AEL - First Aid Handbook
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1 AEL - First Aid Handbook CONTENTS: General Procedures Emergency Principles- Basic Protocol Unconscious & not breathing 1 CPR Hands Only CPR Unconscious & breathing Conscious & breathing Choking & Heimlich maneuver Loss of consciousness (fainting)..5 Convulsion/ Seizures.. 5 Wounds..6 Bleeding External bleeding.7 2. Internal bleeding Mixed bleeding..8 Blisters....9 Asthma attack....9 Burns Heat Stroke Orthopedic injuries Head, neck & spine injuries Multiple trauma Allergic reactions..14 Eye injuries. 14 Dental injuries Animal bites..15
2 General Procedures - MILD INJURY: reassure victim about mildness of injury. - MODERATE INJURY: suggest follow-up by a physician if symptoms persist. - SEVERE INJURY: CALL FOR AMBULANCE. Maintain basic life support until help arrives. When possible, reduce the chance of infection by using a barrier (like latex gloves) when treating open wounds. Emergency Principles Basic Protocol DO NOT PANIC - Your calmness will help both you and the victim. Inspire confidence 1. EVALUATE - scene / victim situation. You can t help if you become a victim 2. CALL FOR HELP 107 (ambulance) / 911 (Police) 3. PRIMARY ASSESSMENT: COUNSCIOUSNESS & BREATHING A. Level of consciousness: victim alert? TAP & SHOUT B. Is the victim breathing? Observe chest movement for no more than 5 or 10 sec. Consider gasping as NOT breathing 4. SECONDARY ASSESMENT. Head to toe exam. Primary Assessment Results: 1. Unconscious and not breathing: CPR 2. Unconscious and breathing: RECOVERY POSITION 3. Conscious and breathing: SECONDARY ASSESSMENT CPR Hands Only Sequence: 1. Unconscious and not breathing: CPR Hands Only or CPR Push HARD and FAST in the center of the chest. No training needed A. Evaluate scene. Secure. B. Conscious? No. C. Call ambulance D. Breathing? Observe chest movement for 10 sec. No breathing or gasping. E. Start with 100 compressions per minute (depth of compression - 2 inches / 5 cm) 1 cycle = 100 compressions per minute 1 AEL - First Aid Handbook October 2015
3 1. Put the person on his/her back on a firm surface 2. Kneel next to the person's neck and shoulders 3. Place the heel of one hand over center of the person s chest, between the nipples. Place your other hand on top of the first hand. Keep your elbows straight and position your shoulders directly above your hands. Arms locked. 4. Use your upper body weight (not just your arms) as you push straight down on the chest. Compress at least 2 inches / 5 cm. Push hard at a rate of about 100 compressions a minute. Note: Relaxation and compression should be of equal duration. Let chest come back to normal position CPR Sequence: A. Evaluate scene. Secure. B. Conscious? No. C. Call ambulance D. Breathing? Observe chest movement for 10 sec. No breathing or gasping. E. 30 compressions (depth of compression - 2 inches / 5 cm) F. Open airway & give 2 breaths. 1. If person is not breathing perform 30 chest compressions. Push hard and fast in the center of the chest. 2. Open the person's airway using the head-tilt, chin-lift maneuver. 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 airway. 3. With the airway open pinch the nostrils shut for mouth-to-mouth breathing and cover the person's mouth with yours, making a seal. 2 AEL - First Aid Handbook October 2015
4 4. Give two rescue breaths. Give the first rescue breath lasting one second and watch to see if the chest rises. If it does rise, give the second breath. If the chest doesn't rise, repeat the headtilt, chin-lift maneuver and then give the second breath. If after reposition airway chest is not rising, continue doing compressions (Hands Only CPR) 1 cycle = 30 compressions + 2 breaths NOTE: Children and drowning person s sequence changes if you are ALONE. Do 5 cycles of CPR (30 compressions + 2 breaths) FIRST and the call the ambulance. In these cases the need for CPR is due to a respiratory cause and the chances to restart heart are greater so CPR shouldn t be delayed at all. 2. Unconscious and breathing RECOVERY POSITION - Don t move the victim if you suspect there is a head or neck (spinal) injury. For eg: falling from twice your height, polytrauma, car crash, etc. - Do turn an unconscious breathing victim 3 AEL - First Aid Handbook October 2015
