WHAT IS FIRST AID? Module 1 What Is First Aid? First aid is the initial care of the injured or sick. It is the care IMMEDIATE ACTION

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1 Module 1 What Is First Aid? WHAT IS FIRST AID? Objectives At the end of this module you should be able to: Explain what first aid is Practice scene safety Prevent transmission of decease Explain the legal considerations Skills Display the desirable traits of a first aider Provide care as defined by law PRINCIPLES OF FIRST AID First aid is the initial care of the injured or sick. It is the care administered by a concerned person as soon as possible after an accident or illness. It is this prompt care and attention prior to the arrival of the ambulance that sometimes means the difference between life and death, or between a full or partial recovery. First aid has limitations, as not everybody is a paramedic or doctor, but it is an essential and vital element of the total medical system. FIRST AID SAVES LIVES!...ask any person who works in the emergency medical field. IMMEDIATE ACTION As in most endeavors, the principle to be adopted in first aid is immediate action. Bystanders or relatives not knowing what to do, or being too timid to try have unwittingly contributed to unnecessary deaths and chronic injuries. If a person is sick or injured, then they need help. OSHA 1

2 THE AIMS OF FIRST AID Preserve Life Prevent Condition Deteriorating Promote Recovery Airway Breathing Circulation Dress Wounds Immobilize Fractures Position Casualty Reassure Relieve Pain Handle Gently Protect from Cold It is important that any action taken by the first aid provider is commenced as quickly as possible. Quick action is necessary to preserve life and limb. A casualty who is not breathing effectively, or is bleeding copiously, requires immediate intervention. If quick effective first aid is provided, then the casualty's has a much better chance of a good recovery. It should be remembered though that any action undertaken is to be deliberate and panic by the first aid provider and bystanders will not be beneficial to the casualty. Try to remain calm and think your actions through. A calm and controlled first aider will give everyone confidence that the event is being handled efficiently and effectively Assess the situation quickly and safely and summon appropriate help Protect casualties and others at the scene from possible danger To identify, as far as possible, the nature of illness or injury affecting casualty. To give each casualty early and appropriate treatment, treating the most serious condition first. OSHA 2

3 PRIORITIES OF FIRST AID Save the conscious casualties before the unconscious ones as they have a higher chance of recovery. Save the young before the old. Do not jeopardize your own life while rendering First Aid. In the event of immediate danger, get out of site immediately. Remember: One of your aims is to preserve life, and not endanger your own in the process of rendering First Aid. BODY SUBSTANCE ISOLATION (BSI) BSI is the practice of isolating all body substances of individuals undergoing medical treatment. It is important that any First Aid practitioner properly protects both themselves and their patient from possible cross-contamination from body substances. Blood Faeces Urine Vomit Saliva Vaginal secretions METHODS OF TRANSMISSION Avoid direct contact with blood and other bodily fluids. Indirect contact - materials. Airborne infection - colds, flu. Poor hygiene - hand washing. Always wear protective gloves and goggles when dealing with blood and body fluids Always dispose of contaminated material safely Before approaching any incident, always check for scene safety and put on protective gloves. OSHA 3

4 SCENE SAFETY When confronted with an accident or illness on duty it is important to assess the situation to determine what kind of emergency situation you are dealing with, for your safety, the victim s safety and that of others. Do a quick survey of the scene that includes looking for three elements: Hazards that could be dangerous to you, the victim, or bystanders. The cause (mechanism) of the injury or illness. The number of victims. Note: This survey should only take a few seconds. Legal considerations Implied Consent involves an unresponsive victim in a lifethreatening condition. It is assumed or implied that an unresponsive victim would consent to lifesaving help. Only perform First Aid assistance for which you have been trained. Informed Consent: When a reliable patient gives consent to treatment after being informed of the risks and benefits OSHA 4

5 MODULE 2 PATIENT ASSESMENT Objectives At the of this unit you should be able to Do an initial assessment Primary and Patient Take and evaluate vital signs Do a head to toe survey on an injured person Define symptoms and vital signs Skills Assure open airway Take a pulse Determine respiratory rate Determine skin temperature Measure Blood pressure Initial assessment Goal of the initial assessment: Visually determine whether there are life-threatening or other serious problems that require quick care. Determine if victim is conscious - by tap and shout. Check for ABC as indicated: A = Airway Open? Head-tilt/Chin-lift. B = Breathing? Look, listen, and feel. C = Circulation? Check for signs of circulation. Note: This step-by-step initial assessment should not be changed. It takes less than a minute to complete, unless first aid is required at any point. Patient assessment Assessment Sequence Components: If victim is responsive Ask them what injuries or difficulties they are experiencing. Check and provide first aid for these complaints as well as others that may be involved. If victim is not responsive (Unconscious or incoherent). Observe for obvious signs of injury or illness: Check from head to toe Provide first aid/cpr for injuries or illness observed. OSHA 5

6 Symptoms and signs Symptoms what the patient tells you dizziness, nausea, pain, chest pain Signs What you see hear and smell Vital Signs (Body Temperature, Pulse Rate, Respiration Rate, Blood Pressure) What are vital signs? Vital signs are measurements of the body's most basic functions. The four main vital signs routinely monitored by medical professionals and healthcare providers include the following: body temperature pulse rate respiration rate (rate of breathing) blood pressure (Blood pressure is not considered a vital sign, but is often measured along with the vital signs.) Vital signs are useful in detecting or monitoring medical problems. Vital signs can be measured in a medical setting, at home, at the site of a medical emergency, or elsewhere. Notes OSHA 6

7 What is body temperature? The normal body temperature of a person varies depending on gender, recent activity, food and fluid consumption, time of day, and, in women, the stage of the menstrual cycle. Normal body temperature, according to the American Medical Association, can range from 36.5 C, or Celsius to 37.2 C. A person's body temperature can be taken in any of the following ways: orally Temperature can be taken by mouth and rectally Temperatures taken rectally (using a mercury or digital thermometer) Axillaries Temperatures can be taken under the arm using a mercury or digital thermometer... by ear A special thermometer can quickly measure the temperature of the ear drum, which reflects the body's core temperature (the temperature of the internal organs) First aiders normally don t have thermometers and have to rely on feeling the skin temperature Skin temperature Cool and clammy Cold and moist Cold and dry Hot and dry Goose pimples usually sign of shock Loss of body heat Exposure to extreme cold Excessive heat and fever Malaria, pain, fear OSHA 7

