splint the joint above and below the injured area. œ Put padding such as cloth between the splint and the victim’s skin. œ Put splint on the both sides of the fracture bone, if possible. œ If two first aiders are present, one should support the injured site and minimize movement of the extremity until splinting is complete. œ Apply splint firmly and not so tightly to affect the blood supply. Check CSM before and after applying a splint and if the pulse disappears, loosen the splint so that you can feel the pulse. Leave the fingers and toes exposed so that CSM can be checked easily. œ Elevate the splinted extremity, if possible promote gravity-induced drainage from the limb and reduce the swelling. œ Apply a cold pack to the injury around the splint. Do not apply ice if pulse is not felt. œ Check for sign and symptom of reduced circulation, for example, swelling, bluish discoloration, tingling or numbness, cold skin, apply ice on the injured part.

Splinting of Shoulder STEPS TO DO

CHAPTER 5  Splints and Slings

1

Fig. 5.1:  Splinting of shoulder

41

FIRST AID MANUAL FOR NURSES

Splinting of Humerus STEPS TO DO

1

2

UNIT II  Procedures and Techniques in First Aid

3

Fig. 5.2:  Splinting of humerus (upper arm)

Splinting of Elbow STEPS TO DO

1

42

FIRST AID MANUAL FOR NURSES

2

Fig. 5.3:  Splinting of elbow

Splinting of Forearm STEPS TO DO

CHAPTER 5  Splints and Slings

1

43

FIRST AID MANUAL FOR NURSES

2 Fig. 5.4:  Splinting of forearm

Splinting of Wrist, Hands and Fingers

UNIT II  Procedures and Techniques in First Aid

STEPS TO DO

1

2 44

FIRST AID MANUAL FOR NURSES

3 Fig. 5.5:  Splinting of wrist, hands and fingers

Splinting of Femur STEPS TO DO

CHAPTER 5  Splints and Slings

1

45

FIRST AID MANUAL FOR NURSES

2 Fig. 5.6:  Splinting of femur (thigh)

UNIT II  Procedures and Techniques in First Aid

Splinting of Knee STEPS TO DO

1 46

FIRST AID MANUAL FOR NURSES

2 Fig. 5.7:  Splinting of knee

Splinting of Both Legs STEPS TO DO



Splinting of Injured Leg STEPS TO DO

1

2

2 Fig. 5.8:  Splinting both legs together

CHAPTER 5  Splints and Slings

1

Fig. 5.9:  Splinting of injured leg with padded boards

47

FIRST AID MANUAL FOR NURSES

Fig. 5.10:  Splinting of ankle and foot

SLINGS

UNIT II  Procedures and Techniques in First Aid

A sling is a bandage or device used to support an injured part of the body especially forearm. A shirt or sweater can be used as a sling in an emergency situation.

Uses of Sling y y y y

It is worn in case of arm injuries. It immobilizes the arm. It helps to relieve pain. It helps to prevent injury from getting worse.

Do’s and Dont’s in Sling y A sling should neither be too tight (to impede the blood circulation) nor too loose (to fit the desired purpose). y Check the slinged arm for numbness or tingling. y Check the pulse after applying sling. y Check the skin around and near the sling. It should not be pale blue or cold to touch. y Before applying a sling, check for any serious cuts and the area should not bleed. y For forearm slings, use padding for the injured arm and tie the sling around the victim’s neck on the uninjured side. Contd... 48

FIRST AID MANUAL FOR NURSES

y In case of collar bone or shoulder slings, drape the long side of the bandage down from the shoulder on the uninjured side bring it over the victim’s arm and tie it behind their back. y Consult a doctor in case of severe bleeding, broken bone and dislocation of the joints.

Types of Slings There are mainly two types of slings: 1. One for forearm injury 2. One for a collar bone or shoulder injury One for Forearm Injury STEPS TO DO

(Clavicle, upper arm, forearm, wrist and rib) 1 Hold and place triangular bandage lengthwise against the victim’s upper body. The long side of bandage should extend down from their shoulder on the uninjured side. The shorter sides should point to the injured arm and meet near the elbow. Leave the tip of the bandage over the victim’s shoulder for now. 2 Gently place the victim’s injured arm over the bandage and across the chest. The wrist should be slightly higher than the elbow and the middle of the cloth’s long edge. 3 Support the injured arm with one hand with the other hand and place a padded layer, i.e., folded towel cloth or newspaper around the injured arm.

5 Tie the two ends of the bandage behind the victim’s neck on the uninjured side. This will avoid any strain on the injured site. 6 To stop the victim’s arm from slipping out of the sling, use safety pins or paper tape to secure it. One for Collar Bone or Shoulder Bone STEPS TO DO 1 Gently place the victim’s fingertips on their shoulder on the uninjured side. 2 Take one end of the triangular bandage and hold it near the victim’s fingertips. 49

CHAPTER 5  Splints and Slings

4 Bring the bottom of the bandage up over the injured arm and behind the victim’s neck.

FIRST AID MANUAL FOR NURSES

3 Tuck the bandage under the elbow so that it supports the victim’s arm on the injured side. 4 Bring the other end of the bandage behind the victim’s back and tie the two ends behind their neck.

UNIT II  Procedures and Techniques in First Aid

5 Tuck any extra fabric behind the sling near the elbow or use paper tape or safety pins to keep it in place.

50

6

Transportation of the Injured INTRODUCTION Moving a casualty is not only risky but can also worsen or aggravate a victim’s injury or condition. So a victim should not be moved until he/she is ready for transportation to a hospital if required or in case of an immediate danger, i.e., y In case of fire or danger of fire. y Explosive or in case of other hazardous material. y In cases when it is impossible to protect the accident scene from hazards. y In cases where it is impossible to gain access to the other victim’s in the situation (i.e., a vehicle) who need life saving care. y A cardiac arrest victim is usually moved unless he or she is already on the ground or floor because cardiopulmonary resuscitation must be performed on a firm surface.

PRINCIPLES OF TRANSPORTATION y y y y y

Always provide emergency care to the patient before shifting. Completely examine the body of the victim. Splint any fractures, if found. In case if there is bleeding, control it by applying pressure. Handle the victim carefully. Do not move the victim unnecessarily.

In Emergency Moves The major danger in moving a victim quickly is the possibility of aggra­ vating a spinal cord injury. In an emergency, every effort should be made to pull the victim in the direction of the long axis of the body to provide as much protection to the spinal cord as possible. If victim is on the floor or ground, you can drag him away from the scene by one of various techniques.

In Nonemergency Moves All injured parts should be stabilized before and during moving.

FIRST AID MANUAL FOR NURSES

ONE PERSON MOVES

Drag Shoulder Drag (Fig. 6.1)

For a shorter distance over a rough surface, this method is used. With the forearms, the victim’s head is stabilized and the victim is dragged.

Fig. 6.1:  Shoulder drag

UNIT II  Procedures and Techniques in First Aid

Ankle Drag (Fig. 6.2)

This method can be done on a smooth surface. This is the fastest method for a short distance. The victim is held by the rescuer’s both hands from the ankles and dragged.

Fig. 6.2:  Ankle drag

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Blanket Pull (Fig. 6.3)

Roll the victim onto a blanket and pull from behind his head.

Fig. 6.3:  Blanket pull

Helping Victim to Walk or Human Crutch STEPS TO DO 1 The victim should be conscious for this procedure (Fig. 6.4).

3 Help the victim stand with himself/herself on unaffected side of the victim. 4 Ask the patient to walk while you support the injured side.

Fig. 6.4:  Human crutch

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CHAPTER 6  Transportation of the Injured

2 Explain the steps of this method to victim.

FIRST AID MANUAL FOR NURSES

Cradle Carry (Fig. 6.5) This method is used for children and lightweight adults who are unable to walk. It cannot be used for heavy patients. In this method, one carries the casualty on his arms just like carrying a baby.

Fig. 6.5:  Cradle carry

UNIT II  Procedures and Techniques in First Aid

Fireman’s Carry (Fig. 6.6) This is used in victims who are uncon­ scious. STEPS TO DO 1 Reassure the casualty. 2 Help the casualty to rise to the upright position. 3 Grasp his right wrist with your left hand. 4 Bend down with your head under his extended right arm (so that your right shoulder is at the level with the lower part of his abdomen). 5 Place the right arm around his legs. 6 Rise to the correct position taking his weight on your right shoulder. 54

Fig. 6.6:  Fireman’s carry

FIRST AID MANUAL FOR NURSES

Pack Strap Carry (Fig. 6.7) When injury makes the fireman’s carry unsafe, this method is used. It is best for longer distances than the one person lift.

Fig. 6.7:  Pack strap carry

CHAPTER 6  Transportation of the Injured

Piggy Back Carry (Fig. 6.8) This method is used when the victim does not have any fractured limb and cannot walk but can use the arms to hang onto the rescuer.

Fig. 6.8:  Piggy back carry

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TWO OR THREE-PERSON MOVES Two person, assist in helping the victim to walk.

Four-Handed Seat Carry (Figs 6.9A and B) This method is used when the victim is conscious and is able to assist the first aider by using one or both arm. STEPS TO DO 1 The two rescuers kneel on the knee (opposite). 2 Both the rescuers now stretch their hands at the front. 3 Afterward each rescuer holds his right wrist by left hand and with right hand he holds other rescuer’s left wrist. 4 Now a seat has been created for the victim to sit.

UNIT II  Procedures and Techniques in First Aid

5 The rescuers then stand up and walk slowly with the victim sitting on that seat.

A

B Figs 6.9A and B:  Four-handed seat carry

56

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Two-Handed Seat Carry (Fig. 6.10) STEPS TO DO 1 T his method is used in case a victim is having a hand fracture and cannot catch the helper. 2 B  oth the helpers stand face to face by the side of the injured person and hold him by one hand from the chest line. 3 N  ow they lift him slightly and catch each other’s fingers by holding hand from the middle portion of his thighs. The left side helper should keep his palm toward the lower side by forming shape of hook with the help of fingers. Both should catch a handkerchief or some cloth tightly. Now both helpers should start walking slowly.

The Fore and Aft Method (Fig. 6.11) STEPS TO DO 1 This method is used when sufficient space is not there for the use of chair. In this method, one helper catches the injured person by putting his hand under the knees and the other helper catches him by encircling his chest. Both the helpers carry the injured person slowly. 57

CHAPTER 6  Transportation of the Injured

Fig. 6.10:  Two-handed seat carry

FIRST AID MANUAL FOR NURSES

Fig. 6.11:  Fore and aft method

UNIT II  Procedures and Techniques in First Aid

Chair Lift Any ordinary chair can be used for this method. Sometimes a wheelchair can also be used for the same. STEPS TO DO 1 The chair should be strong and sturdy enough to carry the casualty. 2 A  ssist the casualty to sit on the chair and secure him/her in position with a broad bandage. 3 Stand facing each other one in front and one behind the casualty. 4 Support the back of the chair. 5 Tilt the chair backward slowly to secure the casualty. 6 Lift the casualty in chair and move off together in the same pace.

58

7 Stretchers INTRODUCTION The safest way to carry an injured victim is on a stretcher. It is used to carry seriously ill or injured casualties to an ambulance or to a shelter.

PRINCIPLES OF STRETCHER y y y y

Check the stretcher and make sure that it is in a working condition. Check that the stretcher is strong enough to bear the weight of the casualty. Explain and reassure the casualty before placing him on the stretcher. The casualty in case of conscious and restless is to be secured before moving.

TYPES OF STRETCHER

Standard Stretcher or the Furley Stretcher (Fig. 7.1) This is a standard first aid equipment which consists of: y y y y

A canvas and plastic sheet Carrying poles Handles Transverse and canvas bed: The transverse ends are so joined that the stretcher can be opened and closed. When closed, the poles lie close together with the canvas bed folded at the top.

Fig. 7.1:  Standard or Furley stretcher

FIRST AID MANUAL FOR NURSES

Pole and Canvas Stretcher (Fig. 7.2)

UNIT II  Procedures and Techniques in First Aid

It is most commonly used for lifting the casualty. It consists of a canvas or plastic sheet with handles and side sleeves and a pair of carrying poles. The stretcher is made firm by inserting the spreading bars over the ends. The stretcher helps to move the casualty from one to another stretcher or from a stretcher to a trolley.

Fig. 7.2:  Pole and canvas stretcher

Improvised Stretcher (Fig. 7.3) It is used in emergency situation where stretcher is unavailable. A hard surface like advertising board door is used.

Fig. 7.3:  Improvised stretcher

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Trolley Cot (Fig. 7.4) These are the adjustable stretcher beds on wheels with brakes. It can be adjusted to suit the casualty condition.

Fig. 7.4:  Trolley cot

LOADING A STRETCHER This means the method by which the casualty is transferred from the accident site to the stretcher. There are two methods that can be used to shift the casualty from the site to the stretcher. These are as follows:

1.  Blanket Lift (Fig. 7.5) STEPS TO DO 1 Four persons are required for this lift. 2 Place the folded blanket lengthwise alongside the casualty against the back.

4 Two persons should stand on either side of the casualty. 5 On command lift the casualty together.

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CHAPTER 7  Stretchers

3 Turn and support the casualty in supine position and tightly roll the open ends of the blanket toward the casualty.

FIRST AID MANUAL FOR NURSES

Fig. 7.5:  Blanket lift

UNIT II  Procedures and Techniques in First Aid

2.  Manual Lift (Fig. 7.6) This method is used in those conditions where blankets/sheets are unavailable.

Fig. 7.6:  Manual lift

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Principles of Lifting Know your capabilities. Do not try to handle too heavy or awkward load rather seek help. Use a safe grip. Use as much of the palms as possible. Keep the back straight. Tighten the muscles of the buttocks and abdomen. Bend knees to use the strong muscles of thighs and buttocks. Keep arms close to the body and elbows flexed. Position feet, shoulder width for balance one in front of the other. When lifting, keep and lift the victim close to your body. While lifting, do not twist your back. While lifting and carrying, do so slowly, smoothly and in unison with other helpers. œ Before moving the victim, tell him/her what you are doing. œ œ œ œ œ œ œ œ œ œ œ

Caution y In case of lifting heavy person, never bend over from the waist, grab him and use your back muscles to lift him. y Do not twist when lifting.

CHAPTER 7  Stretchers 63

4

8

Basic Life Support INTRODUCTION Basic life support (BLS) is a life-saving skill that depends upon the victim’s condition and need. Heart attack is the main cause of death. Apart from this, a few main conditions leading to heart stoppage or cardiac arrest are electrocutions drug intoxication, drowning and suffocation. Many victims can be saved if the life-saving skill is performed within time, also called resuscitation. These skills are: y Rescue breathing: This provides the required amount of oxygen into the lungs. y Chest compression: This helps in pumping oxygenated blood to the vital organs. y Automated external defibrillator (AED): This is an electronic device that analyzes the heart rhythm and delivers an electrical shock to the heart of a person in cardiac arrest in an effort to reestablish a heart rhythm that will generate a pulse. y Choking care: It includes chest compression in order to expel an obstructing object from the airway.

CARDIAC ARREST Cardiac arrest refers to a sudden stop of the breathing. or Stoppage of cardiac functions which can be reversible.

Causes of Cardiac Arrest There are number of reasons given below: y Heart attack y Airway obstruction y Electrocution y Traumatic injury like head injury

FIRST AID MANUAL FOR NURSES y y y y y y

Certain medications like cardiac drugs and overdose of depressant drugs Drug abuse or overdose Drowning Myocardial infarction Hypothermia Electrolyte disorder

How to Identify a Cardiac Arrest Victim or Sign and Symptoms of Cardiac Arrest y y y y y y

Absence of carotid and femoral pulse Apnea Dilated pupils Unconsciousness Cyanosis Seizure

Recovery Position (Figs 8.1A to D) It is used in an unresponsive victim who is breathing when found or after receiving BLS. The aim of putting the victim in this position is as follows: y Helps to keep the airway open y Allows fluid to drain from the mouth y Prevents aspiration in case a victim vomits.

A

CHAPTER 8  Basic Life Support

Fig. 8.1A

65

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B

UNIT II  Procedures and Techniques in First Aid

C

D

Figs 8.1A to D:  Steps involved how to move a person into the recovery position

66

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Recovery Position (Adult or Child) STEPS TO DO 1 E xtend the victim’s arms that is farther from you above the victim’s head (usually left arm) 2 Position the victim’s other arm across the chest. 3 Bend the victim’s nearer leg at the knee. 4 P  ut your forearm that is nearer the victim under the victim’s nearer shoulder with your hand under the hollow of the neck. 5 C  arefully roll the victim away from you by pushing on the victim’s flexed knee and lifting your forearm while your hand stabilizes the head and neck. The victim’s head is now supported on the raised arm. 6 W  hile continuing to support, the head and neck position, the victim’s hand palm down with fingers under the armpit of the raised arm with forearm flat on the surface at 90° to the body (i.e., tilt on left side). 7 W  ith the victim now in position, check the airway and open the mouth to allow drainage. Recovery Position in Infant 1 H  old the infant face down on your arm with the head slightly lower than the body. 2 S upport the head and neck with your hand, keeping the mouth and nose clear.

Before proceeding for rescue breathing, the victim is assessed for whether he/she is breathing. If the victim is breathing and is unresponsive, then put him/her in recovery position. Since the victim who is not breathing may be in cardiac arrest. So ask someone to call EMS number immediately and if possible arrange for AED.

Methods for Performing Rescue Breathing Mouth-to-Mouth Method (Fig. 8.2)

This method is the simplest, easiest, quickest and effective method in case of an emergency. Pinch the victim nose shut and seal your mouth over 67

CHAPTER 8  Basic Life Support

RESCUE BREATHING

FIRST AID MANUAL FOR NURSES

Fig. 8.2:  Mouth-to-mouth method

the victim’s mouth. Now breath into victim’s mouth while watching rose in the chest confirming air going in.

UNIT II  Procedures and Techniques in First Aid

Mouth to Nose

This method is used in the cases where it is difficult to open the mouth of the patient for example, in certain cases where mouth is injured. Hold the victim’s mouth and closed seal your mouth over the nose in order to breath in and then let the mouth open to let the air escape. Mouth to Stoma

This is practiced in case where patient are part of some past illness, injury and for some reasons where breathing through hole in their neck is called stoma. In such cases, in order to check ABCs, check this hole to see victim’s breathing pattern. Cup your hand over the victim’s mouth and nose seal your barrier device or your mouth over the stoma and have rescue breaths. Mouth to Barrier Device (Fig. 8.3)

A mouth to barrier device is an apparatus that is placed over a 68

Fig. 8.3:  Mouth to barrier device

FIRST AID MANUAL FOR NURSES

victim’s face as a safety precaution for the rescuer during rescue breathing. Two types of mouth to barrier devices are used: 1. Masks 2. Face shields.

CARDIOPULMONARY RESUSCITATION (CPR) Introduction Cardiopulmonary resuscitation (CPR) is a life-saving measure that can be used in a number of emergency situations where the heart stops beating or when the victim is not able to breathe normally, i.e., gasping or no breathing at all, e.g., heart attack, near drowning, suffocation, etc. in which someone’s breathing or heartbeat has stopped. CPR is a technique of pushing down on a person’s chest and breathing into his/her mouth. This helps move blood to the victim’s brain to help prevent brain damage until and unless medical professional arrives. The American Heart Association recommends that every individual whether trained or untrained should be able to begin CPR with chest compressions as it is better to do something than to do nothing. As such an effort of doing something can help to save a precious life.

Advice from American Heart Association For an untrained: If a person is not trained in giving CPR, then that person can provide hands-only CPR. This is uninterrupted chest compressions of 100–120 per minute until the arrival of paramedics. An untrained person need not to try any rescue breathing. y Trained and ready to go: In case of a trained person and if the person is confident, then check the victim for breathing and presence of pulsation. If there is no breathing or pulse within 10 seconds, begin chest compressions. Start CPR with 30 chest compressions before giving two rescue breaths. y Trained but rusty: If one has received a training on CPR previously but is not confident, then just deliver chest compressions at the rate of 100–120 per minute. The above advice applies to adults, children and infants requiring CPR but not newborns (infants up to 4 weeks old) y

CHAPTER 8  Basic Life Support

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Importance of CPR a. CPR keeps oxygenated blood flowing to the brain and other vital organs, still definitive medical treatment is provided to restore the normal heart rhythm. b. When the heart stops, the lack of oxygenated blood can cause brain damage in only a few minutes, a person may die within 8–10 minutes.

UNIT II  Procedures and Techniques in First Aid

Preliminaries (What all to Check Before Beginning CPR) 1. Safety of the environment for the person. 2. The victim for being conscious/unconscious. 3. If the victim is unconscious, tap or shake his/her shoulder and ask loudly “are you ok”. 4. If the person does not respond and there are two rescuers then: ƒ Have one person call local emergency number and get the AED (If one is available) ƒ Have the other rescuer begin CPR 5. If you are alone and have immediate access to a telephone, call emergency number before beginning CPR. Get the AED (if one is available). 6. As soon as an AED is available, deliver one shock, if instructed by the device, then begin CPR. Steps of CPR (Cardiopulmonary Resuscitation) STEPS TO DO Remember to follow steps given by the American Heart Association, i.e., letters: C-A-B 1 C–Compressions 2 A–Airway 3 B–Breathing Points to be Checked before the Beginning of CPR y y

70

Check whether the victim is conscious or unconscious. If the victim appears unconscious, shake him/her shoulder ask loudly “Are you OK?” (Fig. 8.4).

FIRST AID MANUAL FOR NURSES

Fig. 8.4:  Ask the victim if he/she is ok y y

y y

If a person does not respond and you are alone, immediately call the emergency number to see help (Fig. 8.5). Before the beginning of CPR, except in case of drowning when the victim is suffocated, then begin CPR for a minute and then call 108 or local emergency number. If there are two rescuers, one should call the emergency number and the other should start the CPR. If an AED is immediately available then deliver one shock by the device, if instructed and start CPR.

CHAPTER 8  Basic Life Support

Fig. 8.5:  Call at 108 (emergency number)

Compression

The aims of compression help in restoring the blood circulation. STEPS TO DO 1 Place the victim or lie the victim on his/her back on a firm surface. 2 Kneel next to the victim’s neck and shoulder (Fig. 8.6). 71

FIRST AID MANUAL FOR NURSES

Fig. 8.6:  Position for giving compression to the victim

3 Place the heel of one hand over the center of the person’s chest between the nipples/lower half of breast bone midway between the nipples.