5 3. Conscious and breathing SECONDARY ASSESSMENT ONLY after primary assessment (conscious & breathing) head to toe examination to identify any injury or sign of disease. We look for bleeding, fractures, wounds, pain, swelling, drainage, eye/year/mouth injury CHOKING SIGNS A person who can make sounds and/or can cough, but is having difficulty breathing. Conscious, but with anxiety PARTIAL OBSTRUCTION Coughing is silent Unable to make audible sounds Blueness around mouth or skin Making the Universal Sign of choking (holding hands around throat) TOTAL OBSTRUCTION WHAT TO DO Encourage to cough REASSURE AND HELP THEM TO BE CALM Stay with the person Do NOT: HIT them on the back or put your hands in the mouth of the person Administered abdominal thrusts: Heimlich's Maneuver Repeat until the object is dislodged Or the victim is able to speak or cough Or until the victim becomes unconscious If unconscious lower to floor and call ambulance. Begin CPR. HEIMLICH MANEUVER 1. Ask the person if he/she is choking and let him/her know you ll help him/her. (He can be having an asthma attack, allergy or simply joking). 2. Stand behind the person. Wrap your arms around the waist. 3. Make a fist with one hand. Position it slightly above the person's navel. Grasp the fist with the other hand. Press hard into the abdomen with a quick, upward thrust as if trying to lift the person up. Do not be afraid of pressing hard. If obstruction is not solved, the person s condition is life threatening If you're the only rescuer, perform abdominal thrusts before calling #107. If another person is available, have that person call for help while you perform first aid. If the person is pregnant or obese, put your fist over sternum and just push inwards. If the person becomes unconscious, perform standard CPR with chest compressions and rescue breaths. 4 AEL - First Aid Handbook October 2015
6 LOSS of COUNSCIOUSNESS (FAINTING) Partial or complete loss of cerebral function + Most common causes: hypotension, hypoglycemia, hyperventilation, dehydration, straining. + Less common causes: neurological cause (eg: seizure, stroke) or cardiac cause (eg: arrhythmia) (pg.4) If the person is breathing: - Restore blood flow to the brain by raising the person's legs above heart level (if possible) - Loosen belts, collars or other constrictive clothing. - Check the person's airway to be sure it's clear. Watch for vomiting RECOVERY POSITION - If the person is not breathing CPR. Continue CPR until help arrives or the person responds and begins to breathe. NOTE: To reduce the chance of fainting again, don't get the person up too quickly. If the person doesn't regain consciousness within one minute, call 107 or your local emergency number. CONVULSIONS/SEIZURES Sudden, involuntary, irregular muscle contraction caused by malfunction of brain activity. When we call an ambulance? 1st time it happens / lasts more than 5 min/ major injury while seizure NO Put anything in the mouth Put your fingers in the mouth Restrain or immobilize the victim YES Clear the area of objects Put something soft under the head Stay with the victim until regains consciousness Give anything by mouth Try to pull out tongue Put victim on their side during recovery (after seizure) Check how much time it lasted 5 AEL - First Aid Handbook October 2015
7 WOUNDS Care for bleeding FIRST & then infection. - If bleeding, check how to proceed in BLEEDING section (pg 8). -ONCE or IF bleeding is stopped: 1. Wash with water or saline solution and neutral soap (if available) 2. Use gauze or clean pad to clean, not cotton. 3. Add antiseptic. Best choice is chlorhexidine. If not available and there s no allergy to iodine, use betadine (iodine solution). Avoid using hydrogen peroxide and alcohol. 4. Cover wound. Keep moisture balance for quick healing. Tips: *Change bandage every 24 hrs. or more if dressing shows discharge. *Do not wash severe wounds as it will provoke bleeding again. * Add antibiotic ointment if dirty wound or signs of infection: redness, warmth, swelling, pain, pus discharge. *Use non allergenic tape for dressing. Amputation: + Care for bleeding and cover with dressing. Take to the hospital. + Dismembered body part should be carried wrapped in gauze/pad in plastic bag and these into a bag with ice (never in contact with ice directly) Penetrating object + Do NOT remove + Clean around + Protect with padding to immobilize object. + Take to hospital. BLEEDING 1. External: you see blood and where is it coming from (origin) 2. Internal: you don t see blood directly and don t see the origin. 3. Mixed: you see blood, but not origin. Blood flows through natural cavity (e.g.: nosebleed) 6 AEL - First Aid Handbook October 2015
