First aid Nursing

Ms. Usha. S
Assistant
lecturer
JSS CON
Mysuru
 Introduction
• Any emergency is the unforeseen event which calls for prompt and quick
action to save the life of a person or to prevent from further damage.

• At any moment, you or someone around you could experience an injury

or illness.

• Using basic first aid, you may be able to stop a minor mishap from
getting worse.

• In case of a serious medical emergency, you may even save a life.

 Definition
First aid is an immediate temporary assistance given to a person who
is injured or suddenly becomes ill, using facilities or materials
available at that time before regular medical help is imparted.
It includes assessing the victim for life threatening condition,
performing appropriate interventions to sustain life and keeping the
person in the best possible physical and mental conditions until he/she
can enter the emergency or casualty unit in the hospital.
 objectives of first aid
To preserve life
To prevent further injury and deterioration
of the condition.
To prevent complications related to injury
or illness or conditions.
To make the victim as comfortable as
possible to conserve the strength.
To put the injured person under professional
medical care at the earliest.
 Scope of first aid
Diagnosis Treatment Disposal

 For diagnosis, the first aider must  Remove the causative agent from the  Arrange for the safe transportation of
first know how the accident or causality. the causality to the care of a doctor or
sudden injury has occurred. This can  Eg: falling machinery, fire, electrical hospital as soon as possible
be from the victim or from witness. wire, poison etc.  Inform the family or relatives at
 Watch for symptoms like faintness, once.
bleeding, thirst, pain or shivering.
 Watch for abnormal signs like
swelling, baldness.
 Essential qualities of a first aider
Prompt and quick: As soon as an accident or injury takes place, the first aider should be

prompt and quick, to render help to the victim, without delay.

Calm and controlled: He should be a calm and controlled sort of person because he has to
take immediate action, without any fuss or panic.

Wise and intelligent: He should be intelligent and wise enough to decide the immediate
treatment even before a complete diagnosis, especially in case of serious injuries and
severe bleeding.

Resourceful: He should be resourceful enough to make available his first aid material at
once or get the required things on the spot, for giving immediate relief to the victim.
Sweet tempered and sympathetic: The first aider should use sweet and encouraging
words to lessen the victim’s distress. He should keep the victim has comfortable as
possible and should be able to allay the victim’s fears with sympathy.

Skillful and tactful: The first aider should be skillful and tactful to judge the symptom
and history of the case without wasting any time. If need be, he should be able to master
requisite support from the crowd.

Dexterous and clever: Should be able to help the injured without causing and/ or
aggravating pain, and to use the appliances and/ or procedure efficiently and effectively.

Conference and perseverance: He should have perseverance and should not give up. It
may take time for the patient to respond to his handling.
 Principles of first aid
Make sure that victim’s airway is not blocked by the tongue, secretions or
some foreign body- restore respiration.
Make sure that person is breathing. If not, administer artificial respiration –
restore respiration.
Make sure that the patient has a pulse, if no pulse is felt, administer
cardiopulmonary resuscitation {CPR} –to restore circulation.
Check for bleeding-take measure to control bleeding.


