FIRST AID LECTURE NOTE

INTRODUCTION TO FIRST AID

• First aid is the immediate, temporary

assistance or treatment given to a sick or
injured person by a trained first aider or
qualified medical personnel (nurse or doctor)
before sending the person to the hospital.
 Aims / Objectives of First Aid

• 1. To preserve life – First aid can make the

difference between life and death.
• 2. To limit worsening of the victims
condition – The difference between temporary
and permanent disability
• 3. To promote recovery – The difference
between rapid recovery and long
hospitalization
• 4. To provide pain relief as far as possible
 Qualities of a First Aider

• 1. The first aider must:

• 2. Have the necessary knowledge
• 3. Have sympathy and understanding
• 4. Be a good observer
• 5. Have common sense
• 6. Have initiative, a sense of leadership and
confidence
• 7. Have the ability to act quickly, make
decisions and improvise
Responsibilities of A First Aider (Steps to Emergency Action)

• 1. Assess the situation

• a. You must be able to decide by rapid and safe assessment and
appreciation of the situation and decide what action should be taken first.
• b. Find out if anyone has taken charge of the situation. Do so if they is no
one in charge. If someone has taken charge, give assistance.
• 2. Make the area safe
• a. The first aider must pay attention to the safety of the victim and
him/herself
• b. Stop any cause of injury which is active or threatening e.g. fire, escape
of gas, road traffic accidents and electricity. If it cannot be stopped, move
the victim from the danger.
• c. Give the conscious victim confidence by talking to him and listening to
his/her complaints and reassuring him
 Provide Emergency Aid

• Identify as far as possible the injury or nature of illness affecting the

casualty and give early and appropriate treatment, treating the most
serious conditions first.
• Always think of the victims
A – Airway
B – Breathing
C – Circulation
A- Make sure the victims airway is not blocked by the tongue, secretions
or foreign body. If this happens open the airway
B--Make sure the victim is breathing by looking, feeling and listening. If
not, administer artificial resuscitation by mouth-mouth respiration.
C- Make sure the casualty has a pulse. If no pulse is felt, administer or
give chest compressions.
 Get help

• Get people such as by-standers to:-

• Fetch blankets, splints, water or whatever is necessary
• Control crowd and traffic and set warning signs
• Send for help to emergency services as required such as
the ambulance or doctor with detailed message stating
very clearly:-
• The site of the accident (house address or location)
• The no of injured people, the nature and severity of the
injuries
• The degree of urgency
 Remain with the victim
• Remain with the victim until appropriate care
is available. Report your observations to those
taking over care of the victim and give further
assistance if required.
• Avoid / prevent cross infection between
yourself and the victim as much as possible by
avoiding direct contact with body fluids where
possible, wash hands and wear protective
gloves if available.
 Caring with confidence

• Every casualty needs to feel secure and in safe

hands. The first aider must create an air of
confidence and reassurance by:-
• Being in control, both of yourself and the situation
• Acting calmly and logically
• Being gentle, but firm with your hands and speaking
to the casualty kindly but purposefully.
• To build trust, the aider must talk to a conscious
casualty throughout the examination and treatment.
 Caring with confidence cont’d

• Explain what you are going to do

• Try to answer questions honestly to allay fears
as best as you can. If you do not know the
answer, say so.
• Gain an injured or sick child’s confidence by
talking first to someone he/she trusts. Always
explain simply to the child what is happening
and what you intend to do. A child must not
be separated from his/her parent/guardian.
• Protecting Yourself Against Infection
• 1. Carry protective gloves as much as possible
• 2. Cover your own sores or wounds with
waterproof material
• 3. Wear a plastic apron when dealing with
large quantities of a casualty's body fluids and
wear plastic glasses to protect your eyes against
splashes.
•
 Protecting Yourself Against Infection
cont’d.
• Take care not to prick/cut yourself with any sharp
object found near or on the casualty
• If you get a splash into any wound on your body
or into your nose, eyes/mouth, wash thoroughly
with soap and water and consult a doctor.
• Use a mask or face shield for mouth-mouth
ventilation if casualty’s mouth or nose is bleeding
• Dispose of blood and water safely after treating
the casualty.
• In addition to the above, the first aider must check
for unconsciousness and put the victim in the
recovery position if unconscious (Recovery position-
mouth downward so that fluid can drain from the
airway, chin up to keep the airway open, arms and
legs locked to stabilize the position of the casualty).
• Never give an unconscious victim anything to
eat/drink.
• Look for medical alert tags usually a
necklace/bracelet which will inform your decisions.
 SHOCK

• Shock is a depression of vital centres in the

medulla oblongata of the brain (controls vital
functions of the body such as breathing) due
to insufficient or decreased blood supply or
fluid in the body.
• The circulatory system distributes blood round
the body, so that oxygen and nutrients can
pass through and perfuse (get to) the tissues.
• When the circulatory system fails, shock
develops. If not treated swiftly, vital organs
such as the heart, brain and kidney fail leading
to death.
• Shock may also occur if the blood supply to
the body’s vital organs is reduced through
blood loss or loss of other bodily fluids
through burns, severe diarrhea or vomiting.
• The body responds to fluid loss initially by
diverting the blood supply from the surface to
the vital organs.
• It is important to differentiate circulatory
shock from psychogenic shock.
• The later occurs when a person suffers deep
emotional crises, while circulatory shock
occurs from reduced function of the
circulatory system
• Causes of Shock
• Immediate
• 1. Failure of the heart to pump blood
through the circulatory system (a common
cause is a heart attack/failure)
• 2. Dilation of blood vessels due to severe
infection
• 3. Reduction of blood supply to vital organs
through severe blood loss
(bleeding/haemorrhage)
• 4. Loss of other body fluids from severe
burns, severe vomiting/diarrhea
 Remote

• 5. Severe pain (catecholamine – adrenaline

release)
• 6. Injuries that are severe and extensive,
such as may occur from accidents
• 7. Exposure to extreme heat/cold
• 8. Severe allergies
• 9. Poisoning especially from gas (e.g.
carbon monoxide)
• 10. Bites and stings of poisonous snakes and
insects.
• 11. Fear, fright and other emotional stress
 Shock may be primary/secondary.

• 1. Primary shock-occurs immediately after

an accident/illness
• 2. Secondary shock-occurs several hours
after an accident/illness. Secondary shock is
very severe and can result in death if not
properly managed.
•
• Signs and Symptoms
• Early Stages
• 1. A rapid pulse (over 100bmp) and often
too faint to be felt at wrist but can be felt at
the carotid artery at the side of the neck or
femoral artery at the groin. The rapid pulse is
due to adrenaline release which causes the
heart to pump the small amount of circulatory
blood more rapidly.
• 2. Pale, grey-blue skin which is cold to touch.
This is due to the limitation of blood supply to
the skin as a result of the shutdown of the small
blood vessels in non-vital organs to supply vital
organs. In the care of victims with dark skin, it is
necessary to rely on the colour of the mucous
membrane on the inside of the mouth or under
the eyelid/nail beds.
• 3. Sweating and moist (cold) clammy skin
• 4. Subnormal temperature
• 5. Low blood pressure due to decreased
circulatory volume
 As Shock Develops:-

• 1. Weakness and giddiness

• 2. Nausea and possibly vomiting
• 3. Victim may be thirsty
• 4. Rapid shallow breathing as the victim
tries to take in as much oxygen as possible
• 5. Weak pulse
 As the brains oxygen supply lessens:-
• 1. The victim becomes restless, anxious and
even aggressive
• 2. May yawn and gasp for air (“Air hunger”)
• 3. The victim may become unconscious
• 4. Finally the heart will stop (cardiac arrest)
•
 Types of Shock

