1

FIRST AID REFRESHER

November 2010

Susan Baines

2

Contents

• Changes to guidelines• Ringing for help• Assessing patients• Unconscious and breathing – fainting/seizures• Unconscious and not breathing• Choking• Assessing the walking wounded• Soft tissue injuries• Fractures• Everyday First Aid – bumped head, nosebleed, burns,

bleeding

3

Changes to guidelines

• The Resuscitation Council UK are updating their guidelines but these won’t come into force until April 2011

• For untrained bystanders the recommendation is to call for help, ask for an AED (automated external defibrillator) and trainer if possible and commence chest compressions.

• For trained first aiders the recommendations are the same i.e. compressions and rescue breaths until advised/taught otherwise.

• New First Aid app available that can be downloaded on iPhone

4

Ringing for help

• Before anyone rings for an ambulance you need to assess the patient for breathing/consciousness etc so that when you do ring, the ambulance service can grade the incident appropriately and determine which vehicle to send and in what response time

• When ringing for ambulance if possible give the postcode of where you are

5

Assessing patients

• Check for danger

• Check the patient for any response

• Maintain airway – head tilt, chin lift

• Look, listen and feel for normal breathing for no more than 10 seconds

6

Unconscious and breathing• Assess (breathing normally) – call for help – place in the recovery positionFainting• If unconscious, recovery position• Raise the legs if possible• If conscious, lay flat and raise the legsDo not confuse fainting with loss of consciousness from other underlying

conditionsSeizures• Protect from harm• Place something soft under the head• DO NOT restrain or put anything in the mouth• If possible time the seizure• Only call for an ambulance if the seizure is prolonged or multiple seizures

occur• Stay with the person until fully recovered

7

Unconscious and not breathing

• Assess (not breathing normally) – call for help – commence CPR

• Start chest compressions, 30 compressions at a rate of a 100-120/min at a depth of 5-6cm

• After 30 compressions open the airway again using head tilt and chin lift

• Give 2 rescue breaths• Return to chest compressions immediately• Continue with chest compressions and rescue breaths in

a ratio of 30:2• DO NOT INTERUPT RESUSCITATION unless the

patient starts to regain consciousness AND starts to breath normally

8

Choking It is important not to confuse this

emergency with fainting, seizure or other conditions that may cause sudden breathing difficulties and loss of consciousness – you need to ask the question “are you choking”

General signs of choking

• Attack occurs whilst eating• Victim may clutch their neck

Signs of mild airway obstruction

Response to question “are you choking?”• Victim speaks and answers yes

Other signs• Victim is able to speak, cough and

breathe

Signs of severe airway obstruction

Response to question “are you choking?”• Victim unable to speak• Victim may nod in response

Other signs• Victim is unable to breathe• Breathing sound wheezy• Attempts at coughing are silent• Victim may be unconscious

9

Adult Choking Treatment(also used in children over the age of 1 year)

• Assess severity• Mild airway obstruction (effective cough)• Encourage cough. Continue to check for deterioration

to ineffective cough or until obstruction relieved• Severe airway obstruction (ineffective cough)• Conscious - 5 back blows, 5 abdominal thrusts• Unconscious - Start CPR

Should you encounter a person with an apparent obstruction who is coughing effectively, DO NOT slap them on the back. Reactions to the slaps may cause the person to inhale the object and cause complete obstruction.

10

Assessing the walking wounded

• Look Are they pale/flushed/sweaty Are they showing signs of pain/discomfort Are they bleeding from anywhere Are there any signs of swelling/bruising/deformity Can they move normally• Listen Can they talk normally Can they tell you what happened/ what is happening Are they confused/disorientated

11

Soft Tissue Injuries

Sprains – involve over extension of a joint. Can include ligament, blood vessel, nerve or tendon damage.