If the victim is bleeding severely or if he has swallowed poison or if the heart or
breathing stopped, every second count for his survival.
Arrange without delay for shifting of the victim to hospital for medical attention,
although most injured persons can be safely moved.
It is very important, not to move a person with serious neck and/or back injuries
unless taking proper measure to ensure him from further complications.
Keep the victim quiet and make him lie down. Turn the victim on his side to prevent
choking if there is no danger about neck injury. keep him warm with blanket.
Reassure the victim, try to remain calm yourself. Your calmness can allay the
victim’s fear and panic.
Do not try to arouse an unconscious person by slapping or
shaking.
Do not allow crowd to gather near the victim so that fresh air is
allowed.
Look for an emergency identification card for medical
information related to victim.
 Golden rules of first aid
• Do first things first, quickly-quietly without fuss or panic
• Reassure the casualty through encouraging words.
• Check ABC rule
• Open the airway by tilting the head.
• Give artificial respiration if breathing has stopped
• Perform chest compression if the pulse is not present
• Stop bleeding if any direct pressure
• Treat for shock
• Do not allow people to crowd around
• Don’t remove clothes unnecessarily
• Arrange for transportation of the casualty
• Client or victim should be sent to a hospital or doctor by quickest means of
transport.
• Always inform police about serious accidents and the relatives.
 Equipments for first aid-first
•
aid kit
• Wound cleaner/antiseptic {100ml} 1 roll of elastic
• Swabs for cleaning wounds adhesive[25mmx3m]
• Cotton wool for padding • 1 roll of non-allergic adhesive
• Sterile gauze {minimum 10} strip[25mmx3m]
• 1 pair of forceps • 1 packet of adhesive dressing
• 1 pair of scissors strips[10]
• 1 set of safety pins • 4 first aid
• 4 triangular bandages dressing[75mx100mm]
• 4 roller bandages{75mm} • 4 first aid
• 4 roller bandages{100mm} dressing[150mmx200mm]
• Crepe bandage • 2 straight splints
• Bulb syringe and sterile eye • 2 pairs latex gloves
dressings. • 2 CPR mouth pieces
• Thermometer
 First aid in cardiac arrest
Definition: It is defined as abrupt cessation of cardiac function, which is
potentially reversible. The heart may be in state of asystole.
Causes of cardiac arrest Signs of cardiac arrest

• Unresponsiveness
• Coronary heart disease • Sudden loss of
• Cardiomyopathy consciousness
• Congestive heart failure • Absence of carotid
• Noncardiac causes-any pulse
trauma, drowning, • Cessation of respiration:
suffocation, electric No chest wall
shock and severe allergic movement
reactions. • Dilation of pupils
• Marked cyanosis
 CARDIAC ARREST
• Ventricle fibrillation
• Ventricular tachycardia
Indications • Asystole
• Pulseless electrical activity
of CPR RESPIRATORY ARREST
• Drowning
• Stroke
• Foreign body in the throat
• Smoke inhalation
• Drug overdose
• Electrocution or injury by lightning
• Suffocation
• Accident, injury
• Coma
• Epiglottis paralysis
 BASIC LIFE SUPPORT {BLS}
DEFINITION: It is a maneuver that aims at maintaining a certain level
of circulation until more definite treatment with advanced life support
can be given. Management of collapsed client requires prompt
assessment and restoration of circulation airway and breathing.
 ADVANCED CARDIAC LIFE SUPPORT
{ACLS}
DEFINITION: In this, the steps of resuscitation combined with the use
of medical equipments and drugs in the hospital setting are used to
improve the survival rates. Early CPR coupled with early defibrillation is
a very powerful combination.
 Three  Apnea
cardinal  Absence of
signs of carotid and
femoral pulse
cardiac  Dilation of
arrest
pupil.
 Purposes of CPR
To maintain blood circulation by chest compression. {C}

To maintain an open and clear airway.{A}

To maintain breathing by artificial respiration {B}

To provide basic life support till advanced life support arrives.
 Steps of bls/acls
Scene safety:

Scene should be safe for the rescuer and the victim.

Check responsiveness:

• Tap the persons shoulder and shout, “Are you Ok”?

• Look for normal breathing. Call national helpline number 102 for ambulance if there is
no response.

Breathing assessment:

Scan the chest at eye level from head end, sides or foot end to find out chest movements.
Check carotid pulse
By doing head tilt, chin lift method

Find the groove between the thyroid notch and the sternomastoid muscle. Here
pulse can be felt.
Check the pulse of only one side at a time.

Take only 5-10 seconds.

