First aid badge blue workbook 2015 by St John Northern Region Youth

Blue Level First Aid

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> 1 First Actions ......................................................................................................................................................................................

Scene Assessment

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Conscious and Unconscious Patient Management

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FIRST ACTIONS

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Scene Assessment

First aid is the first assistance or treatment of the ill or injured. The aims of first aid are to: • save lives • prevent the patient’s condition worsening • promote recovery. Student Activity By the end of the session you will demonstrate knowledge of how to: • approach a scene • maintain safety of self, the scene, patient and bystanders • utilise bystanders at a scene • gather the information required • prioritise a scene • provide appropriate information when calling for help.

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FIRST ACTIONS

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Scene Assessment What things would you do to ensure the safety of yourself and others?

What could you get bystanders to do?

Please identify as many hazards as you can that could affect your safety at the following scenes: Location

Safety Hazards

Factory Office

Road

Home

FIRST ACTIONS

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Your Safety Viruses There are ranges of viruses (for example, HIV, Hepatitis B and Hepatitis C) that are carried in body fluids. Body fluids such as saliva have an extremely low amount of viruses and are unlikely sources of infection. Meningococcal disease Meningococcal disease is caused by a bacteria and is characterised by a sudden onset of acute flu-like symptoms, that is, feeling unwell, joint pain, decreased level of consciousness, possible nausea, vomiting, headache and rash (very serious). Infected droplets of respiratory secretions transmit meningococcal disease from person to person. People in close contact are seriously at risk. Prevention • Correct hygiene when blowing noses, coughing and sneezing • Do not share drinks, drink bottles or other personal items that have been in contact with the mouth.

Safety Guidelines for First Aiders: • • • • • • •

avoid direct contact with blood or any other body fluid if possible, use disposable gloves. If gloves are not available, place your hands in plastic bags cover any cuts or scratches on your own skin first have the injured person apply pressure to their wound themselves if possible wash your hands after dealing with a patient clean up all body fluids using household bleach (1 part to 10 parts water) do not share personal items.

TERESTING FACTS

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FIRST ACTIONS

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Calling 111: 1. Phone 111 Available 24 hours everyday of the year Pre-paid mobiles can still be used even if you have run out of credit 2. Ask for ambulance 3. Keep calm, be clear 4. Tell them where the patient is 5. Tell them who you are and your phone number 6. Tell them what has happened. Members of the deaf/hearing impaired community can register for 111 txt service: visit www.deaf.org.nz

Notes:

FIRST ACTIONS

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Conscious and Unconscious Patient Management The patient is managed according to their condition. Student Activity By the end of the session you will be able to demonstrate the use of: â&#x20AC;˘ DRSABC to assess a patient â&#x20AC;˘ the correct placement of a patient depending on their level of consciousness.

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FIRST ACTIONS

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Patient Assessment Plan Immediate Actions

Action Dangers to self, bystanders and patient(s) and make D= Check scene safe R= Check Response using voice and touch S= Send for Help. Call 111 and ask for ambulance A= Open and clear Airway B= Look, listen and feel for normal Breathing Give 30 chest compressions at approximately 100 per C= CPR. minute, then give 2 breaths. Attach AED if available and follow prompts. Continue until the ambulance arrives. You can add a “D” for “defibrillate” to remember the AED.

Follow up Actions

Responsiveness of patient: • conscious • unconscious. Reassurance: • starts as soon as you arrive • be confident. Collect information – try to determine: • the history of the incident • the signs that the patient is displaying • the symptoms that the patient is complaining of • check for Medic Alert bracelet. Treat as necessary: • loosen constrictive clothing • treat serious wounds • give nothing by mouth. Position: • patients who are wide awake should be allowed to find their own position • patients not wide awake should be lying down • patients who are unconscious should be on their side if reasonably possible (supported) or in the recovery position • patients in cardiac arrest should be on their back. Temperature: • maintain warmth by covering. Monitor and remain with patient.

FIRST ACTIONS

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Activity List six questions you could ask an injured patient when collecting information: • • • • • •

Immediate Actions Complete the following chart from memory:

D R S A B C

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FIRST ACTIONS

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> 2 Health Literacy

HEALTH LITERACY

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Think of a range of illnesses and injuries. Considering the seriousness of the illness or injury, describe what would make you consider contacting each of the services below? Ambulance

Doctor

Healthline

Poisons Centre

Discuss your answers in your groups. Your tutor will ask you to share your answers.

Notes:

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HEALTH LITERACY

> 3 Medical Conditions ......................................................................................................................................................................................