• 1. Hypovolemic shock – this is caused by severe

blood/fluid loss such as from a traumatic bodily injury
such as burns. This makes the heart unable to pump
enough blood to the body (decreased circulatory
volume). Water forms 90% of blood thus loss of fluid
causes severe decrease in circulatory volume.
• a. Haemorrhagic shock- this type of shock falls
under hypovolaemic shock and results from significant
bleeding that occurs relatively quickly. Trauma is the
most common cause but can also result from medical
conditions such as bleeding duodenal/gastric ulcers,
colon cancers or excessive bleeding from the uterus in
women.
• 2. Septic shock- this results from bacteria
multiplying in the blood and releasing toxins
(systemic inflammatory response syndrome
(SIRS). Common causes include pneumonia,
intra-abdominal infection and meningitis.
• 3. Anaphylactic shock- this is an emmergency
and occurs due to a severe allergic reaction to a
substance e.g. drugs (always indicate allergy on
patients chart) food, sulphur compound, wasp,
bee etc. The patient immediately develops a
swelling of the lips, face, cough, difficulty in
breathing and becomes restless.
• 4. Cardiogenic shock- This occurs when cardiac
muscles are damaged and the heart is unable to pump
blood to the body. It can result from a myocardial
infarction, arrhythmias and chronic cardiac failure
(CCF)
• 5. Neurogenic shock- This is caused by a
spinal/head injury that results in loss of nerve control.
This causes the nerve system to lose control over the
vascular system. Blood vessels dilate and they is
insufficient blood to fill them. There is no actual blood
loss.
• 6. Psychogenic shock- Also known as “fainting
spell” occurs when the victim suffers deep emotional
crises. There is sudden dilation of blood vessels which
temporarily halts blood flow to the brain.
 First Aid Management Of A Victim In Shock

• The aims of a first aider in the management of

shock are to:-
• a. Recognize shock
• b. Treat any obvious cause
• c. Improve blood supply to the brain, heart,
lungs and other vital organs
• d. Arrange immediate removal to the
hospital
 Shock should be managed as follows:

• 1. Treat any obvious cause of shock you

identify such as bleeding
• 2. Lay the victim down on the bed, floor or
the place where the accident occurred
• 3. If it’s on the floor, lay the casualty on a
blanket to protect him/her from the cold floor
• 4. Keep the casualty’s head low (if possible)
to facilitate blood flow to the brain but take
care in suspected fractures.
• 5. Cover the casualty with a blanket to keep
him/her warm (light blanket indoors) but do
not overheat the victim as they may lose more
fluid through sweat
• 6. Remove any tight clothing around the
neck, chest and waist such as belts to reduce
constriction
• 7. Ask by-standers to stand far away from
the patient so as not to overcrowd him. Keep
reassuring a conscious victim.
• 8. Relieve pain as far as possible by placing
the casualty in the most comfortable position,
supporting an injured leg.
• 9. Maintain airway and breathing by
ensuring that the patient’s airway is clear.
Check and record pulse and level of response
Give
cardiopulmonary resuscitation (CPR) if there is
no pulse or respiration.
• 10. Keep patient still and quiet and reassure
• 11. Get help as soon as possible. Provide details as to
the cause of shock
• 12. In cases where the situation is serious and the
patient might require surgery, the stomach should be kept
empty to facilitate the administration of anaesthesia.
• 13. If the first aider is sure that no haemorrhage is
present and fluid is not being lost, sips of sweet tea can be
given.
•
• Recovery from shock can be recognized when:-
• The pulse becomes slower and stronger
• The skin feels warmer and regains its colour
• Respirations are slower and deeper
•
 HAEMORRHAGE (BLEEDING)
• Bleeding is the escape of blood from a
damaged or diseased blood vessel (capillaries,
veins or arteries). Capillaries- smallest of
blood vessels that form part of
microcirculation. Heart-arteries-arterioles
which narrow further into capillaries.
• Bleeding from capillaries is minute,
comprising the oozing of blood. It can be
stopped by applying finger pressure.
• Bleeding from a vein is slow and even. It can
be stopped by applying compression for about
5 minutes.
• Bleeding from an artery is more profuse and
occurs as a result of deep and severe injury
since arteries are located deeper. It comes in
spurts.
•
 Causes of Haemorrhage

• 1. Injury to the blood vessel wall due to

direct injury, surgery, an accident ect.
• 2. Diseases of the blood e.g. haemophilia,
leukaemia.
• (haemophilia- disease of the blood as a result
of lack of clotting factors and causes delays in
the coagulation of blood.
• Leukaemia- cancer of the blood as a result of
proliferation of abnormal White cells)

• 3. Infection of the blood vessel wall eg

malignancies
 Types of bleeding

• Bleeding may be classified according to:-

• 1. Situation- a person can bleed either internally or
externally.
• a. External- occurs when the skin is broken from
wounds causing blood to escape from damaged blood
vessels to the outside of the body and it can be seen.
• b. Internal- this may occur when there is an injury
such as a blow, fractures or bullets. The blood escapes
from an injured blood vessel into the tissues or internal
organs or into the cavities of the body such as the chest,
abdomen, intestine or skull and may not be seen.
Internal bleeding becomes visible when the blood leaves
the body through the natural openings such as when
blood is vomited after haemorrhage into the stomach or
the ear or nose after the fracture of the base of the skull.
• 2. Source- This is the type of bleeding associated
with the type of blood vessel
• a. Artery- Bleeding of bright red blood because it’s
carrying oxygen. It escapes under considerable
pressure and spurts out with each heartbeat. It may
jet several feet high (if a main artery is injured) and
can rapidly reduce the volume of circulating blood.
• b. Vein- blood is dark red in colour because it does
not carry oxygen but carbon dioxide. It escapes with a
steady continuous flow and may gush out if a major
vein is severed.
• c. Capillary- blood oozes at the site of the wound
and ceases spontaneously. The colour is between
dark and bright red.
 Time of onset

• Primary- when bleeding occurs immediately

after injury/disease
• b. Reactionary bleeding- bleeding which
occurs within 24 hours after an injury after an
injury or operation. This may occur because at
the time of the injury, the BP is low and shock
may be present. When the BP rises later, it
dislodges the blood clot which has temporarily
sealed the damaged blood vessel.
•
• c. Secondary- this is bleeding that occurs
after 24 hours of an injury or operation. It
occurs 7-10 days and may be largely due to an
infection (sepsis) which breaks down blood
clots and opens up the blood vessels.
Secondary haemorrhage develops slowly but
is very dangerous.
 Signs and Symptoms

• 1. The face, lips, inside of the eyelids

(conjunctiva) and nail beds of the casualty
becomes pale. (blood moves to supply deeper
more vital organs like the brain, heart ect)
• 2. The skin is cold and clammy and sweating
may be present.
• 3. Subnormal temperature
• 4. Breathing becomes shallow accompanied by
yawning, sighing and gasping due to less
circulating oxygen.
• 5. Rapid weak pulse
• 6. Casualty is anxious, frightened and restless
• 7. Casualty may feel dizzy or faint
• 8. Feeling of thirst due to loss of fluid
• 9. Effects on the brain due to reduced
blood supply to the brain include dimmed or
blurred vision, giddiness, buzzing or ringing in
the ears, dilated pupils, mental confusion,
unconsciousness and death will result if not
treated
• 10. 1f a casualty is bleeding internally into
the abdomen, it may become swollen, tender
or rigid. They may be bleeding from the
rectum or vagina.
 Aims of Management

• 1. To control the bleeding

• 2. To prevent and minimize the effects of
shock
• 3. To arrange urgent removal of casualty to
hospital if necessary
• Arrest (Stoppage) of Bleeding
• There are 3 physiological ways of checking
loss of blood
 Nature’s Method

• Formation of a clot – a clot forms as a ‘cork’ to

plug or seal the injured blood vessels
(especially if the vessel is small and prevents
further loss of blood)
• When an artery is torn, its elastic inner coat
contracts and turns in thus helps to narrow
the lumen of the vessel and holds the clot in
place to stop bleeding
• Lowered BP diminishes the volume and
pressure of blood in the vessels. This gives the
walls of the blood vessels time to turn in and
the clot time to form.
 First Aid Treatment For Arresting External
Bleeding
• There are 3 first aid methods for stopping the escape of
blood externally.
• 1. Direct pressure
• i. Quickly use your fingers and thumb to press the site
of the wound to squeeze them together or use your palm
to press the bleeding part.
• ii. Place the casualty in a suitable position and elevate
the bleeding part above the heart if possible.
• iii. Maintain pressure without releasing it for 10-15
minutes to allow clot to form.
 DIRECT METHOD CONT.