UNIT II  Procedures and Techniques in First Aid

4 Place the other hand on top of the first hand. The elbows should be straight and positioned directly above the hands (Fig. 8.7). 5 Use the upper body weight (not just your arms) as you push straight down on (compress) the chest at least 2 inches (approximately 5 cm) but not greater than 2.4 inches that is (approximately 6 centi­meters). Push hard at the rate of 100–120 compressions in a minute (30 compressions and two breaths). If a person (rescuer) is alone then give 15 compressions and one breath.

Fig. 8.7:  Position of hands during compression

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6 If you are not trained in CPR then continue chest compression till the signs of movement appear or until emergency medical personnel arrives. Whereas if you are trained in CPR, go on checking the airway and rescue breathing. Airway

Victim’s airway should be patent, for this open the victim’s airway using head tilt chin lift maneuver (Fig. 8.8). STEPS TO DO 1 Put your palm on the person’s forehead and gently tilt the head back then with the other hand gently lift the chin forward to open the airways. 2 Check the victim for normal breathing pattern for about not more than 5 or 10 seconds. 3 Look for the chest motion or movement.

Fig. 8.8:  Head tilt chin lift

4 Listen for normal breathing sound. 5 Feel for the victim’s breath on your cheek or ear. 6 If the victim is not breathing normally, begin mouth to mouth breathing (if trained in CPR). 7 If the victim is unconscious (may be heart attack) and you are not trained in emergency procedure, skip mouth to mouth breathing and continue chest compression.

The aim of the breathing is breath for the victim. Rescue breathing may be mouth-to-mouth or mouth-to-nose in case the mouth is seriously injured or cannot be opened. STEPS TO DO 1 Open the airway (head tilt chin lift maneuver). Pinch the nostril shut for the mouth to mouth breathing. Cover the victim’s mouth with your mouth making a seal (Figs 8.9A and B). 2 Get ready to give oxygen rescue breath. 73

CHAPTER 8  Basic Life Support

Breathing

FIRST AID MANUAL FOR NURSES

A

B

UNIT II  Procedures and Techniques in First Aid

Figs 8.9A and B:  Rescue breathing

3 If the chest does not rise with the first rescue breath, then give the second breath. If again the chest does not rise, repeat the (head tilt chin lift maneuver) and then give the second breath. 30 chest com­pressions and two breaths are considered as one completed cycle. 4 Resume chest compression to restore circulation. 5 After the completion of the five cycles (about two minutes) even if the victim has not begun moving and an (AED) automated external defibrillator is available, apply it (administer one shock). 6 After giving one shock with AED then resume CPR starting with chest compressions for two more minutes before administering a second shock. If one is not trained in using AED, then one can seek guidance from emergency medical operator. 7 In case where AED is not available, then follow the below written step. 8 Continue giving CPR until the sign of movement appears or emergency medical personnel arrives or take over.

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To Perform CPR on a Child (1–8 Years) The procedure for giving CPR to a child is same as for the adult except the below written steps. STEPS TO DO 1 If there is only one rescuer, perform five cycles of compressions and breath to the child. This will take two minutes (Fig. 8.10). 2 Use AED. 3 Call at local emergency number after the first step. 4 In case the rescuer is trained in using AED, even then perform the step one before using AED. 5 Use only one hand to perform chest compression. 6 Breathe more gently. 7 Use the same ratio of compression and breaths as for adults, i.e., 30 compressions followed by two breaths. This will be completing one cycle. 8 After providing the two breaths at once, begin the next cycle of compressions and breaths.

CHAPTER 8  Basic Life Support

Fig. 8.10:  Give 5 cycles of compressions

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FIRST AID MANUAL FOR NURSES

9 After completing five cycles (about five minutes) of CPR if there is no response and there is the availability of AED, apply it. In case of children, pediatric pads are used. 10 Never use AED for infants (children younger than the age of one year). 11 Administer one shock then start CPR beginning with chest compression for two more minutes before administering. 12 If the first aider is not aware of how to use AED, he/she should do it under the guidance of emergency medical operator. 13 Continue until the child moves or help arrives.

To Perform CPR on Infant (0–1 Year) The cause of arrest in babies occurs from lack of oxygen from drowning or choking. y If you know that the infant has an airway obstruction, then perform first aid for choking. y If the cause of the infant not being able to breathe is not known, then immediately perform CPR.

UNIT II  Procedures and Techniques in First Aid

STEPS TO DO 1 Check the scene. 2 Examine the situation. 3 Stroke the baby and watch for a response (Fig. 8.11). 4 Never shake the infant. 5 If the infant does not respond, follow ABC (airways, breathing, compression). 6 I f you are only one rescuer and CPR is required, perform it for two minutes, i.e., five completed cycles before calling local emer­gency numbers (Fig. 8.12).

Fig. 8.11:  Stroke the baby

7 I f another rescuer is with you, ask him to call the local emergency contact number while you attend the infant. 76

FIRST AID MANUAL FOR NURSES

Fig. 8.12:  Give 5 completed cycles of CPR

Compression in Case of Infant

The aim of compression in case of infant is to restore the blood circulation. STEPS TO DO 1 Put the baby on his/her back on a firm, flat surface. It can be on the floor, ground or table.

Fig. 8.13:  Compress the chest

3 Compress the chest gently about 1.5 inches (4 cm) and compressions are to be given at a rate of 100 compressions in two minutes.

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CHAPTER 8  Basic Life Support

2 Imagine a horizontal line drawn between the baby’s nipple. Place two fingers of one hand just below this line in the center of the chest (Fig. 8.13).

FIRST AID MANUAL FOR NURSES

Airway STEPS TO DO 1 Victim’s airway should be patent, for this open the victim’s airway using head tilt chin lift maneuver.

UNIT II  Procedures and Techniques in First Aid

2 Check for breathing within 10 seconds by placing your ear near the baby’s mouth. Look for chest movements, listen breath sound and feel for breath on your cheek and ear (Fig. 8.14).

Fig. 8.14:  Listen breath sounds

Breathing STEPS TO DO 1 With your mouth seal the baby’s mouth and nose. 2 Give two rescue breaths. With the strength of your cheeks to deliver gentle puff of air (rather than deep breaths from your lungs) and to slowly breathe into the baby’s mouth one time, take one second for the breath. Watch to see if the baby’s chest rises. If it does, give a second rescue breath. If the chest does not rise, repeat the head tilt chin lift maneuver and then give the second breath (Figs 8.15A and B). 3 If still the infant’s chest does not rise, check immediately for any foreign material.

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A

B Figs 8.15A and B:  A. Give 2 rescue breaths; B. Perform head tilt chin lift maneuver

1 Give two breaths after every 30 compressions. 2 Perform CPR for 2 minutes before calling for help. Continue CPR till there are signs of life or medical help arrives.

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CHAPTER 8  Basic Life Support

If an object is present, sweep it out with your finger. If the airway seems to be blocked, perform first aid for a choking baby.

FIRST AID MANUAL FOR NURSES

UNIT II  Procedures and Techniques in First Aid

ADULT BASIC LIFE SUPPORT ALGORITHM FOR HEALTHCARE PROVIDERS

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BLS FOR HEALTHCARE PROFESSIONALS CABs of CPR

CHAPTER 8  Basic Life Support 81

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UNIT

III First Aid in Emergencies

Unit Outline  First Aid Assessment: Primary and Secondary Survey  Asphyxia  Drowning  Heart Attack  Shock  Fainting  Wound  Hemorrhage/Bleeding  Injuries to the Bones, Joints and Muscles  Hanging/Throttling/Strangulation  Falls  Burns  Poisoning  Bites and Stings  Foreign Body in the Eye  Foreign Body in the Nose  Foreign Body in the Mouth/Choking  Foreign Body in the Ear  Frostbite  Heat Exhaustion and Heatstroke  Abdominal Injuries  Chest Injuries  Crush Injuries  Sprain and Strain

9

4

First Aid Assessment: Primary and Secondary Survey INTRODUCTION First-aider should perform quick and thorough assessment of the victim and the surroundings in order to preserve life, prevent further worsening of the condition and promote recovery of the victim. Ideal assessment should be conducted rapidly but with a calm approach; it should analyze the situation and the casualty. This would be helpful in prompt diagnosis and immediate treatment of the condition. y

y

Assessing the situation: Thoroughly assess the situation and decide the priority. Assessment of the situation includes the hazards (e.g., fire, road traffic accidents, falls, exposure to gas and fumes, electrical contact, collapsing buildings, etc.) that can pose danger to the human life. Maintaining safety during the assessment is of utmost importance to guard oneself and the victim against casualties. Assessment of the victim: Assessment of the victim includes a thorough examination of breathing difficulties, circulatory compromise, uncontrolled or severe bleeding, open chest or abdominal wounds, or any other life-threatening condition.

Quick and systematic assessment helps in classifying the patients as per their severity and need of care. It is divided into primary and secondary survey as discussed here: Primary survey is an approach to the initial evaluation of criticallyill or injured patients performed in order: y y y y y

Airway (check if airway is patent by asking patient to speak and inspecting mouth/larynx) Breathing (measure pulse oximetry and inspect/auscultate the chest wall) Circulation (palpate pulses and measure blood pressure) Disability [assess the Glasgow Coma Scale (GCS) and pupillary size] Exposure (undress the patient and examine for occult injury; palpate for vertebral tenderness and rectal tone)

FIRST AID MANUAL FOR NURSES

PRIMARY SURVEY The primary survey is the first step in the treatment of trauma patients. Advanced Trauma Life Support, or ATLS, is another name for it. The primary survey consists of five phases (ABCDE method) that must be completed in the correct order. 1. Airway Assessment (Cervical Spine Stabilization) STEPS TO DO 1 The patient has a patent airway if he or she answers questions correctly (at least for the moment). 2 Keep an eye on the patient for any signs of respiratory distress. 3 Examine the patient’s mouth and larynx for any injuries or obstructions (e.g., blood, vomit, burns, soot). 4 Assume cervical spine injury in blunt trauma patients until proven otherwise. 5 The chances for intubation are particularly less if the patient is unconscious (and thus unable to guard their airway) or in respiratory distress. 6 Patients with burn injuries and signs of respiratory involvement (e.g., soot in the oropharynx) are frequently intubated as a precaution. 7 Perform a cricothyrotomy, if orotracheal intubation is difficult. Nursing Assessment

Tachypnea, use of accessory muscles of respiration and stridor are the signs of respiratory distress.

UNIT III  First Aid in Emergencies

2. Breathing STEPS TO DO 1 Pulse oximetry can be used to check your oxygenation levels. 2 Examine and listen for injury to the chest wall (e.g., absent breath sounds, asymmetric or paradoxical movement). 3 Do not delay the treatment of a tension pneumothorax or hemothorax in an unstable patient, just for the purpose of imaging. 3. Circulation and Hemorrhage Control STEPS TO DO 1 Palpate central (e.g., carotid, femoral) and peripheral (e.g., radial, popliteal, posterior tibial, dorsalis pedis) pulses to determine circulatory condition. 2 For blood typing and crossmatch, as well as resuscitation, set up two large-bore intravenous lines (at least 16 gauge) (if needed). 86

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3 If placing an intravenous line is impossible or difficult, an intraosseous line should be utilized instead. 4 Manual pressure or tourniquets can be used to stop bleeding that is not stopping. 5 Patients who have recently lost their pulses may require an emergency thoracotomy (especially in patients with stab wounds to the chest). 6 If patient is hypotensive, administer a bolus of intravenous saline. Clinical Consideration

Transfuse plasma, platelets and red blood cells in a 1:1:1 ratio if there is severe hemorrhage and chronic hemodynamic instability. It treats and prevents coagulopathy associated with massive hemorrhage. y

Note FAST AND eFAST In trauma patients, a quick, standardized bedside ultrasonographic test is utilized to screen for free fluid (especially blood). It can be extended FAST (eFAST) to include a pneumothorax examination. y

Remember that blood loss due to hypovolemic shock requires a blood up to approximately 1.5 L. Keep in mind the compartments where a lot of blood could end up: ƒ Outside (external hemorrhage) ƒ Thoracic cavity ƒ Pelvic cavity ƒ Abdominal cavity ƒ Thighs (e.g., multiple femur fractures)

4. Disability (Neurological Evaluation) STEPS TO DO 1 Determine the GCS score of the patient. 2 Intubation is recommended if the GCS score is less than 8. 3 Examine the size of patient’s pupils. 4 Assess motor function and light touch sensation if the patient is cooperative. 87

CHAPTER 9  First Aid Assessment: Primary and Secondary Survey

The Focused Assessment with Sonography for Trauma (FAST) examination is usually conducted, especially on patients who are hemodynamically unstable. In hemodynamically stable patients, it may be done during the secondary survey.

FIRST AID MANUAL FOR NURSES

5. Exposure (Environmental Control) STEPS TO DO 1 Completely undress the patient. 2 Examine the entire body, especially the patient’s back, for evidence of occult injury. 3 Cover the patient with warm blankets and warm intravenous fluids if he or she is hypothermic. 4 Check for spinal injuries and vertebral tenderness and rectal tone by palpating them.

SECONDARY SURVEY An assessment is performed in critically-ill or injured patients if they are determined to be stable after a primary survey. It includes a focused history, more thorough physical examination, and select diagnostic studies (e.g., imaging). It can detect commonly missed injuries (e.g., aortic, rectal and ureteral injuries). y y y

UNIT III  First Aid in Emergencies

y

After the primary survey has been finished and the patient has been pronounced stable, this procedure is carried out. A complete medical history and a comprehensive physical examination are required. Additional diagnostic tests are customized to the patient’s residual symptoms, damage mechanism and comorbidities. The main goal is to reduce the number of injuries that go unnoticed.

The secondary survey must be completed quickly following the given order:

History Taking A detailed history should be collected about the event and previous medical history. The following points should be kept in mind while collecting history from the victim or his caregiver: y Identify the cause of the incident such as whether it was caused by disease or an accident. y Inquire about the medication the victim is taking. y Inquire about the medical history. Check to see if there are any ongoing or previous disease conditions. y Determine whether a person has any allergies such as to medicines or latex.

88

FIRST AID MANUAL FOR NURSES y y

Check when the person last had something to eat or drink. If you see a medical warning bracelet, it could mean you have an ongoing medical condition, like epilepsy, diabetes, or allergy.

Quick Reminder Use the mnemonic AMPLE when assessing a casualty to ensure that you have covered all aspects of the casualty’s history: A —Allergy—does the person have any allergies? M —Medication—is the person on any medication? P —Previous medical history—do you know of any pre-existing conditions? L —Last meal—when did the person last eat? E —Event history—what happened?

Physical Examination

Medical Cues Medications: A victim may be carrying medications for his existing disease condition. Such as: anti-inflammatory for arthritis, or nitroglycerin for angina.

Insulin pen: This indicates that a person is diabetic.

Inhaler/puffer: This indicates that a casualty has asthma or any restrictive respiratory condition.

Fig. 9.1:  External cues

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CHAPTER 9  First Aid Assessment: Primary and Secondary Survey

Look for external cues: Look for various external indicators about a casualty’s condition as part of your assessment (Fig. 9.1).

FIRST AID MANUAL FOR NURSES

Head and Face

Inspect the face and scalp. Look for: y

Bleeding, lacerations, bruising, depressions or irregularities in the skull, Battle’s sign (bruising behind the ear indicative of a base of skull fracture).

Look specifically at the: y y y y y y

Eyes: For foreign bodies, subconjunctival hemorrhage, hyphema, irregular iris, penetrating injury, contact lenses. Ears: For bleeding, blood behind tympanic membrane (suggestive of base of skull fracture). Nose: For deformities, bleeding, nasal septal hematoma, CSF leak. Mouth: For lacerations to the lips, gums, tongue or palate. Teeth: For subluxed, loose, missing or fractured teeth. Jaw: For pain, trismus, malocclusion suggestive of fracture.

Palpate the: y y

Bony margins of the orbit, the maxilla, the nose and jaw. The scalp/skull looking for evidence of fracture.

Test eye movements, pupillary reflexes, vision and hearing Neck

UNIT III  First Aid in Emergencies

Inspect the neck—it is necessary to open the collar to do this—while maintaining manual in-line stabilization of the neck. Examine the anterior neck (as per the primary survey), checking for: y y y y y y

Tracheal deviation Wounds/bruising to the neck Subcutaneous emphysema Laryngeal tenderness Distention of the neck veins Carotid pulsation and the presence of a hematoma, listen for a bruit

Assess the cervical spine by palpation of the cervical vertebrae. Chest

Inspect the chest, observe the chest movements. Look in particular for: y y

90

Bruising (from seat belts) Asymmetric or paradoxical chest wall movement

FIRST AID MANUAL FOR NURSES y

Penetrating wounds are rare in children, but in cases where there is a stabbing or other assault look for “hidden” wounds—checking areas such as the axilla and back.

Palpate for clavicular and rib tenderness and auscultate the lung fields and heart sounds. Abdomen

Inspect the abdomen, the perineum and external genitalia. Look in particular for: y y y

Seat belt bruising/handlebar injuries Distention and rigidity or tenderness, which could indicate internal bleeding Blood at the urinary meatus/introitus

Pelvis

Inspect the pelvis for grazes over the iliac crest. Examine for bruising, deformity, pain or crepitus on movement. Check clothing for any evidence of incontinence, which suggests spinal or bladder injury, or bleeding from orifices, which suggests pelvic fracture. Limbs

Inspect all the limbs and joints, palpate for bony and soft tissue tenderness and check joint movements, stability and muscular power. Examine sensory and motor function of any nerve roots or peripheral nerves that may have been injured. Back

A log roll should be performed either in the primary survey or in the secondary survey. Inspect the entire length of the back and buttocks. y y

Palpate, then percuss, the spine for tenderness. Palpate the scapulae and sacroiliac joints for tenderness. Inspect the anus. Digital examination is rarely needed—if it is indicated, it should only be performed once. 91

CHAPTER 9  First Aid Assessment: Primary and Secondary Survey

Palpate for areas of tenderness, especially over the liver, spleen, kidneys and bladder, and auscultate bowel sounds.

FIRST AID MANUAL FOR NURSES

Further Planning and Documentation y y y y

y

Any injuries discovered during the inspection should be accurately documented. Any immediate treatment, such as covering wounds and splinting fractures, should be administered. Analgesia, antibiotics, or tetanus immunization should all be prescribed. Following the secondary survey, the priorities for further investigation and treatment can be reviewed, and a definitive care plan can be formed. The patient may require advanced imaging in computed tomography (CT), as well as relocation to the ward, critical care, or theater at this point.

Caution Things not to attempt: � Never put anything into the mouth of an unconscious victim. y Never move a casualty without first doing the above checks. y Never put anything under the head of a victim who is lying down. The airway may get obstructed as a result of this. y Never move a victim unless absolutely necessary, as this may result in more injuries.

The secondary survey mnemonic—Has My Critical Care Assessed Patient’s Priorities Or Next Management Decision?—has been shown in Table 9.1.

UNIT III  First Aid in Emergencies

TABLE 9.1:  Mnemonic for Secondary Survey Mnemonic

Secondary survey

Has My Critical Care Assessed Patent’s Priorities Or Next Management Decision?

Head/skull Maxillofacial Cervical spine Chest Abdomen Pelvis Perineum Orifices (PR/PV)* Neurological Musculoskeletal Diagnostic tests/definitive care

* Tubes and fingers in every orifice. Include “AMPLE” history. Source: ATLS secondary survey mnemonic: Has My Critical Care Assessed Patient’s Priorities Or Next Management Decision? Emerg Med J. 2006;23(8):661-2.

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Monitoring Vital Signs y

y

y

TRIAGING OF THE TRAUMA PATIENTS Trauma triage refers to the application of trauma evaluation to prioritize patients for treatment or transportation based on the severity of their injuries. Primary triage is carried out at the scene of an accident and secondary triage at the casualty clearing station at the site of a 93

CHAPTER 9  First Aid Assessment: Primary and Secondary Survey

y

Level of response ƒ Level of response gives an idea about level of consciousness of the patient. ƒ Assess the level of response using AVPU scale to identify any deterioration in the condition of the patient. ƒ Mnemonic AVPU: A—is the casualty Alert, V—does the casualty respond to Voice, P—does the casualty respond to Pain, U—is the casualty Unresponsive? Breathing ƒ Check the breathing rate and listen for any breathing issues or strange noises when checking a casualty’s breathing. Rate—Count the number of breaths per minute. Depth—Are the breathings deep or shallow? Ease—Are the breathings easy, difficult or painful? Noise—Are the breathings quiet or noisy, and if noisy, what are the types of noise? Pulse ƒ The pulse can be felt at the wrist (radial pulse) or in the neck if that is not possible (carotid pulse). ƒ Record the following points.  Rate (number of beats per minute)  Strength (strong or weak)  Rhythm (regular or irregular) Body temperature ƒ A low or high body temperature could be a sign of a lifethreatening disease. ƒ A fever of more than 100.4°F (38°C) is usually caused by infection, although it can also be the result of heat exhaustion or heatstroke.

FIRST AID MANUAL FOR NURSES

major incident. Triage is repeated prior to transport away from the scene and again at the receiving hospital. The patients who are most likely to worsen clinically are given priority. Patients should be reviewed periodically because triage is a dynamic process. Triage considers vital signs, prehospital clinical course, mechanism of injury, and other medical problems.

Triage Categories y y

y

UNIT III  First Aid in Emergencies

y

94

Priority 1 (P1) or Triage 1 (T1): immediate care needed—requires immediate lifesaving intervention. Color code red. Priority 2 or Triage 2: intermediate or urgent care needed— requires significant intervention within 2–4 hours. Color code yellow. Priority 3 or Triage 3: delayed care—needs medical treatment but this can safely be delayed. Color code green. Dead is a fourth classification and is important to prevent the expenditure of limited resources on those who are beyond help. Color code black.

10 Asphyxia INTRODUCTION Asphyxia is a serious emergency situation which results from inadequate oxygen supply to the body or in other words as a result of accumulation of excessive carbon dioxide in the body. The nerve cells in our brain need a continuous oxygen supply and in case of insufficient supply to the nerve cells in the brain can survive only up to for minutes only without oxygen. Without oxygen the nerve cells will die and the victim becomes unconscious and it may also lead to a fatal condition (death).