CPR and choking

Chest Pain

Breathing Disorders

Seizures and stroke

Anaphylaxis

Diabetes

Hot and Cold conditions

Poisoning

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MEDICAL CONDITIONS

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Cardio Pulmonary Resuscitation Cardio Pulmonary Resuscitation (CPR) is given when a patient is unresponsive with no signs of life. CPR is a mechanical means of externally supporting the patient’s breathing and circulation. The aim of CPR is to keep blood circulating through the body - keeping the organs alive, until ambulance or medical personnel can take over. Note: chest compressions are the most important aspect of CPR – much more so than mouthto-mouth. Student Activity By the end of the session you will: • correctly demonstrate single-person CPR on a patient who is unresponsive and not breathing (the range covers adult, child and infant) • correctly demonstrate the management for an obstructed airway in a conscious and unconscious patient (the range covers adult/child and infant). You may have to do CPR on patients who suffer from: • cardiac arrest • choking • drowning • electrical shock • severe allergic reaction • severe trauma.

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MEDICALCONDITIONS CONDITIONS MEDICAL

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Immediate Actions Signs and Symptoms:

Management:

The patient may:

The first aider should:

• be unresponsive to voice or touch

• check for danger

• have breathing difficulty or not be breathing at all

• call 111 and ask for ambulance

• feel cold to touch

• position patient

• have other injuries that need treatment.

• begin CPR and apply an AED

• open and clear airway

• treat other injuries • not stop until help arrives.

UNCONSCIOUS PATIENT Not breathing No signs of life

Breathing

Place on side (supported) if possible or in recovery position

Commence CPR

Follow up Actions

Continue CPR

HAND OVER TO AMBULANCE

MEDICAL CONDITIONS

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Priority Actions

D R S A B C

Check Dangers to self, bystanders and patient(s)

Check Response using voice and touch

Send for Help. Call 111 and ask for ambulance

Open and clear the Airway

Look, listen and feel for normal Breathing

Start CPR. Give 30 chest compressions at approximately 100 per minute, then give 2 breaths and "D" to remember: attach AED as soon as available. Continue ratio of 30:2 until the ambulance arrives.

Remember: "30 to 2 no matter who" "push on the chest hard and fast" "chest compressions alone are better than no CPR" Note: If a cadet is physically unable to manage chest compressions they should be able to â&#x20AC;&#x153;coachâ&#x20AC;&#x2122; a bystander to do them.

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MEDICALCONDITIONS CONDITIONS MEDICAL

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Chain of Survival The most important aspect of the chain of survival is prevention. PREVENTION

EARLY RECOGNITION

EARLY ACCESS RING 111

EARLY CPR

EARLY DEFIBRILLATION

EARLY ADVANCED CARDIAC CARE

If the chain of survival is followed the likelihood of successful revival is increased significantly. What helps this success? • Prevention • EARLY recognition of heart attack signs • EARLY access to medical services • EARLY CPR • EARLY defibrillation (AEDs) • EARLY advanced cardiac care. Some Causes of Cardiac Arrests Some of the causes of cardiac arrests: • ventricular fibrillation – the heart muscle starts to beat out of sync • electric shock • drowning • other medical conditions. Automatic External Defibrillators Automatic External Defibrillators (AEDs) are machines designed for a first aider to use with minimal training, at the scene of a sudden cardiac arrest. The machine guides the operator through the process. Every minute defibrillation is delayed the patient’s chance of survival decreases.

MEDICAL MEDICALCONDITIONS CONDITIONS

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Choking Possible symptoms and signs Partial (mild) airway obstruction: • Breathing laboured, gasping or noisy • Some air escaping from the mouth • Patient coughing or making a “crowing noise” • Extreme anxiety or agitation.

Total (severe) airway obstruction: • Patient unable to effectively cough, breathe or speak, with no air movement • Patient making obvious efforts to breathe with in-drawing of spaces between the ribs and above the collar bones • Patient’s face is greyish in colour with blue (cyanosed) lips due to lack of oxygen • Patient clutching the throat with both hands (universal choking sign).

Partial (mild) airway obstruction What to do — step by step Never use back blows on a person who is able to cough effectively or breathe

Reassure and encourage the patient

If unsuccessful, give up to five chest thrusts

• With an adult or child standing or sitting wrap both arms around the patient, at chest level • Place one fist with the thumb side against the patient’s breastbone, in the center of the chest • Grasp that fist with your other hand and give up to five, separate, inward thrusts • Continue the thrusts until the obstruction is dislodged or the patient becomes unconscious • Place a baby face upwards on your lap and give up to five sharp chest thrusts just below the nipple line, as for CPR, but at a slower rate. The chest thrusts are given separately with a check after each one to see if the obstruction has been relieved.

3 If the obstruction has not been relieved,

continue by alternating back blows and chest thrusts until the ambulance arrives

Unconscious What to do — step by step Call 111 for an ambulance.

• Stay with the patient until full recovery has occurred • Encourage the patient to cough and expel the foreign body • If the obstruction is not relieved, call 111 for an ambulance.