• iv. Place a thick pad of dressing (sterile if

possible) over the wound and hold it there. The
dressing should be a thick pad of material.
• v. Ensure that the covering extends well above
the level and beyond the edges of the wound.
• vi. Retain the dressing and any supporting parts
in position and bandage firmly but not tightly.
• vii. If bleeding continuous, do not disturb the
original dressing but add more dressings and
bandage firmly.
• viii. Keep the bleeding part at rest.
 2. Indirect pres sure

• This is applied at the appropriate pressure point

between the heart and the wound. It is applied
when bleeding cannot be controlled by the use of
direct pressure or when it is impossible to apply it.
It is always not successful because of subsidiary
bleeding. The pressure point is a site where an
important artery passes over a bone.
• The artery is pressed against the underlying bone
to stop or prevent the flow of blood beyond that
point. The pressure must be firm and done by
means of digital pressure. Digital pressure implies
the compression of the artery between the finger
and the underlying bone
 Indirect method cont.
• . When about to apply digital pressure, first feel for
pulsation of the artery to compressed and apply firm
steady pressure proximal to the bleeding point
sufficient enough to arrest the bleeding.
• There are several points in the body where digital
pressure can be applied but only the accessible
arteries that the first aider can easily find without
fear of damaging other structures must be
compressed. Some principle pressure points include
the brachial artery, radial artery, femoral artery,
palmer arch (For profuse hand bleeding, the hand
must be raised above the heart; this may be followed
by application of a pad and bandage).
 3. Tourniquet
• This is a loop of a band either rubber or a rope
used to encircle a limp. When it is tightened, it
compresses the artery against the bone and
arrests the flow of blood in the main artery
leading to the wound. Tourniquet should only
be applied when other methods have failed as a
last resort to arrest bleeding as its application
could be dangerous. If it is applied too tightly or
continuously, for a long time, the circulation of
blood to the part and beyond the spot where it
is applied may be completely arrested, leading
to gangrene (death or necrosis of local tissues).
 How To Apply A Tourniquet
• 1. Place the casualty in a comfortable and
restful position and raise the limb
• 2. Place cotton wool, clothing, scarf or
handkerchief over the place where tourniquet
is to be applied
• 3. Apply the tourniquet with just sufficient
pressure to arrest the bleeding
• 4. Relax and tighten the pressure every 10-
15 minutes until the wound can be attended
to by a skilled person.
• 5. An improvised tourniquet such as a plain
rubber tube, scarf, handkerchief, stockings,
bandage or rope can be used.
• NB: Always treat for shock if the casualty has
signs and symptoms of shock
 BLEEDING FROM SPECIAL AREAS

• the nose), septal deviation, septal Epistaxis

(Nasal Bleeding)
• Nasal bleeding occurs in up to 60% of the
general population. It is common and affects
more men than women. Most cases of
epistaxis occur in the anterior part of the nose
• Causes- bleeding can either be caused by a local
or a systemic factor
• Local – chronic sinusitis, epistaxis digitorum
(nose picking), foreign body, intranasal
neoplasm, polyps, rhinitis (inflammation of the
mucus membrane of perforation, trauma,
fracture of the base of skull
• Systemic – Haemophilia, hypertension,
leukaemia, liver disease, Medications (e.g.
aspirin, warfarin (anticoagulants).
•
 First Aid Management

• 1. If the victim is conscious and there is no

likelihood of a broken skull:-
• 2. Sit the victim in a comfortable position with
his/her head slightly forward
• 3. Put a towel around the victims neck to
prevent blood from wetting his/her dress
• 4. Pinch the victims nose or ask the victim to
pinch his/her nose firmly between the thumb and
the forefingers for about 5-20 minutes
• 5. Instruct the victim to breathe through the
mouth
 First aid management cont.
• 6. You can also apply a cold compress on the nose.
You can either use ice cubes covered by a
handkerchief or a handkerchief wrung in ice water
• 7. Tell the victim to keep quiet and not to blow
his/her nose for a few hours
• 8. Advice the victim to see a doctor if severe
• 9. If the victim is unconscious, lay him or her
down with head turned to one side to allow the
blood to flow out and prevent it trickling from the
back of his/her mouth in the trachea
• 10. Send the victim to the hospital immediately.
•
Bleeding From The Gum Or Tooth Socket
• The bleeding from the gum usually occurs a
few hours after removal of a tooth.
• First Aid Management
• Sit the casualty down comfortably
• Place a towel around the victim’s neck
• Apply direct pressure by placing a thick cotton
wool or a pad of gauze firmly on the socket
area but not into the socket
• Tell the casualty to bite hard on the pad and
keep this for about 10-15 minutes
• To find this less tiring, the casualty should rest
his chin or in a cupped hand with the elbow
on a table
• Seek medical aid if bleeding is not controlled
• Do not wash out the mouth or plug the
socketsee
•
 Haematemesis (Vomiting Of Blood)
• This is when blood in the stomach is vomited out. The
blood may be coming from any part of the alimentary
tract.
• Causes –Gastric/duodenal ulcer, ruptured blood
vessels in the esophagus, malignancy of the GI tract.
• Signs and Symptoms
• 1. Vomiting of fresh red or dark brown blood
(coffee ground) due to partial digestion
• 2. Other general effects of loss of blood such as
pallor or paleness of the lips, nail beds and inside the
conjunctiva may look pale.
• 3. Pulse may be weak and fast with shallow
breathing and low BP may be present.
• First Aid Management
• 1. Lay the victim down immediately in a
comfortable position and ask him/her to keep still
as any movement might cause bleeding
• 2. Remove tight clothing around the neck, chest
and waist
• 3. Reassure the victim as he/she must be afraid
• 4. Nothing should be given by mouth to
eat/drink
 First aid management cont.

• 5. Ice cubes may be given to the victim to

suck. This may remove the nasty taste of
blood in his/her mouth
• 6. Treat for shock if necessary
• 7. All specimen of vomit should be retained
and taken to the hospital for inspection
• 8. This is an emergency. Seek medical help
immediately.
•
 Haemoptysis (Bleeding From The Respiratory Tract)

• This is coughing up of blood which may be coming from any

part of the respiratory tract usually from the lungs. It may be
caused by diseases of the lungs e.g. pneumonia, T.B.
• Signs and Symptoms
• 1. Coughing of blood that is bright red in colour and frothy
(because it is mixed with air)
• 2. The amount of blood may be specks in the sputum or
may be large
• 3. There may be shock because of the large amounts of
blood loss

•
• 1. Place the victim in a comfortable position either sitting up
in a chair or if at home, propped up in bed
• 2. Loosen all tight clothing around the neck, chest and waist
• 3. Reassure the patient and keep him still and quiet. Do not
let him talk or get excited for any movement/excitement might
cause further bleeding
• 4. Give ice cubes to suck. Nothing else should be given to
eat/drink
• 5. Treat for shock if necessary
• 6. Save any specimen of sputum for inspection in the hospital
• 7. Seek medical help immediately
•
•
 Bleeding From A Varicose Vein

• Varicose veins are twisted, dilated veins most

commonly located on the lower extremities.
They occur when the veins become distended
and enlarged as the valves which take blood to
the heart no longer work. Blood which should
have been pushed back up to the heart leaks
downward, pooling in the lower extremities of
the body, causing the veins to bulge.
• The veins just under the skin are vulnerable and
rapture from a blow or strain.
• These veins are mostly found in people who sit
or stand in one position for prolonged periods of
time. Risk factors include chronic cough,
constipation, family history of venous disease,
obesity, old age, pregnancy. Females are more
at risk than males.
• Potential complications include infection, leg
ulcers and thrombosis.
 First Aid Management
• 1. Apply direct pressure with your hands on the
bleeding point and keep it there
• 2. Lay the victim down and raise the leg resting the
heel on folded clothing, log, box or any higher object
• 3. Remove any tight bands like beads, leggings etc.
• 4. Replace the pressure of your hand with a clean
pad such as a well folded handkerchief and bandage
• 5. Retain this firmly without slipping and seek
medical aid
•
 Malaena (Blood in Stool)

• This is the presence of blood in the stool.