CAUSES y y

y y

y

y y y

Drowning: A condition in which water gets into the air passage. Chocking: It is the partial or total obstruction of the airway by a foreign body. This may be caused from blood, mass of food, vomitus or even a broken teeth or an artificial teeth. In cases where tongue may fall back the throat leading to obstruction, i.e., unconscious. Collapsed lungs or chest compression: This may be caused by: ƒ Collapsed building. ƒ A victim being crushed against the wall or pressure from a crowd. ƒ In case of RSA (road side accident). ƒ Any penetrating injury to the chest is gunshot or stab injury (knife or sharp weapon). Gas poisoning: It may lead to spasm of the airway followed by obstruction and asphyxia. For example, carbon monoxide poisoning irritant gases, like coal gas motor exhaust fumes/toxic fumes smokes, etc. Electrical accidents or injuries Strangulation: In case of suicidal attempt. Suffocation: Gas or smoke-filled environment.

FIRST AID MANUAL FOR NURSES y

Others: ƒ High altitude ƒ Deep sea diving ƒ Cyanide poisoning ƒ Tetanus ƒ Head injury ƒ Stroke ƒ Asthma

SIGNS AND SYMPTOMS y y y y y y y y y y

Noisy and difficulty in breathing Cyanosis of face, fingers, lips, nails, toes, may appear bluish in color Distended neck veins Disorientation Unconsciousness Convulsions may occur Rapid pulse Shallow breathing Dark spots in front of eyes and loss of vision Cessation of respiration (gasping)

COMPLICATIONS

UNIT III  First Aid in Emergencies

y y y

Coma Brain death Death

AIMS OF FIRST AID To restore the victim’s breathing and maintain respiration. y Ask someone to immediately call for emergency medical services. y Remove the causes of asphyxia, i.e.: ƒ Choking: Remove the object by abdominal thrust (Heimlich maneuver). ƒ Drowning: Remove the victim safely from water. ƒ Suffocation: Remove anything or object which may block the airway. 96

FIRST AID MANUAL FOR NURSES ƒ ƒ

Gas poisoning: Move the victim to fresh air. Asthmatic attack: Help the victim to attain Fowler’s position (upright position and assist in medication) after removing the cause of asphyxia follow the below given steps.

STEPS TO DO 1 Make the victim lie down comfortably on the floor. 2 C  heck his/her clothing. Loosen tight clothing especially near and around the neck. 3 I f the victim is in the room ventilate the room by opening the windows and turning on the exhaust fan. 4 C  heck airway breathing circulations (ABCs) if the victim is unconscious but breathing. 5 I f the victim is unconscious and not breathing as well as there is no pulse then immediately perform CPR. 6 For CPR follow the below written method: i. Open airways (head tilt chin lift).



ii. Place one hand on the lower half of the breastbone midway between the nipples and entangle or interlock the second hand on the top of the first.



iii. Give 30 chest compressions followed by two rescue breaths.



iv. Repeat 30 chest compressions and 2 rescue breaths until sign of circulation is observed or until the victim starts breathing at his/her own.



v.  Check the carotid pulse, pupils and gradual disappearance of cyanosis.



vi. If the pulse is not regained, continue the procedure till the victim gets medical help.



vii. In case of infant, follow the procedure of CPR for infant.

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4

11

Drowning INTRODUCTION A death caused by being underwater and not able to breath. or A condition when water enters the lungs causing asphyxia. or A condition when water enters the lungs causing the throat to go into spasm by obstructing the air passage.

HOW CAN DROWNING BE FATAL When a victim is underwater he/she can breathe for a few seconds but after some time the victim struggles to inhale air as long as possible but as slowly or gradually he/she goes below the water then the victim starts to exhale air and inhale water.

CAUSES y y y y

Drinking alcohol while boating or swimming Blows to the head or seizures when in water Inability to swim Leaving small children unattended around bath tubs and pools

SIGNS AND SYMPTOMS y y y y y y y y y

Vomiting Blush skin of the face and lips Pale appearance Cold skin Chest pain Cough with pink frothy sputum Lethargy Restlessness No breathing

FIRST AID MANUAL FOR NURSES

AIMS OF FIRST AID y y

To ensure an open airway To restore breathing STEPS TO DO

1 Remove the casualty from water as soon as possible. 2 Do not be hasty and ensure your safety first (do not endanger yourself ). 3 Lay the victim on his back. 4 Remove any tight/constricted clothing near and around neck, chest and waist. 5 Check victim’s breathing for 10 seconds by following—look, listen and feel. 6 If the victim is breathing, put him/her in recovery position. 7 If the victim is unresponsive then follow DRSABCD action plan which is described below: DRSABCD





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CHAPTER 11  Drowning



D = Danger: Ensure safety of self-victim and other R = Response: Check out for response-call victim’s name, squeeze the shoulders. If there is a response.   Make the victim comfortable   Check the injuries if any   Monitor response If there is no response follow the next step: S = Send for help; Ask someone to call for an ambulance A = Open victims mouth if foreign material is present then   Place the victim in recovery position   Clear airway (finger can be used); open airway by tilting head with chin lift B = Breathing; Check for breathing, look, listen and feel If victim’s breathing is normal   Place victim in recovery position   Monitor breathing   Manage injuries   Treat for shock If victim’s breathing is not normal then begin CPR C = CPR   Start CPR: 30 chest compressions followed by 2 breaths. Continue CPR till victim recovers or the help arrives.

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D = Defibrillation   Defibrillate the victim if a defibrillator is available   Observe for signs of circulation   Check the carotid pulse, pupils and gradual disappearance of cyanosis.   If the victim starts breathing at any time then treat for hypothermia. Cover the victim with warm clothes and blankets.   If victim recovers completely replace the wet clothes with dry ones.   Shift to hospital.

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4

Heart Attack INTRODUCTION A heart attack is a life-threatening condition commonly caused due to sudden obstruction of the blood supply to part of the heart muscle, for example, a clot obstructing a coronary artery (coronary thrombosis) can cause heart attack. The severity of a heart attack is mostly determined by how much of the heart muscle is damaged. Aspirin can be taken to try to decrease the extent of heart muscle damage.

CLINICAL MANIFESTATIONS y

y y y y y y y y y

Continual, central chest pain that may radiate to the jaw and down one or both arms. Unlike angina, the discomfort does not go away when the casualty rests. Breathlessness Discomfort occurring high in the abdomen, which may feel similar to severe indigestion. Collapse, often without any warning Sudden faintness or dizziness Casualty feels a sense of impending doom “Ashen” skin and blueness at the lips A rapid, weak, or irregular pulse Profuse sweating Extreme gasping for air (air hunger) STEPS TO DO

1 Make the casualty as comfortable as possible to ease the strain on his heart. A half-sitting position, with his head and shoulders supported and his knees bent, is often best. Place cushions behind him and under his knees. 2 Attempt to prevent them from walking or doing anything difficult. Place them in the Fowler’s position (sometimes referred to as the “W” position).

FIRST AID MANUAL FOR NURSES

3 Reassure the victim. If at all possible, eliminate any sources of tension or anxiety. 4 Inquire if the casualty has any medication with them. Allow them to take their own glyceryl trinitrate (GTN) medicine if they have it. 5 Assist the casualty to take up to one full-dose adult aspirin tablet (325 mg) or four baby aspirin (81 mg each). Advise him to chew it slowly. 6 Monitor and record vital signs—level of response, breathing, and pulse— while waiting for help. Stay calm to avoid undue stress. 7 Begin cardiopulmonary resuscitation (CPR) with chest compressions if the victim becomes unconscious and is not breathing regularly. 8 Automated external defibrillator (AED) can be used if available for giving a shock. An AED is a device that attaches electrodes to a person’s skin and analyzes the heart’s rhythm. 9 An auditory prompt from the device alerts the user to hit a shock button if defibrillation (a shock) is required to restart the heart’s rhythm. 10 The device gives shocks to the heart to allow it to return to its regular beat.

UNIT III  First Aid in Emergencies

Note The two shockable rhythms are entricular fibrillation (VF) and pulseless ventri­cular tachycardia (VT) while the nonshockable rhythms include sinus rhythm (SR), supraventricular tachycardia (SVT), premature ventricular contraction (PVC), atrial fibrillation (AF).

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13 Shock

4

INTRODUCTION Shock is a fatal life-threatening condition in which enough oxygen-rich blood does not reach the vital organs in the body. This means that the cells do not get enough oxygen to enable them to work properly leading to damage to the vital organs like brain and heart may also cause permanent organ damage or even death.

CAUSES The common causes of shock are as follows: y Hemorrhage or severe bleeding or severe blood loss: In this there is excessive blood loss which in turn deprives the vital organs of the oxygen amount needed by these organs to function adequately. An amount of 500 mL 1500 mL of blood loss can lead to shock. y Cardiac-related problem: This include all the conditions where the heart cannot pump sufficient blood to meet the body’s need which may cause shock. For example, major heart attack (this can damage the heart muscles to the extent that it may not be able to squeeze therefore unable to push blood through the blood vessels). y Nervous system injury: It includes injuries caused by neck or spine injuries. In such cases the blood vessels enlarge causing insufficient blood supply. y Dehydration: It may occur in heatstroke or in case of severe vomiting or diarrhea. y Severe burns: In case of large partial thickness or full thickness. Burns shock may occur due to shift of plasma from vascular space into the interstitial space or loss through the surface of burn wound. Hypovolemic shock is most commonly seen. y Allergic reaction: This occurs because of powerful reaction to substance eaten or injected can occur within a minute or even seconds. It can cause death if it is not treated immediately. This may be caused by medications, like penicillin and related drugs, food and

FIRST AID MANUAL FOR NURSES

food additives, insect stings (honeybee yellow jacket, wasp, hornet), plant pollen radiographic dyes.

SIGNS AND SYMPTOMS Weak and rapid pulse Cold clammy skin Dizziness Nausea Faintness Pallor skin Diaphoresis (due to reduced aldosterone secretion) Anxiety Lightheadedness Yawning Confusion Loss of consciousness (in extreme cases) Enlarged pupils.

y y y y y y y y y y y y y

STEPS TO DO 1 Lie the victim down with the head low and leg raised and supported to increase the flow of blood to the victim’s head or elevate the legs 8 to 12 inches (if spinal injury is not suspected).

UNIT III  First Aid in Emergencies

2 Call local emergency number and tell them that the victim is in shock; the cause to be specified (Bleeding or heart attack). 3 Check for any tight clothing around the neck, chest and waist, loosen that clothing as it may constrict blood flow. 4 Do not panic, reassure the victim if conscious, keep the victim warm comfortable and calm fear and pain can make shock worse by increasing the body’s demand for oxygen. 5 Check the victim breathing, pulse and level of response. 6 If the victim becomes unconscious open airway, check the breathing and manage as unconscious client. 7 Do not give the client anything through mouth. 8 Lay an unresponsive breathing victim on his/her side (recovery position). 9 Give CPR if the person shows no signs of life such as coughing or movement.

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Fainting

INTRODUCTION It is referred to as passing out, blacking out, or losing consciousness unexpectedly. A transient restriction in blood supply to the brain causes this partial or complete loss of consciousness. Usually, the person falls or slumps over. It could be a mild, transient occurrence or the result of a medical problem. Most of the time fainting is not an indication of a serious underlying condition, although it can be and so should not be taken lightly, especially if there is no apparent reason for the loss of consciousness.

CAUSES y y y y y y y y y y y

Syncope (when brain is deprived of blood flow) Neurologic syncope (caused by transient ischemic attack, stroke or seizure) Hyperventilating Heart Rhythm problems Low blood sugar Low blood pressure Straining Dehydration Overheating Emotional stress Exhaustion

WARNING SIGNS y y y y y

The patient claims to be nauseated. Frequently yawning Feelings of agitation Lightheadedness and dizziness are common complaints. The skin appears pale, is chilly to the touch, and may be clammy or sweaty.

FIRST AID MANUAL FOR NURSES

Chest tightness is a common complaint. Experiencing palpitations

y y

SIGNS AND SYMPTOMS Dizziness Weakness Nausea

y y y

y y

Cold, pale and clammy skin Blurred vision

PREVENTION Drink a lot of water. Take frequent pauses and get as much exercise as possible. When the person is worried or breathing too quickly, use a paper bag to slowly breathe in and out. Avoid being in a hot atmosphere.

y y y y

STEPS TO DO 1 Place the person on his or her back. To restore blood flow to the brain, raise the person’s legs above heart level. 2 Place the person face up on the ground and raise his/her feet 8–12 inches. 3 Relax collars, belts, shirts and shoes. 4 Loosen any constrictive apparel the person is wearing.

UNIT III  First Aid in Emergencies

5 Apply a cool, damp compress, over the person’s forehead. 6 Attempt to keep the person from standing until he or she has recovered completely. 7 Start cardiopulmonary resuscitation (CPR) if the victim is not breathing. Someone should dial emergency number. 8 Continue CPR until assistance comes. 9 Allow the person to relax rather than sitting or getting up as soon as they regain consciousness. 10 Giving them a hard candy or sweet to suck on will assist boost their blood sugar levels if they are diabetic and have skipped a meal. 11 Check to see if the individual who has passed out is jerking or has unusual muscle spasms, as this could suggest a fit.

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Nursing Alert y If the person is unconscious and vomits, turn him or her rapidly to allow the fluid to drain while protecting the person’s airway. y Do not attempt to feed anything by mouth to someone who is unconscious. y Do not attempt to reawaken a person who has fainted by shaking or slapping him/her. Things not to attempt, when someone is fainted: ƒ Slap someone who has fainted ƒ Shake someone who was fainted ƒ Throw water on him/her ƒ Shout at him/her ƒ Attempt to move the person ƒ Place a pillow under the person’s head ƒ Make him/her sit or stand up

CHAPTER 14  Fainting 107

15

4Wound INTRODUCTION

Wound is an injured area due to any reason. In this, skin and skin tissues are cut or broken. It may be small or large. When it occurs, it damages the dermis layer of the skin. Minor wounds are not serious but cleanliness of the wound is very important and major wounds are closed wounds as it happens most during accidents, surgery or due to any traumatic force.

DEFINITIONS An open wound is a break in the skin’s surface and bleeding can be seen. or A break in the skin’s surface resulting in external bleeding and may be infected by the invasion of bacteria.

TYPES OF WOUND Wounds are of two types: 1. Open wound 2. Closed wound

Open Wound It is an injury which may be external or internal breakdown of the body tissues. Most of the open wound are minor and can be treated at home. There are different types of open wound which are discussed here: y Abrasion: Scrapping of the skin occurs with little or no blood loss. In an abrasion, the nerve endings are often torn causing pain. Ground–in–debris may be present in abrasions. This can turn out to be a serious condition if it covers a large area or if a foreign matter is embedded in it. Abrasion is also known as road rash, scrape, rug burn. y Laceration: In a laceration, the skin is cut with jagged and irregular edges. It is as a result of forceful tearing away of the skin tissue.

FIRST AID MANUAL FOR NURSES y

y

y

y y

Incision: This is a skin wound with smooth edges and may be similar to a surgical or paper cut. There is bleeding from the wound which may depend upon the depth, location and size of the wound. Puncture wound: These are the wounds caused by some pointed/ sharp object like nail or knife. The wound formed is deep, narrow, thus increasing the risk of infection. The object causing injury may remain impaled in the wound. It also includes stab wound (caused by sharp objects) and missile wound (caused by bullet). Avulsion: Avulsion usually occurs on fingers, hands and ears. In an avulsion, there is partial tearing of the patch of the skin which becomes loose and is hanging from the body or completely removed. This wound can lead to heavy bleeding. Amputation: It involves cutting and tearing of a body part, i.e., arm, hand, leg, finger, toe and foot. Sharpnel injury: Type of missile wound characterized by multiple small entrance wounds.

Closed Wound

GENERAL MANAGEMENT OF THE WOUNDS y y y

Check ABC (airway, breathing and circulation) Control bleeding Treat for shock

CHAPTER 15  Wound

In closed wound, the skin is intact and the underlying tissue is not directly exposed to the outside world. There are different types of wound: y Contusion: It is also called bruise. A bruise occurs when the blood vessels are damaged or broken as the result of a blow to the skin or an injury caused by a blow with a blunt instrument where the subsurface tissue is injured but the skin is not broken. y Crush injury: This type of injury occurs when a force or pressure is put on a body part. Most commonly the body is squeezed between two heavy objects causing bleeding, fracture, nerve injury compartment syndrome, etc. y Blast injury: It occurs due to direct or indirect exposure to an explosion.

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FIRST AID MANUAL FOR NURSES

FIRST AID MANAGEMENT ACCORDING TO THE TYPE OF WOUND

Abrasion (Fig. 15.1) STEPS TO DO 1 Wash your hands with soap and water with vigorous scrubbing action. 2 Wear gloves. 3 Clean or rinse the cut/scrap with water. Run water directly into the wound and allow it to run out pressure of (5–8 psi) is required to irrigate the wound with water. 4 Do not scrub the wound it can bruise the tissue. 5 Never use strong cleaning solution on Fig. 15.1:  Abrasion abrasions, e.g., H2O2 (hydrogen peroxide) iodine or spirit (rubbing alcohol) because these solutions may irritate the wound. Clean tap water is sufficient for cleaning the wound. 6 Smaller cuts and abrasions usually stop bleeding on its own. 7 If the bleeding does not stop, gently apply firm direct pressure on the wound with a sterile or clean dressing or cloth.

UNIT III  First Aid in Emergencies

8 If the blood still seeps through the above applied dressing or cloth, put another dressing on the top and continue applying pressure. 9 If the cut is on the hand or arm, control the bleeding by raising it above the head. 10 If still bleeding is there then seek medical help immediately. 11 Once the bleeding has stopped, check the wound it should be clean, now cover it with a sterile bandage or gauge pads (to prevent it from infection). 12 If the cut is small, leave it open and do not cover it.

13 In case of major wound apply dressing and change the dressing every day or as required. ƒ A thin layer of antibiotics ointment can be applied on the scrapes/ cuts to prevent it from further getting infected. ƒ Look for the sign of infection. If the wound does not heal, immediately seek medical help. 110

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ƒ The sign of infections to be checked properly, like increasing pain, fever redness and swelling on the wound. ƒ Wound is warm to touch. ƒ Check for pus/drainage from the cut.

Lacerations (Fig. 15.2) STEPS TO DO 1 Wash your hand with soap and water with various scrubbing actions. 2 Wear gloves. 3 Clean the wound even if it is a small one (this will prevent it from infection) 4 Use ordinary tap water. 5 Do not apply any antiseptic solutions, these may damage the skin tissues and hamper in the process of healing. 6 If bleeding is there, then stop it with direct pressure. 7 If the wound is caused by gravel. The size would be large and deep. If it is longer than 5 cm, involving deeper tissue then stitches should be applied. 8 If the wound or part of wound has a damage or dead skin, in that case damaged part needs to be removed to prevent infection developing in it. 9 Wounds caused by penetrating glass metal, etc. need medical attention and X-ray imaging should be done to check if anything is left inside. 10 Gaping wound needs stitches. Certain wounds are not stitched straightway, e.g., if the wound is more than 6 hours old and infected then it should not be stitched. The infection is treated first and then the wound is stitched.

CHAPTER 15  Wound

Fig. 15.2:  Laceration

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11 A tetanus booster is given to the victim. 12 Some wound may need antibiotic coverage, like: ƒ Wound with jagged ends ƒ Wound contaminated with feces, soil or, manure ƒ Deep puncture wound ƒ Wound in older people ƒ If victim’s resistance to infection is low, e.g., chemotherapy or if the victim is taking steroid therapy, diabetes victim, etc. 13 Keep checking on sign of infection, e.g., painful wound, swollen red and tender warm. 14 Do not breath on an open wound. 15 Do not try to remove a struck object instead seek medical help. 16 Never push body parts back in rather cover it with a clean cloth/ material until medical aid arrives.

Incised Wound (Fig. 15.3) STEPS TO DO 1 The first step is to stop the bleeding by applying pressure on the incised wound. Place a sterile absorbent gauge on wound before applying pressure. Press it for some time. In a few minutes, the bleeding will stop.

UNIT III  First Aid in Emergencies

2 If the absorbent gauge gets soaked, do not remove it, rather place one more gauge piece on it as the clot formed on the wound may get dislodged and wound will bleed again. 3 In case the wound is on the leg or hands, then elevate it above the heart level to reduce the flow of blood near the cut.

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Fig. 15.3:  Incised wound

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4 To prevent infection and to remove the dirt and debris, the wound is cleaned thoroughly with soap. 5 Once the wound is clean and bleeding has stopped, then apply some antibacterial ointment or use a gauze dipped in petroleum jelly to cover the wound. 6 If still there is severe bleeding, seek medical help as it may require suturing. 7 On having injury, take a tetanus shot within 24 hours.

Punctured Wound (Fig. 15.4) If bleeding is less, then there is higher risk of getting infected as the germs may not get flushed out; so routine wound care is must in puncture wound. STEPS TO DO 1 Check the wound thoroughly. 2 Follow routine wound care. 3 If there are some small objects or dirt in the wound, remove it. 4 Do not remove larger impaled objects. 5 Gently press the wound to promote bleeding. 6 Do not put/apply any medication on the puncture wound. 7 Wash the wound in running water directly at the puncture site. 8 Cover or dress the wound and seek medical attention.

CHAPTER 15  Wound

Fig. 15.4:  Punctured wound

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Impaled Objects Impaled objects should never be removed from the wound as they may lead to more bleeding and injury. So it should be left in place and dressing should be applied around it. STEPS TO DO 1 Control bleeding if present, by applying direct pressure at the sides of the object. 2 Dress the wound around the object carefully and support the object while bandaging. 3 With the help of folded clothes or large dressings, secure the object in place. 4 Seek medical help.

Amputation (Fig. 15.5) In an amputation injury, some step to be followed properly. They are: STEPS TO DO 1 Control the bleeding. 2 Check the victim’s wound and provide wound care properly. 3 Recover the amputated part.

UNIT III  First Aid in Emergencies

4 Along with amputated part, seek medical care for the same region. 5 A  mputated part is to be wrapped in a dry sterile dressing or a dry clean cloth.

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Fig. 15.5:  Amputated fingers

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6 Do not put water on it. 7 Do not wash it. 8 Put the part in a plastic bag and seal it. 9 N  ow put the sealed bag in another bag or container with ice. It should not directly be in touch with the ice and never surround it with ice. 10 I mmediately seek medical attention and carry the part along with the victim.

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16 Hemorrhage/Bleeding INTRODUCTION Hemorrhage or bleeding is an escape of blood from a ruptured blood vessel. Bleeding may be internal or external.