8 What is the pulse rate? The pulse rate is a measurement of the heart rate, or the number of times the heart beats per minute. As the heart pushes blood through the arteries, the arteries expand and contract with the flow of the blood. Taking a pulse not only measures the heart rate, but also can indicate the following: heart rhythm strength of the pulse. PULSE Average pulse rate ranges Adults Children Toddlers Newborns beats per minute beats per minute beats per minute beats per minute How to check your pulse: As the heart forces blood through the arteries, you feel the beats by firmly pressing on the arteries, which are located close to the surface of the skin at certain points of the body. The pulse can be found on the side of the lower neck, on the inside of the elbow, or at the wrist. Taking your pulse: Using the first and second fingertips, press firmly but gently on the arteries until you feel a pulse. Begin counting the pulse when the clock's second hand is on the 12. Count your pulse for 60 seconds (or for 15 seconds and then multiply by four to calculate beats per minute). When counting, do not watch the clock continuously, but concentrate on the beats of the pulse. If unsure about your results, ask another person to count for you. If your physician has ordered you to check your own pulse and you are having difficulty finding it, consult your physician for additional instruction. Rapid and regular Rapid regular thread No pulse Hypertension, fright, high blood pressure Shock, blood loss Cardiac arrest OSHA 8

9 Practical feel the pulse on your partner Name 1 Age Pulse rate location Temporal Carotid Radial Pedal Name 2 Age Pulse rate location Temporal OSHA 9

10 What is the respiration rate? The respiration rate is the number of breaths a person takes per minute. The rate is usually measured when a person is at rest and simply involves counting the number of breaths for one minute by counting how many times the chest rises. Respiration rates may increase with fever, illness, and with other medical conditions. When checking respiration, it is important to also note whether a person has any difficulty breathing. Normal respiration rates for an adult person at rest range from 15 to 20 breaths per minute. Respiration rates over 25 breaths per minute or under 12 breaths per minute (when at rest) may be considered abnormal. Children breaths per minute Children breaths per minute Respirations Deep gasping labored Airway obstruction, heart failure, asthma Rapid shallow Shock cardiac problems Painful difficult labored Dyspnea Snoring Stroke fractured skull drugs Gurgling fluid in lungs Temporary cessation Hypoxia lack of oxygen Notes OSHA 10

11 What is blood pressure? Blood pressure, measured with a blood pressure cuff and stethoscope by a nurse or other healthcare provider, is the force of the blood pushing against the artery walls. Each time the heart beats, it pumps blood into the arteries, resulting in the highest blood pressure as the heart contracts. One cannot take his/her own blood pressure unless an electronic blood pressure monitoring device is used. Electronic blood pressure monitors may also measure the heart rate, or pulse. Two numbers are recorded when measuring blood pressure. The higher number, or systolic pressure, refers to the pressure inside the artery when the heart contracts and pumps blood through the body. The lower number, or diastolic pressure, refers to the pressure inside the artery when the heart is at rest and is filling with blood. Both the systolic and diastolic pressures are recorded as "mm Hg" (millimeters of mercury). This recording represents how high the mercury column is raised by the pressure of the blood. High blood pressure, or hypertension, directly increases the risk of coronary heart disease (heart attack) and stroke (brain attack). With high blood pressure, the arteries may have an increased resistance against the flow of blood, causing the heart to pump harder to circulate the blood. According to the American Heart Association, high blood pressure for adults is defined as the following: 140 mm Hg or greater systolic pressure and/or 90 mm Hg or greater diastolic pressure These numbers should be used as a guide only. A single elevated blood pressure measurement is not necessarily an indication of a problem. Your physician will want to see multiple blood pressure measurements over several days or weeks before making a diagnosis of hypertension (high blood pressure) and initiating treatment. A person who normally runs a lower-thanusual blood pressure may be considered hypertensive with lower blood pressure measurements than 140/90. OSHA 11

12 Before you measure your blood pressure: Rest for three to five minutes without talking before taking a measurement. Sit in a comfortable chair, with your back supported and your legs and ankles uncrossed. Sit still and place your arm, raised level with your heart, on a table or hard surface. Wrap the cuff smoothly and snugly around the upper part of your arm. The cuff should be sized to fit smoothly, while still allowing enough room for one fingertip to slip under it. Be sure the bottom edge of the cuff is at least one inch above the crease in your elbow. It is also important, when taking blood pressure readings, that you record the date and time of day you are taking the reading, as well as the systolic and diastolic measurements. This will be important information for your physician to have. Ask your physician or another healthcare professional to teach you how to use your blood pressure monitor correctly. Have the monitor routinely checked for accuracy by taking it with you to your physician's office. It is also important to make sure the tubing is not twisted when you store it and keep it away from heat, to prevent cracks and leaks. Proper use of your blood pressure monitor will help you and your physician in monitoring your blood pressure. Practical feel the pulse on your partner Name Age BP Comment While waiting for medical assistance to arrive, a secondary survey can be done to gather more detailed information about the injury. The secondary survey is a series of checks for injuries and other problems that are not an immediate threat to life, but could cause problems if not properly cared for. To ensure that nothing is missed, the injured athlete must be examined systematically starting with an interview to determine exactly what happened, assessing vital signs, and conducting an injury check from head to toe, looking for injuries. Understanding the mechanism of injury and how it relates to the potential severity of an injury is often the only indication to warrant calling for emergency assistance. Always take a conservative approach. OSHA 12

13 Head to Toe Examination First of all, establish communication with the patient. This is an important part of calming and reassuring them. Next, determine where the athlete hurts. If the athlete is unconscious, try to gain as much information as possible from anyone who witnessed the injury, or who may have knowledge of the injured athlete. This emphasizes the importance of having pertinent athlete information outlined on a medical history form. If the athlete is conscious, ask pertinent questions in order to obtain a detailed history. Get them to relate what happened, and ask them if they heard or felt anything abnormal, and have them describe the pain. Also determine whether or not there is any related history of injury. You will need to adapt your questioning according to each individual situation that you are involved with. A head to toe examination should be done to gather information about signs and symptoms of the injury. It should cover the head, neck, chest, abdomen, pelvis, back, and the extremities. Signs of injury such as bruising, deformity, swelling, can be physically seen or felt and unusual sounds (such as crunching or grating) can be heard. Look for- discolorations, deformities, wounds, chest movements Feel for- deformities, tenderness, pulsations Listen-Breathing patterns, grating noises Smell- Odors, alcohol, chemicals First, conduct a visual inspection beginning at the head and continue down the body to the feet. Many injuries, such as dislocations or fractures, are easily spotted, while others are not. If you have any doubt that an injury exists, treat for the worst case scenario. When looking for signs of bleeding it are important to slide your hands carefully under the body (without moving the patient, pull them out and look at them each time. Blood temperature is the same as body temperature and sweat, and the location of the bleeding may be missed if the hands are not looked at. Always be sure to wear protective gloves. Next, you may need to gently touch the injured patient to determine more information about the injury. Always use great care; if at all possible, do not move the patient. When palpating the injury, look for deformities, swelling, bruising and/or guarding; listen for unusual sounds such as crunching, grating or popping; and feel for swelling, muscle spasm, and skin condition. Notes OSHA 13