Call for help

Call ambulance
Give all information like:

• Self identification

• Place {venue} from where you are calling, number of patients{single or mass causality }

• Approximate age of the victim

• Condition of the patient like gasping, no breathing, presence or absence of pulse

• Whether you are going to start CPR or not

• Ask them to send an emergency medical service {EMS} team with automated external
defibrillator {AED}

• DO not disconnect the call, unless you get the reply or message to do so from the other end.
Do chest compression:
 Place the victim on a hard surface in supine position, push the clothes aside, and start with early chest
compressions.
 Kneel at victims side.

 Locate the lower rib margin using index finger of the hand and move the fingers up to the point where rib
connects the sternum.
 Place the heel of the hand on the center of the person’s chest along the nipple line, lower half of the
sternum.
 Place the heel of the other hand on top of the first hand , interlacing fingers together, do not allow them to
touch the chest.
 Keep arms straight and the shoulders directly over the hands {chest of the victim}. Begin 5 cycles of CPR.

 Compress the chest of adult for 2-2.4 inches depth @ rate of 100-120 compressions per minute.
Allow complete recoil of the chest and do not lift hands off chest.

Provide 30 chest compressions, followed by two ventilations and

evaluate after four cycles.
Then continue with chest compressions. Do not interrupt chest
compressions to check pulse.
The compression rate is 100-120 per minute and compression
ventilation ratio is 30:2 {one or two rescuers}.
 Artificial respiration {resuscitation techniques}

Technique 1
Open the airway, unless you suspect neck injury. Place the victim on his back.

Wipe any foreign substance-solid or liquid-out of his mouth with the cloth.

Place the palm of one hand on the forehead and tilt the head back, place the fingers of the
other hand under the chin and lift to bring it forward. This position prevents obstruction of
airway by the tongue.
Opening the airway may start the person’s breathing again. Watch the chest rise and fall,
listen to the sound of breathing by placing your cheek close to the victim’s mouth and nose,
to feel any exhaled air.
Technique 2

• Pinch the nostril closed. Use the thumb and index finger of the hand
that is on the victim’s head to exert the necessary pressure and maintain
proper tilt.

• Place your mouth over the victim’s mouth, and give two full breaths,
each ventilation should cause the victim’s chest to rise and fall.

• If this fails, suspect an obstruction of the airway {Choking}.

• When you are able to ventilate the victim quietly take technique 3.
Technique 3

o Feel the carotid pulse in the neck, if there is no pulse, give CPR. If there is pulse
but still no breathing, begin technique 4.
Technique 4

• With victim’s head tilted as in technique 1, and his nose pinched shut, place
your mouth over the victims and blow hard.

• Remove your mouth and allow the victim to exhale and you take another
deep breath.

• Watch for the rise and fall of the chest and listen for the sounds of inhaled air.

• Then blow again. Repeat the procedure, giving one vigorous breath every
second until the victim starts to breathe spontaneously or help arrives.
Musculoskeletal injuries-fractures, dislocation
muscle injuries
Definition: Any injury that affects the bones, muscles, ligaments, nerves
or tendons resulting in pain are considered as musculoskeletal injuries.

• They are caused by sudden impact, force vibration and unbalanced

positions.
 Causes of musculoskeletal injury
Postural strain
Repetitive movements
Prolonged use of computer
Proof posture
Trauma
Uncomfortable working condition
Exerting too much force
Vibrations
Working too long without breaks
Sitting in the same position for extended periods
 Symptoms Common affected areas

• Shoulders
• Acute pain • Wrists
• Swelling, • Back
numbness, tingling • Hips
• Fatigue • Legs
• Sleep disturbances • Knees
• Feet
 Types of musculoskeletal injuries
Tendinitis
Carpal tunnel syndrome
Osteoarthritis
Rheumatoid arthritis
Fibromyalgia
Bone fractures
Muscle/tendon strain
Ligament sprain
Tension neck syndrome
Radial tunnel syndrome
Degenerative disc disease

 Sprains and strains
A sprain is an overstretching or tearing of ligaments of a joint and a
strain is an overstretching or tearing of muscles or tendons.