TYPES OF HEMORRHAGE y

y

y

Arterial bleeding: In this, the blood is brighter red in color that may pulsate or spurt. This is the most serious kind of bleeding that may cause severe blood loss. Venous bleeding: In venous bleeding, the blood is dark red in color, flows steadily or gushes. It is easier to control venous bleeding as compared to arterial except if a deep vein is cut and injured. Capillary bleeding: Capillary bleeding is the most common type of bleeding here the blood oozes from capillaries. It is also known as superficial abrasion wound.

SIGNS AND SYMPTOMS y y y y y y y y y y y y y y

Dizziness Shock Blood coming from open wound Clammy skin Low blood pressure Shortness of breath Paleness Rapid pulse Increased heart rate Abdominal pain in case of internal bleeding Chest pain in case of internal bleeding Blood in stool (black, bright red and maroon) Blood in urine (red, pink and tea colored) Blood in vomit (bright red and brown)

FIRST AID MANUAL FOR NURSES y y

Bleeding from nose (bright red) Vaginal bleeding (heavier than usual or after menopause)

AIMS OF FIRST AID y y y

To control the bleeding as soon as possible. To prevent infection. Seek immediate medical aid.

EXTERNAL BLEEDING STEPS TO DO 1 Put on the gloves to protect yourself. If gloves are not available, use several layers of gauge pads or any waterproof material. 2 Check the area by exposing the wound to know exactly from where the blood is coming. 3 Clean the area with clean cloth. 4 Now place a sterile gauge pad or a clean cloth and apply firm pressure at that point as direct pressure stops most of the bleeding. 5 If still the bleeding does not stop in 10 minutes press again for another 10 minutes and elevate the part above the heart level to reduce blood flow. 6 If bleeding still continues, apply pressure at a pressure point to reduce the flow of blood in combination with direct pressure over the wound.

8 When the bleeding stops, apply a pressure bandage on the wound and inspect the victim for other injuries. Use a roller gauge bandage for this purpose and it should be applied tightly over the dressing above and below the wound site. 9 Do not apply pressure bandage tightly that it may cut off circulation. 10 Do not use tourniquet (it can damage the nerves and blood vessels). 11 Treat the victim for shock by elevating the legs 8–12 inches. 12 Keep the victim warm.

CHAPTER 16  Hemorrhage/Bleeding

7 Using pressure points requires a skilful first aider who knows that a pressure point exists where an artery is near the skin’s surface and where it passes close to a bone.

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INTERNAL BLEEDING Internal bleeding is a life-threatening conditions as the blood collects inside (abdominal cavity). In case of injury to kidney, liver, spleen, stomach causing severe pain and swelling. STEPS TO DO 1 Provide a comfortable position to reduce pain. 2 Do not give the victim anything by mouth. 3 If the victim is unconscious check ABCs. 4 Give the unconscious victim side-lying position to prevent aspiration of secretions. 5 Treat for shock by raising the victim legs 8–12 inches.

BLEEDING FROM OTHER SITES

Bleeding from Tongue It often occurs due to tongue bite as a result of accidents and injury. Tongue and mouth is highly vascular and if it is accidently hurt, can lead to abundant bleeding.

UNIT III  First Aid in Emergencies

STEPS TO DO 1 Reassure the victim: Tongue cutting and injuries usually occur in children. It is a very scary and painful situation for a child so calm the injured victim to treat the injury. 2 Hand washing/wash your hands: In order to prevent the victim from infection, proper hand washing is carried out. 3 Wear gloves: It protects your hands and helps in reducing infection as blood can carry diseases. 4 Make the victim sit up: This position is comfortable for the victim and helps the blood flow out of the mouth preventing aspiration and at times of vomiting. 5 Check the cut: An injury and cut to the tongue leads to severe bleeding hence, it is important to examine the depth and size of the injury. 6 If the wound is deep and half an inch in length and if there is some foreign material embedded in it then immediately seek medical condition. 7 Apply pressure: With a clean cloth or gauge for a minimum period of 15 minutes. This will stop the bleeding. If the gauge or cloth is soaked with blood, do not remove it instead apply another one on it and put direct pressure on it.

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8 Apply ice on the site of injury: Wrap an ice cube with a thin clean cloth and apply it directly on the wound for not more than 3 minutes at a time. This can be done up to 10 minutes a day. Ice can also be sucked. 9 Rinse the mouth: After the injury is settled rinse your mouth with a warm salt water solution. This keeps the wound clean it can be done 6 times a day. 10 Continue with normal dental care: In case there is no dental injury, continue regular dental hygiene but in case of dental injury, visit a dentist as early as possible.

Bleeding from Gums Bleeding from gums may be due to tooth extraction or injury. STEPS TO DO 1 Rinse the mouth with water. 2 Inspect the site of bleeding. 3 Put a cotton wool ball in the socket and ask him to bite.

Vaginal Bleeding Bleeding from vagina can be a result of internal injury, miscarriage or due to severe menstrual bleeding. Signs and Symptoms y y

Bleeding from vagina (mild to severe) Abdominal pain The victim may go into shock

Aims of First Aid

To stop bleeding and prevent the victim in going to shock. STEPS TO DO 1 Maintain privacy, give the victim a sanitary dressing to clean the vagina and put a clean sanitary dressing at the entrance of the vagina. 2 Give the victim a comfortable position (lay her with shoulder slightly raised and knees bent) it can be supported by the blankets. 3 If the victim expresses pain, the casualty can have her own pain killer. 4 If still bleeding is there and severe, minimize shock by treating it and shifting the victim to casualty for immediate medical aid.

CHAPTER 16  Hemorrhage/Bleeding

y

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Bleeding in the Eyeball This may occur as a result of injury. STEPS TO DO 1 Wash and rinse the eyes with cold water 2 Inspect the eye thoroughly 3 Apply cold compression 4 If the bleeding still continues or it stops, seek medical aid (ophthalmologist).

Bleeding of Varicose Vein Varicose vein is common in adults population. This condition is rare but if it occurs it may lead to severe bleeding Definition

It is a condition when a person’s vein becomes enlarged, dilated and overfilled with blood. Varicose veins are painful and located under the surface of the skin (usually on leg). They are easily visible, appear thick and knobby, have a blush purple or red color. Causes y y y

UNIT III  First Aid in Emergencies

y y y y y

Obesity Increased pressure in the veins of legs Congenital heart valve condition (venus insufficiency) Pregnancy Menopause Prolonged standing Pressure on abdomen Tumors

Signs and Symptoms y y y y y y y

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Pain (dull in nature) Swelling Discoloration Ulcers around the ankle Severe bleeding Sign and symptoms of shock Unconsciousness

FIRST AID MANUAL FOR NURSES y y y

Itchy skin can felt over the location of the varicose vein Ulceration or varicose vein Bruising and bleeding. STEPS TO DO

1 Check the site and apply a dressing with firm pressure to the site of hemorrhage. 2 Immediately elevate the bleeding leg (to encourage blood to return to the heart). 3 If the victim is wearing any constriction clothing then remove it, i.e., tie/ stocking/tummy tucker, etc. as it may impede the blood flow back to heart. 4 If bleeding does not stop and the dressing is soaked with blood then put another dressing on the top of the first one and again apply pressure. 5 The leg should be raised and supported. 6 Observe the victim for shock. 7 Shift the victim to the hospital as soon as possible. Note

Bleeding from the Scalp This can occur as a result of head injury.

CHAPTER 16  Hemorrhage/Bleeding

Understanding what normal leg veins are: Veins are blood vessels which take blood back to the heart. Blood flows up the leg veins into larger veins and toward the heart. There are three types of veins in the legs: 1.  Superficial veins: These are present just below the skin surface larger superficial veins can be easily seen and felt. The superficial leg veins are the ones that may develop into varicose vein. 2.  Deep leg veins: There are the ones which pass through the muscles these cannot be seen or felt. 3.  Perforator veins: There are the one the small communicating veins that take blood from the superficial veins into the deep veins. There are one way valves at intervals inside the larger veins. These valves prevent blood flowing back in the wrong direction. When we stand there is quite a height of blood between the heart and legs. Gravity tends to pull the blood back down but is prevented from doing so by the vein valves and by the normal flow of blood toward the heart.

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What to Look for in case of Scalp Injury/Head Injury

Level of consciousness Nausea Dizziness Confusion Loss of memory, i.e., does not recall the event before or during injury Headache Scalp wound Watery discharge/bleeding/oozing from the scalp wound or ear or nose

y y y y y y y y

STEPS TO DO 1 Check the level of consciousness by using AVPU scale.

UNIT III  First Aid in Emergencies

Note AVPU SCALE A Alert (is that either victim responding to a question or not)? V Voice (does the victim respond to voice and is he/she able to follow simple question) P Pain (if the victim does not respond to alertness and voice, i.e., first and second then the response to pain. In this condition try to pinch the victim then check if the victim moves or opens his /her eyes) U Unresponsive (do the victim respond to question to questions or a gentle shake). Interpretation of AVPU Scale �  If the victim is alert or responsive = conscious and head injury is mild (observe breathing, pulse and level of consciousness till medical aid arrives). �  If not alert and even not responsive = partially or fully unconscious then head injury could be severe. (Treat as for unconscious victim till medical aid is not reached). 2 If the casualty is conscious lay the victim down with his head and shoulder slightly raised. If the victim is comfortable let him sit down and give something cold to hold against the injury (bag of ice or frozen peas wrapped in a cloth). Ice should not be applied directly. 3 Check the conscious victims breathing rate, pulse and level of consciousness every 10 minutes till medical aid is given/or till the ambulance arrives. 4 If the casualty is unresponsive and unconsciousness (follow the management same as that of unconscious victim).

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5 Never pack ear or nose rather clean them and put a light dressing. 6 Secure the dressing with a triangular bandage if still bleeding continues rapidly apply pressure on pad. 7 Immediately shift the victim to the hospital.

Bleeding from Ears Ear is a very vascular body part and can bleed severely if injured or due to trauma. Bleeding from the ear is in the form of ear drainage that contains combination of pus, wax fluid and blood. The most common cause of bleeding from the ear is a ruptured or perforated eardrum (tympanic membrane). The victim may feel extreme sharp pain followed by earache and deafness. Object in the Ear STEPS TO DO 1 Calm and reassure the victim. 2 If the object is sticking out and easy to remove, then remove it with tweezers and then get medical help. 3 If the object is not visible, never reach inside the ear canal with tweezers as it may lead to dangerous medical aid (ENT deptt.). 4 Gravity can also help dislodge the object. Tilt the head to affected side. Shake it gently and do not strike the victim’s head. Insect in the Ear

1 Turn the persons head in a way to bring the affected side up and closely look if the insect flies or crawls out. 2 Do not let the victim put his/her finger in the ear as the insect may sting. 3 Even if the insect does not come out. Try pouring baby oil, olive oil or mineral oil into the ear. Oil should only be used in case of insect in the ear, it should not used in case of any object as it can make the other objects to swell up and lead harmful situation rather than doing good. 4 After pouring oil, in case of an adult, pull the earlobe gently backward and upward. This makes the insect suffocate and may float out in oil. 5 In case of a child, pull the earlobe gently backward and downward. 6 Even if the insect comes out completely, seek medical aid.

CHAPTER 16  Hemorrhage/Bleeding

STEPS TO DO

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Ruptured Eardrum

A ruptured eardrum needs immediate medical attention as it will cause severe pain. STEPS TO DO 1 Calm the casualty 2 Place a sterile cotton gently in the outer ear canal to keep the inside of the ear clean. 3 Do not put any liquid into the ear. 4 Get medical help. Cuts on the Outer Ear STEPS TO DO 1 Clean the area 2 Cover the injury with sterile dressing and the apply direct pressure till the bleeding stops. 3 If the bleeding does not stop, apply the pressure for another few minutes. 4 Pain and swelling can be reduced by applying cold compresses over the dressing. 5 If the part of the ear is cut off, place the part in a clean cloth to cover it, put it on ice (ice packed in plastic cover). 6 Immediately get medical help. Drainage from Inside the Ear

UNIT III  First Aid in Emergencies

STEPS TO DO 1 Cover the outside of ear with a sterile dressing. 2 Have the person lie down on the side with the affected ear down so that it can drain. 3 Seek medical help immediately. Caution Things Not to be Done in Case of Ear Injury y Never try to stop/ block any drainage from the ear. y Do not try to remove any object from the ear if it is not visible y Never remove an object the ear by probing with a pin, sharp object, cotton swab as this will push the object damaging the middle ear. y Do not push or pour any liquid into the ear. y Never try to wash or clean the inside of ear canal.

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Bleeding from the Nose (Epistaxis) A nose bleed occurs when blood flows from one or both nostrils. Generally, it occurs as a result of rupture of tiny blood vessels inside the nostrils. Causes

The common causes are as follows: y Blow to the nose y High blood pressure y Blowing the nose forcefully y Increased environmental temperature. Aims of First Aid y

To control the bleeding.

y

To keep the airway open.

STEPS TO DO 1 Make the victim sit (not to lie down) as keeping the nose above the heart level will reduce bleeding. 2 M  ake the victim lean forward (not backward) (head tilt forward). So that the blood drains out through the nose rather than going down to the throat which could block the airway. 3 A  sk the victim to pinch the soft part of the nose (with thumb and index finger) with a brief pause every 10 minutes. 4 Make the victim breathe through his/her mouth.

6 Seek medical aid even if the bleeding stops. 7 U  se pressure points to stop bleeding. Pressure points can be used in an emergency to control and stop the bleeding by reducing circulation to areas in the body which in turn can prevent the victim from going into shock till the medical care is reached.

Pressure points is a spot where the main artery to an injured part lies near the skin surface and over a bone.

Technique of Applying Pressure

The pressure is applied at the above-mentioned parts with the fingers (digital pressure) or with the heel of the hand. The main aim for applying

CHAPTER 16  Hemorrhage/Bleeding

5 Instruct the victim not to speak, swallow spit or sniff as it can break the clots that have started to form in the nose.

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pressure is to compress the artery against the bone shutting off the flow of the blood from the heart to the wound. Pressure points technique should only be used after direct pressure and elevation have filled. The name of pressure points are listed below: y y y

UNIT III  First Aid in Emergencies

y

126

Carotid pressure point Subclavian pressure point Facial pressure point Temporal pressure point

y y y y

Brachial pressure point Radial or ulnar pressure point Palmarch pressure point Femoral pressure point.

17

4

Injuries to the Bones, Joints and Muscles FRACTURES A fracture is a complete or partial break in the bone, or a break in the continuity of the bone (crosswise, lengthwise, in multiple pieces).

Causes y y y y y y y y

High force impact/stress Trauma Injury Fall Accidents Medical conditions (osteoporosis) Aging Stress fracture (athletes)

Signs and Symptoms y y y y y y y y

Swelling and tenderness around the injury Pain and prevent moment of the part Bruising and bleeding from site Deformity Grating sensation is present. Angulation: Area may be bent at an unusual angle. If it is an open fracture bleeding affected area cannot be moved. Weakness and inability to bear weight.

Types (Fig. 17.1) y

Open fracture: Fracture in which a bone breaks in a manner that the bone fragments stick out through the skin or a wound penetrates down to the broken bone is called an open or compound fracture. It is a serious type of fracture as the skin is punctured or the broken leading to infection in the wound and the bone.

FIRST AID MANUAL FOR NURSES

Fig. 17.1:  Types of fractures

UNIT III  First Aid in Emergencies

y

y y

y y

y

128

Closed fracture: Here the broken bone does not break the skin. It is a simple fracture but can be a dangerous one and should not be neglected. Comminuted: In this, the bone is shattered/broken into many pieces. Greenstick: The bone partly fractures on one side but does not break completely because the rest of the bone can bend; commonly seen in children. Avulsion: This kind of fracture occurs due to a pull from a muscles or ligament on the bone (Fig. 17.2). Compression: It is also called crush fracture. It occurs in the spine (spongy bone). It is related to a medical condition osteoporosis in which the front portion of a vertebra in spine may collapse. Fracture dislocation: One of the bones of the joint has several fracture and joint become dislocated.

FIRST AID MANUAL FOR NURSES

Fig. 17.2:  Avulsion fracture of ankle y

y y

Fig. 17.3:  Hairline fracture of fibula

CHAPTER 17  Injuries to the Bones, Joints and Muscles

y

Hairline fracture: It is a partial fracture of the bone. It is very difficult to detect this type of fracture (Fig. 17.3). Impacted fracture: In this, due to a fracture, one fragment of the bone goes into another. Longitudinal fracture: The fracture/break occurs along the length of the bone. Oblique fracture: A fracture that is diagonal to a bone’s long axis.

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FIRST AID MANUAL FOR NURSES y y

y y y

Spiral fracture: In this, one part of the bone as a result of fracture has been twisted (Fig. 17.4). Pathological fracture: As the name suggests, it is due to some underlying disease condition that has weakened the bone causing fracture. Stress fracture: A bone breaks due to repeated stresses and strains. Very common among athletes. Torus (buckle) fracture: Here the bone deforms but does not crack. It is very painful. It is common in children (Fig. 17.5). Transverse fracture: It is a straight break right across a bone.

UNIT III  First Aid in Emergencies

Fig. 17.4:  Spiral fracture

Fig. 17.5:  Torus fracture of wrist

Causes y y y y y

Injury Direct force (by force of blow) Indirect force [fracture of collar bone after a fall on the outstretched hand (high-energy twisting type of injury)] Fracture by muscular action (fracture of knee cap after powerful high muscles jerk) Force of ligament

Management Follow DRSABCD action plan while waiting for an ambulance. It is described as here.

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D— Danger (make sure the site of accident, injury is safe for the rescuer and the patient.) R— Response [check the victim for response (tap the victim and shout Are you ok?)] If the victim responds, they should follow three steps which are written here. 1. Make the victim comfortable 2. Check and note the injury 3. Check the response

In case there is no response, follow the next step.

S—Send for help Call an emergency number and ask for ambulance. A—Airway ƒ Open the victim’s mouth if foreign material is present ƒ Place the victim in recovery position ƒ Clear airway with fingers ƒ Open airway by tilting head with chin lift

Management of Fracture According to the types: Open Fracture

In this, the bone protrudes out from the skin, the management is written here.

CHAPTER 17  Injuries to the Bones, Joints and Muscles

B—Breathing ƒ Check for breathing LLF (look, listen and feel) If the victim is breathing normal: ƒ Place the victim in recovery position ƒ Monitor breathing ƒ Manage injuries ƒ Treat for shock If the victim’s breathing is not normal: ƒ Start CPR (cardiopulmonary resuscitation) ƒ Ratio should be 30:2, i.e., 30 compressions followed by two breaths ƒ Continue CPR until help arrive or victim recovers D—Defibrillation if available apply defibrillator. Turn on AED (automated external defibrillator)

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STEPS TO DO 1 Stabilize and support the arm 2 Elevate the limb 3 Put sterile dressing over the wound and apply direct pressure to control bleeding Apply pads over and around the wound 4 Secure dressing with a firm bandage 5 Immobilize and elevate the limb 6 Shift the victim to the hospital Closed Fracture

In this, no bone protrude from the wound. STEPS TO DO 1 Stop and control the bleeding. This can be achieved by gently squeezing the sides of the (wound) together. 2 The wound should not be left open rather a dressing is to be placed around the edge of the wound. 3 Immobilize the joint above and below the fractured site and after that splint the limb. 4 Handle the victim gently.

UNIT III  First Aid in Emergencies

5 To reduce and minimize the bleeding the affected limb is to be elevated. 6 To minimize the shock both legs can be elevated. 7 To stabilize the fractured bone end splints and bandages are must.

MANAGEMENT OF HEAD AND SPINAL INJURIES AND NECK FRACTURE Head injury refers to injury to the skull, scalp and brain. Severe head injury can result in unconsciousness due to irreversible brain damage. Because head injuries are often linked to neck and spinal injuries, they must be treated with extreme caution.

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Spinal fractures can happen indirectly when landing on the feet or buttocks in a heavy fall, when being thrown forward suddenly (like in a car accident during a collision) or when lifting a very heavy weight. A whiplash injury is a specific neck injury caused by a fast movement of the head forward and backwards (e.g., during a car collision). Direct spinal fractures can be caused by falling from a height on the back across a bar or a fall of a heavy weight on the back (e.g., during an earthquake or landslide) (Fig. 17.6).

Fig. 17.6:  Mechanism of whiplash injury characterized by forceful, rapid back-and-forth movement of the neck

Three main types of head injuries are as follows: 1. Concussion y y y y

Concussion occurs when the brain is violently shaken. A casualty may pass out briefly (no more than 2–3 minutes). A concussed casualty should not be left on their own and should Ideally be monitored for 24 hours.

2. Compression y

y

Compression injuries are extremely dangerous because the brain is under severe pressure as a result of cranial cavity hemorrhage or edema. A skull fracture or head injury can cause compression, although disease can also cause it (type of stroke, brain tumor, meningitis, etc.).

3. Fractured Skull y

Skull fractures are extremely dangerous because a broken bone in the skull can cause direct damage to the brain, resulting in bleeding and compression.

CHAPTER 17  Injuries to the Bones, Joints and Muscles

Types of Head Injuries

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Any victim who has sustained a head injury and has a poor reaction level should be treated as if they have a fractured skull.

y

Causes and Etiology of Spinal and Head Injuries Falling from a height, for example, from a ladder Diving into a shallow pool and hitting the bottom Falling from a motorbike or horse Sudden deceleration in a vehicle A heavy object falling across their back An injury to the head or face

y y y y y y

Signs and Symptoms Bleeding from any site, i.e., scalp, neck or the back Changes in the position of the head, neck and back (odd position). Moderate to severe pain in neck region and head Neck stiffness Discharge [bloody or cerebrospinal fluid (CSF)] from the ears, mouth or nose Vomiting Blurred vision Not able to move. Weakness may occur in an arm or leg. Numbness may be felt in the extremities. Convulsion Loss of consciousness Loss of control over the bladder and bowel

y y y y y y y y y y y

UNIT III  First Aid in Emergencies

y

Red alerts for suspecting spine and head injuries: • Fall from a height • Victim received a blow to the head, neck and back • Suffered major accident such as car accident or motor vehicle accident • Dived into a shallow water • Suffered multiple injuries, crushed-in type of injuries STEPS TO DO 1 Get and gather the complete history of how the injury occurred (any recent injury to head, neck and back). 2 Note the signs and symptoms (mentioned above), any of the signs and symptoms if seen follow immediate care.