8 1. External Bleeding RED: REST ELEVATE DIRECT PRESSURE + Even & firm direct pressure (exception open fracture or penetrating object) with whatever available. Chose, if possible, to do pressure with sterile or clean gauze/pad, but use hand if nothing available. + In case of severe/moderate bleeding never remove first bandage, add bandage on top if necessary, use a compression bandage around the wound (without taking previous bandages) and add cold pack over it. + Elevate wound if possible. + Do not wash if bleeding heavily as it washes away clothing agents. If severe take to hospital. + Open fracture / penetrating object INDIRECT compression + Severe bleeding DIRECT + INDIRECT compression Indirect compression is an alternate method to control bleeding when not able to apply direct pressure over the wound (open fracture / penetrating object) or in combination with direct pressure and elevation in massive bleeding, eg: arterial bleeding. + Press at the site or point where a main artery supplying the wounded area lies near the skin surface or over bone. This pressure may help slow down the flow of blood from the heart to the wound. 7 AEL - First Aid Handbook October 2015
9 + Tourniquet: Not recommended nowadays. It should be the LAST resource. Only use in: - Amputation with massive bleeding - Massive bleeding with shock symptoms (life risk) 2. Internal Bleeding May occur after any significant physical injury. Difficult to diagnose. Bleeding may be: a. filling a cavity (chest, abdomen, head) b. or in tissues (bruises) Severe internal/external bleeding brain blood flow is reduced SHOCK SYMPTOMS: pale skin, cold sweating, fast and weak pulse, difficult to breath, loss of conscious, weakness, hypotension, incoherence, somnolence. WHAT TO DO? - Call an ambulance - Lay the person face-up - Cover the victim with a blanket. Keep warm. - Lift feet if possible - Control bleeding if possible - Start CPR if person is not breathing (check primary assessment: conscious & breathing) 3. Mixed bleeding Nosebleed + Lean the victim head slightly forward and tell them to breathe through their mouth. Never tilt the head back. + Pinch the soft part of the nose firmly between thumb and forefinger, just below the end of the bone during 5 minutes. + If severe nosebleed, pack nostril with gauze for 30 minutes and apply icepack over. NOTE: If nose bleeding is due to hypertension or bump in the head, let blood flow. Do not stop it. 8 AEL - First Aid Handbook October 2015
10 Ears Bleeding Due to infection stop bleeding Due to head trauma don t stop bleeding. Let blood flow. BLISTERS DO NOT BREAK ANY KIND OF BLISTERS Cover the blister with a bandage and keep it clean. Change the dressing daily and wash your hands before touching the blister to avoid infection. If it breaks put the skin in the place again and cover it and/ or treat it as any other injury. ASTHMA ATTACK SYMPTOMS: Cough, wheezing, trouble breathing, inability to speak. If the victim is aware of his illness: - Let the victim sit down (do not lay down as it s harder to breath) - Offer 2 puffs of inhaler if available - Wait one to two minutes; in case of no relief. Apply a second dose of puffs - If after a few minutes there is no change, call an ambulance If the victim is not aware of his illness: - Call an ambulance - Let the victim sit to help breathing - Be aware to the following symptoms: lips or skin color (purple or blue), somnolence, slow breathing 9 AEL - First Aid Handbook October 2015