• The sprain in most common in the wrists and ankles.

Pain,

Symptoms in Swelling,
sprain
Bruising,

Partial loss of function in the joint

 First aid for strain and sprain
Apply the principle RICER: Rest, Ice, Compression, Elevation,
Referral
Rest the casualty, raise the injured part

Apply a compression bandage to injured part.

Apply ice pack to the area-apply for 20 minutes every 2 hours

Seek medical advice.

 Dislocation
Definition: A dislocation is a separation of bones at a joint. Most common joint that
can dislocate are shoulder, knees, jaw, thumb and finger joints.

Causes of dislocation Signs and symptoms

• Severe pain
• Sudden twist • Unnatural
movement
• Fall
• Swelling
• Accident • Bruising
• Contact sport injuries • Deformity at the
• Muscle weakness joint
 First aid for dislocation

Management of dislocation is very similar to that of a fracture and

involves:
Immobilization and support of injured part by use of slings or
simple support measures.
Apply ice or cold compress to the injured part to help reduce
pain and swelling.

 Shock
Definition: Condition in which the blood circulation towards vital organs
is depleted and vitals falls below normal is called shock.

• It is life threatening condition because it decrease the function of vital

organs, if it is not treated immediately it will lead to death.
 Causes of shock
Various cardiac problems like cardiac failure or heart attack

Any kind of allergic reactions

Severe hemorrhage due to injuries and accidents

Loss of fluid from body due to severe diarrhoea and vomitting.

Electric shock

Severe burn and dehydration

Bacterial infection

Extreme cold and heat moisture

Any gas poisoning


Types of shock
Hemorrhagic shock
Neurogenic shock
Respiratory shock
Cardiac shock
Circulatory shock
Hypovolemic shock
Metabolic shock
septic shock
Anaphylactic shock
Traumatic shock
Insulin shock
Electric shock
 Signs and symptoms of shock
Cold and clammy skin
Pale and cyanosis
Pulse is weak and rapid
Low BP
Fainting/dizziness
Diminished vision
Increased breathing pattern
Dilated pupils
Nausea and vomitting
 First aid management for shock
Firstly reassure the victim.

Provide comfortable position for the patient

Elevate foot end side to improve blood supply to heart and reduce blood flow to extremities.

In case of head injury, reduce the pressure by raising the head slightly.

If breathing problem is observed, then raise head and shoulder by providing comfortable position to victim.

Loosen the tight clothing around neck and chest, waist.

Provide blanket to victim, to keep body warm.

Stop bleeding by pressure and immobilise the fracture part to treat cause of shock.

Check pulse, respiration and level of consciousness.

If pulse and breathing stops, establish airway methods.

Start resuscitation as possible.

Keep the victim in recovery position.

Transport to nearest hospital without any delay.

 First aid in burns

Definition: It is defined as skin or body damage by dry heat. It may

happen due to fire, a piece of warm metal, sun burn, electric current, the
friction of moving rope or wire, acidic or alkali, etc.

Scald: It is defined as when the person’s skin and body are damaged by
wet heat. It may happen when a person comes in contact with boiled
water, steam, hot oil, hot coal tar, hot food, and any kind of hot liquid.
 Causes of burn
Chemical burns{by acid or alkali}

Electric burn by electric current

Radiation burn by x-ray or nuclear

Dry heat {by flame, hot metal}

Wet heat {by boiling or steam}

Due to friction of rope and wheels

Sun burn

Thermal burn
 Types of burns

Superficial burn Deep burn

Partial thickness
Full thickness burn
burn
Extent of a burn

Rule of NINE
 RULE OF NINES
• Head-9%
• Upper chest-9%
• Upper back-9%
• Arms-9%+9%
• Abdomen-9%
• Lower back-9%
• Thigh-9%+9%
• Lower legs-9%+9%
• Perineum-1%
Signs and symptoms

• Redness of skin

• Blister formation

• Pain {severe, mild, no pain}

• Swelling

• Draining of fluid

Aims of first aid for burn

Stop victim burning

Reduce pain

Find out injuries/damage and treat them

Reduce the risk of infection

 First aid management
• Remove the victim from the source of burn/fire. Assess scene safety first.