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3 Calm the casualty and provide reassurance. 4 Do not move the casualty at all until and unless the victims life in danger. 5 Check for response, if no response, start rescue breathing but do not tilt the head backward rather pull the lower jaw open.

How to Immobilize the Head, Neck and Back STEPS TO DO 1 Ask the victim not to move his head, neck and back (to lie still). 2 Log roll or place rolled towels or apply on both sides of the neck. 3 Secure it in place and make sure that it should not be interfere with the victim breathing. 4 If a collar is available, use it to immobile the neck. 5 If nothing is available, a newspaper can be used (10 cm/4 inches).

7 The center of the collar is placed at the front of casualty’s neck just below the chin. Fold the collar around the neck secure the position. 8 Check for the breathing pattern of the victim, it should not be obstructed or difficult due to the above procedure. 9 After immobilization of the head, neck and back, check the victim for bleeding and shock. If present, treat it immediately. 10 Check the casualty for sensation (never plug the ear if there is bloody or transparent discharge rather incline the head toward the injured site. Cover the ear with light dressing). 11 Shift the casualty to the hospital without any delay.

FIRST AID FOR ROAD SIDE ACCIDENT STEPS TO DO 1 Calm and reassure the person. 2 Observe the scene. 3 Check the response of the victim and react accordingly.

CHAPTER 17  Injuries to the Bones, Joints and Muscles

6 Fold the newspaper and wrap it either in a triangular bandage or a scarf, stocking whatever is accessible.

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4 If it is a motorbike accident and the victim is wearing a helmet, do not try to remove the helmet. 5 Do not move the victim (suspect all the cases for a spinal cord injury). 6 Immediately shift the victim to hospital.

FIRST AID FOR MINOR HEAD INJURIES STEPS TO DO 1 Check the severity of the injury. 2 Calm and reassure the casualty. 3 Take an ice pack in a cloth and apply it to the injured area for a period of 15–20 minutes for first 24 hours. If an ice pack is not available, then a bag of frozen vegetables in a cloth can be used as it reduces swelling and bruising. Ice and ice packs are never applied directly on the victim’s skin. 4 If the cut or wound is smaller one, then cover it with gauze and secure it. 5 After 24 hours, hot fomentation can also be applied. 6 Seek medical aid if required. 7 Hot and cold fomentation helps to reduce the swelling and relieve pain.

FIRST AID FOR BLEEDING SCALP

UNIT III  First Aid in Emergencies

STEPS TO DO 1 Check for the response of the victim. 2 If the casualty is conscious, give half-sitting position with head and shoulders supported. 3 If there is any kind of discharge from the ear, incline the victims head toward the injured side, cover the ear with sterile dressing. Secure it lightly. 4 In case the victim is conscious and breathing well, then give recovery position (till ambulance arrives). The head should be placed or lay on the affected side. 5 Keep on checking the level of response, pulse rate and breathing pattern. If in any case it ceases or stops, immediately start resuscitation. 6 Seek medical aid immediately.

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FIRST AID IN JAW FRACTURE This is a serious kind of fracture as it may be related to head injury, serious eye injury and airway complications. It also carries the risk which is as follows: y

y y y

The internal bleeding may block the airway, i.e., by bleeding into the throat, lungs, mouth, nose or as a result of broken teeth lacerated tissue. Asphyxia (due to absent or inadequate cough reflex which may lead to blood or any foreign body to reach to lungs). Severe bleeding Severe pain victim may be unable to open the mouth. STEPS TO DO

1 Check the response of the victim. 2 If the victim is conscious and breathing well, put in recovery position or half sitting with head tilted to the injured side, clean any blood, saliva, mucus and vomit.

4 Check the airway and it should be clear. Remove the fake teeth make sure the tongue does not slip back. 5 Control any kind of bleeding. 6 Ask the victim to remain quiet and not to speak or open his/her mouth. 7 If the jaw appears to be broken or dislocated, make the victim lean forward and support the injured part (jaw) with one or both the hands. 8 Apply a narrow bandage over the chin (In cases where jaw is hanging). 9 In case of unconscious victim and serious jaw injury but the victim breathing, put the victim in recovery position to prevent aspiration not apply narrow or jaw bandage instead put a soft pad under the victims head to raise it slightly to keep the weight off the jaw. 10 Perform ABC of resuscitation if the victim is unconscious and does not breathe properly. 11 Immediately shift to the hospital.

CHAPTER 17  Injuries to the Bones, Joints and Muscles

3 If unconscious but breathing normally, put the victim on their side in a supported position.

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FRACTURE OF RIBS A rib fracture occurs when there is a crack or break in one of the bones of the rib cage. A break in the thick tissue (cartilage) that joins the ribs to the breastbone is also called fractured ribs. It occurs as a result of direct blow to the chest often from a car accident or fall from height. Fracture of the ribs should be considered serious as it injures the other body organs (vital organs—lungs, heart). STEPS TO DO 1 Check the response and level of consciousness. 2 Stabilize the fractured rib by applying improvised padding over the injured area and a broad fold triangular bandage to secure the arm to the chest wall over the padding. 3 Use an elevation sling to provide support to the arm on the injured side. 4 Shift the victim to the hospital as soon as possible.

FRACTURE OF COLLAR BONE STEPS TO DO

UNIT III  First Aid in Emergencies

1 Call for medical help (arrange for an immediate shift to a hospital). 2 Immobilize the shoulder, keep it close to the body, i.e., across the casualty’s chest with fingertips almost resting on the opposite shoulder. Place a pad between the limb and the chest. 3 If possible, create sling with the hand elevated above the elbow. 4 With a broad bandage, bandage the upper arm to the side of the chest. Tie a knot in front of the injured side. 5 Support it (upper limb) with a triangular sling.

FRACTURE OF THE SCAPULA Scapula fracture is rare because scapula is a sturdy and well-protected bone. This is caused by high-energy vehicular trauma or fall from height.

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Signs and Symptoms y y y

Pain Swelling Bruising

y y y

The victim holds the injured scapula close to the body. Movement will increase pain. Pain with each deep breath.

STEPS TO DO 1 Support the injured arm with sling, place a triangular bandage or cloth under it and over the uninjured shoulder. 2 Tie the sling at the side of the neck. 3 Control bleeding (direct pressure with bandage) 4 Get medical help.

FRACTURE OF RADIUS, ULNA AND HUMERUS STEPS TO DO

2 Do not move the arm unnecessarily. 3 Get a splint. 4 Apply the splint over the fractured site or triangular bandage can be used. 5 Seek medical help.

FRACTURE OF THE TIBIA, FIBULA AND FEMUR STEPS TO DO 1 Check and assess the injured area. 2 Stop bleeding if present. 3 In case of fractured femur, apply the splint beginning from groin region to the heel and another one from armpit to heel. Tie it with the help of bandage. 4 In case of fracture tibia and fibula, apply splint over the fractured part and wrap it with bandage. 5 Immediate seek medical help.

CHAPTER 17  Injuries to the Bones, Joints and Muscles

1 Check and assess the site of the injury or injured area.

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FRACTURE OF ANKLE AND FOOT STEPS TO DO 1 Check and assess the site of injury. 2 In case a bone is broken through skin, do not try to push it back into the place rather apply a clean dressing and shift the client to hospital. 3 Stop bleeding if present 4 Check for swelling. Remove any constricted clothing, remove toe rings, anklets, etc. or any thread if tied. 5 Immobilize the part and elevate the ankle above the heart level. 6 Compress the ankle tightly by wrapping with an “ace” bandage or elastic ankle brace. 7 Shift to the hospital.

FRACTURE OF THE PELVIS Pelvic injury is fatal or life threatening, it may involve the lower spine and cause injury to the bladder too. STEPS TO DO 1 Calm the victim and give reassurance. 2 Lie the victim down in a comfortable position.

UNIT III  First Aid in Emergencies

3 Put a pelvic sling to immobilize the part. 4 A pelvic sling can be improvised by a triangular bandage, a foil space blanket. 5 Tie the victim’s ankle together with the help of triangular bandage. 6 Now apply figure-of-eight around the victim’s ankles, across their shoe laces and tied underneath their feet, (tying ankles together bring in the feet which prevents outward rotational forces on the pelvis). 7 Now unfold the space blanket under the knees (to minimize movement). Pull the blanket upward until it is central. 8 Get the help of an assistance to lift the victim’s bottom off the ground only (an inch), victim can be lifted by grabbing by their belt or waist band. 9 Spread the blanket around the casualty’s waist down to the crease between the victim’s buttocks and the top of the thighs.

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10 Gently lower the casualty on the blanket. 11 Bring either side of the blanket around the casualty’s hip, twist the end until it feels as though it is doing something but not too tight to compress it. 12 Shift the victim to hospital.

COMPLICATIONS OF FRACTURE

Early Complications y y y y y y y

Shock—as a result of hemorrhage Damage to surrounding tissue, nerve or skin Hemarthrosis Compartment syndrome Wound infection Thromboembolism Fat embolism

Late Complications y y y y y

Delayed union Nonunion Malunion Contracture Osteomyelitis Deformities avascular necrosis

Caution Some precautions to be taken while applying first aid in case of fractures: y Do not massage the fractured limb. y Never try to align or straighten the broken limb. y Do not move the victim without support to the broken bone. y Do not move the joints above or below the fracture. y Do not give oral liquids or food.

SPLINTING MATERIAL Splinting material that can be used to immobilize a part: y y

Splints Bandages

y y

Padding Cravats/ties

CHAPTER 17  Injuries to the Bones, Joints and Muscles

y

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Splints The splints can be improvised from items like rolled newspaper, rolled magazine, boards, poles, sticks, tree limbs or cardboard. If the above items are not available, then the victim’s chest can be used to immobilize the fractured leg.

Bandages These can be improvised from steps torn from clothing, belts, towels or blankets. Materials like wire and cord should not be used.

Padding Padding may be improvised from items like blanket, jacket, poncho or even soft leafy vegetation. Put padding are put between the splint and the limb. Extra padding are used at sensitive or bony areas.

Cravats/Ties Cravats are made from muslin bandages. If muslin material is not available, then shirt or sheet can be used. It is used to secure splints. Use a minimum of 4 ties, two above and two below the fracture. The ties should be tied away from the body on the splint and a cravat should never be placed directly under a fractured area.

UNIT III  First Aid in Emergencies

Slings These are useful in case of arm fractures especially triangular bandage. A sling can be made from an improvised material, i.e., a belt and a piece of cloth, towel, blankets. It is used by suspending it from a person’s neck to provide support to the fractured arm. In this, the person’s hand should be higher than the victim’s elbow and sling should be applied in a manner that the supporting pressure is on the uninjured side.

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18

Hanging/Throttling/ Strangulation

4

INTRODUCTION Hanging/Throttling or Strangulation is a condition when a person strangulates himself or herself with a piece of rope, cloth, string in order to end his/her life. Commonly ceiling fans or a tree is used for hanging. Strangulation is a form of asphyxia, in which the airway is compressed and the flow of air to the lungs is cut off when pressure is applied to the exterior of the neck. y y

Hanging: Suspension of the body by a noose around the neck. Strangulation: Constriction or squeezing around the neck or throat.

Nursing Alert Hanging may cause a broken neck. Therefore, the casualty must be handled extremely carefully.

CAUSES y y y y y

Murder Suicidal tendencies Accidental by tie/cloth caught in machinery Manual chocking Postural asphyxia

SIGNS AND SYMPTOMS y y y y y y y

A constricting object around the neck An observing the victims, neck marks can be seen on it or around the neck. Congested face where veins can be seen. Tiny spots on the face Tiny spots in the white portion of the eye Difficult in breathing (uneven breathing pattern) Impaired consciousness

FIRST AID MANUAL FOR NURSES

Cyanosis (bluish discoloration of the skin) Death

y y

EFFECTS It has fatal effects: Respiratory asphyxia: Interrupt cerebral blood flow due to occlusion of blood vessels in the neck Cardiac inhibition secondary to nerve stimulation

STEPS TO DO 1 Without any other thought when seeing a victim in case of hanging immediately remove any constriction from around the victim’s neck as it may interfere with breathing. While doing so support the body if still it is hanging. 2 There are chances of spinal injury so do not move the casualty unnecessarily instead elevate the chin this will give the victim a better airway. 3 Do not destroy or interfere with any material on the spot as it may be a part of evidence for the police.

UNIT III  First Aid in Emergencies

4 Lay the casualty on floor, check for manual choking if present continue first aid as for choking victim. 5 Open the airway and check the victim for breathing look, listen and feel (LLF). 6 If the victim is breathing, place the client in recovery position until the ambulance arrives. 7 If the client is not breathing then immediately prepare to resuscitate. Caution y In the event of a spinal injury, do not move the victim needlessly. y Save any constricting material once you have removed it for the authorities, who may require it as proof. y If the victim is unresponsive, check for regular breathing and start cardiopulmonary resuscitation (CPR) with compressions if necessary.

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19 Falls

4

INTRODUCTION Falls are very commonly seen in all age group that may vary from a few injuries to broken bones and even death.

CAUSES Nearly 66% of falls result from: y Slips y Trips Whereas rest 34% are due to: y Fall from height.

Slips It may be occur due to: y Weather changes/hazards y Spills y Loose rugs/ mats y Wet or oily walking surface

Trips Trip accidents may occur due to: y Collision between foot and object that may lead to fall. y A view which is obstructed may lead to falls or due to poor lighting. y Wrinkled carpets/slippery carpets y Uneven steps y While capturing pictures in camera, mobile, if the surface is wet, muddy or sleep.

Fall from Height It can be accidental or a person may jump intentionally. y Parachute accidents y Suicidal attempts

FIRST AID MANUAL FOR NURSES

Defenestration: The act of throwing out someone or something out of the window.

y

High Risk Victims Prone to Fall Age Loose or tight footwear not of appropriate size Working on heights (buildings, electrical poles, towers, etc.).

y y y

STEPS TO DO 1 Check and monitor the level of consciousness. 2 Check pulse rate and airway breathing. 3 If the victim is not breathing, start CPR. 4 To prevent and reduce the risk of shock, cover the victim with coat or blanket. 5 Examine the victim physically for the signs of fracture and bone dislocation. Provide first aid for fracture and dislocation if they are present. 6 If there is no suspected injuries and the victim is breathing well, then put the victim in recovery position.

UNIT III  First Aid in Emergencies

7 Shift the victim to hospital as early as possible.

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20 Burns INTRODUCTION Burn of the skin or deeper tissue is a type of injury which may be caused by heat, chemicals, electricity or radiation sources. Mild heat burns and sunburn may need only simple first aid, but severe burns can be a medical emergency.

BURN LEVELS AND DEGREES There are three type of burns first, second and third. Each degree of burn is based on the severity of damage to the skin. First degree can be classified as minor burn, second degree as moderate and third degree being most severe (Figs 20.1 and 20.2). The damage to the skin is described as below: y First-degree burn: Skin is red, nonblistered dry and painful. Swelling may or may not be present. Skin is not broken. y Second-degree burns: Blisters that may be keeping clear fluid skin is swollen red and there can be a thickening of the skin, pain is present. y Third-degree burn: Widespread thickness with a white, leathery appearance may have sign of shock (pale, clammy skin, nausea, vomiting, fast breathing).

Fig. 20.1:  Degrees of burn

FIRST AID MANUAL FOR NURSES

Fig. 20.2:  Rule of Nines to determine extent of burn injuries

UNIT III  First Aid in Emergencies

y

Fourth-degree burn: Here the damage of third-degree burns extend beyond the skin into tendons and bones.

TYPES

Superficial Burn It is also known as first-degree burns is a mild burn to the top layer of the skin (epidermis). Which may turn pink or red and be painful (24–48 hours). These burns are not to be bandaged to avoid irritability of the skin. Normally they heal in a week. These are caused by: y Over exposure to the sun y Steam or hot liquid y Flames y Electricity

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Hot object like iron Chemicals like tile cleaner, car battery, acid, drain cleaners lime chlorine, etc.

Deep Burns Also known as second degree, third degree, and fourth degree burns. It is a severe type of burn in which all the skin layers are completely destroyed. Deep burns have little or no pain. It takes time to heal and usually leave a scar.

CAUSES y y

y y y y

Contact with fire or flames—46% Scalding injuries ƒ Steam ƒ Hot tea, milk, coffee ƒ Hot bath water Thermal burns: By contact with hot objects like iron or ovens, etc. Electrical burns: By contact with electrical sources. Chemical burns: Contact with some acid or alkali. Others: Include a combination of fireworks, inhalation, sun burn.

TREATMENT

Sunburns y y y

CHAPTER 20  Burns

y

Avoid sun exposure Wear personal protective clothing like long sleeves and trousers to cover every part of skin. Wear sunscreen or sunblock: It should be applied whenever one goes outside or reapply every hour, after exposure to water, etc. Use a good sunscreen with minimum SPF 30. Drink plenty of water: In some cases sunburn can cause dehydration. So one should drink eight to ten glasses of water a day to maintain hydration.

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Thermal Burns STEPS TO DO 1 Put out the fire: If the victim’s clothing is on fire stop the burning process, drop the victim down and roll the victim on the ground, i.e., use, stop, drop and roll method. 2 Stop a person whose clothes are on fire from running or being in standing position as the victim may inhale the flames worsening the condition. 3 Use water to put out any flames because even if the fire is out still burns can continue to injure the tissues so it is advisable to cool the burn area with water immediately. 4 Remove the victim’s clothes and other jewellery (before the area become swell) as it may still be hot and continue to burn the victim. Do not remove clothing stuck to the skin as pulling will further damage to the skin. 5 Check ABC (airway, breathing and circulation).

UNIT III  First Aid in Emergencies

6 Determine the depth (degree) of burn. This will help in medical care. 7 Assess the extent of burn as it helps in estimating how much body surface area the burn covers. Follow the rule of nine. 8 Determine what part of the body are burned. Burn on the face, head feet and genitalia are more severe than the burns on any other part. A circumferential burn is more dangerous than a noncircumferential burn because circumferential burns can have constriction and tourniquet effects on circulation and in some cases breathing may be affected. All such severe burns require medical care. 9 Determine if other injuries or preexisting medical problem exist or if the victim is elderly (over 55) or very young (under 5). A medical problem or belonging to one of those age group increase burn severity. 10 Check and assess the burns severity. Most burns are minor they can be treated at home or outside medical setting but for moderate and severe burns medical attention is must without any delay. 11 Seek medical attention in the following cases: ƒ If victim has difficulty in breathing ƒ In case of electrical injury ƒ Third-degree burn ƒ Second-degree burn ƒ In case of victim is under 5 or over 55 years of age ƒ In case of other injury exist ƒ In case where face, hand, feet and genitalia are burned ƒ In case of child abuse is suspected.

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Chemical Burn (Fig. 20.3) A chemical burn is caused by the touch of a caustic or corrosive substance on the skin. Both acid and alkalis, liquid and chemical burns are a kind of serious burns because chemical once in a contact with the skin continues to burn so they should be removed from the victim as rapidly as possible. First aid is same for all the chemical burns except a few specific ones for which a chemical neutralizer has to be used.

Fig. 20.3:  Chemical burn

Alkalis such as drain cleaners cause more serious burns than acids such as battery acid because they penetrate deeper and remain active longer. Petroleum products (organic compounds) are also capable of burning. STEPS TO DO

5 Seek medical attention immediately for all chemical burns.

CHAPTER 20  Burns

1 Immediately flush the chemical with water for about 20–30 minutes use a sink, hose or a shower to flush the area. Washing with larger amounts of water dilutes the chemical concentration and washes it away. 2 If the chemical is dry one, then first brush it from the skin before flushing it with water as water may activate a dry chemical and cause more damage to the skin. The first aider should protect himself/herself first from exposure to the chemical by taking safety precautions. 3 Remove the victims contaminated clothing and jewellery while flushing with water as clothing can hold chemicals allowing them to continue to burn as long as they are in contact with the skin. 4 Cover the burned area with a dry and sterile dressing.

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Electrical Burns and Shock Electrical shocks even mild can lead to serious internal injuries. A current of 1000 volts or more is considered high voltage but even the 110 volts found in ordinary household current can be deadly. Types of Electrical Burns

Electrical burns are of three types: 1. Thermal burn (flame) 2. Arc burn (flash) 3. True electrical injury (contact) Thermal Burn (Flame)

This burn occurs when the clothing or object is in direct contact with the skin are ignited by an electrical current. These injuries are caused by the flames produced by the electrical current and not by the passage of electrical current or arc. An Arc Burn (Flash)

This kind of burn occurs when the electricity jumps, or arcs from one spot to another. The electrical current does not pass through the body. Although the duration of the flash may be brief, it usually causes extensive superficial injuries.

UNIT III  First Aid in Emergencies

True Electrical Injury (Contact)

This occurs when an electric current truly passes through the body. Electrical injuries may cause only minor external burns where the electricity both entered and left the body (called entrance and exit wounds). This electricity flowing through the body may disrupt the normal heart rhythm and cause cardiac arrest burns and other injuries. In an electric shock, electricity enters the body at the point of contact and travels along the path of least resistance (nerves and blood vessels). The major damage occurs in the body. The outside burn may appear small. Usually, the electricity exits where the body touches a surface or comes in contact with a ground (e.g., a metal object). Sometimes a victim has more than one exit site. STEPS TO DO 1 The victim should not be touched until and unless the area is safe. 2 Disconnect, unplug or turn off the power

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3 Call emergency medical service number 4 Check ABC 5 If the victim is unconscious and unresponsive give BLS. 6 Care for the burn ƒ Stop burning process ƒ Remove clothes and jewellery ƒ Cool the area ƒ Cover the burn. 7 Treat the victim for shock ƒ Lie down the victim ƒ Elevate the legs ƒ Maintain the normal body temperature of the victim.

GENERAL CARE IN CASE OF BURN VICTIM

Care of First Degree Burn STEPS TO DO 1 Remove the heat sources 2 The burned area should be cooled with water (room temperature). Apply cold by immersing the burned area in a bucket or sink or cover a larger area with wet cloth. 3 The area should be immersed in water until the part burned is pain free both in and out of the water. (usually 10 minutes but may take 30 minutes) (Fig. 20.4). 4 Cold water stops the burn from progressing into deeper tissue and thus helps in relieving pain. 5 Remove clothing jewellery and any other constriction item before the area becomes swell. 6 Protect the burn from friction or pressure.