11 BURNS Determine the extent of damage to body tissues to distinguish a minor from a serious burn. When produced by contact with hot liquids or solids: - Cool the burn with water for at least 20 minutes or with cold compresses. - Remove burning clothing if not stuck to skin and constrictive items (rings, bracelets, etc.). - Never break blisters. - If mild, protect burns with clean dry bandages or sterile gauzes. - If severe cover with cling plastic or clean plastic bag and take person to the hospital. When produced by direct contact with fire: - Don t let the person run. Tell him/her to roll on the floor. - Remove burning clothing if not stuck to skin. - Cool the burn. Hold the burned area under cool (not cold) running water for 20 minutes or until the pain subsides. -Keep body temperature with a blanket When produced by radiation exposure: - Hydrate the victim with a lot of water. - Cover the burn with cold compresses. - Remove burning clothing if not stuck to skin and constrictive items. - Move to ventilated and cool place. When produced by inhalation of smoke: - Monitor breathing - If not breathing, begin CPR - Burns in the face should always be checked by a doctor When produced by chemicals: - Flush liquid on the burn with water for 20 minutes. - Remove affected clothing. - Dry without friction and cover affected area. - If burn is from a dry chemical, dust off chemical, then flush with water. When produced by electricity: - Turn power source off before touching the person. - Unconscious and not breathing: CPR Unconscious and breathing: RESCUE POSITION Conscious and breathing: SECONDARY ASSESSMENT - Treat entrance and exit of electricity as a wound. 10 AEL - First Aid Handbook October 2015
12 HEAT STROKE SYMPTOMS: Skin very hot (>40 C), dry & red, thirsty, nauseous, headache, cramps, palpitations, rapid and shallow breathing, confusion or unconsciousness. - Get the person out of the sun and into a shady or airconditioned location - Lay the person down - Loosen or remove the person's clothing - Cool the person with cool water or ice packs in the neck, armpits and inner thigh - Have the person drink cool water if conscious. - If it is necessary, call an ambulance ORTHOPEDIC INJURIES JOINT INJURY SPRAIN DISLOCATION MUSCLE INJURY STRAINED/PULLED/TORN MUSCLE CRAMPS CONTRACTURE BONE INJURY FRACTURE Sprain Symptoms: Local pain, swelling, deformity, bruising, difficulty using and moving the joint Yes: R.I.C.E No: Apply ice directly on the skin as it burns. Do not use creams, aerosol & painkillers as first treatment Dislocation Symptoms: Pain, swelling, bruising, deformity, difficulty or inability to move the joint Yes: R.I.C.E No: Don t put back in place, or apply heat, move victim before immobilizing the joint. Strained/pulled/torn Symptoms: Swelling, bruising, pain and difficulty moving the muscle at the site of injury. Yes: R.I.C.E No: Apply ice directly on the skin as it burns. Do not use creams, aerosol & painkillers as first treatment 11 AEL - First Aid Handbook October 2015
13 Muscle Cramp Symptoms: Sharp pain and hard knot in cramping muscle Yes: Stretch or massage the area gently, applying local heat to relax and heal. No: physical activity without warming up, avoid self-medicating as it can cover other symptoms. Contracture Symptoms: Same as muscle cramps, the difference is that the contraction is sustained over time. Yes: Stretch or massage the area gently, applying local heat to relax and heal. No: physical activity without warming up, avoid self-medicating as it can cover other symptoms. Fracture Symptoms: Intense pain which increases with movement, swelling, deformity, unable to use limb, redness/bruising Yes: R.I.C.E. Splint and immobilize including 2 joints. Take out constrictive objects. if open wound apply dressing. No: Do not move the limb or try to put into place, apply heat or direct cold as it burns. R.I.C.E. * REST. Do not move * ICE. Ice pack for periods of half an hour * COMPRESS by wrapping injury firmly / comfortable support * ELEVATE injured part (if possible & doesn t cause further damage) NOTE: Children s bones easily break, but recover quickly. Important to immobilize ASAP. HEAD, NECK & SPINE INJURIES Assume a person has a spinal injury after an accident if: There's evidence of a head injury with an ongoing change in the person's level of consciousness The person complains of severe pain in his/her neck or back The person won't move his/her neck An injury has exerted substantial force on the back or head The person complains of weakness, numbness or paralysis or lacks control of limbs, bladder or bowels The neck or back is twisted or positioned oddly 12 AEL - First Aid Handbook October 2015