14 Scalp and skull Wounds and deformities, depressions, bony projections, facial bones, swelling, discolorations Eyes- Cuts, impaled objects, burns, pupil size Pupil size Dilated unresponsive cardiac arrest, unconscious, drugs amphetamines Constrictive unresponsive- Central nervous system disorders, drugs Unequal- Stroke, head injury Not focusing Shock, coma OSHA 14

15 Ears and nose Fluids Mouth Foreign objects, smells Spine Fractures, injuries, tenderness, deformities Chest and abdomen Breathing, tenderness, injuries, collar bone, equal expansion ribs, air entry cuts, penetrations, tenderness Pelvis Tenderness, fractures Lower extremities Fractures, sprains, cuts, deformities Skin color Red High blood pressure, stroke sunburn Cherry red carbon monoxide poisoning Blue lack of oxygen Yellow-liver disease Black and blue seepage of blood under the skin Notes OSHA 15

16 PRIORITY FROM HIGH TO LOW CONDITION EXAMPLES 1st Airway 2nd Breathing 3rd Circulation Injuries that may affect ABC s (above) or have potential for life-long disability Minor injuries - Foreign body blocking airway - Tongue or fluids blocking airway - Swollen airway - Injured chest and/or lungs - Brain not controlling breathing properly - Not enough oxygen reaching blood - Heart not pumping blood - Damage to heart - Severe bleeding - Fractures that could affect breathing - Fractures open, sever or multiple bones - Head/spinal injuries - Critical burns - Minor fractures - Minor bleeding - Non-critical burns - Behavioral problems - Choking on food - Unconscious, lying on back - Allergic reaction, airway infections - Chest injury, broken ribs - Poisoning, drug overdose, stroke, electric shock - Not enough oxygen in air, carbon monoxide poisoning - Heart Attack, angina, cardiac arrest, cardiovascular emergencies - Amputations, chest wounds, internal bleeding - Broken ribs, shoulder blade - Broken upper leg, pelvis, crushed arm - Fall from a 6 foot ladder 3rd degree burns to the hands - Broken lower leg, lower arm, hand, finger, etc. - Bleeding not spurting or free-flowing - 2nd degree burns to the forearms Grief or panic OSHA 16

17 Module 3 Airway and Cardio pulmonary resuscitation Objectives At the end of this module you must be able to Evaluate ABC Demonstrate how to clear a patient s airway Perform cardio pulmonary resuscitation List steps when providing mouth to mouth Describe the steps in procedures to correct airway obstructions Locate the anatomical position of the hart Explain how CPR work Describe how to deliver chest compressions and rates Skills Determine if patient has an airway obstruction and clearing it Properly apply head tilt chin lift procedure Determine respiratory arrest Properly perform mouth to mouth Correctly evaluate a patient to detect cardiac arrest Perform one man CPR on mannequin Artificial respiration Clinical death -0 minutes cessation of breathing Lethal brain damage begins 4-6 minutes Biological death -10 minutes brain cells start dying Components of a respiratory system: Lung Bronchus Larynx Pharynx Nasal Air Passage Trachea Airway Management An unconscious casualty has no control over his or her muscles, including the muscles that control the tongue. If an unconscious casualty remains on his or her back, the risk of airway obstruction is great. An unconscious casualty may also have material in the mouth such as food, blood or vomit, which may obstruct the airway. It is vital that such material is removed. OSHA 17

18 Care of the airway in an unconscious casualty takes precedence over any other injury or illness. This includes spinal injuries. The method to be employed to provide care for the airway is to put the casualty into the stable side position. Immediately the casualty is on his or her side, the airway should be checked and, if blocked, manually cleared. External Causes CAUSES OF ASPHYXIA / HYPOXIA Respiratory Tract Smothering Tongue Strangling Food Internal Causes Hanging Foreign Bodies Mechanism Control Centre Crushing Drugs Illness Electric Shock Chest pressure Poisons Muscle Spasm Head injuries Accidents Carbon Monoxide Inhibits the uptake of oxygen Cyanide Breathing Colour SIGNS AND SYMPTOMS Noisy, Distressed or Absent Cyanosis of Lips, Ear Lobes and Finger Tips OSHA 18

19 CLEARING THE AIRWAY This procedure should always be done with the casualty lying on his or her side to avoid accidental inhalation of obstructions. ROLL the casualty into the side position, taking care not to extend the neck or twist the head USE two fingers to clear the mouth of any visible obstruction REMOVE dentures only if loose Avoid probing deeply as this may force a hidden obstruction further into the airway Airway management for a casualty requiring EAR or CPR depends on a clear airway and a suitable position of the head, allowing access to the airway. A clear airway is maintained on an infant by supporting the head in the horizontal position. DO NOT extend the head backwards. If difficulty is encountered maintaining the airway in the horizontal position, tilt the infant s head back slightly with a gentle movement. This is sometimes called the sniffing position. BACKWARD HEAD TILT This method is used for a casualty in the side position, or when on his or her back prior to commencement of EAR or CPR. PLACE one hand on the casualty s forehead SUPPORT the chin with the other hand TILT the head gently backwards, avoiding undue extension of the neck On completion of the head tilt, the casualty s jaw is supported by one hand under the point of the chin, with the index finger aligned along the jaw line. Avoid the soft tissues of the neck. The mouth should be open. OSHA 19

20 JAW THRUST In some instances involving injuries or illness, the casualty s airway may be difficult to open. An alternative method of airway maintenance is the jaw thrust. APPLY pressure with the fingers behind the angle of the jaw THRUST the jaw gently forward and up, opening the airway. Cardiopulmonary Resuscitation Cardiopulmonary resuscitation (CPR) is expired air resuscitation (EAR) used in conjunction with external cardiac compressions (ECC). It is the singularly most effective form of active resuscitation available, and is used universally by trained first aid providers and medical personnel. The technique is used to assist in resuscitation of casualties in cardiac arrest. While expired air resuscitation is the method by which oxygen is provided to the casualty, external cardiac compressions, when applied correctly, duplicate the heart's mechanical function of pumping the oxygenated blood around the body. This combination of techniques is the basis of CPR. Effective CPR can sustain a casualty until more expert definitive medical treatment is available. It is vital that CPR is initiated immediately on contact with the casualty. A particularly important aspect of CPR is that the rescuer's hands are positioned correctly in relation to the casualty's heart. There are two common methods used to locate the correct position of the heart; the Xiphoid Location, and the Calliper Method. Xiphoid Location Place two fingers of one hand over the casualty's Xiphoid process, the small 'bump' at the base of the sternum. The other hand is then placed with the palm of the hand in the centre of the sternum, above the two fingers. This position on the lower part of the sternum approximates the location of the heart. OSHA 20