8 Keep the burned arm or leg elevated. 9 Give analgesic and anti-inflamatory drug to relieve pain in adults and acetaminophen in children.

CHAPTER 20  Burns

7 When burning sensation is not there, then apply aloe vera gel or if available, cut from the plant, e.g., if you have aloe vera plant in your house or nearby the area where the incident occurred. Remove a few meaty leaves near the bottom of an aloe vera plant cut the leaves in half down the middle and score the inside with your knife. This will release the aloe from the leaves. Collect the aloe in a dish.

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Fig. 20.4:  Immerse the burnt part in water

Care for Second Degree Burn STEPS TO DO Follow initial 6 steps of first degree burn. 1 W  hen burning sensation is not there apply a thin layer of topical antibiotic therapy it will prevent the entrance of bacteria.

UNIT III  First Aid in Emergencies

2 W  ith a dry nonsticking, sterile dressing, if available, cover the burned area. If a sterile dressing is not available use a clean cloth. Covering the area reduces the amount of pain by keeping air from the exposed nerve endings. 3 C  overing the wound with a dressing further prevents moisture loss through evaporation, reduces pain and keeps the burned area clean. The dressing should be loose and not fixed to the skin with tapes. 4 I n case of burns of toes or fingers, dry dressing is to be placed between them. 5 Victim should have water as much as he/she can drink. 6 Seek medical attention.

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Care of Large Second Degree Burn STEPS TO DO 1 After the burn cools. Gently apply a thin layer of anti-bacterial ointment. This will help to decrease the number of bacteria to a level that it can be controlled by the body’s defense mechanism and prevents the entrance of bacteria. 2 Remove clothing and jewellery from the burned area. If stuck don’t pull off but cut it carefully. 3 Cover the burn wound with a dry nonsticky and sterile dressing or a clean cloth as it will help in reducing the pain by keeping air from exposed nerve endings and prevent moisture loss through evaporation and to keep the wound clean. 4 In cases where the toes or fingers have been burned, the first aider should place dry dressings between them. 5 Have the victim drink as much water as possible, if fully conscious and oriented. 6 Keep monitoring ABCs and check the victim at intervals for the risk of shock, elevate burned arms or legs above the level of the heart this will help decreasing swelling and pain. 7 Seek medical attention.

Care of Third Degree Burn STEPS TO DO 1 Cover the burn area with dry sterile and nonsticky dressing or clean cloth. 2 Prevent shock. 3 If the victim is in a condition of shock, treat it by elevating the legs and keep the victim warm with a clean sheet or blanket.

CHAPTER 20  Burns

4 Seek medical attention.

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21 Poisoning INTRODUCTION It occurs as a result of exposure to a harmful substance. This can be due to breathing in (inhalation), swallowing, ingestion, injecting, ingested or by other means, like skin contaminating poisons (it occurs mostly under the age of 5 years).

CAUSES y y y y y y y y y y

Drugs, like over-the-counter drugs and prescription medications, like aspirin overdose, sedatives and elicit drugs, like cocaine Detergents and cleaning products (household) Insecticides Certain foods Carbon oxide gas (gas engines, fires, space heaters, etc.) Chemicals Paints Indoor and outdoor plants (eating of toxic plants) Enemity (in order to intentionally kill someone by adding poison in food) Suicidal attempts

SIGNS AND SYMPTOMS y y y y y y y y y y

Irritability Seizures Bluish lips Chest pain Difficulty in breathing Confusion Dizziness Drowsiness Palpitations Numbness

FIRST AID MANUAL FOR NURSES y y y y y y y y y y y y

Tingling Nausea Vomiting Abdominal pain Diarrhea Loss of appetite Cough Double vision Skin rash Burns Unusual odor from the breath Stupor

TYPES OF POISONING

Ingested Poison STEPS TO DO 1 Collect history on the type of poison taken (usually an assistant can do this). 2 Check and monitor the victim’s for airway breathing and circulation. 3 If the victim is not breathing and does not respond, then begin rescue breathing and CPR.

5 Identify the poison if it is possible (an assistant can ask to search for the clue.) 6 Vomiting is never induced, do not ask the victim to vomit until and unless the cause of poisoning is identified, for example, in acidic, alkaline and chemical poisoning-induced vomiting may burn the mucosa. If possible save vomit for analysis. 7 Call at the poison control center and follow the instruction on phone.

CHAPTER 21  Poisoning

4 Make sure that the victim has been poisoned before giving any treatment. Find out any of the following to confirm poisoning: ƒ Labored breathing ƒ Vomiting ƒ Burns around the mouth ƒ Bad odor from the breath ƒ Chemical smelling breath

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8 If the victim vomits, clean the victim’s mouth and provide a comfortable position. 9 If the victim has convulsions, provide first aid as for convulsions. 10 Lie the victim flat on the floor with head turn on the one side (on victim left side). This position (left side of victim), positions the end of the stomach where it enters the small intestine (pylorus), straight up. In this position gravity will delay (by as much as 2 hours). The poisons advance into small intestine where absorption into the victim circulatory system is faster, secondly, it helps prevent breathing foreign material into lungs if vomiting begins. 11 Never leave the victim alone. 12 Seek medical aid. Caution Never ever give milk or water to dilute poisons unless advised by poison control center. Fluid (milk or water) may dissolve a dry poison, i.e., tablets, capsule more rapidly and fill up the stomach. Forcing the stomach content, i.e., the poison into the small intestine where poisons are absorbed faster.

Inhalation Poisoning STEPS TO DO 1 Call for help

UNIT III  First Aid in Emergencies

2 Check the site for your safety 3 If it is safe, rescue the person from the damage of gas, smoke, fumes. 4 If possible, open the door and windows to remove the fumes. 5 Check the victims ABC 6 If necessary, provide CPR 7 Seek medical aid as soon as possible.

Carbon Monoxide Poisoning This mainly occurs in industries or as a result of household accidents. This gas is produced by the incomplete burning of organic material such

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as charcoal wood, natural gas, paper gasoline, propane or other fuel improperly ventilated appliances and engines, particularly in a tightly sealed or enclosed space may allow carbon monoxide to accumulate to dangerous level. It is present in all carbon-based fuels. How Carbon Monoxide is Fatal

Carbon monoxide is a toxic (poisonous) gas. It causes serious effect in human beings by combining with hemoglobin to form carboxyl hemoglobin in the blood preventing hemoglobin from carrying oxygen to the tissues reducing the oxygen-carrying capacity. Of the blood leading to hypoxia. Signs and Symptoms y y y y y y y y y y y

Palpitations Dull headache Nausea Vomiting Vertigo Mental confusion Blurred vision Loss of consciousness Shortness of breath Respiratory failure Brain damage STEPS TO DO

1 Calm and reassure the victim. 2 Shift the victim to fresh air, loosen any tight clothing by moving the person from the carbon monoxide area.

4 If possible, turn off carbon monoxide sources. 5 If the victim is not breathing, immediately begin CPR and ask the assistant to call emergency. 6 Continue CPR until the victim begins breathing or emergency help arrives (as in case of co-poisoning oxygen therapy is required).

CHAPTER 21  Poisoning

3 If the victim is unconscious, check for injuries before moving the victim.

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Aspirin Poisoning Aspirin poisoning is also called acetylsalicylic acid. It is very common pain reliever drug almost found in every house. It is believed to act as follows. It inhibits the release of the hormone-like substance called progesterone. This chemical helps to regulate blood vessels elasticity and changes the function of blood platelets. This aspirin can affect blood clotting and ease inflammation. Causes

It can be divided into: y Intentional causes y Accidental causes Intentional Cause

This is found in cases where a person consumes it for committing suicide and attention-seeking purpose or for gaining sympathy. It is also used to kill someone, i.e., murder. It is also used for child abusing. Accidental Cause

When the drug/first aid kit at home is in reach of the child. The child can easily consume it. If it is given inappropriately, i.e., not calculating the drug dose, especially in young children and the elderly. Signs and Symptoms

UNIT III  First Aid in Emergencies

y y y y y y y y y y y y

160

Vomiting Hyperventilation (deep and rapid breathing) Dehydration Fever Dizziness Ringing in the ear Impaired hearing Drowsiness Confusion Disturbance in gait Coma Confusion

FIRST AID MANUAL FOR NURSES

STEPS TO DO 1 Check the condition of the victim. 2 Collect the history of overdose. 3 Check the level of consciousness. 4 If conscious and breathing, let the victim vomit or induce vomit and produce recovery position. 5 If conscious, check the victims airway, breathing and pulse. Never induce vomiting in an unconscious victim rather start CPR.

DDT Poisoning DDT is also called dichlorodiphenyltrichloroethane. It is a colorless crystalline tasteless odorless organo chloride used as an insecticidal and environmental impacts. DDT can be consumed accidently if kept at home (to keep away from flies and mosquitoes). It can also be used for suicidal and murder attempts. Signs and Symptoms y y y y y y y y y

Irritation on the skin and eyes Facial and mouth paresthesia Parasthesia in extremities Vomiting Weakness Seizures Circulatory and respiratory failure Liver damage Hypersensitivity

1 Same as aspirin poisoning.

Food Poisoning Food poisoning occurs when a person consumes food or drinks that may be contaminated with viruses, bacteria, parasites or toxins that are harmful for the body. Food contamination can occur while the food is being produced processed, not cooked and handled properly.

CHAPTER 21  Poisoning

STEPS TO DO

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Causes

Allergens Bacterial infection Viral infection Mild toxins and contaminants parasite infection

y y y y

Signs and Symptoms

Nausea Vomiting Diarrhea Stomach cramps Headache Fever Dehydration

y y y y y y y

STEPS TO DO 1 Check the victim for response. 2 Collect history asking the details of food consumed. 3 Control nausea and vomiting and, if possible, collect the gastric contents in a bottle. 4 Prevent the victim from dehydration (give oral rehydration or get one from pharmacy). 5 Keep checking the pulse and respiration until ambulance arrives.

UNIT III  First Aid in Emergencies

6 Shift to the hospital.

Acid Poisoning This type of poisoning is common at homes, hospitals, industries where acidic products are used, like toilet cleaners, metal cleaner, rust remover, lysol, etc. Signs and Symptoms y y y y

162

Abdominal cramps Pain Gastric perforation Corrosive burns of the mucous membrane

FIRST AID MANUAL FOR NURSES y y y y y

Decreased respiratory rate Tachycardia Hypothermia Increased blood pressure Circulatory failure STEPS TO DO

1 Check the condition and response of the victim. 2 Take the history. 3 Observe the sign and symptoms. 4 Never ever induce vomiting in acid poisoning as it may burn the mucous membrane while coming out. 5 Try to neutralize it with milk of magnesia. 6 Shift to the hospital.

Alkali Poisoning Give the victim a comfortable position. It is a life-threatening condition and can occur in factories, homes, dispensaries drain cleaners detergents bleach are used. Signs and Symptoms

y y

Pain Corrosive burns of mucous membrane Burn of esophagus Decreased respiratory rate Increased pulse rate Shock Vomiting Gastric perforation Collapse STEPS TO DO

1 Assess the victim’s condition. 2 Check sign and symptom.

CHAPTER 21  Poisoning

y y y y y y y

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3 Obtain history. 4 Never induce vomiting. 5 Milk or water can be given to the victim. 6 Alkaline product can be neutralized with weak acids, like vinegar or lemon juice. 7 Give the victim a comfortable position. 8 Make arrangements to shift the victim to the hospital.

Organic Phosphate Poisoning It is a kind of accidental poisoning which occurs by ingestion of organic phosphate, like insecticides and pesticides. Signs and Symptoms

Anxiety Headache Ataxia convulsion Depression of respiration and circulation Tremor General weakness Cyanosis Coma

y y y y y y y y

UNIT III  First Aid in Emergencies

STEPS TO DO 1 Remove the victim from the site of the exposure. 2 Ask history (from casualty or any other source). 3 The victim cloths should be removed and the entire body should be cleaned with soap and water. The faster the poison is washed off the victim gets less injury. 4 The first aider should wear protective cloths and gloves before handling a victim. 5 If the victim is breathing but unconscious, then provide recovery position till emergency care is given. Keep monitoring the breathing pattern of the victim. 6 Immediately shift the victim to the hospital.

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Kerosene Poisoning Kerosene is an oil used as a fuel for lamps as well as for heating and cooking. It contains poisonous ingredient, the hydrocarbons, the substance that contains only hydrogen and carbon. Signs and Symptoms y y y y y y y y y y y y y y y

Difficulty in breathing due to throat swelling (inhalation) There may be pain in the eyes, ears, nose and throat Abdominal pain Bloody stool Burns Vomiting Low BP Collapse Convulsions Headache Seizures Weakness Euphoria Dizziness Depression STEPS TO DO

1 Check the victim’s condition and proceed accordingly. 2 Collect history and check signs and symptoms. 3 Call poison control center and seek help, follow the advice on phone. 4 Induce vomiting, if advised by poison control center.

6 If the chemical is swallowed, give the victim milk or water. 7 If inhaled, move to fresh air. 8 Seek medical help immediately.

CHAPTER 21  Poisoning

5 If the kerosene is spilled on the skin and eyes, immediately flush the skin and eyes with lots of water at least 15–20 minutes.

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Datura Poisoning (Devil’s Trumpet) It is also called moon flowers or thorn apple. Datura poisoning occurs because of accidental or mistaken consumption of seeds of the tree. It is third most common poisoning in India. Signs and Symptoms

Flushed face/red patched skin Hot dry skin Dry throat Dilated and fixed pupils Difficulty in swallowing Decreased respiration Shock Tachycardia Coma Death due to the heart failure and respiration

y y y y y y y y y y

STEPS TO DO 1 Check the condition of the victim. 2 Induce vomiting if the victim is conscious. 3 Provide recovery position till the ambulance arrives. 4 If the victim is unconscious and not breathing, start CPR.

UNIT III  First Aid in Emergencies

5 Seek medical help immediately.

Alcohol Intoxication It is also called drunkenness. It is a physiological state where alcohol (ethanol) enters the blood stream at a very fast rate than being metabolized by the liver. Metabolized alcohol is less harmful as it breaks down the ethanol into non-intoxicating by products. Signs and Symptoms y y

166

Euphoria Flushed skin

FIRST AID MANUAL FOR NURSES y y y y y y y y y y y

Severe impairment of balance Low body temperature Slow and irregular breath Impairment in muscle coordination Nausea Vomiting Pale clammy skin Poor decision-making ability Coma and death can also be occur Reddened and moist face Unresponsive and unconsciousness STEPS TO DO

1 Assess the condition of the victim and check for ABCs. 2 Call poison control center for advice. 3 Monitor and maintain the victim’s airway and breathing. Resuscitate the person, if required. 4 If the victim becomes unconscious and is breathing, then place the victim in recovery position (as the victim likely to vomit) and check airway and breathing. 5 Check for injuries and provide treatment. 6 Protect the client from hypothermia.

CHAPTER 21  Poisoning 167

4

22

Bites and Stings SNAKE BITE Snake bite usually occurs among farmers, plantation workers and trekkers. It often results in two punctured wounds from the snakes fangs. Sometimes poisoning may even occur from the bite.

Types of Venomous Snakes The venomous snakes are listed here: y y y

Coral snake Copperhead Rattlesnake (Fig. 22.1)

y y y

Cobra Viper Water moccasin

Signs and Symptoms y y y y y y

Fang masks Burning sensation Numbness/tingling Excessive sweating Diarrhea Bloody discharge from the wound

y y y y y y

Increased thirst Bleeding from nose, gums and respiratory tract Vomiting Bloody sputum Loss of muscle coordination Fever

Fig. 22.1:  Rattlesnake

FIRST AID MANUAL FOR NURSES y y y

Convulsion Dizziness Shock

y y y

Rapid pulse Shallow respiration Fainting

STEPS TO DO 1 Check the site, do not panic. 2 Reassure and calm the victim and ask the victim not to move (to lessen the flow of lymph and hence minimize spread of victim). 3 Wash the wound thoroughly with soap and water 4 Immobilize the affected area (helps stop lymphatic spread of venom). 5 Slightly elevate the area. 6 Apply ice pack locally. 7 Loosen any constricting items as the affected area may swell. 8 Above the bitten area, tie a bandage 2–4 inches above the bite so that venom is prevented from spreading. 9 Note any kind of bleeding and keep the victim warm. 10 Assess the victims pulse rate, respiration and blood pressure (BP). 11 No water no food (follow the golden rule of first aid) 12 Shift to the hospital.

Caution

DOG BITE Dog bites are commonly encountered in daily life as dogs are the common pets among human beings (Fig. 22.2). Dog bite can sometimes become a serious and life-threatening condition. Dog bite possesses a risk of rabies and chances of infection are also very high.

CHAPTER 22  Bites and Stings

Do not do the following in case of snake bite: y Cut or suck the venom out (leads to infection). y Do not use a tourniquet on wound as it will restrict blood flow. y Do not use too much of ice (increases damage to the wound). y Do not have alcoholic caffeine as it will increase heart rate. y Do not cover the bite area and puncture mark.

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Fig. 22.2:  Dog bites cause rabies

If the animal is suffering from rabies, it can transmit this viral disease to person bitten. For this the animal is to be observed for a period of 10 days. If the dog remains healthy after 10 days, then the risk of rabies is less. But in some cases it has been seen that the chances of rabies even persists after months or years of bite.

Rabies

UNIT III  First Aid in Emergencies

A fatal infection of central nervous system is caused by a virus transmitted to human via bites of infected animals. This virus is present in the saliva of the infected animals. If not treated, it will travel to brain via peripheral nerves and cause death of the person.

Signs and Symptoms Bruise/puncture Cuts Breakage in the skin The area becomes red and swollen Fever

y y y y y

y y y y y

Headache Hydrophobia Paresthesia 50–60% Sensitive to loud noise Cough

STEPS TO DO 1 Examine the bite: Check the bitten area for the type of bite, i.e., from a shallow scratch to deeply punctured torn or joints/bones crushed.

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2 Clean the wound thoroughly with soap and water immediately. Wash the bitten area all around with a sufficient amount of water (tap water) for a few minutes followed by an antibacterial soap again for another few minutes. Washing with soap and water helps to clean the wound of any germs around the wound or from the dog’s mouth. Wound is to be washed for at least 15–20 minutes. 3 If the wound is bleeding, stop the bleeding first by applying pressure. After washing if the wound continues to bleed too much then apply pressure to the bite by covering it with a clean gauze piece if it is not available one can use a clean towel or cloth (thick). Check the bleeding after 10–15 minutes of pressure. Note Other animal bites that can cause rabies: y Cats y Bats y Foxes y Rats y Wolves y Rodents 4 Apply an antibacterial cream if available and bandage the bite. Neosporin or bacitracin if available can be applied on the wound. If it is not available, do not waste time searching for it (antibacterial cream helps to prevent the infection). The bandage should have enough pressure to protect the injury and also make sure that it is not too tight to affect the circulation or cause discomfort to the victim. 5 Shift the victim to the hospital for vaccination, i.e., TT (tetanus toxoid) if it is not received in last years and for booster if the last vaccine date is more than 5 years old from the recent bite.

Spiders do not harm humans because they are not able to pierce the skin with their fangs. A spider bite (Fig. 22.3) also referred to as arachnidism is an injury that results from the bite of the spider. Although in India the effects of most spider bites are not serious (Indian spiders are not venomous as compared to spiders of other countries). But if bitten by a spider which is venomous it causes latrodectism (a condition caused by the neurotoxin present in the bite by the spider leading to pain, muscle rigidity, vomiting, and sweating).

CHAPTER 22  Bites and Stings

SPIDER BITE

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Fig. 22.3:  Black widow spider

Signs and Symptoms y y y y

Pain Tenderness Necrotic lesion Bleeding may occur with bite

y y y

Gooseflesh Sweating High BP

Habitat As a defense mechanism (spider do not feed on humans) where the spider found. UNIT III  First Aid in Emergencies

y y y y

On the ground Under rocks On plants In trees

y y y

Caves On water In human houses or dwelling

Effect of Spider Bite In humans, the effects are of two types: 1. Spider venom which is neurotoxic may affect the human nervous system. The black widow venom is neurotoxic and it is fatal. 2.  Spider venom which is necrotic causes damage to the tissues surrounding the site of bite. The brown recluse spiders have necrotic venom.

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Most spider bites are harmless and it may cause any minor injury, here are the points to follow: STEPS TO DO 1 Clean the wound with mild soap and water. 2 Apply antibiotic ointment. 3 Apply cold compression. Use a cloth filled with ice (help to reduce swelling and pain). 4 It bite is on arm or leg elevate it. 5 Use pain killer if pain is there.

When to Seek Medical Care Seek prompt medical care if: y Not sure whether the bite was from a poisonous spider. y The victim has severe pain, abdominal cramping, breathing difficulty.

SCORPION STING Scorpion (Fig. 22.4) are members of Arachnida class and very similar to spiders, ticks and mites. They have two pincers, 18 legs and on elongated body with a tail composed of segments ranging in length from 9 cm to 21 cm. It is mostly found in black and red colors. Scorpions do not bite but they do sting.

CHAPTER 22  Bites and Stings

Fig. 22.4:  Scorpion

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Signs and Symptoms Swelling (mild to moderate) Severe pain Numbness at sting site

y y y

y y

Excessive salivation Nausea and vomiting

Habitat Burrows Grounds Trees

y y y

y y

Under rocks Loves to hide in sand

STEPS TO DO 1 Calm and reassure the victim. 2 Immobilize the victim. 3 Wash the scorpion sting site with water. 4 Apply ice pack on the area. 5 Do not slash the sting site to let venom out. 6 Keep observing the victim for serious reaction like shock, hyperventilation, disorientation, muscle spasm, increased pulse rate, increased heart rate. 7 Immediately shift to the hospital.

UNIT III  First Aid in Emergencies

BEE AND WASP STING A bee sting is a puncture wound or laceration in the skin caused by a bee. Bee and wasp (Figs 22.5A and B) inject venom by stinging people and stinger may be left inside the skin. The venom is poisonous to human body and may cause mild to severe allergic reaction.