Normally dark stools with altered blood (black
‘tarry stools’) are passed when bleeding occurs
higher up in the intestine e.g. from duodenal
ulcer due to intestinal juices coming into contact
with the blood.
• Bleeding from the lower end of the intestinal tract
may produce bright red blood in the stool and
may be due to haemorrhoids (piles), dysentery,
cancer of the lower bowels e.g. rectum,
perforation and colitis (inflammation of the
colon). NB: Patients on iron treatments have black
 First Aid Management
• 1. Lay the victim down in a comfortable
position
• 2. Reassure the victim and ask him/her to
stay quiet and still
• 3. Treat for shock if necessary
• 4. Save any stool specimen for inspection
• 5. Do not give anything to eat or drink
• 6. Seek medical help immediately.
•
 WOUNDS

• A wound is a break in the continuity of the tissues

of the body either internal or external.
• Classification of Wounds
• Open – An open wound is a break in the skin or
mucous membrane
• Closed – A closed wound involves injury to
underlying tissues without a break in the skin or a
mucous membrane.
• Types of Open Wounds
• The type of wound depends on the object that caused the
wound
• 1. Incision or Incised Wound (clean cut wound) -This
may be caused by any sharp instrument such as a knife,
razor, cutlass, glass, sheet metal etc. This type of wound
bleeds profusely because blood vessels are cut and the
edges of the wound tend to separate.
• 2. Lacerated (Torn) Wound- These wounds are caused
by machines, claws of animals, barbed wire causing tearing
with ridged edges. There is less bleeding but the wound
can get easily infected.
• 3. Abrasions – This is a superficial wound in which the
topmost layer of the skin (the epidermis) or mucous
membrane is scraped off by sand paper or rough surface.
• 4. Punctured Wound (Deep Stab) – This is caused by a
pointed object such as a nail, dagger, pin, needle, garden
fork or a long thorn puncturing the skin. The wound is small
on the surface but may be deep. External bleeding is
seldom severe or not at all. It is dangerous because there
may be internal bleeding as an internal organ or artery may
be punctured.
• 5. Avulsion Wound – These wound involves the possible
separation or tearing of tissues from the victim’s body
caused by bites of animals, humans and machine.
• 6. Gunshot Wounds – This is caused by a bullet or
similar projectile objects such as shells, bombs and
grenades driving into or through the body. There may be
internal injuries such as fractures
•
 Types of Closed Wounds

• 1. Contusion (Bruised) Wound – This is caused by a blunt

force trauma that damages the tissue under the skin. It can be
caused by a blow from a hammer, blow with a blunt instrument,
a fall on a hard surface etc. There is slight bleeding into the
tissues while the skin remains unbroken.
• 2. Haematoma – also referred to as a blood tumour caused by
damage to a blood vessel that in turn causes blood to collect
under the skin.
• 3. Chronic Closed Wounds- Chronic wounds caused by a
relatively slow process that leads to tissue damage. Chronic
wounds include venous and diabetic ulcers. Typically, an
insufficiency in the circulation or other systemic support or tissue
causes it to fail and disintegrate. Infection then takes hold of the
site and it becomes a chronic abscess. Once the infection hits a
critical point, it can spread locally or systemic.
 General First Aid Management of Wounds

• Your aims as a first aider are:-

• 1. To control bleeding
• 2. To prevent and minimize the effects of
shock
• 3. To minimize the risk of infection
• 4. To arrange urgent removal of the
casualty to the hospital
• Your management should be as follows:-
• 1. Remove or cut clothing to expose the wound if
necessary. Watch out for sharp objects such as glass
that may injure you.
• 2. Control any bleeding immediately
• 3. Clean the skin around the wound with small
swabs of gauze or cotton possibly moistened with
soap and water. Care must be taken to work outwards
from the wound and avoid touching the wound with
material used for skin cleaning
• 4. Remove any loose foreign matter e.g. gravels,
grass pieces of wood etc. from the wound but not
anything embedded in the wound
• 5. Thoroughly dry the wound and its surrounding
areas with fresh gauze/cotton wool, making sure not
to contaminate the wound
• 6. Cover the wound with a clean dressing ideally
freshly opened pack of gauze. Do not use cotton wool
or dirty dressings. Avoid pressure on any foreign body
• 7. Cover the dressing with a thick pad of cotton
wool or any suitable material such as a clean
handkerchief
• 8. Bandage firmly but not too tightly and rest the
injured part
• 9. Seek medical help immediately in major wounds
• 10. Minor wounds can be cleaned and treated by
the first aider using available material.
 Complications Of Wounds
• The severity of a wound whether mild, moderate or
severe depends on its size, type, site or position,
depth, injuries to internal organs and complications.
The most dangerous complications of wounds
include
• Shock
• Bleeding
• Infection
•
• Injury to deeper organs – internal bleeding
can result from punctured wounds. This may
cause peritonitis (inflammation of the
peritoneum), pneumothorax (air in the chest
cavity)
• Broken bones or fractures- if limbs are injured
as can occur in road traffic accidents, gunshots
or machinery a fracture of one or more bones
• can occur.
 SPECIAL WOUNDS
• Penetrating (Stab) Wound of The Chest
• This is an injury to the chest that produces a
hole in the chest cavity, causing damage to the
lung or collapse which prevents normal
function of the lungs (breathing). This is an
extremely serious condition that will result in
death if not treated immediately.
 Signs and Symptoms

• 1. The victim may be in shock, anxious or

apprehensive
• 2. He/she may gasp for air
• 3. The victim may cough up blood
• 4. Cyanosis may be present
• 5. During inspiration, the noise of air being
sucked into the chest can be heard
• 6. On expiration, a frothy blood or blood
stained bubble may be expelled from the
wound.
 First Aid Management

• The immediate aim of the first aider is to seal the

wound and prevent air sucking into the chest cavity.
• 1. Until a dressing can be applied, immediately
seal the wound with an open hand or any air tight
material available such as an ID card
• 2. Place the victim in a sitting up position. This
makes breathing a little easier.
• 3. Cover the air tight material with a good
thickness of gauze or any material and retain in
place strapping firmly to the chest wall
• 4. Watch the victim closely for signs of shock and
treat immediately
• 5. Do not give victims with chest injury,
anything to eat or drink
• 6. Send to the hospital immediately.
• Abdominal Wounds
• It may be caused by pointed objects, bullets,
bombs, fragments etc. Such wounds may cause
internal bleeding.
• Signs and Symptoms
• 1. The victim may complain of intense pain,
nausea and vomiting
• 2. There may be spasms of the abdominal
muscles
 First Aid Management

• 1. Place the victim on his back with his hips and

knees well bent over a cushion, a pillow or any
other bulky cloth material to relax the abdominal
muscles so that the wound does not gape.
• 2. Raise the victims head and shoulder slightly
and support them
• 3. Loosen clothing around the waist and any
tight vest
• 4. Turn the head to one side so that any
vomitus may escape easily from the mouth
• 5. If no internal organ is protruding, cover the
wound with a sterile/clean dry dressing and
bandage firmly
• 6. If internal organs are protruding through the
wound:-
• a. Do not attempt to push them back in or to
manipulate them in any way
• b. Cover lightly with a large gauze dressing
• c. Secure the dressing in position with light
pressure
• 7. Treat for shock by making the victim completely
warm
• 8. Do not give anything to drink. Dry mouth may be
moistened with water
• 9. The victim must be transported in the supine
position (lying on the back with face upwards) to the
hospital immediately.
 BURNS AND SCALDS
• Burns is a type of injury caused by dry heat (fire,
sun, and hot metal), electricity, extreme cold,
chemicals, radiation or friction. Most burns only
affect the skin (epidermis and dermis). Rarely
deeper tissues, such as muscle, bone and blood
vessels can also be affected.
• Scalds are caused by wet heat i.e. hot liquids and
vapor. Those at greatest risk for are children
(below 4 years), older people (65 years and
above) and people who live in wooden houses.
Approximately 1.1 million people require
medical attention from burns injury each year.
 Effects of Burns

• 1. Shock – due to loss of body fluids (serum)

from the burnt surface. The size of the area of
the body burnt is thus a better guide to the
severity of the burns than the depth of the tissue
destroyed.
• 2. Infection – there is a big risk of infection
because the protective layer of the skin is
destroyed and it is exposed to germs.
• 3. Reddening of the skin or blister formation,
destruction of the skin and deeper tissues.
• 4. Pain may be very severe
• 5. Scarring and deformity
 Classification of Burns