14 If you suspect someone has a spinal injury: Call emergency medical help. Keep the person still. Place heavy towels on both sides of the neck or hold the head and neck to prevent movement. Provide as much first aid as possible without moving the person's head or neck. Don t press directly on bleeding if you suspect of scalp fracture. Don t block ears and nose if bleeding, don t wash wounds if severe, just control bleeding. If the person shows no signs of breathing, begin CPR, but do not tilt the head back to open the airway. If the person is wearing a helmet, don't remove it. If he she/needs CPR, do Hand only (chest compressions). If you absolutely must roll the person because he or she is vomiting, choking on blood or in danger of further injury, you need at least one other person. With one of you at the head and another along the side of the injured person, work together to keep the person's head, neck and back aligned while moving or rolling the person onto one side. MULTIPLE TRAUMA General Suggestions: CALL for help 107 (ambulance) / 911 (Police) Unconscious and not breathing: CPR Unconscious and breathing: RESCUE POSITION Conscious and breathing: SECONDARY ASSESSMENT TREAT life threatening injuries first! STOP Bleeding STABILIZE fractures, possible spinal, head, neck injuries AIR tight seal for hissing pulmonary chest wounds KEEP warm to avoid shock STAY with victim until help comes 13 AEL - First Aid Handbook October 2015
15 ALLERGIC REACTIONS Minor Reactions Feeling hot/flushed Itching, nettle sting-like rash/welts/hives (urticaria) Red, itchy watery eyes or congested nose. sneezing, Swelling (face, lips, eyes, hands), Stomach ache, vomiting or diarrhea Severe Reaction Difficult/noisy breathing, wheeze, breathlessness, chest tightness, persistent cough, difficulty talking, change in voice, hoarseness Swollen tongue, swelling, tightness, itchiness of the throat (feeling of lump in throat ). Impaired circulation pale clammy skin, blue around the lips and mouth. Decreased level of consciousness, sense of impending doom, becoming pale/floppy, collapse. Treatment: Person with known condition of allergies who carries medication: - 1 st treatment: antihistaminic. - If reaction continues despite antihistamine and severe symptoms appear: EpiPen should be administered & call the ambulance. Unknown condition: call the ambulance or take to hospital. EYE INJURIES SYMPTOMS: redness of eye, pain, stinging sensation, excessive tears, acute discomfort. Superficial Foreign Material Avoid rubbing eye Check on the eye ensuring to look up and down and then side to side Tilt the head back and separate the eyelids Flush the eye with water Foreign Material Embedded Avoid rubbing eye Don t try to remove the object If the object is big cover the eye with paper cups and tape it, if the object is small cover the eye with clean gauze/pad. Bind up both eyes to prevent eye movement Chemical Burns Flush it immediately with clean water or saline solution If the person wear contact lenses don t try to remove it when adhered to any part of the eye 14 AEL - First Aid Handbook October 2015
16 DENTAL INJURIES SYMPTOMS: Local pain, visible chip or break, missing tooth. Frequently accompanied by soft tissue injuries to lip or tongue In case of a knocked out permanent tooth: - Look for the tooth - Pick it up by the crown not the root & follow one of this two choices: + Reinsert + Wash it with water and introduce the tooth in a glass of water, milk or saline solution ANIMAL BITES: All animal bites are potentially dangerous. Identify the animal. +Use gloves. If bleeding is minor put the injury under the water for 20 minutes and clean it with white soap. Cover with a sterile gauze and put a bandage on it. + In case of severe bleeding, direct pressure with a clean, dry cloth to stop the bleeding. + Signs of infection: swelling, redness, increased pain or discharge. 15 AEL - First Aid Handbook October 2015
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