21 Caliper Method The middle finger of one hand is placed on the `sternal notch', the depression above the sternum below the throat. The middle finger of the other hand is placed at the base of the Xiphoid process. Both hands are then moved together so that the thumbs meet in the middle of the sternum. The lower hand is then positioned palm down across the lower part of the sternum, close to the thumb of the upper hand. This approximates the location of the heart. INDICATIONS FOR CPR: unconsciousness usually no respirations, although there may be brief irregular, 'gasping' breaths no pulse PROCEDURE FOR ADULT AND OLDER CHILD ONE- PERSON CPR: check for DANGER check for response, gently shake and shout call for help roll casualty away from you check and clear airway look, listen and feel for breathing If not breathing place casualty on back on a firm flat surface open airway give two effective breaths assess the rise and fall of the chest check for carotid (neck) pulse (5-10 seconds) kneel beside casualty's chest locate correct hand position place hands centrally over heart, fingers entwined lean over casualty, arms straight, elbows locked commence 30 compressions, with even pressure approximately 1/3 the depth of the chest compressions - rate of 100 per minute give two effective breaths relocate correct hand position 30 compressions continue cycles and re check pulse around every 1 minute OSHA 21

22 As air is forced under pressure into the casualty, and pressure is exerted by compressions, the risk of causing the casualty to vomit is very real. Rescuers must be alert at all times to avoid the airway becoming soiled by vomit. Upon detection of vomit in the casualty's mouth, roll him/her into the stable side position, clear the airway, and when clear, roll casualty back and resume CPR. CPR is to be continued once begun until either the casualty is revived, the rescuer is relieved by expert medical aid, or until the rescuer is too exhausted to continue. Should the casualty regain his/her pulse and breathing, put him/her into the stable side position and observe closely, as often the casualty lapses back into cardiac arrest. If pulse only returns, continue with EAR. RESUSCITATION SUMMARY CHART: OSHA 22

23 Module 3 Choking Objectives At the end of this module you should be able to Explain the term chocking Recognize chocking List the causes for chocking Demonstrate how to treat chocking in conscious and unconscious patients Skills Demonstrate Back blows Manual sweeps Abdominal thrust Chocking How Can You Tell? Total Obstruction: Talk Cough NO Breathe Partial Obstruction: Coughing Breathing YES Talk Major Causes: Loose fitting dentures Alcohol Food pieces too big Talking/laughing while eating OSHA 23

24 CHOKING CASUALTY Recognition of Severe Obstruction Cannot speak / breathe Cannot make any sounds Silent cough Cyanosis Ask Are you choking? and Would you like some help? Act quickly following the steps outlined below: CONSCIOUS CASUALTY: Stand behind casualty, lean them forward slightly from the waist, with a flat hand give 5 firm slaps between the shoulder blades. If this is unsuccessful, then follow with Abdominal Thrusts outlined below. AMDOMINAL THRUSTS (HEIMLICH MANOEUVRE) Put your arms around the casualty s trunk. Put one fist slightly above his navel and well below the breastbone. Grasp your fist with your other hand and pull sharply inwards and upwards. Give thrusts until the object is expelled and he can breathe, cough, talk or he stops responding. UNCONSCIOUS/UNRESPONSIVE CASUALTY Call Cardiac Ambulance. Place the casualty on the floor. Procedure: Open the airway Check the mouth for foreign body. Remove any visible obstruction Check breathing If not breathing: Attempt 2 inflations If chest does not rise, reposition head and repeat procedure If chest does not rise start chest compressions, 30:2 After each set of 30 compressions check mouth for visible obstruction and remove Continue resuscitation at 30:2 until help arrives or the casualty responds OSHA 24

25 Module 4 Wounds and bleeding Objectives After this module you should be able to Identify the most types of wounds Demonstrate how to effectively treat bleeding Explain the different types of bleeding Apply correct dressings Signs and Symptoms Treatment Preventing patient going into shock List the conditions associated with internal bleeding Skills Control bleeding by direct pressure, direct pressure and elevation Control bleeding with pressure points Control bleeding by splinting Survey for shock COMPONENTS OF THE CIRCULATORY SYSTEM HEART A muscular organ the size of you fist. Pumps blood around the body, then to the lungs to pick up oxygen BLOOD Transportation of gases Nutrition Regulation Protection Excretion OSHA 25

26 ARTERIES Arteries bring oxygenated blood to the body tissues Muscular vessels with elastic walls that helps the arteries to expand with each surge of blood being pumped away from the heart VEINS Bring de-oxygenated blood back to the heart Smaller than arteries with thinner walls BLOOD VOLUME AND COMPOSTION Average Adult = 5 Liters Average Child = 2 Liters Red Blood Cells Plasma White Blood Cells Platelets WOUND TYPES Contusion Laceration Incised wound Puncture wound Special SPECIAL Abrasion Gunshot wound Amputations Penetrating chest wound Bites EXTERNAL BLEEDING ARTERIAL Spurts from wound Bright red blood VENOUS Flows from wound Dark red colour OSHA 26

27 CAPILLARY Oozes from wound Brick red colour HAEMORRHAGE CONTROL (PEEP) Posture / Position Elevation Expose and Examine Pressure and bandage (Pressure Direct / Indirect) EXTERNAL BLEEDING External bleeding is usually associated with wounds, those injuries that are caused by cutting, perforating or tearing the skin. Serious wounds involve damage to blood vessels. As arteries carry oxygenated blood from the heart, damage to a vessel is characterized by bright red blood which 'spurts' with each heartbeat. Damage to veins appears as a darker red flow. Capillary damage is associated with wounds close to the skin and is of bright red 'ooze' from below the surface. TYPES OF WOUNDS Incision is the type of wound made by 'slicing' with a sharp knife or sharp piece of metal. Laceration is a deep wound with associated loss of tissue the type of wound barbed wire would cause. Abrasion is a wound where the skin layers have been scraped off. Puncture wounds are perforations, and may be due to anything from a corkscrew to a bullet. Amputation is the loss of a digit or limb by trauma. OSHA 27

28 CARE AND TREATMENT LIFE THREATENING BLEEDING DRABC quickly check the wound for foreign matter immediately apply pressure over the wound to stop any bleeding call for an ambulance apply a non-adherent dressing apply a pad lay the casualty down raise and support the injured part above the level of the heart if possible apply a firm roller bandage treat for shock if required If unable to stop the bleeding consider a constrictive bandage. Constrictive bandages are a measure of last resort, and should only be used in a life threatening situation where all else fails. INCISIONS and LACERATIONS. DRABC quickly check the wound for foreign matter immediately apply pressure to stop any bleeding apply a non-adherent dressing apply a firm roller bandage immobilize and elevate the injured limb if injuries permit ABRASIONS DRABC check the wound for foreign matter swab with a diluted antiseptic solution apply a non-adherent dressing or a light, dry dressing if necessary OSHA 28