• To distinguish a minor burn from a

serious burn, the first step is to determine
the extent of damage to body tissues. The
three (3) classifications are first degree,
second degree and third degree.
• 1. First degree – This is the least
serious burns in which only the outer
layer of skin is burned and not all the way
through. The skin is usually red with
swelling and pain.
• 2. Second degree – This is when the
first layer of the skin is burned through to
the second layer (dermis). Blisters
develop and the skin takes on an intensely
reddened appearance. Second degree
burns produce severe pain and swelling.
• 3. Third degree burns - This is the most
serious burns and involves all layers of the skin
and causes permanent tissue damage. Fat,
muscle and even bone may be affected. The
burnt area may be charred black or appear dry
and white. Difficulty inhaling and exhaling,
carbon mono-oxide poisoning or other toxic
effects may occur if smoke inhalation
accompanies the burn.
 Depth of Burns
• Burns can also be classified according to its
depth
• 1. Superficial burns – Involves only the
outer layer of the skin and is characterized by
redness, swelling and tenderness e.g.
sunburn, scalds by a splash of hot tea/ coffee.
Superficial burns usually heal well if prompt
first aid is given and does not require medical
treatment unless extensive.
• 2. Partial thickness burns – These damage
a partial thickness of the skin and require
medical treatment. The skin looks raw and
blisters form. It heals well but can be serious if
extensive. 50% of partial thickness burns can
be fatal and less in children.
• 3. Full thickness burns – These damage all
layers of the skin. Damage may extend beyond
the skin to affect nerves, muscle and fat. The
skin may look pale, waxy and sometimes
charred. They require immediate medical
attention.
 Assessment of Burns

• The rule of nine accesses the percentage

of burns and is used to guide treatment
decisions including fluid resuscitation.
This rule assigns percentages in multiples
of nine to major body surfaces.
 Adults

Part of Body Percentage of Body area

• Head and neck 9%

• Each upper limb (front and back) 18%
• Each lower limb (front or back ) 18%
• The trunk (front or back) 18%
• Perineum 1%
 Children

Part of Body Percentage of Body area

• Head and neck 17%
• Each upper limb (front and back) 18%
• Each lower limb (front or back ) 14%
• The trunk (front or back) 18%
• Perineum 1%
NB: Find and attached diagram from any Surgical
nursing Text book.
•
First Aid Priorities (Emmergency Procedures at a Burns Scene)

• 1. Establish your own safety before

attempting to treat the casualty
• 2. Deal with any airway problems (A, B, C)
• 3. Stop the burning by rapid cooling to
prevent further damage, reduce swelling,
minimize shock and alleviate pain
• 4. Irrigate chemical burns
• 5. Cover the injury to protect it from
infection
• 6. Check for other injuries and remove
restrictive objects and obtain appropriate
medical aid
•
 General Management of Burns

• 1. Reassure the victim

• 2. Treat for shock
• 3. Cover the burnt area with sterile dressing
and apply a bandage
• 4. For facial burns, make a mask from a clean
dry sterile material. Cut holes for mouth, nose and
eyes
• 5. Immobilize badly burnt limbs
• 6. Seek medical attention immediately
• DO NOT
• 1. Apply lotions/ ointments to the injury. It
can increase the risk of infection
• 2. Apply adhesive dressings/tape to the
injury
• 3. Break blisters, remove loose skin or
interfere with the injured part.
•
 Minor Burns and Scalds

• These burns are often caused by domestic

accidents. They are small superficial and can
be treated by the first aider.
• 1. Reassure the casualty and place the
injured part under slow running cold water or
immerse it in cold water for at least 10
minutes to stop the burning and relieve the
pain
• 2. Gently remove any rings, watches, shoes
and other constrictive clothing from the
injured area before it starts to swell
• 3. Cover the area with a sterile dressing or
any clean, non-fluffy material
• 4. Give lots of fluids orally to prevent
dehydration
• 5. No adhesives should be used and do not
break blisters
 Severe Burns and Scalds
• The longer the burning continues, the more
severe the injury. If the casualty has been burned
in a fire, it should be assumed that smoke or hot
air has also affected the respiratory system
(smoke inhalation). The two essential priorities
are: a. Initiate rapid cooling of the burn
• b. Check the casualties breathing (A, B, C)
• 1. Lay the casualty down and protect the
burned area from contact with the ground if
possible
• 2. Pour cold water over the burnt area for at
least 10 minutes for a thorough cooling
• 3. Watch the casualty for signs of difficulty in
breathing and be ready to resuscitate if
necessary
• 4. Gently remove any rings, watches, belts,
shoes before swelling. Carefully remove burned
clothing unless it is sticking to the burns
• 5. Cover the injury with a sterile dressing or
some other suitable material such as a clean
plastic bag for a burnt hand/ foot
• 6. Record details of the casualty’s injuries,
circumstances and potential hazards such as gas.
• 7. Reassure the casualty and treat for shock.
Monitor and record breathing and pulse rate and
are ready to resuscitate if necessary
• DO NOT
• 1. Overcool the casualty especially if burns
cover a large area to prevent hypothermia
• 2. Remove anything sticking to the burns.
You may cause further damage and introduce
infection into the burns
• 3. Give a severely burnt person anything to
eat/drink.
•
 SPECIAL TYPES OF BURNS

• Burns To The Mouth and Throat

• Burns to the face and within the mouth and
throat are very dangerous as the airway
rapidly becomes inflamed. This injury can
occur when burns are sustained in a confined
space as the casualty may have inhaled hot
air/gas, after drinking a very hot
liquid/swallowing corrosive material
 Signs and Symptoms of special burns

• 1. Severe pain in the injured area

• 2. Damage to the skin around the mouth
• 3. Redness, swelling or actual burning of
the tongue
• 4. Difficulty in breathing
• 5. Hoarseness of the voice
• 6. Unconsciousness
• 7. Signs and symptoms of shock
• E.G. Mostly drug reactions, etc
First Aid Management of special types of burns
• 1. If the casualty is conscious, reassure him
and give sips of cold water at frequent
intervals. If unconscious, open the airway,
check breathing and pulse and be prepared to
resuscitate. Place the victim in the recovery
position.
• 2. Remove any constricting clothing or
jewelry around the neck to improve air supply
• 3. Give oxygen if available and treat shock
• 5. Send the victim to the hospital
immediately
 Electrical Burns

• Burns may occur when electricity passes

through the body. Damage occurs at the point
of entry and exit of the current. They may be a
track of internal damage. The position and
direction of entry and exit wounds will alert
you to the likely extend of the hidden injury.
Burns may be caused by a lightening strike or
by low/ high-voltage current. An electric shock
can cause cardiac arrest.
• Signs and Symptoms
• 1. Unconsciousness
• 2. Signs of shock
• 3. Full thickness burns with swelling,
charring at both entry and exit
 First Aid Management

• 1. Make sure contact with the electrical source is

broken (if it is high voltage, do not attempt to touch
the victim even with wood. If it’s low voltage, use a
dry stick to remove the victim’s limbs or make a
loose loop around the victims leg and pull it)
• 2. Flood the sites of injury with plenty of cold
water to cool the burns and cut away any burned
clothing if necessary
• 3. Place a sterile dressing, a clean/sterile
material over the burns to protect them against any
infection
• 4. Seek medical help immediately
•
 Chemical Burns
• Corrosive chemicals cause burns when they come
into contact with the skin. The strongest corrosives
are found in the industries although some cleaning
products at home can also cause burns. Chemical
burns are always serious and require agent
attention. Note the name of the brand that caused
the burns if possible. Some chemicals give off
deadly fumes so ensure your own safety. Cover your
nose if necessary.
• chemical burns Signs and Symptoms
• 1. They may be evidence of chemicals in
the vicinity
• 2. Intense stinging pain of the skin
• 3. Skin may be stained or reddened
• 4. Blistering and peeling may develop
First Aid Management of chemical burns

• 1. Make sure the area is safe. Ventilate the

area (open doors and windows) and seal the
chemical container.
• 2. Remove the casualty from the area if
necessary
• 3. Flood the affected area with slow
running water to disperse the chemical and
stop the burning for at least 20 minutes
• 4. Gently remove any contaminated
clothing while flooding the injury
• 5. Continue treatment as for severe burns.
Observe the victim airway and circulation
closely
• 6. Send the victim to the hospital
immediately
•
•
 Chemical Burns To The Eye

• Splashes of corrosive chemicals can easily

enter the eye rapidly causing severe scarring
and even blindness
• Signs and Symptoms
• 1. Intense pain in the eye
• 2. Inability to open the injured eye
• 3. Redness and swelling around the eye
• 4. Copious watering of the eye
• 5. Evidence of chemical substances or
containers in the immediate area.
First Aid Management of chemical burns to the eye