Signs and Symptoms y y y y

174

Pain at the site of sting. The pain is instant sharp, burning lasting a few seconds. A swollen red mark itchy and painful. Swelling peaks around 48 hours and lasts for up to a week. Systematic reaction may be: ƒ Raised itchy bumps on the skin ƒ Itching over the whole body

FIRST AID MANUAL FOR NURSES ƒ ƒ ƒ ƒ ƒ ƒ

Mouth and throat swelling Difficulty in breathing Nausea and vomiting Chest pain Low BP In severe cases, death can occur

Types y y y

Hornets Yellow jackets Wasps

A

Figs 22.5A and B:  (A) Bee; (B) Wasp

CHAPTER 22  Bites and Stings

B

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STEPS TO DO 1 Check the site of the bite. 2 Remove any stringer remaining in the skin. 3 Stringer can be scrapped out with a credit card knife or blade, etc. 4 To relieve pain apply ice cover it with a cloth. Do not apply ice directly. 5 Wash the site with soap and water thoroughly. Apply steroid tropical cream to relieve from swelling and itching. 6 Get the victim tetanus immunization. 7 Check for any allergy treatment as it may require treatment antihistamines. 8 Allergic reaction in certain people whose immune system are oversensitive to the venom and can be fatal. Hence, seek immediate medical advice without wasting time. 9 Monitor ABCs. 10 Shift to hospital in case of wasp. 11 Wash the sting area with soap and water to remove as much as venom. 12 Apply cold pack. Ice should be covered in a cloth. Do not apply ice directly. 13 Baking soda and colloidal oatmeal can be used in the bath as they are soothing to the skin.

UNIT III  First Aid in Emergencies

14 Pain can be relieved by analgesic. 15 Itching and swelling can be removed by antihistamines and chlorpheniramine maleate. 16 Consult a doctor before taking medicine. 17 If a severe reaction occurs, immediately seek medical help. Caution In case of sting bites, watch the victim for 30 minutes for any signs and symptoms of allergic reaction (difficulty in breathing, swelling in other areas, anxiety, nausea, vomiting). If any of these arise be alert, first treat shock and immediately shift the victim to the hospital.

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TICK BITE Tick bite (Fig. 22.6) is not poisonous but can carry serious diseases like Lyme disease, Rocky Mountain spotted fever.

Fig. 22.6:  Tick

Tick bite is painless due to which the person may not even know that the tick is embedded in his/her skin. STEPS TO DO 1 Pick out the tick with the help of the tweezer. Never grab the tick rear of its body as this may cause internal gut to rupture as a result the contents get squeezed out causing infection. 2 Wash the bite area with soap and water. 3 Place an ice pack over the bite to relieve pain. 4 Apply calamine lotion to relieve itching.

HUMAN BITES Human bites can be as dangerous as or even more dangerous than animal bites because of the types of bacteria and viruses contained in the human mouth. Human bites that break the skin can become infected. Deep puncture wounds are caused by bites from sharp, pointed teeth, which can harm tissues and introduce microorganisms. The tissue is also crushed by bites. Because of the increased danger of infection, each bite that breaks the skin requires immediate first assistance.

CHAPTER 22  Bites and Stings

5 Watch for untoward signs if present, i.e., severe headache, fever, rash, breathing problem, then immediately seek medical advice.

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Human bites carry only a small risk of transmitting the hepatitis or human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) viruses. However, medical advice should be sought right away.

Etiology The causes of human bite wounds include the following: Aggressive behavior, often in combination with alcohol (the cause of most clenched-fist injuries) Sexual assault Domestic violence Child abuse Occupational injury to dental personnel Seizure-related tongue lacerations Nose biting (punishment for adultery in several cultures) Accidents during sporting events Aggressive play of children in daycare centers

y y y y y y y y y

Types of Human Bites Occlusion bites occur when the teeth sink deeply enough into the skin to compromise the skin’s integrity. Clenched-fist injuries happen when a closed fist collides with another person’s teeth, injuring the dorsal aspect of the 3rd, 4th, or 5th metacarpophalangeal (MCP) joints, most commonly the 3rd MCP.

y y

UNIT III  First Aid in Emergencies

STEPS TO DO 1 Clean the bitten area with soap and water. 2 Apply pressure to the bite with sterile gauze or a clean cloth if it is bleeding. 3 Apply antibiotic ointment to the area once the bleeding has stopped. 4 Cover the wound with sterile gauze or a bandage. 5 Give painkillers such as acetaminophen or ibuprofen. 6 If the bite wound is on a limb, it should be elevated. 7 If the bite wound is over the joint, it must be cleaned out and immobilized. 8 It is advised that patients with a history of two or fewer immunizations receive tetanus immunoglobulin and tetanus toxoid.

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4

Foreign Body in the Eye INTRODUCTION Eye is a very delicate organ anything that enters the eye from outside, be it dust particle or a metallic object, likely to affect the cornea or the conjunctiva. The eye is covered interiorly by a transparent layer/as cornea. This cornea protects the delicate organ (eye), also through cornea, light enters the eye and it helps focus the light on the retina at the back of the eye. The conjunctiva is the thin pinkish colored mucous membrane that covered the sclera or the white portion of the eye. The conjunctiva runs over the edge of the cornea and also covers the most area under the eyelid. When a foreign object enters the eye, can cause scratches on the cornea in case of minor case and infection of damage in vision (in severe cases).

SIGNS AND SYMPTOMS Pressure or discomfort in the eye Excessive blinking y Pain y A sensation that something is in the eye y Tears from the eyes y Pain on looking at light y Redness or blood-shot eye. It is very rare that a foreign object may penetrate the eye. In case, an object penetrates the eye, it is called intraocular object and in such cases there is discharge of fluid or blood from the eye. y y

CAUSES y y y y

Explosions Blowing wind Falling debris Accident with tools hammers, drills, lawn mowers.

COMMON OBJECTS THAT CAN ENTER EYES y y

Sawdust Eyelashes

y y

Dirt Sand

FIRST AID MANUAL FOR NURSES

Cosmetic Contact lens

y y

y y

Metal particles Glass material (shords)

Caution Removing a foreign object from the eye can lead to serious eye damage. Hence, below are the conditions when a victim should immediately get emergency treatment: y If the foreign object contains chemicals y Entered the eye at a high rate of speed y Is embedded in the eye y The eye is bleeding y If the foreign object has sharp or rough edges y If the victim is not able to close his/her eye y If simple irrigation failed. STEPS TO DO 1 Re-assure the victim. 2 Check the eye for type of foreign object. 3 Completely restrict the movement of the eye. 4 Wash hand with soap and water. 5 If it is a minor one, may ask the victim to try flushing the object with water gently.

UNIT III  First Aid in Emergencies

6 A shower may also help to flush the foreign object. 7 If the victim is wearing contact lenses, they should be removed while irrigating the surface of the eye as there are chances of the foreign object being embedded on the undersurface of the eye. or

First aider can perform simple irrigation which is described here:



  Pull the lower lid of eye gently down and ask the victim to look up and again while doing the same as the victim to look up in order to find the object.



  If the object is visible, use medicine dropper filled with clean warm water to flush the eye. Eye can also be flushed by filling head back also.

8 A damp or wet clean cloth can also be used to remove a small object. Never try removing a large object. 9 Seek immediate medical care even if the object has been removed.

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4

Foreign Body in the Nose INTRODUCTION The nose is surprisingly deep space that extends clearly back into the face and connects to the back and the mouth. Any object stuck in the nose may be inhaled into the lungs, blocking the airflow or it may dislodge and travel into the mouth and the victim may swallow it. It is very common in children.

CAUSES y y

It may be put in nose voluntarily by the children while playing Trauma (when a victim falls and gets stuck in face, there is possibility of object being stuck in the nose and of it being completely out of view).

SIGNS AND SYMPTOMS y y y

y y y y

Difficulty in breathing Pain Nose bleeding (due to scratching of nose, nasal space connects to the back of the mouth. There is possibility of its being pushed back to throat and the victim may swallow it or chock on it) Choking Wheezing Inability to speak Infection (Lost or forgotten tissue paper)

TYPES OF FOREIGN OBJECTS y y y y

Marbles Seeds (beans, peas) Crayon pieces Erasers

y y y

Cotton Beads Buttons

FIRST AID MANUAL FOR NURSES

STEPS TO DO 1 Re-assure the victim. 2 Give the victim a comfortable position. 3 Make the victim to breathe through his/her mouth. 4 If the object is visible and partially out of the nose, then with the help of tweezers, try to remove it. If it does not come out, do not push it further into the nose. 5 If the object is deep, then pinch the clear side of the nose closed and ask the victim to blow his or her nose hard, several times. This will help in removing the object.

UNIT III  First Aid in Emergencies

6 Seek immediate medical help.

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25

Foreign Body in the Mouth INTRODUCTION A foreign object can be swallowed by any one. The most common age is infant and toddlers who keep on exploring things and hence they are at the higher risk than the adults. Usually the object goes into the stomach (digestive system) and will exit from the body naturally. In a few cases, it may stick on the way posing a risk to the victim. Objects that can be swallowed: y y y

Small magnets Buttons Rocks (pebbles)

y y y

Small buttons Pins Erasers

There are two types of airway obstructions: (1) partial and (2) complete. 1. P  artial: Breathing is difficult; breathing may be noisy, and some air escape from the mouth can be felt. 2. Complete: Breathing may be difficult; there is no sound of breathing; no air escapes from the nose or mouth. Nursing Alerts and Warning Signs of Choking y y y y y y y

The person has trouble breathing. Attempts to cough something out but fails. The person is unable to speak or make any sound Places his hands on his throat. The lips and tongue turn blue. The veins in the face and neck protrude out. The person becomes disoriented and may be loses consciousness.

SIGNS AND SYMPTOMS y y y y

Choking Difficulty in breathing Wheezing Cough

FIRST AID MANUAL FOR NURSES

Vomiting Fever Pain in abdomen: If the object is stuck in esophagus or bowel.

y y y

STEPS TO DO 1 Follow the American Red Cross recommendations, the five and five approach to first aid. ƒ Give five back blows: First deliver five back blows between the person’s shoulder blades with the head of your hand. ƒ Give five abdominal thrusts state (Heimlich maneuver) not to be used on infant rather chest compressions are to be used. ƒ Alternate five back blows and five abdominal thrusts. 2 If the victim becomes unconscious immediately, begin cardiopulmonary resuscitation (CPR). 3 Shift to hospital.

TREATMENT FOR CHOKING IN ADULTS AND CHILDREN

Effective Cough (Partial Airway Obstruction) Reassurance and encouragement to maintain coughing to eliminate foreign material should be given to a casualty with an effective cough. The rescuer should call an ambulance if the obstruction is not removed.

y

UNIT III  First Aid in Emergencies

y

Ineffective Cough (Severe Airway Obstruction) Conscious Victim STEPS TO DO 1 Call an ambulance if the victim is conscious. 2 Perform up to five sharp, back blows with the heel in the middle of the back between the shoulder blades. 3 Check to see if each back blow has relieved the airway obstruction. The aim is to relieve the obstruction with each blow rather than to give all five blows (Procedure is explained in Fig. 25.1).

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Unconscious Victim STEPS TO DO 1 If a solid material is visible in the airway of an unconscious person with an obstructed airway, the finger can be used to remove it. 2 CPR should be started right away.

CHAPTER 25  Foreign Body in the Mouth

Fig. 25.1:  Heimlich maneuver

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FIRST AID MANUAL FOR NURSES

3 If you are alone and choking: ƒ Bend over and press your abdomen against any sturdy object such as a chair back. ƒ Alternatively, use your hands to perform abdominal thrusts on yourself, exactly as you would on someone else.

Treating for Chocking Infants (104°F) Reduced response level or unconsciousness Seizures

y y

UNIT III  First Aid in Emergencies

y y y y y

STEPS TO DO 1 Assist the casualty in moving to a cooler location. 2 Examine the victim’s respiration and level of consciousness. 3 Assist the victim in lying down with their legs slightly lifted. 4 Circulate the air around the worker to speed cooling.

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5 Remove the victim’s outerwear and wrap him or her in a cool, moist sheet. Remove the wet and cold sheet and replace it with a dry sheet once the casualty’s temperature has returned to normal. 6 Place cold wet clothes or ice on the head, neck, armpits, and groin; or soak the clothing with cool water. 7 If the casualty is conscious, ask him or her to drink some water (This is an exception to the general first aid rule of not offering a casualty anything to drink or eat). 8 Continue to monitor the casualty’s respiration and level of consciousness. 9 Transport the victim to a medical facility or hospital as soon as possible.

TREATMENT Two conditions may arise when treating a patient of heat exhaustion and heatstroke: 1. Person is unconscious, but is still breathing. 2. Person has stopped breathing. Person is unconscious, but is still breathing: y

Place the individual in the recovery position. Continue to observe the victim and check his breathing.

Person has stopped breathing: y y

Cardiopulmonary resuscitation (CPR) should be performed. Do not stop resuscitation: ƒ Until the individual awakens, moves, opens his eyes, and breathes properly. ƒ Aid (trained in CPR) arrives and takes over. ƒ You are too fatigued to continue. ƒ The scene becomes unsafe for you to continue.

Referral to health care facility: Following initial stabilization, always refer the casualty to a health care facility for further medical follow-up.

DIFFERENCE BETWEEN HEAT EXHAUSTION AND HEATSTROKE The differences between heat exhaustion and heatstroke have been shown in Figure 28.1.

CHAPTER 28  Heat Exhaustion and Heatstroke

y

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FIRST AID MANUAL FOR NURSES

UNIT III  First Aid in Emergencies

Fig. 28.1:  Differences between heat exhaustion and heatstroke

198

29 Abdominal Injuries INTRODUCTION The abdomen can be injured in a variety of ways, and the injuries can be minor or severe. The abdominal organs beneath it, such as the liver, spleen, and stomach, are vulnerable to significant damage since the abdominal cavity is not protected by bones. Organs and large blood vessels can be punctured, lacerated, or ruptured. There may be external bleeding, protruding abdominal contents, internal bleeding and injury as a result of severe abdominal injuries.

CLASSIFICATION Abdominal injuries may be classified into two categories: 1. B  lunt: This type of abdominal trauma occurs when there is a direct blow, a strong impact, or a sudden increase in speed. A blunt trauma scenario may be a fall from a height or a motor vehicle accident. Organs most affected are: spleen > liver > small and large intestine. 2. P  enetrating: This abdominal trauma, such as gunshot and stabbing wounds, entails breaking the skin. Some penetrating injuries only affect the skin’s top layer such as fat and muscles. Penetrating injuries, in comparison to blunt injuries, are far more dangerous once they enter the abdominal cavity. Gunshots that hit a person’s abdominal cavity can do a lot of harm. A penetrating injury can sometimes affect both the chest and the upper section of the abdomen. There are four regions of the abdomen (as described in Fig. 29.1) to consider in penetrating injury: 1. Anterior abdomen 2. Thoracoabdominal area 3. Flank 4. Back

FIRST AID MANUAL FOR NURSES

Fig. 29.1:  Regions of penetrating abdominal injury

SIGNS AND SYMPTOMS Severe pain in the abdominal area Inability to stand upright or straight Abdominal swelling, distention Bleeding open wound (with potential intestinal protrusion) Blood in the urine Nausea Vomiting Shock

y y y y y y y y

STEPS TO DO

UNIT III  First Aid in Emergencies

1 Always suspect internal bleeding in an abdominal injury, and perform first aid for shock for any obvious external injuries. Do not touch nor replace the swollen organs. 2 Assist the person in lying down in the most comfortable position possible. The suitable position is usually a prone position or on the undamaged side with both knees drawn up. This position is suggested for pain and spasm relief. 3 While you inspect the injuries, keep the person completely still. 4 Loosen any clothing that is too tight, especially around the neck and waist. Continue to look for evidence of injury and stop any bleeding. 5 Cover the wound with a sterile bandage and secure it; the casualty might be able to assist. Raise and support the injured person’s knees to relieve the tension. 6 The casualty should be treated for shock. While waiting for help, assess the vital indicators such as breathing, pulse and level of responsiveness.

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Caution y Do not touch any protruding intestine, and do not put pressure on the wound. Cover the area with a clean plastic bag or plastic wrap to prevent the wound from drying out. Help the casualty bend his knees. y If the casualty loses consciousness and is not breathing normally, begin cardiopulmonary resuscitation (CPR) with chest compressions. y Do not allow the casualty to eat or drink because an anesthetic may be needed.

CHAPTER 29  Abdominal Injuries 201

30 Chest Injuries INTRODUCTION A chest injury is an injury that occurs in the chest wall or the bones, skin, fats, and muscles surrounding your lungs, including the ribs and sternum. It can also occur in any of the organs found inside the chest. Chest trauma can result in fractures, lung or heart contusions, and rib bruising due to wall injury. It can compromise breathing, resulting in hypoxia. Hypoxia is a disease in which the body as a whole (generalized hypoxia) or a specific part of the body (tissue hypoxia) is deprived of sufficient oxygen. A chest injury that goes untreated can cause one or both lungs to collapse, putting pressure on the heart and resulting in cardiac arrest.

TYPES y y

Closed: The skin is intact and air does not enter the chest cavity through the chest wall. For example: a rib injury. Open: The chest wall has been penetrated by a foreign object. For example: pneumothorax, penetrating chest wound.

CAUSES y y y

Blunt trauma Crush injuries Penetrating objects

FIRST AID FOR VARIOUS TYPES OF CHEST INJURIES

Rib Injuries y y y

A direct impact to the chest from a hit or a fall, or a crush injury, might fracture one or more ribs. The casualty’s respiration may be substantially hampered if there is a wound over the fracture or if a broken rib pierces a lung. An injury to the chest can result in a “flail chest” injury, in which a section of cracked ribs separates from the rest of the chest wall (Figs 30.1A to D).

FIRST AID MANUAL FOR NURSES y

y

When the casualty inhales, the separated portion moves within, and when he exhales, it moves outward. This is known as “paradoxical” breathing. Lower rib fractures can induce internal bleeding and injury to internal organs including the liver and spleen.

Signs and Symptoms y y y y y y y y

Trouble breathing Shallow breathing Tenderness at site of injury Deformity and bruising of chest Pain upon movement/deep breathing/coughing Dusky or blue lips or nail beds Crackling feeling upon touching victim’s skin Assess for the signs of internal bleeding such as coughing up of bright red frothy blood.

A

C

D

Figs 30.1A to D:  Flail chest and its pathophysiology

CHAPTER 30  Chest Injuries

B

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STEPS TO DO 1 Assist the casualty to a seat and ask him to support the damaged side’s arm; assist him if necessary. Put the arm on the affected side in a sling for added support. 2 Place large amounts of padding over the flail area. 3 Monitor and observe the victim for any breathing problems. 4 Arrange for the casualty to be taken or sent to the hospital. Caution y Do not allow the casualty to eat or drink because an anesthetic may be needed. y If the victim loses consciousness, place him on the ground, backward, with his airway open. Start CPR with chest compressions if he is not breathing. If he needs to be placed in the recovery posture, do it on his wounded side so that the lung on the uninjured side can fully function.

Penetrating Chest Wound y y

UNIT III  First Aid in Emergencies

y y y

y

If a sharp item penetrates the chest wall, the organs in the chest and upper abdomen may be severely damaged, leading to shock. Lungs are especially vulnerable to injury, either from internal damage or wounds that perforate the two-layered membrane (pleura) that surrounds and protects each lung. Pneumothorax occurs when air enters between the membranes and exerts pressure on the lung, causing the lung to collapse (Fig. 30.2). The pressure around the wounded lung may build up to the point where it affects the unaffected lung, leaving the victim breathless. This pressure buildup in a tension pneumothorax may prevent the heart from adequately filling with blood, limiting circulation and causing shock. Sometimes, blood collects in the pleural cavity (a hemothorax) and puts pressure on the lungs.

Signs and Symptoms y y y y y

204

Difficult and painful breathing Cyanosis of skin and lips (gray or bluish coloration) Clammy, pale skin Breathing is fast and shallow. Asymmetrical movement of chest as the injured side may not rise.

FIRST AID MANUAL FOR NURSES

Fig. 30.2:  Pneumothorax—the presence of air in the pleural cavity

If there is a sucking chest wound: y y y y

Sound of air being drawn into the wound along with bubbling blood. Crackling feeling to the skin around the wound due to air entry. Neck veins are becoming more visible. Blood is gushing from the wound. STEPS TO DO

1 Assist the victim in taking a seat. Encourage him to lean toward the wounded side of his body and cover the wound with his palm. 2 Wrap a plastic bag or foil around the wound and the surrounding region. 3 Only tape the plastic covering on three sides to prevent air from getting in but not out.

5 If required, perform cardiopulmonary resuscitation (CPR). If they are breathing, put them in the recovery position, with the wounded lung on the bottom. This will assist protect the healthy lung. 6 Call for emergency help. While waiting for help, continue to support the casualty in the same position as long as he remains conscious. 7 Until emergency help arrives, monitor and record the casualty’s vital signs—level of reaction, respiration and pulse.

CHAPTER 30  Chest Injuries

4 If the victim loses consciousness, check their breathing and open the airway.

205

31 Crush Injuries INTRODUCTION When a body part is subjected to a high degree of force or pressure, such as when pressed between two large objects, a crush injury occurs. Crush injuries are most common on construction sites, industrial sites, construction zones, storage facilities, and in traffic accidents. They can cause a limb’s blood flow to be disrupted. When the flow of blood to an area is blocked by a big weight, there is a risk of toxins building up in the muscle beneath the crushing weight. Toxins can be discharged into the rest of the body and induce kidney failure if blood flow is restricted or hindered for longer than 15 minutes. This is known as “Crush syndrome”, and the sufferer is in a lot of pain.

SIGNS AND SYMPTOMS y

y

Minor crush injuries: For example: fingers jammed in a door or a heavy object falling on the toes. ƒ Bruises/lacerations ƒ Mild to moderate pain Major crush injuries: It causes serious damage below the skin, in the tissues, organs, muscles, and bones. If the injury leads to cutting off of blood supply, muscle and tissue damages could be of grave nature and in extreme cases could result in paralysis. ƒ Damaged tissues and muscles ƒ Severe bruising ƒ Extreme pain ƒ Chances of open wounds ƒ Damages to the layers of the skin ƒ Compartment syndrome (Fig. 31.1)

FIRST AID MANUAL FOR NURSES

Compartment

Fig. 31.1:  Compartments—groupings of muscles, nerves, and blood vessels in limb, surrounded in a tough, nonelastic membrane called a fascia

Compartment syndrome Compartment syndrome develops when swelling or bleeding occurs within a compartment. Because the fascia does not stretch, this can cause increased pressure on the capillaries, nerves and muscles in the compartment, restricting blood flow, oxygen perfusion and waste removal leading to tissue ischemia. The 5 (or 6) Ps of compartment syndrome are often used as a diagnosis: • Pain • Pallor • Paresthesia—numbness or tingling • Pulse • Paralysis (Poikilothermia—inability to regulate temperature, i.e., different temperatures between the affected limb and nonaffected limb)

1 If the casualty has been crushed for less than 15 minutes, immediately release him as soon as feasible. External bleeding should be controlled, and any suspected fracture should be held still and supported. The casualty should be treated for shock. 2 Do not, however, elevate his legs.