29 PUNCTURE WOUND DRABC check the wound do not remove any penetrating object apply pressure to stop any bleeding stabilize with a ring pad and non-adherent dressing apply a firm roller bandage rest and elevate injured limb if injuries permit AMPUTATION DRABC apply immediate pressure to stop any bleeding apply a large pad or dressing to the wound treat for shock rest and elevate injured limb if possible collect amputated part keep dry, do not wash or clean seal the amputated part in plastic bag or wrap in similar waterproof material place in iced water do not allow the part to come in direct contact with ice. Freezing will kill tissue. ensure the amputated part travels to the hospital with the casualty Care should be taken to obtain medical advice for prevention of tetanus. REMEMBER, so as not to disturb clotting on the wound, do not remove the initial dressing. If bleeding continues and seeps through the bandage and padding, remove and replace these, leaving the initial dressing in place. OSHA 29

30 NOSEBLEED (EPISTAXIS) have the casualty pinch the fleshy part of the nose lean slightly forward advise casualty not to swallow blood maintain this posture for approximately ten minutes apply cool compress to neck and forehead if bleeding persists, obtain medical aid advise the casualty not to blow or pick nose for several hours Internal Bleeding VISIBLE INTERNAL BLEEDING Visible internal bleeding is referred to this way because the results are visible: Bleeding in the lungs frothy, bright red blood coughed up by the casualty. Anal or vaginal bleeding usually red blood, mixed with mucous. Bleeding in the stomach dark 'coffee grounds', or red blood, in vomitus. Bowel, or intestinal bleeding dark, loose, foul smelling stools. Bleeding in the urinary tract - dark or red colored urine CONCEALED INTERNAL BLEEDING In these cases, the first aid provider is heavily reliant on history, signs and symptoms. Judgment and experience play a part, but it may come down to a first aider's 'gut feeling'. If you are unsure, assume the worst and treat for internal bleeding. OSHA 30

31 APPROX VOL. ½ Litre EFFECT ON THE BODY Little or no effect. Safely given as a donor. 2 Litres Pulse quickens Pale sweaty Rapid breathing Very anxious 3 Litres Rapid pulse, may not be palpable at wrist Very rapid breathing Collapsed /unconscious Pre-terminal event SIGNS AND SYMPTOMS pale, cool, clammy skin thirst rapid, weak pulse rapid, shallow breathing 'guarding' of the abdomen, with fetal position if lying down pain or discomfort nausea and/or vomiting visible swelling of the abdomen gradually lapsing into shock CARE AND TREATMENT call for an ambulance position the casualty supine, with legs elevated and bent at the knees (only if conscious) if unconscious, side position with support under the legs to elevate them reassurance treat any injuries give nothing by mouth OSHA 31

32 Module 5 Bandages and Wound Dressings A bandage is a piece of material used either to support a medical device such as a dressing or splint, or on its own to provide support to the body. Purposes of bandages Support and immobilize limbs. Keep splints in position. Keep wound dressings in position. Cover and protect wounds. Control bleeding and swelling. Main types of bandages: Roller Tubular Triangular When applying bandages to elbows and knees (to hold dressings in place or support sprains or strains) flex the joint slightly, apply the bandage in a figure of eight and extend the bandage quite far on each side of the joint. OSHA 32

33 COMPRESSION BANDAGE The term compression bandage describes a variety of bandages with many different applications Short stretch compression This type of bandage that is capable of shortening around the limb after application. This dynamic is called resting pressure and is considered safe and comfortable for Long-term treatment Long stretch compression bandages have long stretch properties have a very high resting pressure and must be removed at night or if the patient is in a resting position OSHA 33

34 A good bandage should tightly surround the leg on all sides, decrease in pressure from the distal to the proximal side and does not constrict the leg anywhere. At the knee the bandage should include the head of the fibula. Congestion in the hollow of the knee space and thus chafing of the bandage can be avoided if the lower leg is bent at a right angle during bandaging. The more the patient can move in the bandage, the greater the success of the treatment will be How to apply plasters and other dressings Before applying any dressing, you should wash and dry your hands. You should also follow the advice outlined below. Make sure that you (or the person who is bleeding) are sitting, or lying down. Tell the person what you are doing as you apply the dressing. If the affected area is bleeding, it should stop if you apply pressure and raise the area higher than the heart. Use a dressing that is slightly bigger than the wound you want it to cover. Hold the dressing at the edges, keeping your fingers away from the part that's going to cover the wound. Place the dressing on top of the wound - don't put it on from the side. A little bit of pressure on the affected area should stop it from bleeding again but make sure that you don't restrict the circulation. OSHA 34

35 Sterile dressing pads attached to bandages Sterile dressing pads come in a protective wrapping. Once they are out of the wrapping, they are no longer sterile (hygienic). When applying a sterile dressing pad: hold the bandage on either side of the pad, lay the pad directly on the wound, wind the short end once around the limb and the pad, wind the other end around the limb to cover the whole pad, and tie the ends together over the pad to secure it, and put slight pressure on the wound. OSHA 35

36 General rules Use clean dressings where possible. Once applied, do not remove, if bleeding continues, bandage over existing dressings. Cover entire wound. Not too loose or tight. Use dry dressings - except in certain circumstances (burns). Tuck away loose ends. Keep fingers and toes open where possible. Test for distal pulse, capillary refill, mobility and sensation on fingers and toes of the injured limbs Always report absence of any of these! (Possible threatened limb) Test 3 times! (If the arm is involved) 1. Before treating the wound (except in severe bleeding, first stop the bleeding with direct pressure) 2. After covering the wound with a bandage. 3. After putting the arm in a sling (with legs test only twice, as in (i) and (ii) above Eyes and ears OSHA 36

37 Wrist, palm Elbow Head OSHA 37

38 Legs OSHA 38

39 Module 6 Shock and fainting What Is Shock? Objectives After this module you should be able to Define shock Explain how it is cause Explain the signs and symptoms Skills Put patient in recovery position Treat for shock Shock Shock is a life-threatening condition, and should not be confused with the flood of adrenaline that accompanies dangerous or fearful situations. This reaction to danger or fear is called the 'fight-or-flight' reaction, and is often confused with, and referred to as, 'shock'. CAUSES OF SHOCK Loss of blood and body fluids may be due to hemorrhage, burns, dehydration and severe vomiting and diarrhea Heart attack this is a very serious condition Sepsis or toxicity such as severe blood poisoning Spinal injuries due to the injury and the reaction of the nervous system Shock is a deteriorating condition, and one that does not allow a casualty to recover without active medical intervention. As a first aid provider attending a casualty, you should ask yourself the following: Does the injury appear serious? If I don't do anything to help, is the casualty likely to become worse? If the casualty's condition worsens, is death a possibility? If the answer to these questions is 'YES!', then you should treat for shock. SIGNS AND SYMPTOMS pale, cool, clammy skin thirst rapid, shallow breathing rapid, weak pulse nausea and/or vomiting evidence of loss of body fluids, or high temperature if sepsis present collapse and unconsciousness progressive 'shut-down' of body's vital functions OSHA 39