Signs and symptoms

• Sudden pain in the joint

• Unable to weight bear

• Bruising/swelling

• Tender or painful to touch

12

Strains – involve overstretching of the major muscles of the limb. Tendons attached to the muscle will tear if the muscle is forced to stretch excessively

Signs and symptoms• Pain increasing with movement• A “crack” may be heard as the tendon

parts from the bone• Swelling if near a joint

13

Treatment

RICER RestIceCompressionElevationReferral if increase in pain and/or swelling or reduction in movement

What to avoidHeat – increases bleeding into affected areaAlcohol – increases swellingRunning – increases blood flow and can make injury worseMassage – increases bleeding, avoid for first 72 hours

14

Ice TherapyDangers to be aware of:

• Never apply ice directly to the skin as it can cause an ice burn

• Ice should not be applied to the following vulnerable areas as it can cause damage to peripheral nerve tissue:

The neck The upper part of the collar bone The bony aspects of the elbow The front of the hip region The outer side of the knee• Ice should not be applied to the kidney region under the

back of the ribs.

15

FracturesSigns and symptoms• Pale• Cool, clammy skin• Rapid weak pulse• Pain/ tenderness at injured site• Guarding of injured site• Loss of power to the limb• May be bleeding if there is an open fracture• Nausea• Deformity

TreatmentImmobilise limb to reduce movement and painWill need to go to the hospital

16

Managing everyday incidentsNosebleedSit the person down with head tilted slightly forwardAsk them to pinch the soft part of their nose After 10 minutes check for further bleedingIf still bleeding apply pressure for a further 10 minutesIf still bleeding severely and not stopped after 30 minutes will need

medical attentionIf bleeding stops advise person not to blow or pick the nose for at least

an hour to ensure clot is not dislodged.BurnsAs soon as possible cool the burn with cold running water for a

minimum of 10 minutesCover the burn with a sterile dressing if necessaryFor deep burns or minor burns covering a large area, medical attention

is necessary

17

Major bleedsMain aim is to stop the flow of blood.GlovesLook at wound to see if anything is embedded in itAsk person to apply pressure to the wound (or around the wound if there is

anything embedded)If the wound is on a limb and there is no evidence of fracture, elevate the limbCover the wound with clean dressingDepending on the wound, steristripping may be helpfulMedical helpBleeding (minor)GlovesObservations as aboveClean the woundApply dressing

Bleeding

18

Your aim is to prevent injury to the eye.• Sit the casualty down facing the light. • Ensure you examine every part of the eye, ask the casualty to look up,

down, left and right. • If you can see an object on the white of the eye:• Wash it out using the sterile saline pods – only drop the water on to the

white part of the eye. Tip the head back and drop into the corner of the eye • Objects under the upper eyelid:• Ask the casualty to pull the upper lid down over the lower lid. • The lower lashes may brush the object clear. • Caution:• Do not touch anything that is sticking to or embedded in the eyeball or the

iris, the coloured part of the eye. • Place an eye pad over the eye. • Take or send the casualty to hospital.

Foreign body in the eye

19

Minor head injury and knocks to the head are fairly common. Following the injury, if the person is conscious and there is no deep cut or severe head damage, it is unusual for there to be any damage to the brain.

If there is any loss of consciousness, medical assistance will be required.

Treatment of minor head injuriesIce to any swollen areasIf bleeding – treat bleedObservation – vomiting, confusion, dizziness, blurred visionHead injury advice letter/ inform parent as necessary/ refer

to hospital as necessary

Head Injuries

20

WRITTEN ADVICE FOLLOWING A HEAD INJURY

• Name …………………………………………… Date ………………..Dear ParentYour son/ daughter sustained a head injury today at ………. Whilst there are no obvious signs of concussion, it is possible that complications may occur up to

24hrs following injury.If any of the following symptoms occur, take them to the nearest hospital A&E department

immediately:• Persistent vomiting• Increased drowsiness/ dizziness• Lack of consciousness or becoming unconscious• Confusion• Loss of balance or weakness• Disturbance of vision• Severe persistent headache• Any form of fit• Any discharge/ bleeding from nose or ears• Please ensure that a responsible person is available to observe your son/ daughter for the next

24 hours and is alert for the above symptoms.• If you are concerned in any way go straight to hospital• S. Baines (School Nurse)This leaflet has been produced for information only and does not cover all possibilities.

21

REMEMBER

If you are a qualified First Aider deal with the situation as it arises, ask for assistance from other first aiders as necessary. Please remember to record all incidents that happen in school as accurately as possible on the medical room record sheet.