• 1. Immediately hold the affected eye under

gentle running cold water for at least 10 minutes.
• 2. Make sure you irrigate the eye thoroughly
from the unaffected eye to the affected eye
• 3. Ensure that the water for rinsing does not
splash on you or the casualty
• 4. Do not allow the casualty to touch the
injured eye or forcibly remove contact lenses
• 5. If the eye is shut in a spasm of pain,
gently but firmly pull the eyelids open
• 6. Put a sterile eye pad/ a pad of clean,
non-fluffy material over the injured eye and
ask the casualty to hold it
• 7. Bandage the pad loosely in position if it
will take some time to get medical attention
• 8. Identify the chemical if possible and
send the casualty to the hospital.
•
•
 FRACTURES

• A fracture is a break, chip or crack in the

continuity of a bone.
• Causes
• 1. Direct force –This is when the
fracture/break occurs at the point where it is
stuck, crushed or where a blow falls e.g. a car
running over a leg or hammer hitting a finger.
• 2. Indirect force – This is when a break
occurs some distance away from the impact.
The force may travel from a point of impact
through the body to break the bone
elsewhere e.g. clavicle broken due to a fall on
the hand or head of femur broken from a
heavy fall on the heel.
• 3. Muscular action- occurs when the break
is caused by a violent muscular contraction
pulling the bone e.g. a patella broken when
avoiding a fall backwards.
 Types of Fractures

• Fractures are classified according to their shape, the

extent of damage done to the bone and the
surrounding soft tissue i.e. muscles, nerves and blood
vessels.
• 1. Closed or simple fracture – The bone is broken
in only one place, the skin is not broken and there is
no wound leading to the broken bone.
• 2. Open or compound fracture – This is a broken
bone that penetrates the skin. There is immediate
need for treatment and surgery is often required to
clean the area of the fracture and repair the fracture.
• 3. Comminuted fracture – This occurs when the
bone is broken into several pieces and produces
 Types 0f fractures cont.

• 4. Complicated fracture – This is a simple

or compound fracture which causes damage to
an important structure such as a large artery,
vein or a nerve.
• 5. Incomplete/greenstick fracture – This
is usually seen in children. The bone is
partially broken or bent because it is soft
• 6. Depressed fracture – This a break in
one or more bones in the skull usually
occurring as a result of a blunt force/trauma
• 7. Impacted fracture – The fragments of
the broken bone in this fracture is driven into
and firmly wedged into the other fragment
• 8. Pathological fracture – A break in the
bone as a result of a bone disease e.g.
osteoporosis
• 9. Stress fracture – This is a break caused
by repeated stress on the bone such as a heavy
continuous weight on the bone. It is usually a
sports injury.
 Shapes of Fractures

• 1. Transverse – this is when the bone is

broken straight from one end to another
• 2. Oblique – the bone is broken in a
slanting direction from one end to another
• 3. Spiral – when the fracture extends round
the bone as well as its length
• 4. Longitudinal – when the bone splits
lengthwise
• 5. T-shape – this occurs when a
longitudinal fracture combined with a
transverse fracture
•
 General Signs and Symptoms

• The fracture may be recognized by some or all of the following

signs and symptoms
• 1. Pain and tenderness at the point where the bone is
broken.
• 2. Deformity – there may be a change in the shape of the
injured limb, it may be bent, twisted or shortened and appear
unnatural
• 3. Swelling – there may be swelling and sometimes bruising
• 4. Loss of power or control – the injured part cannot be
moved normally
• 5. Crepitus – there may be grating sensation caused by
ends of the bone rubbing against one another which may be
heard and felt.
•
Objectives of First Aid Treatment in fractures
• The objectives of first aid treatment of
fractures are to:-
• 1. Relieve pain
• 2. Prevent the broken ends of the bone
from damaging blood vessels and nerves or
piecing the skin
• 3. Prevent blood loss if it’s an open wound
• To achieve the above objectives:-
• 1. The fractured bone must be immobilized or
fixed so that it cannot move. This must be done on
the spot unless there is danger
• 2. The greatest care must always be taken to
support the fractured part during treatment until it
is properly immobilized.
• 3. In open fractures, the wound must first be
dressed to prevent infection and stop bleeding
• 4. Raise the injured leg if possible to prevent
swelling
• 5. If fracture is only suspected, it should be
treated as an actual fracture until proven
otherwise
General Rules for Immobilizing The Limbs

• 1. Immobilize the whole limb including the

joints both above and below the fracture
• 2. The immobilized part should be padded
especially where bony parts project e.g. ankle,
the knee and the wrist
• 3. Tie knots on the uninjured side. When
natural method or splints are used, the knots
should be tied over the splints.
• 4. If any joint (leg, knee or elbow) is
affected, the position of the limb must not be
changed. The limb must be immobilized in the
position in which it was found
• 5. Bandages should be passed under
casualties through the natural hollows such as
the knees, loins and heels
 Types of Immobilization

• There are 3 main types:-

• 1. Natural (body splinting)- this means
fixing or bandaging of an injured limb to the
uninjured part of the body using the latter as a
splint e.g. a fractured arm can be tied to the
chest and a fractured leg tied to another leg.
• 2. Mechanical splinting - This is
immobilization using a splint and it is the most
effective method of fixation. The splint should
be strong enough to give support, they must
be long enough to extend beyond the joints
on either side of the fracture and the splint
should be padded on either side in contact
with the injured limb.
• 3. Improvised splinting – Firmly folded
newspapers, walking sticks, umbrellas, tree
branches, brooms and any straight firm
material can be used as splints
• Improvised slings- Placing the injured arm in a
buttoned up coat, shirt or jacket, using a belt
or pinning the sleeve of a coat, jacket or shirt
to the lapel.
•
 First Aid Management of Open Fractures

• 1. If possible, get someone to support the

injured limb while you work on the wound.
Cover the wound with a sterile or clean pad
and apply pressure to control bleeding.
• 2. Do not press down directly on a
protruding bone
• 3. Add more dressing after arresting the
bleeding
• 4. If a bone is protruding, build up pads of
soft, non-fluffy material around the bone until
it can be bandaged over the pads
• 5. Secure the dressing and padding;
bandage firmly but not tightly
• 6. Immobilize the injured part and do not
move the casualty until the injured part is
secured and supported unless in danger
• 7. Treat for shock if necessary
• 8. Do not give the casualty anything to eat
or drink
• 9. Seek medical attention immediately
•
 Management of Close Fractures

• 1. Instruct the casualty to keep still and

steady and support the injured part with your
hands until it is immobilized
• 2. For firmer support, secure the injured
part to a sound part and bandage or use
mechanical splinting
• 3. Do not move the casualty until the
injured part is secured unless there is danger
• 4. Raise the injured part if possible and
treat for shock if necessary
• 5. Ensure that the bandaging is not too
tight and check for circulation often
• 6. Do not try to replace a dislocated bone
into the socket and do not give the casualty
anything to eat or drink
• 7. Seek medical attention
 Specific Fractures

• Fracture of the Humerus

• Signs and Symptoms
• 1. The usual signs of fracture are present –
pain, loss of power, deformity, swelling and
crepitus
• 2. The victim may support the injured part
with the forearm across the chest
• 3. If the fracture is near the elbow, there is
likely to be swelling and the casualty may not
be able to bend the elbow
 First Aid Management
• 1. Stop bleeding and treat the wound if any
• 2. Ask the casualty to place arm across the
chest
• 3. Place a large soft pad, folded towel or
cotton wool in the axilla, on the chest and
between the arm and the body
• 4. Bind the arm to the side of the chest with
2 triangular bandages or 2 broad bandages
• 5. Support the arm in a sling
• 6. Seek medical help
•
 Fracture of the Ulna and Radius

• Any fracture of the forearm is likely to result in pain,

tenderness, inability to use the forearm and a kind of
wobbly motion at the point of injury.
• First Aid Management
• 1. Sit the casualty down and treat any wounds if
necessary
• 2. Put the forearm across the chest, the palm of the
hand should be in with the thumb pointing upwards
• 3. Support the forearm in this position by means of
a large arm sling
• 4. Bind the upper arm to the chest with a broad
folded bandage and tie the knots in front of the chest
 Fracture of the Femur

• Signs and Symptoms

• 1. The leg has a wobbly motion and there is
complete loss of control below the fracture
• 2. Any attempt to move the limb results in
a spasm of muscles and causes excruciating
pain
• 3. The fractured leg is shorter than the
uninjured one
•
 First Aid Management
• 1. Stop bleeding and cover wounds if any. Treat
for shock
• 2. Ask the casualty to lie flat on his back. Gently
and without force, bring the injured leg in line with
the uninjured leg

• 3. Apply a well-padded splint between the limbs

extending from the groin to the foot.