40 CARE AND TREATMENT DRABC control any bleeding call 000 for an ambulance if conscious, position supine, with legs elevated if unconscious, stable side position with support under the legs to elevate them reassurance maintain body temperature, but do not overheat treat any other injuries Fainting CAUSES: Taking in too little food and fluids (dehydration) Low blood pressure Lack of sleep Over exhaustion TREATMENT: Lay casualty down, and slightly elevate legs Make sure she has plenty of fresh air As she recovers, reassure her and help her sit up gradually Look for and treat any injury that has been sustained through falling Notes OSHA 40

41 Module 7 BURNS Objectives After this module you should be able to Assess types of burns Treatment of burns Treat associated injuries Prevent infection Skills Provide care for burns OSHA 41

42 BURNS are caused by contact with flame, hot objects, chemicals, electrocution, radiated heat, frozen surfaces, friction or radiation. SCALDS are caused by contact with boiling fluids or steam. The results of either injury are disfigurement, scarring and severe pain. As with most potentially serious injuries, prevention is better than cure. Burns are classified as either: SUPERFICIAL - reddening (like sunburn), outer layer of skin only PARTIAL THICKNESS - blistering, damage to deeper layers of skin FULL THICKNESS - whitish or blackened areas, damage to all layers of skin, plus underlying structures and tissues The severity of burns is dependent on certain factors such as; the age of the casualty, the depth of the burns, the part of the body burnt, and the area affected. The burnt body area of a casualty is assessed as a 'percentage', and is arrived at by reference to 'THE RULE OF NINES'. Eleven areas of the body are designated each worth 9%, e.g. arm = 9%, etc. The percentages are added, and the total given as the percentage of the total body area burnt. SIGNS AND SYMPTOMS: red, blistered, white or blackened skin pain in superficial and partial thickness burns shock breathing difficulties hoarse voice and/or snoring sound when breathing OSHA 42

43 CARE AND TREATMENT DRABC cool only with clean water if possible, and resist using other substances o up to 20 minutes for thermal or radiation burns o minutes for chemical burns o 30 minutes for bitumen burns consider scoring or cracking bitumen if it is encircling a limb cover with a clean, non-adherent burn dressing (or plastic wrap etc.) remove tight clothing and objects, e.g. jewellery call 000 for an ambulance treat for shock if the burn is severe. ensure that contaminated clothing is removed unless it is adhering to the burn flush chemicals from the skin, pay special attention to eyes DO NOT break blisters Ensure that the cooling process does not become excessive and cause shivering. Burns to the face inevitably have an effect on the casualty's breathing, and these effects may take some time to appear. It is important that any casualty who has inhaled smoke, fumes or superheated air, or has been burnt on the face, should seek medical aid as soon as possible after the incident. A doctor should see infants or children who receive any burns. NOTES OSHA 43

44 Module 8 Fractures Objectives After this module you should be able to Identify different types of fractures Define an open fracture Locate and name major bones of the extremities List the functions of the skeleton Skills Identify injuries Provide care for injuries Use basic splints There are 206 bones in the human body and they are important, not just because they hold our skin up, but they act as factories for the production of blood and essential blood cells through bone marrow. Bones are also integral to the body's strength. Some bones have a protective function (skull), some a supporting function (pelvis), while others are for movement (fingers, jaw). When a bone is broken, or fractured, it affects not only blood production and function, but there are also complications associated with the muscles, tendons, nerves and blood vessels which are attached, or are close, to the bone. Fractures are generally classified as: OPEN where the bone has fractured and penetrated the skin leaving a wound CLOSED (simple) where the bone has fractured but has no obvious external wound COMPLICATED (comminuted) which may involve damage to vital organs and major blood vessels as a result of the fracture OSHA 44

45 Treatment for fractures is based on SPLINTING, which endeavors to replicate the supporting function of the bone. While little practical splinting can be offered for a fractured skull, a first aid provider can certainly offer effective and functional support for fractured limbs. Fractures may be caused by a number of methods: DIRECT FORCE, where force is applied sufficiently to cause the bone to fracture at the point of impact. INDIRECT FORCE, where force or kinetic energy, applied to a large, strong bone, is transmitted up the limb, causing the weakest bones to fracture. SPONTANEOUS OR SPASM-INDUCED fractures are associated with disease and/or muscular spasms. These are usually associated with the elderly and people with specific diseases affecting the bones. Care should always be exercised when assessing an elderly casualty as the condition known as OSTEOPOROSIS or 'Chalky Bones' causes bones to fracture easily, often in several places. Always suspect a fracture if an elderly person complains of pain or loss of power to a limb. Be especially aware of fractures at the neck of the femur (near the hip), a very common fracture in the elderly. Young children are also prone to fractures, and the common fractures suffered by children tend to be associated with the arms and wrists. As young bones do not harden for some years, children's fractures tend to 'bend and splinter', similar to a broken branch on a tree hence the common name 'greenstick fracture'. OSHA 45

46 Notes The skeleton OSHA 46

47 FUNCTIONS OF THE SKELETON Support Movement Protection Produce red blood cells CLOSED FRACTURE Recognition: Surrounding skin unbroken Swelling, redness and pain Recognition: Accompanied by a wound; Bone may be protruding OPEN FRACTURE COMPLICATED FRACTURES Involves major blood vessels or organs, nerve injury or soft tissue injury. Recognition: Signs/symptoms of shock may be present Bone cuts major artery May be gross swelling Example: If lungs are punctured one may cough up bright red frothy blood GREEN STICK FRACTURES A spilt in young immature bone. Most common in children. OSHA 47