• Place the victim on the floor, cover him with the blanket tightly and put off the fire by rolling him.

• If the fire is in a closed room first aider should cover his/her mouth with a wet face towel with all precaution and approach the
victim by crawling on the floor.

• Reassure the victim and provide a comfortable position.

• If the burn is superficial, then immerse the burnt area in the cool water.

• Do not put any lotion or cream over the burnt area.

• Offer victim tea, coffee to keep him warm.

• Provide rest to burn part.

• Elevate burn part.

• Remove the rings or bangles, if hand and arms are involved.

 Management of chemical burns
• Remove the victim from the source of chemical exposure.

• Put water on the burnt part and wash thoroughly.

• Reassure the victim and provide a comfortable position.

• Do not put ant lotion or cream over the burnt area.

• Put a clean and sterile dressing over the burnt part.

• Provide rest to the burn part.

• Offer him tea or coffee if the victim is not vomitting.

• Make arrangements for transport, send victim to the nearest hospitals as soon as
 Management of electric burns
 Put off the source of current.

 Place sterile or clean dressing over burn part.

 Minimize and treat shock.

 If the victim is unconscious, check CAB.

 Place the victim in the recovery position and start CPR.

 Arrange transportation and send the victim immediately to the nearest

hospital for the medical facility.
 First aid for severe burns
• Remove the victim from the source of burn.
• Reassure him.
• If clothing is sticking to the burnt area, don’t try to pull it.
• Keep victim warm, by covering with sheet or blanket.
 Unconsciousness
Definition: Unconscious is the state in which a person is unable to respond
to stimuli and appears to be asleep. Person may be unconscious for a few
seconds as in fainting or for longer periods of time.

• People who become unconscious do not respond to loud sounds or

shaking. They may even stop breathing or their pulse may become faint.
This calls for immediate emergency attention. The sooner the person
Causes of unconsciousness
Common causes include:
A car accident
Severe blood loss
A blow to the chest or head
A drug overdose
Alcohol poisoning
Common causes of temporary unconscious include:
 Cardiac arrest
 Low blood sugar, straining and hyperventilating.
 Low BP, dehydration, problems with heart rhythm.
 Syncope due to lack of blood flow to the brain
 Seizure, stroke or transient ischemic attacks.
Symptoms that may indicate that unconsciousness is about occur
include:

Sudden inability to respond

Slurred speech

A rapid heart rate

Confusion

Dizziness or lightheadedness

First aid measures in unconsciousness

If person is breathing:
o Place him in recovery position, this will help to maintain a clear airway and decrease the
o For providing recovery position, follow the instructions listed below:

• Kneel on the floor next to him.

• Take the arm that is closest to you and position it so that it is perpendicular to his body, forming a right
angle. The head should be facing upward.

• Take his other hand and position it so that the back of the hand is presses against the cheek that is closest to
you.

• With your free hand, bend his knee that is farthest from you. His foot should be resting flat against the floor.

• Help him get onto his side by pulling on the bent knee. After you roll him over, ensure that his top arm is
still helping to support his head.

• Tilt his head back and lift his chin. This helps open airway.

• Make sure there is no obstruction in the airway.

• Keep an eye on his condition, and remain with him until emergency personnel arrives.
If person is not breathing:

• Call for help immediately and begin CPR.

Other first aid measures:

Do not try to arouse an unconscious person. Let him lie quiet.

Do not move patient unnecessarily, because of the possibility of spinal injury. Never
attempt to make an unconscious person sit or stand.
Do not let people gather around, give him fresh air.

Loosen clothing at neck, chest and waist.

Never give water to an unconscious person to drink, it might get into his windpipe.

Apply specific treatment for the cause of unconsciousness.