Apply a long padded splint on the outer side of the

injured limb up to just below the axilla.
•
• 4. Bandage the chest just below the axilla and
pelvis in line with the hip joint.

• Bandage both thighs above and below the

fracture.
• Bandage both knees and bandage legs together.
• Bandage both ankles and feet together with
a figure of eight.
• 5. If splints are not available, place a soft pad
between the thighs, knees and ankles and tie
them together. Place another bandage around
the thighs below the fracture and one around the
legs.
 Fracture of the Tibia and Fibula

• First Aid Management

• 1. Treat for shock, stop bleeding and treat any
open wounds.
• 2. Ask the casualty to lie flat on his back and gently
and without force bring the injured leg in line with
the uninjured leg.
• 3. Place a well-padded splint on the side of the leg
extending beyond the foot to above the knee joint

• 4. Place a second padded splint along the inner

side between the limbs extending from the groin to
the foot
• 5. Secure the splints with bandages around the thigh
above the knees and also bandage below and above
the site of the fracture.
• Bandage both legs together.

• Bandage both feet and ankles together with a figure of

eight.
• 6. If splints are not available bring the feet as nearly
as possible in line without using force or causing pain.
Place soft pads between the thighs, knees and ankles
and bandage above and below the fracture. Also
bandage ankles and feet together but not over the
fracture.
•
•
 SPRAINS AND DISLOCATION

• Sprain
• A sprain is an injury to ligaments, muscles and
tendons which surround a joint and can be caused
by excessive stretching. There may also be tearing
of some of the structures.
• The ligaments are tough elastic-like bands that
connect one bone to another and hold the joints
in place. The ligament can have a partial tear or
can be completely torn apart. Sprains occur most
commonly at freely movable joints.
• The most common joints are the ankles, wrist and
knee.
 Signs and Symptoms of sprains and dislocation

• 1. Severe pain, the pain increases in

severity with any movement of the part
• 2. There is marked tenderness and swelling
of the site
• 3. Bruising occurs later due to bleeding
from torn structures
• 4. There is no deformity of the part but
there is loss of power but not as marked as in
a fracture
 First Aid Management
of sprains

• It is safer to treat the injury as a fracture until

proven otherwise particularly if the pain is
severe. If the first aider is sure that it is only a
sprain, the following management is given:-
• 1. Apply firm pressure to the joint by
surrounding it with a pad of cotton wool and
bandaging it firmly in position or use
compressive wraps/sleeves
• 2. Protect the injured limb from further
injury by not using the joint. Use splints and
crutches
• 3. Rest the injured limb
• 4. Use a cold pack on the area as soon as
possible after the injury (10-15 mins) to
reduce swelling. Do this for about 4 times a
day for the first 48 hours
• 5. Ask the casualty to elevate the injured
limb above his/her heart whenever possible to
help prevent or limit swelling
• 6. Seek medical help to rule out fracture.
•
 dislocations
• Dislocation
• This is a partial or full displacement of bones at a
joint. There may be an associated fracture,
tearing of the ligament or damage to the
membrane that encloses the joint. Dislocations
occur commonly at the shoulder, elbow, fingers,
thumb and jaw.
• Signs and Symptoms
• 1. The signs and symptoms resemble those of
a fracture but there is usually a greater deformity
• 2. There is swelling, obvious deformity
• 3. Pain on motion, tenderness and
discolouration
• First Aid Management
• 1. If the dislocation occurs at any joint of
the upper limb, apply a sling to support the
part. If the affected joint is at the lower limbs,
immobilize the limb with a splint
• 2. Elevate the affected limb
• 3. Never attempt to reduce a dislocation or
correct any deformity at a joint by
manipulating it as this may cause further
injury.
•
 UNCONSCIOUSNESS

• Unconsciousness is a state of unawareness

which results from the interruption of the
brains normal activity. The unconscious
patient is unresponsive to stimuli and because
he/she cannot cough, or clear his throat, there
is a danger of choking. There are different
levels of the conscious state.
• 1. Full consciousness – The victim is well
oriented to person, place and time and
responds well to stimuli in his/her
environment
• 2. Stupor – The victim is disorientated to
person, place and time. The victim may still be
capable of answering simple questions like his
name, address though he may not know
where he is. The victim may be capable of
obeying simple orders like sit up and lie down.
He/she responds to painful stimuli
• 3. Coma – The term is used to describe a
state of complete unconsciousness when all
reflexes are absent and the patient does not
respond to any stimuli at all
• 4. Coma vigil – State of complete
unconsciousness but the victim’s eyes are
wide open. It appears as if the patient is
awake and watchful, when in fact he is not
(natural tears, close eyes with cello tape)
 Causes of Unconsciousness

1. Infections e.g. meningitis, cerebral malaria

2. Diabetic ketoacidosis
3. Hypoglycemia (diabetic/insulin coma or alcohol
induced)
4. Cerebral anaemia- alteration in blood supply to the
brain resulting in lack of oxygen to the brain tissues
5. Severe hypertension with encephalopathy
(permanent/reversible degenerative brain injury)
6. Asphyxia (inability to breath due to suffocation,
choking or foreign body)
7. Drug overdose e.g. alcohol, salicylate, barbiturates,
opioids and hypnotics
 Causes cont.

• 8. Cerebrovascular accident (CVA) or stroke

• 9. Head injury – fracture of the skull, concussion or
compression
• 10. Epilepsy
• 11. Electric shock
• 12. Tumours of the brain
• 13. Eclampsia – acute life threatening complication of
pregnancy characterized by seizures in patients who
have pre- eclampsia with hypertensive disorders
• 14. Major organ failure e.g. hepatic, renal failure and
myocardial infarction
• 15. Drug ingestion and poisoning especially in children
 The Aims of Treatment are to:-

1.Maintain an open airway

2.Assess and record the level of consciousness
3.To treat any associated injuries
4.To gather and retain any evidence of cause of
condition
5.To arrange urgent removal to the hospital
 First Aid Management

• 1. Open the airway by head tilt, chin lift

• 2. Check breathing and pulse and be
prepared to resuscitate if necessary. Assess and
record the level of consciousness
• 3. If the casualty starts to vomit, immediately
place him/ her in the recovery position
• 4. If you suspect spinal injury, do not move
the casualty unless in danger. Use the scoop
stretcher or log roll if the casualty must be
moved
• 5. Remove any loose dentures and clear the
casualty’s mouth of any vomitus/blood
• 6. Ensure sufficient fresh air around the victim by opening
windows if indoors or keep onlookers at a distance
• 7. Examine the casualty quickly but systematically to
identify severe external bleeding, major fractures or head
injury
• 8. Control any bleeding and immobilize suspected fractures
• 9. Keep the casualty reasonably warm
• 10. As you work on the victim, smell his breath, look for
needle marks, and look for warning bracelets, lockets or
cards. Ask by-standers for information
• 11. Place the casualty in the recovery position and seek help
• 12. If he/she recovers consciousness, reassure and seek
medical help
•
DON’TS
1. Do not attempt waking an unconscious victim by
slapping or pouring of cold water on him/her
2. Do not put a pillow under the head of an
unconscious patient as it could block the airway
3. Do not attempt to give an unconscious victim
anything by mouth
4. Do not move the victim unnecessarily because of the
possibility of a spinal injury
5. Never attempt to make an unconscious victim
sit/stand
6. Do not leave an unconscious victim unattended to at
any time.
7. Do not blow concoctions or spices in the nostrils in a
 CONVULSION

• This is a medical condition in which the body

muscles contract and relax rapidly and repeatedly
resulting in an uncontrolled shaking of the body.
During a convulsive attack, there is an involuntary
jerking movement of one or all limbs frequently
associated with loss of consciousness.
• Because convulsion is often a symptom of an
epileptic seizure, the term convulsion is
sometimes used as a synonym for seizure.
However, not all epileptic seizures lead to
convulsions and not all convulsions are caused
by epileptic seizures. It is also sometimes
referred to as fits.
• Convulsions normally occur in young children
and are frequently termed infantile
convulsions. There are most often caused by a
rise in body temperature (febrile convulsion)
and it is the reaction of the brain to the high
body temperature.
 Causes of convulsions

• 1. The onset of an infectious disease e.g.

infections of the brain, ear or throat
• 2. Brain tumour/injury
• 3. Fever (particularly in children) e.g. from
malaria, teething in children
• 4. Toxaemia of pregnancy
• 5. Epilepsy
• 6. Intake of alcohol
• 7. Drug withdrawal
• 8. Alteration in blood sodium levels
• 9. Poisoning
• 10. Gastrointestinal upsets e.g. worm
infestation
• 11. Alteration in blood sugar (hypoglycemia,
hyperglycemia)
 Signs and Symptoms

• 1. Violent muscle twitching with clenched fist and an

arched back
• 2. There is twitching of the face with squinting, fixed or
upturned eyes
• 3. Breath holding with a congested face and neck and
shaking at the mouth
• 4. Loss/altered consciousness
• 5. Slight/ localized twitching or jerking of lips, eyelids,
head or limbs
• 6. Drooling/frothing at the mouth
• 7. Teeth clenching
• 8. Loss of bladder and bowel control
•
 First Aid Management Of Convulsion
• Aim:- The primary aim of management is to
maintain the airway and breathing of the
casualty and prevent injury
• 1. Place pillows or soft padding around the
casualty so that violent movement will not
result in injury.