48 SIGNS AND SYMPTOMS OF FRACTURES Some, or all, of the following: pale, cool, clammy skin rapid, weak pulse pain at the site tenderness loss of power to limb associated wound and blood loss associated organ damage nausea deformity crepitus numbness swelling DANGERS OF UNCONTROLLED MOVEMENT Results from poor fracture management: Closed fracture can become open fracture Damage to skin, nerves and tissue Increased bleeding and swelling Pain and shock Longer rehabilitation Greater disability TREATMENT OF FRACTURES Care and treatment of fractures relies on immobilization and adequate splinting of the injury. However, if the fracture is particularly complex, the wound associated with an open fracture is difficult to control. If the pulse to the distal part of the limb cannot be restored by gentle traction, then the limb should be stabilized in its current position. Urgent ambulance transport should be obtained. Do not waste time with splinting. Generally, fractured limbs should be made immobile and left for medical aid. However, in remote areas or some time from medical aid, you may be required to treat as follows: CARE AND TREATMENT OF A FRACTURED FOREARM check for distal pulse, if none gentle traction until pulse returns treat any wounds pad bony prominences apply adequate splint secure above and below fracture, secure wrist reassess pulse or capillary return elevate injury with arm sling call for an ambulance OSHA 48

49 CARE AND TREATMENT OF A FRACTURED UPPER ARM check for distal pulse, if none gentle traction until pulse returns treat any wounds pad between arm and chest apply 'collar and cuff' sling, secure above and below fracture firmly against chest with triangular bandages reassess pulse or capillary return call for an ambulance CARE AND TREATMENT OF A FRACTURED LEG check for distal pulse, if none gentle traction until pulse returns call for an ambulance treat any wounds immobilize the limb pad bony prominences reassess pulse or capillary return OSHA 49

50 CARE AND TREATMENT OF A FRACTURED PELVIS call for an ambulance check for distal pulse both legs bend legs at knees, elevate lower legs slightly and support on pillows or similar support both hips with folded blankets either side discourage attempts to urinate Thigh fracture - The femur is the long bone of the upper part of the leg between the kneecap and the pelvis. When the femur is fractured through, any attempt to move the limb results in a spasm of the muscles and causes excruciating pain. The leg has a wobbly motion, and there is complete loss of control below the fracture. The limb usually assumes an unnatural position, with the toes pointing outward. By actual measurement, the fractured leg is shorter than the uninjured one because of contraction of the powerful thigh muscles. Serious damage to blood vessels and nerves often results from a fracture of the femur, and shock is likely to be severe. If the fracture is open, stop the bleeding and treat the wound before attempting to treat the fracture itself. Serious bleeding is a special danger in this type of injury, since the broken bone may tear or cut the large artery in the thigh. Carefully straighten the leg. Apply two splints, one on the outside of the injured leg and one on the inside. The outside splint should reach from the armpit to the foot. The inside splint should reach from the crotch to the foot. The splints should be fastened in five places: (1) around the ankle; (2) over the knee; (3) just below the hip; (4) around the pelvis; and (5) just below the armpit. The legs can then be tied together to support the injured leg as firmly as possible. It is essential that a fractured thigh be splinted before the victim is moved. Manufactured splints, such as the Hare or the Thomas half-ring traction splints are best, but improvised splints may be used. Remember DO NOT MOVE THE VICTIM UNTIL THE INJURED LEG HAS BEEN IMMOBILIZED. Treat the victim for shock, and evacuate at the earliest possible opportunity OSHA 50

51 Rib fracture If a rib is broken, make the victim comfortable and quiet so that the greatest danger -- the possibility of further damage to the lungs, heart, or chest wall by the broken ends -- is minimized. The common finding in all victims with fractured ribs is pain localized at the site of the fracture. By asking the patient to point out the exact area of the pain, you can often determine the location of the injury. There may or may not be a rib deformity, chest wall contusion, or laceration of the area. Deep breathing, coughing, or movement is usually painful. The patient generally wishes to remain still and may often lean toward the injured side, with a hand over the fractured area to immobilize the chest and to ease the pain. Ordinarily, rib fractures are not bound, strapped, or taped if the victim is reasonably comfortable. However, they may be splinted by the use of external support. If the patient is considerably more comfortable with the chest immobilized, the best method is to use a swathe in which the arm on the injured side is strapped to the chest to limit motion. Place the arm on the injured side against the chest, with the palm flat, thumb up, and the forearm raised to a 45 angle. Immobilize the chest, using wide strips of bandage to secure the arm to the chest. Do not use wide strips of adhesive plaster applied directly to the skin of the chest for immobilization since the adhesive tends to limit the ability of the chest to expand (interfering with proper breathing). Treat the victim for shock and evacuate as soon as possible. Slings Slings are used to support an injured arm, or to supplement treatment for another injury such as fractured ribs. Generally, the most effective sling is made with a triangular bandage. Every first aid kit, no matter how small, should have at least two of these bandages as essential items. Although triangular bandages are preferable, any material, e.g., tie, belt, or piece of twine or rope, can be used in an emergency. If no likely material is at hand, and injured arm can be adequately supported by inserting it inside the casualty's shirt or blouse. Similarly, a safety pin applied to a sleeve and secured to clothing on the chest may suffice. There are essentially three types of sling; the arm sling for injuries to the forearm, the elevated sling for injuries to the shoulder, and the 'collar-and-cuff' or clove hitch for injuries to the upper arm and as supplementary support to fractured ribs. After application of any sling, always check the circulation to the limb by feeling for the pulse at the wrist, or squeezing a fingernail and observing for change of color in the nail bed. All slings must be in a position that is comfortable for the casualty. Never force an arm into the `right position'. OSHA 51

52 The Arm Sling Support the injured forearm approximately parallel to the ground with the wrist slightly higher than the elbow. Place an open triangular bandage between the body and the arm, with its apex towards the elbow. Extend the upper point of the bandage over the shoulder on the uninjured side. Bring the lower point up over the arm, across the shoulder on the injured side to join the upper point and tie firmly with a reef knot. Ensure the elbow is secured by folding the excess bandage over the elbow and securing with a safety pin. Elevated Sling Support the casualty s arm with the elbow beside the body and the hand extended towards the uninjured shoulder. Place an opened triangular bandage over the forearm and hand, with the apex towards the elbow. Extend the upper point of the bandage over the uninjured shoulder. Tuck the lower part of the bandage under the injured arm, bring it under the elbow and around the back and extend the lower point up to meet the upper point at the shoulder. Tie firmly with a reef knot. Secure the elbow by folding the excess material and applying a safety pin, and then ensure that the sling is tucked under the arm giving firm support. 'Collar-and-Cuff' (Clove Hitch) Allow the elbow to hang naturally at the side and place the hand extended towards the shoulder on the uninjured side. Form a clove hitch by forming two loops one towards you, one away from you. Put the loops together by sliding your hands under the loops and closing with a "clapping" motion. If you are experienced at forming a clove hitch, then apply a clove hitch directly on the wrist, but take care not to move the injured arm. Slide the clove hitch over the hand and gently pull it firmly to secure the wrist. Extend the points of the bandage to either side of the neck and tie firmly with a reef knot. OSHA 52