CHAPTER 31  Crush Injuries

STEPS TO DO

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3 If the casualty has been crushed for more than 15 minutes and you are unable to move the cause of injury, provide comfort and reassurance in his current posture. 4 Call the emergency number for help, giving clear details of the incident to the dispatcher. 5 Monitor and record vital signs—level of response, breathing and pulse— while waiting for help to arrive. Caution

UNIT III  First Aid in Emergencies

y If a victim has been crushed for more than 15 minutes, do not release them. y Do not lift anything that is too heavy. y Because an anesthesia may be required, do not allow the casualty to eat or drink.

208

32 Sprain and Strain SPRAIN A sprain is a stretch or a partial tear of ligaments (which connect two bones or tendons). The most common sites for sprains are ankle and knee.

Causes y y y

Fall A sudden twist A blow to the body that forces a joint out of its natural position.

Signs and Symptoms y y y y y y

Pain (burning in nature) Swelling Discoloration Tenderness Bruising Loss of ability to move and use a joint

STRAIN A strain is an injury to muscle due to overstretching. It is also called muscle pull, occurs when the muscle is stretched beyond to normal range of motion (resulting in muscles tear). Common strains are back and hamstring muscle (located at the back of the thigh).

Causes A twist or pull of a muscle or tendon.

Types Strains are of two types: 1. Acute strain: An acute strain is caused by trauma or an injury such as a blow to the body. It may also be caused by improperly lifting heavy objects or overstressing the muscles.

FIRST AID MANUAL FOR NURSES

2. Chronic strain: It occurs as a result of overuse and prolonged repetitive movement of muscles and tendon.

Signs and Symptoms Pain Muscle spasm Muscle weakness Localized swelling Cramping or inflammation Severe strains may cause complete tear of the muscle and tendon causing disability (in severe cases).

y y y y y y

STEPS TO DO

UNIT III  First Aid in Emergencies

1 Swelling is controlled with RICE therapy ƒ R—Rest (Should not move the injured part) ƒ I—Ice (ice application of an ice pack to the injured part for not more than 20–30 minutes for every 2–3 hours during the first 24–48 hours)

The cold process treats the skin through four stages:



(i) Cold



(ii) Burning



(iii) Aching



(iv) Numbness



 ever put ice directly against the skin as it may damage the skin. Use N a thin towel for protection. A wet cloth transfers cold better than a dry cloth insulators. ƒ C—Compression: Compression of the injured area may squeeze some fluid and debris out of the injury site. To limit internal bleeding, an elastic bandage is applied to the injured area especially at foot, ankle, knee, thigh, hand or elbow. Use specific size of elastic bandages:   2 inches for wrist hand   3 inches for ankle, elbow and arm   4 inches for knee and leg.



 pplying a compression is the most important step in preventing A the swelling. The victim should wear elastic bandage continuously for 18–24 hours. Although cold is applied every 2–3 hours, compression

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should be maintained throughout the day. At night, ask the victim to loosen but not to remove the elastic bandage. ƒ E—Elevation: Elevating the injured area in combination with ice and compression limits circulation to that area reducing internal bleeding and minimize swelling. The injured part should be raised above the level of the heart for the first 24–48 hours after an injury. Do not elevate the injured part in case of suspected fracture.

CHAPTER 32  Sprain and Strain 211

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UNIT

IV Community Emergencies and Resources Unit Summary  Disaster Preparedness or Disaster Management  Fire or Wildfires  Explosions (Nuclear Warfare, Atom Bombs, Hydrogen Bombs)  Flood  Earthquake  Tsunami  First Aid in COVID-19-Related Emergencies  Famine  Role of Nurse in Disaster Management  Psychological First Aid  Rehabilitation  Voluntary Health Organizations

33 Disaster Preparedness or Disaster Management INTRODUCTION Every year thousands of disasters affect somewhere in the world be it a small, large, man-made or natural. The people stuck in disasters are panic, confused and need first aid care, emergency care, treatment, food, shelter, clothing and basic requirements of life. If these are provided on time, people can survive. Moreover, disaster training should be necessary for all. y Disaster management is the creation of plans through which communities reduce vulnerability to hazards and cope with disasters. y Disasters are the sudden catastrophic events that disrupt the pattern of life in which there is possible loss of life and property along with the multiple injuries. y A serious disruption of the functioning of the community or a society causing widespread material economic social and environmental losses which exceed the ability of the affected society to cope using its own resources.

TYPES It is of two types: 1. Natural disaster 2. Man-made disaster

Natural Disaster These are naturally-occurring physical phenomena caused by either rapid or slow onset of events which can be: y Geophysical: For example earthquake, landslide, tsunamis and volcanic activity. y Biological: Disease epidemics and insect/animal plagues. y Hydrological: Floods, avalanches y Climatological: Extreme temperature drought and wild fires y Meterological: Cyclones, storms/wave surges.

FIRST AID MANUAL FOR NURSES

Man-Made Disaster These are the events that are caused by humans and occur in or close to human settlements. These include: y Pollution y Environmental degradation y Accidents y Complex emergencies y Famine y Displaced populations y Industrial accidents y Transport accidents Note

UNIT IV  Community Emergencies and Resources

Hazards—a dangerous event that has the potential or power to injure life, damage property or environment.

216

34

4

Fire or Wildfires INTRODUCTION Wildfires are large fires which often outbreak in wild land areas. These can be spread widely to populated areas posing a threat to human beings, wildlife and property (Fig. 34.1).

CAUSES Almost 90% of wildfires are caused by human beings. They are listed below: y Lightning (natural wildfires occur at a time of drought combined with lightning which strikes and ignites the dry grass or bush) y Campfires y Fireworks y Yard waste burning y Vehicles (parking near or on dry vegetation)

Fig. 34.1:  Explosion of fire

FIRST AID MANUAL FOR NURSES

SAFETY TIPS y

y y y y y y y y y

UNIT IV  Community Emergencies and Resources

y y

y

218

Know your risk: This signifies that the people should gather information like: ƒ Is your area wildfire – prone region ƒ How often wildfires occur in your area ƒ What are the greatest risk factor. Restrict outdoor activities when the quality of air is reduced from nearby wildfires. Regularly listen to news on radio or television, stations and act accordingly. Be ready to evacuate. Get a fire safety tool kit and keep it ready during emergencies. Never leave a campfire unattended. The kids should always be 3 feet away from heat sources. Keep instructing children not to play with the lighters or match sticks. Educate the community about the wildlife safety. Clear dead plants, weeds that are easily flammable at least 50 feet away from your house. Install smoke alarms in your house. Return back only when it is safe. Be cautious of ash pits and hot spots. Never underestimate a small amount of fire even after fire has been extinguished because small fire can flare up without any warning. Document the damage to your house (for insurance purpose).

35

Explosions

(Nuclear Warfare, Atom Bombs, Hydrogen Bombs)

INTRODUCTION Nuclear explosion can cause both immediate and delayed destructive effects. Explosion immediate effects (blast), thermal radiation and ionizing radiation occur within seconds or minutes of a nuclear detonation. Whereas the delayed effects (radioactive fall out and environmental effects) cause damage ranging from a period of one hour to centuries (Fig. 35.1).

EFFECTS OF NUCLEAR EXPLOSION

Blast It is sudden speedy increase in air pressure which spreads out rapidly from the bomb. The blast shock waves knock down all that come into

Fig. 35.1:  Nuclear explosion

FIRST AID MANUAL FOR NURSES

contact, i.e., factories, buildings, window panes, hurls, debris causing destruction. People are crushed and hurt by falling, building and as a result of which one may inflict bruises, cuts, fracture, sprains, etc.

Direct Nuclear Radiations Nuclear detonations create a number of ionizing radiations. The explosion releases directly or indirectly neutrons and gamma rays which are deadly and produce harmful effect on the people.

Thermal Radiations

UNIT IV  Community Emergencies and Resources

The visibility of bright flash from a bomb needs not being closer to the explosion area rather it can be viewed from hundreds of miles away. Apart from being extremely bright, this flash of light is fiercely hot. If a person is 7 miles away from a one megaton explosion, the heat of fireball will/may cause a first degree burn. If 6 miles away, then it will cause second degree burn. If 5 miles away, then it will cause third degree burn. After all the extraordinary heat is capable of igniting a “mass fire” to burst into flames.

Radioactive Fall Out

Fall out is the radioactive particles that fall on the earth as a result of a nuclear explosion. It consists of weapon debris and fission products. Fall out is of two types. 1. Early fall out: The one that occurs within first 24 hours after explosion. 2. Delayed fall out: The one that occurs days or years later. This may occur by a number of ways like: y From direct skin contact with fall out particles in the air (external). y From fall out particles that fell on the ground and later come in contact with the skin. y From eating plants, milk or meat that had radioactive fall out on or in it (internal) y From breathing in radioactive material in the air (Internal).

220

FIRST AID MANUAL FOR NURSES

Global Ecosystem Radioactive material poses a deadly effect on the environment. Be in a nuclear testing uranium mining, radioactive waste burial or nuclear explosions, effects are: y Cancers y Lowered immunity y Genetic damage in human, animal and plant life y Birth defects y Water pollution y Soil pollution.

1 Listen for official information and if warned to evacuate, then leave the place immediately. 2 If there is a prior warning of the attack, then take cover as fast as you can, i.e., below ground. 3 To avoid contact with radioactive material outside, get into a building built of bricks or concrete or a multistory building or a basement to avoid any radioactive material. 4 Radiation levels are extremely dangerous after a nuclear detonation. (highest radiation levels). Later after 24 hours, the level reduces rapidly so it is advisable to stay inside unless told by the authorities. 5 Do not look at the flash or fireball as it may harm your eyes and cause blindness. 6 Lie flat on the ground and cover your head. 7 Immediately, take shelter even if you are far away from ground zero where the attack occurred. 8 Radioactive fall out can be carried to distances far away by blowing winds hence, protect yourself. Remember the following principles – distance, shielding and time. 9 After the blast, immediately remove your clothing to remove radioactive material even if you remove outer layer of clothing 90% of radioactive material is get rid off. Place the clothes in a plastic sheet and away from animals and human beings.

CHAPTER 35  Explosions (Nuclear Warfare, Atom Bombs, Hydrogen Bombs)

STEPS TO DO

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10 Have a shower when possible with lots of soap and water to remove the contamination caused by radioactive material. Never scratch the skin, wash your hairs too. Do not apply conditioner as it may bind radioactive material to your hair making it difficult to come out. 11 Seek immediate medical attention if the following arise: ƒ Weakness ƒ Severe nausea and vomiting ƒ Pallor ƒ Bleeding gums ƒ Bruising ƒ Loss of hairs

UNIT IV  Community Emergencies and Resources

12 Mild nausea and vomiting are the temporary effects and will be fine in few hours.

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36 Flood

4

INTRODUCTION Floods are the most common widespread of all natural disasters. Flood may gradually or take hours or happen suddenly without any warning, e.g., due to any embarkment, heavy rain, spring rains. The loss depends upon the severity of the flood and its location (Fig. 36.1).

DEFINITIONS An overflow of a large amount of water beyond its normal limits. or A flood is an overflow of water that submerges land which is usually dry. or The covering of normally dry land by water that has escaped or been released from the normal confines of any lake, river, creek or other natural watercourses, reservoir, canal, or dam.

Fig. 36.1:  Flood

FIRST AID MANUAL FOR NURSES

FLASH FLOOD Flood which occurs in 6 hours of beginning of heavy rainfall usually due to or associated with cloud bursts, cyclones and storms.

Safety Measures y y y y

y

y y

UNIT IV  Community Emergencies and Resources

y

Beware of the area of your living, i.e., flood prone area. Listen to radio or television for local information. Have a knowledge of flood warning signs and your community alert signals. If you live in a frequently flooded area, stockpile emergency building materials, i.e., plywood, lumber nails, hammer, saw, sand bags should be plastic sheeting, etc. Have a sufficient amount of disaster supplies in hand, i.e., flashlight, extra batteries, portable battery operated radio, first aid kit, cash, credit cards, etc. Move valuable household possessions on to the upper floors or to safe ground if time permits. Turn off all utilities and electrical appliances. Be prepared to evacuate.

During Flood y y y y y y

y y

Listen to the battery operated radio regarding the latest information. All the emergency supplies are to be brought near to you. If it is safe and time to evacuate, then do it quickly. If you are outdoors, climb to a high ground and be there till it is safe and announced back in radio. Avoid walking through flood water as you never know the depth (even water 6 inches deep can sweep you off your feet). If you are in the car and you experience flood, turn around and move toward a safer place. If the car stalls, get out of it and climb to higher ground. Never move stalled vehicles. If still you can manage evacuation by car, then follow recommended evacuation routes (through radio) and leave as early as enough.

After Flood y

224

Flood danger does not end up when water starts to recede. Again listen to the radio or television and return back only when it is safe to go there.

FIRST AID MANUAL FOR NURSES y

y y y y y y y y y y

Do not walk through moving water. Six inches of moving water can knock you off your feet. Instead use a stick or pole to check the firmness of the ground. Examine walls, doors and windows of a building before entering to ensure safety as there are chances of building to collapse. Use battery powered flashlight and lantern to examine building. Do not enter into the building if it still filled with flood water or water stays around. Keep a watch and be vigilant as someone may be in need of help, i.e., disabled, elderly, children or pregnant women. Be cautious and watch out for animals especially poisonous snakes that might reach your hometown along with water. Poke through debris with the help of the stick. Watch for loose plasters and ceiling that may fall. Check for fire hazards. Click pictures of damage both to the house and its contents for insurance claim. Throw away food (canned) that has come in contact with flood water.

After Disaster y y y

Media can highlight the facts so that the general public may be able to help flood affected victims. Immediate aid of floods affected area is the financial aid so all come forward and contribute as per their pocket. Contact local officials, NGOs, and Government Organization to find out what is needed and where it has to be sent.

CHAPTER 36  Flood 225

4

37

Earthquake INTRODUCTION Earthquake is the most destructive natural hazard. It may occur anytime of the year (Fig. 37.1). An earthquake is a sudden, rapid shaking of the earth caused by breaking and shifting of rocks deep beneath the earth’s surface. It cannot be predicted, hence, causing massive destruction and losses.

GENERAL CHARACTERISTICS An earthquake’s vibrations occur in different types of frequencies and velocities, the ground shaking is caused by body waves and surface waves. The actual rupture process lasts for a few seconds (minor) to as one minute (major).

MEASURES TO SAVE ONESELF WHEN YOU EXPERIENCE AN EARTHQUAKE y

In case you are inside the building, cover under a table, bench or against an inside wall. If earthquake is severe, crouch next to a large,

Fig. 37.1:  Earthquake

FIRST AID MANUAL FOR NURSES

y y y

y

y y y y y

y

sturdy object, i.e., refrigerator or file cabinet so that if in any case, the ceiling collapses, then a triangle or space next to the object will protect you. Keep away yourself from glass, windows doors, walls or anything that is at risk of falling at the time of earthquake. If there is no table and chair, then cover your head and face with your arms and crouch down. Do not try to escape while shaking (during an earthquake) as escaping may cause object to fall on you. Move only when you are sure that it is SAFE for you. The most effective way to save you even in most slightly shaking is DROP (drop to the ground), COVER (cover your head and face) and HOLD (do not move till shaking) Beware of aftershocks these can be dangerous. Do not use elevator during an earthquake (if you are on the highest floor). If you are outdoor, find a clear spot away from buildings, trees, streetlight and power lines follow DROP and stay there until shaking stops. If you are in a vehicle, stop the car, pull over and stay there with your seat belt fastened until the shaking has stopped. If you are on a highway overpass, exit your car and lie next to it and not under the car. As the falling debris may crush the roof but it would be safer beside the car; stay there until help arrived. After the earthquake if you find yourself trapped in debris, do as follows: ƒ Do not panic. ƒ Shout for help. ƒ Do not try to kick up the dust or move about. ƒ Cover your mouth with cloth and handkerchief. ƒ Tap hard on a pipe or wall to get yourself rescued.

y y y y

Community should be taught earthquake preparedness measures for safety purposes. They should be taught in school or colleges. Building should be constructed and designed as per the building law to withstand ground shaking. Building a structure on soft soil is to be avoided. Building should not be constructed on the river banks which have alluvial soil.

CHAPTER 37  Earthquake

PREVENTION

227

38

4Tsunami INTRODUCTION

A Tsunami is a series of waves generated by an undersea disturbance, the wave will travel outward in all directions. During a Tsunami, the sea water is displaced with a violent motion and swells up ultimately causing landslides with great destructive powers.

CHARACTERISTICS y y y y

These waves are different from the ordinary waves. They travel much faster than the ordinary waves. They are 800 km/hr normally and wave speed is 100 km/hr. Tsunami is not a single giant wave but can be ten or more waves. Waves follow each other 5–90 minutes apart causing floods as huge water enters the main land.

SAFETY MEASURES y

y y y

Keep yourself updated with latest emergency information. Listen to a radio or television carefully. If announced and told to evacuate, implement it without any delay. Remain away from the area until and unless safe (announcement by local authorities). Never go to the shorelines to watch Tsunami because tsunami as told earlier is not a single wave but a series of giant waves. Never assume that one wave means the danger is over.

PREVENTION y y

Houses, building should not be constructed on tsunami risk region. Coastal homes should be elevated up to a level of more than 3 meters in height as tsunami waves are less than 3 meters, hence, elevation of houses will reduce the possible damage to the property during tsunami.

FIRST AID MANUAL FOR NURSES y y y

Velocity of waves can be reduced to some extent by construction of water breakers. Construction should be done with water and corrosion resistant material. Community center should be constructed at higher level in prone areas as they may be helpful at the times of tsunami by providing shelter to the community.

CHAPTER 38  Tsunami 229

4

39

First Aid in COVID-19Related Emergencies INTRODUCTION

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus. The novel coronavirus (COVID-19) is a highly infectious virus that originated in Wuhan, China’s Hubei province. The virus spreads quickly, resulting in pneumonia deaths all across the world. The majority of those infected with the virus will have mild to moderate respiratory symptoms and will recover without the need for medical attention. Some, on the other hand, will become critically unwell and require medical assistance. Serious sickness is more likely to strike the elderly and those with underlying medical disorders such as cardiovascular disease, diabetes, chronic respiratory disease, or cancer. COVID-19 can make anyone sick and cause them to get very ill or die at any age.

SIGNS AND SYMPTOMS y

y

y

y

Asymptomatic cases: Individuals who test positive for SARS-CoV-2 using a virologic test [i.e., a nucleic acid amplification test (NAAT) or an antigen test] but do not show symptoms compatible with COVID-19 are considered asymptomatic or presymptomatic. Mild illness: Individuals who experience any of the COVID-19 signs and symptoms (e.g., fever, cough, sore throat, malaise, headache, muscle pain, nausea, vomiting, diarrhea, loss of taste and smell) but do not have shortness of breath, dyspnea, or abnormal chest images are considered to have a mild illness. Moderate illness: Individuals with moderate illness have an oxygen saturation (SpO2) of ≥94% on room air at sea level and show indications of lower respiratory disease during clinical examination or imaging. Severe illness: Individuals with a SpO2 of 30 breaths/min, or lung infiltrates of >50% are considered to be suffering from severe illness.

FIRST AID MANUAL FOR NURSES

Critical illness: Individuals with respiratory failure, septic shock, and/or multiple organ dysfunction are considered to be in critical condition.

y

Watch for Red Flags y y y y y

Breathing problems Chest discomfort or pressure that persists New confusion Inability to get out of bed or stay awake Skin, lips, and nail beds that are pale, gray, or blue in hue, depending on skin tone

FIRST AID MANAGEMENT DURING COVID-19 First aid management begins from the point of appearance of symptoms such as fever, sore throat, malaise, etc. In some patients, symptoms do not appear, in that case testing positive on RT-PCR test is an indication to initiate preliminary management. First aid management should only be done in mild to moderate cases. Severe cases should be immediately taken to the hospital for further management.

Patients with moderate COVID-19 who have been suspected or confirmed are isolated to disrupt or suppress the transmission cycle. Mild instances can usually be treated at home. Treatment guidelines given by the Ministry of Health and Family Welfare (MoHFW), Government of India are as follows: STEPS TO DO 1 Physical distancing, indoor mask use, and strict hand hygiene are required for those in home isolation, COVID-19 care centers, or other similarly classified rural facilities. 2 Fever and cough symptoms are treated symptomatically. To maintain hydration, patients are advised to drink plenty of water on a regular basis. 3 Patients can gargle with warm water or inhale steam several times per day. 4 Take your temperature and check your oxygen saturation two to four times a day (with a SpO2 probe on your fingers).

CHAPTER 39  First Aid in COVID-19-Related Emergencies

Caution

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5 Maintain contact with your treating physician and report any changes in your clinical state as soon as possible. 6 Seek medical attention/care if: the patient develops difficulty in breathing, high-grade fever/or severe cough, especially if it lasts more than 5 days, age greater than 60 years, underlying noncommunicable diseases such as cardiovascular disease, hypertension, and coronary artery disease (CAD), diabetes mellitus (DM) and other immuno­compromised states, chronic lung/kidney/liver disease, cerebrovascular diseases, and obesity. 7 Drug treatment for mild cases: ƒ Tablet paracetamol—650 mg paracetamol four times a day if fever >100°F. ƒ If symptoms last longer than 7 days (persistent fever, increasing cough, etc.), consult the doctor about low-dose oral steroids.

UNIT IV  Community Emergencies and Resources

Proning for Self-Management of Dyspnea during Home Isolation Proning is the procedure of moving a patient from their back to their abdomen (stomach) with precise, safe motions so that they are lying face down. Proning is a medically recognized position that helps with breathing and oxygenation. It is especially helpful in COVID-19 individuals who have trouble breathing, especially during home isolation. Importance of Proning y y y

y y

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Prone positioning enhances ventilation and makes breathing easier by keeping alveolar units open. Only when the patient has difficulty breathing and the SpO2 drops below 94 is it necessary to pronate (