• 2. Remove clothes especially around the

casualty’s neck and covering bedclothes to
ensure a good supply of fresh air and avoid
overcrowding the casualty.
• 3. To aid cooling, (especially in children with
febrile convulsion) sponge with tepid water, start
from the forehead downwards. Never pour cold
water on the casualty or immerse him in cold
water as a sudden drop or change in temperature
can be dangerous.
• 4. Place the casualty in the recovery position
once seizures have stopped to maintain a patent
airway and allow vomitus if any to escape and not
be inhaled.

• 5. Reassure parents or relatives of the victim

especially parents of children as this is difficult to
watch.
• DO NOT:-
• 1. Give the casualty anything by mouth until
convulsions have stopped and the casualty is fully
awake (Paracetamol suppository can be given to a
child with febrile convulsion)
• 2. Move the casualty unless he/she is in danger
or near something hazardous

• 3. Restrain the victim,

• 4. Try to make the casualty stop the convulsing
as he/she has no control over it and is not aware
of what is happening.
•
 BITES AND STINGS

• BITES
• Injuries produced by animal or human bites
may cause punctures, laceration or even
convulsions. Not only is care needed for open
wounds but consideration must be given to
the danger of infections such as rabies and
tetanus.
• Human Bites
• Human bites that break the skin may become
seriously infected because the mouth is
heavily contaminated with bacteria.
 First Aid Management

• 1. For minor bites, place an ice pack

immediately on the wound to prevent swelling
and relieve pain
• 2. Bite wounds normally do not bleed
much but if it does, apply direct pressure and
elevate the part if possible
• 3. Clean with mild soap and rinse with lots
of water. Do not pour alcohol or peroxide on
an open wound. This can injure the tissue
• 4. In major bites where body parts have
come off, send tissue that is bitten off to the
hospital. If the hospital is far away, put the
tissue in a bag of ice water and not directly on
ice
• 5. Cover both minor and major bites after
thorough cleansing and send casualty to the
hospital.
• 6. Any record of previous tetanus injection
must be sent with the casualty to the hospital
 Animal Bites

• The bite of any animal whether a wild animal

or pet can result in an open wound which is a
deep puncture that can carry germs far into
the tissues. Dog and cat bites are common.
Although a dog bite is likely to cause more
extensive tissue damage than a cat bite, cat
bites may be more dangerous as cats’ habour
a wider variety of bacteria in its mouth. Many
animals’ especially wild ones transmit rabies
and tetanus is an added danger in animal
bites.
 First Aid Management

• Aims: The first aider must aim at controlling bleeding,

avoiding injury to himself and further injury to the victim
Minimize the risk of infection both to the casualty and
himself
• 1. Control bleeding by applying direct pressure and
raising the injured part
• 2. Wash the site thoroughly with soap and copious
amounts of water
• 3. Dry the area and cover the wound with sterile gauze
if available
• 4. Seek medical help immediately and send records of
all immunizations
•
• Tick Bites
• Ticks can carry diseases and cause injections so should be removed
as soon as possible. They attach to the skin and suck the victim’s
blood
• First Aid Management
• 1. Cover the tick with heavy oil (mineral, salad or machine) to
close its breathing pores. The tick may disengage at once
• 2. If it does not disengage, allow the oil to remain in place for
half an hour
• 3. Carefully remove the tick with a tweezer, taking care all parts
are removed
• 4. Scrub the area thoroughly but gently with soap and water
because disease causing germs may be present on the skin
• 5. If general allergic symptoms occur (severe swelling, signs of
shock), seek medical attention
•
 STINGS
• Stings are caused by scorpions, spiders and insects.
Stings in themselves are not serious but some
people react violently to them (allergic reaction)
and can rapidly develop anaphylactic shock.
Multiple stings can be dangerous and stings in the
mouth or throat are serious as the swelling they
cause can obstruct the airway. The sting initially
causes sharp pain, followed by swelling and
soreness.
•
 Management of Bee Stings

• The bee usually leaves its sting within a wound

and these acts as a ‘foreign body’ and must be
removed immediately.
• 1. If the sting is still in the wound, plug it
out firmly with fine tweezers
• 2. Bathe the area thoroughly with weak
ammonia or a solution of bicarbonate of soda
(2 teaspoonful’s in a pint of water)
• 3. Apply a cold compress to relieve pain
and minimize swelling
• 4. An antihistamine cream may be applied
to reduce the antigenic effect of the sting
• 5. In severe cases, apply a constricting band
above the injection site and keep the affected
site below the level of the heart
• 6. If general symptoms such headache,
severe swelling of the affected part, pain and
shock develops, send the victim to the
hospital immediately
•
 Scorpion Stings

• Scorpions inject venom through a stinger in its

tail. Stings from dangerous species produce
marked systemic effects within 1-2 hours and
can be fatal.
• Symptoms include excruciating pain at the site
of the sting, nausea and vomiting, abdominal
pain, shock and possible development of
coma.
 First Aid Management

• 1. Limit pain at the site of the sting with ice

cubes (cold compress)
• 2. Wash the area with soap and water
• 3. In severe cases, apply a constricting band
above the sting site on the victims arm/leg
(between the site and the heart)
• 4. Keep the affected part below the level of the
heart
• 5. If medical care is available, keep the band in
place otherwise remove it after 30 minutes
• 6. Seek medical help immediately.
•
 DISASTERS
• A disaster is a natural or man-made event that
causes significant physical damage or
destruction, loss of life or drastic change to
the environment. Disasters occur as a result of
inappropriately managed risk. These risks are
the product of hazards and vulnerability. More
than 95% of disasters occur in developing
countries and losses due to disasters are 20
times greater in developing countries than in
industrialized countries.
 Classification of Disasters
• Disasters are classified into natural/man-made
• Natural Disasters
• This is the effect of a natural hazard e.g. flood,
tornado, hurricane, volcanic eruption,
earthquake, tsunami, rapid spread of diseases
and a landslide. The resulting loss of life and
property depends on the vulnerability of the
affected population to resist the hazard.
Natural disasters occur when hazards meet
vulnerability e.g. a strong earthquake will not
result in a disaster in an uninhabited area.
• Man-Made Disasters
• These are disasters resulting from man-made
hazards (negligence, error, failure of man-
made systems) e.g. arson (deliberately setting
fire to a building), terrorism, war, industrial
disasters, structural collapse, fire, radiation
contamination, transportation disasters (rail,
aviation, road, space).
 Disaster Management
• Disaster management involves:-
• 1. Pre-disaster planning, preparedness,
monitoring including management capability
• 2. Prediction and early warning
• 3. Damage assessment and relief management
• Every community prone to natural disasters must
have in place personnel and structures that can
manage disasters if they do occur
• such as the first aid group, health and safety
group, food and welfare group and they must
be well trained and ready at all times to
manage disasters. Meteorological services
must be well equipped and be able to predict
natural disasters to help victims prepare and
evacuate the community if possible
• . The country and community must have
organizations well trained in damage
assessment and relief management in
disasters.
• Disaster management needs a
multidisciplinary team approach involving the
army, police, fire service and first aiders.
• As a first aider your responsibilities as a first aider in
emergencies apply. As individual first aiders, a well-
equipped first aid kit must always be available in
case of a disaster at home.

• Students must find out if NMTC 37 military Hospital

has a disaster management plan and what it says
and list them out for class discussion the next
session.