53 Module 9 Head and spinal injuries What are head and spinal injuries? Objectives At the end of this lecture you should be able to Identify the basic anatomy of the head and neck List possible causes of head and spinal injuries List the signs and symptoms of head and spinal injuries Demonstrate appropriate treatment for head and spinal injuries Skills Apply patient assessment Apply extrication collar Immobilize patient What are head and spinal injuries? The nervous system is made up of the brain and the nerves that run from the brain all over the body. The body cannot work normally without the brain. The brain makes the different parts of our bodies work, but also makes sense of the world around us. For example our vocal chords make sound, but it is the brain that gives these sounds meaning. Our eyes see, but it is the brain that gives what we see meaning. So the brain makes sense of the messages we receive through our five senses (sight, smell, touch, taste, and hearing). Our brain also sends messages to other parts of the body through the nerves. Nerves run from the brain through the spinal cord, which is a hollow tube running through the centre of the bones that make up the spine (although some nerves run straight from the brain to the muscles of the face). Nerves then run from the spinal cord all over the body. The brain tells our hands to move and to grab when we want to pick something up. The brain tells our eyes to blink when they are a bit dry. The brain tells our lungs to work when we need to take a breath. The brain tells our fingers that something is hot so that we do not damage our skin by holding it. The brain also controls our temperature, appetite (need for food) and thirst. OSHA 53

54 Head Injuries HEAD INJURIES can easily mislead the first aid provider by not exhibiting the expected signs and symptoms immediately after the incident. In many instances, the casualty has appeared unaffected after the incident only to collapse with lifethreatening symptoms some hours later. This may be due to a small bleed in the brain that eventually increases and applies excessive pressure on the brain tissue. As a first aid provider, you should always examine the history of the incident, and the mechanism of injury. If, in your opinion, the incident had the potential to cause serious injury, assume the worst and treat as a head injury. Any casualty that has been rendered unconscious or received a hard blow to the head should always be examined by a doctor - NO EXCEPTIONS! Head injuries are generally classified as either: OPEN - a head injury with an associated head wound; or CLOSED - with no obvious sign of injury In many instances, serious head injury is readily identified by certain signs peculiar to the injury. These may include: A straw-colored fluid oozing from the nose or ears. This is cerebro-spinal fluid (CSF), which surrounds the brain. When a fracture occurs, usually at the base of the skull, the fluid leaks out under pressure into the ear and nose canals. 'Raccoon eyes' and 'Battle's sign'. The kinetic energy from a blow, which is transmitted through the head and brain, is expelled through soft tissue, e.g. the eyes, and behind the ears. Bruising at these points indicates that the head has suffered exposure to considerable force. It should be remembered that just because a casualty has two black eyes, this does not necessarily mean that he or she has been struck in the face. 'Raccoon eyes' may indicate a forceful impact elsewhere on the skull. Blurred or double vision. This symptom is common with concussed casualties. It indicates that the brain has been dealt a blow that has temporarily affected its ability to correctly process the sight senses. OSHA 54

55 CONCUSSION is a closed head injury. Of all the head injuries, this is the most insidious, and many casualties have succumbed several hours after the incident. Be especially observant during contact sports or activities involving children - the myth that you can 'run off' your concussion by playing on is a dangerous attitude, and has caused grief to many players, parents and coaches when the casualty eventually collapses. Concussion is potentially very serious, and an indifferent attitude is to be discouraged. FACIAL INJURIES are also head injuries, and the first aid provider should not be unduly distracted by obvious facial injuries and forget to assess the casualty for associated brain injury. Facial injuries are also a complication where the airway is concerned. SIGNS AND SYMPTOMS Any, or all, of the following: history of trauma head wounds deformation and/or crepitus of the skull altered level of consciousness evidence of CSF leaking from ears or nose may have unequal pupils headache 'raccoon eyes' or 'Battle's sign' nausea and/or vomiting restlessness and irritability, confusion blurred or double vision 'snoring' respirations if unconscious CARE AND TREATMENT DRABC call for an ambulance apply a cervical collar only if trained to do so treat any wounds complete rest DO NOT allow concussed casualties to `play on' if unconscious or drowsy, put casualty in the stable side position while supporting the cervical spine allow any CSF to drain freely if in stable side position, put that side down with a pad over the ear OSHA 55

56 REMEMBER Head, neck and spinal injuries are all related. Any person with a head injury who has a disturbed level of consciousness may have sustained a neck injury as well. Spinal Injuries THE SPINAL COLUMN consists of a series of interconnected bones, called vertebrae, which enclose the SPINAL CORD, an integral part of the central nervous system. It is the spinal cord, through its attached nerve roots, which provides the means by which we breathe, move and sense. Between each vertebra are discs of cartilage, which act as shock absorbers and allow the spinal column a degree of flexibility. The spine is divided into: the cervical spine (neck), 7 vertebrae; the thoracic spine (chest), 12 vertebrae; the lumbar spine (back), 5 vertebrae; fused vertebrae of the sacrum a small vertebra called the coccyx. Any injury to the spinal cord has serious ramifications for our ability to function normally, and a separation, or 'lesion, of the cord may cause quadriplegia, paraplegia, or chronic painful conditions, dependent on the location of the injury. It is generally the case that a lesion high in the cervical spine is fatal. Damage to the spinal cord further down to the level of the upper two thoracic vertebrae usually indicates quadriplegia to varying degrees. Lesions down to the lower thoracic vertebrae may give rise to paraplegia. Even if the casualty is not affected to these degrees of severity, spinal injury causes chronic back pain and restricted spinal flexibility. OSHA 56

57 Spinal injuries can be caused by a variety of physical incidents. A common cause of spinal injuries is motorcycle accidents. Riders and pillion passengers are thrown unprotected to the roadway and invariably land heavily in an awkward attitude, putting stress on the spinal column. It benefits the first aid provider to carefully assess the history of the incident and the mechanism of injury before applying active treatment. Road traffic accidents, diving accidents, and sporting accidents provide the majority of casualties. SIGNS AND SYMPTOMS history of trauma generally slow pulse LOOK at the casualty, does the posture seem unnatural? may have pale, cool, clammy skin 'tingling', unusual, or absent feeling in extremities absence of pain in extremities inability to move arms and/or legs penile erection onset of shock CARE AND TREATMENT DRABC call for an ambulance extreme care in initial examination if unable to control airway - carefully remove helmet apply cervical collar if trained to do so treat for shock treat any other injuries maintain body heat if movement required, `log roll' and use assistants always maintain casualty's head in line with the shoulders and spine SPINAL SHOCK is an injury where the spinal column is subject to a forceful blow, but no lesion occurs. The reaction of the nervous system is such that it mimics a severed spine, and the signs and symptoms are identical. Some time later the casualty gradually resumes the use of his or her limbs. For the first aid provider, however, initial examination of the casualty will indicate a spinal lesion, so treat it as one. OSHA 57