1 If the patient is unconscious

Total (severe) airway obstruction

2 Begin CPR

What to do — step by step Call 111 for an ambulance.

1 If the patient is conscious, give up to five back blows

• With an adult or child standing or sitting and leaning forward, use the heel of one hand, and give up to ﬁve back blows between the patient’s shoulder blades • Place a baby face down on your lap for the back blows.

• Quickly check the mouth and use your ﬁngers to remove any visible solid obstruction.

• Begin CPR and continue until the ambulance arrives • Give 30 compressions at the rate of 100 compressions per minute, alternating with two rescue breaths. There may be some resistance to inflations at ﬁrst until the object has been dislodged.

The back blows are given separately with a check after each one to see if the obstruction has been relieved.

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MEDICALCONDITIONS CONDITIONS MEDICAL

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Notes:

MEDICAL MEDICALCONDITIONS CONDITIONS

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First Aid for Medical Conditions Medical Conditions covers the following: • chest pain • breathing disorders • seizures • diabetic emergency • severe allergic reaction • environmental conditions • poisoning.

Student Activity By the end of the session you will be able to describe: • the general signs and symptoms of medical emergencies for all age groups. You will be able to demonstrate the practical skills for assessing and managing: • chest pain (including heart attack) . • neurological emergencies (including stroke and seizures). Resources

Methods

• gloves • inhalers.

• discussion and questioning • demonstration • self-assessment.

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MEDICALCONDITIONS CONDITIONS MEDICAL

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General signs and symptoms of medical emergencies may include: • • • • • • • •

sudden and severe pain sudden changes in vision, headache or dizziness severe or persistent vomiting or diarrhoea persistent high temperature changes in level of consciousness skin rash of unknown origin repeated fainting obvious depression, suicide threats or attempts.

For infants: • • • • •

a seizure or convulsion the baby is blue or very pale you think the baby is having trouble breathing the baby cries a lot, or will not stop crying the baby is limp and unresponsive.

Chest Pain Chest pain has many possible causes. The causes of chest pain fall into two major categories: non-cardiac and cardiac causes. Chest pain is not always caused by heart problems. Other causes of chest pain include, for example: anxiety and rapid breathing or asthma. Chest pain can be caused by angina, heart attack and cardiac arrest. If there is any doubt as to the cause of chest pain in a patient, call 111 and ask for an ambulance.

Cardiac Arrest (heart stoppage)

Diagram of a heart.

Signs and Symptoms: • patient unconscious • no breathing • no signs of life.

Coronary artery

Management: • DRSABC

The distinction between angina and heart attack is difficult for the first aider, correct diagnosis is frequently not made until after an ECG in hospital.

MEDICAL MEDICALCONDITIONS CONDITIONS

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Heart Attacks (blood supply to the heart is reduced) A heart attack can be caused by narrowing of the blood vessels supplying blood to the heart or blocking of the blood vessels because of a clot. Sometimes a heart attack can lead to a cardiac arrest.

Condition

Signs and Symptoms

Management

Angina

• pain in the central chest region

• medication if available

Pain caused when blood flow through the arteries of the heart is insufficient for the needs of the heart muscle.

• pain can spread to the neck, jaw and arms • breathlessness and may appear pale with bluish lips • may have medication with them.

Heart Attack Reduced blood supply to the heart because of a blockage or severe narrowing of a coronary artery. The blood supply to the coronary muscle is obstructed or considerably reduced, resulting in the death of heart muscle.

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• similar to angina but not relieved by rest • heavy pressure on chest and pain may spread • sweating, shortness of breath.

• if conscious, help into a comfortable sitting position • loosen clothing • if symptoms persist for more than 15 minutes, call 111 and ask for an ambulance.

• reassure • if conscious, help into a comfortable sitting position • unconscious – assess ABC, monitor, and place on side (supported) if possible, or in recovery position • if necessary, CPR • medical emergency – call 111 and ask for an ambulance.

MEDICALCONDITIONS CONDITIONS MEDICAL

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Breathing Disorders Asthma Asthma is a fairly common condition in New Zealand where the airways narrow in response to certain triggers, which may differ from patient to patient. The symptoms of asthma are reversible. During an asthma attack, the patient may take reliever medication. If the medication is not sufficient to relieve the asthma attack call 111 and ask for an ambulance. The narrowing of the airway is due to a muscle spasm, which can be associated with a respiratory infection but is more commonly triggered by an allergic reaction to: • pollen • dust • smoke • fur • cold air. Asthma Attack

Signs and Symptoms • Breathlessness and difficulty speaking more than a few words without a gasp of air • Poor skin colour, especially blueness of lips and fingertips

• Wheezing sometimes, but not always • Persistent cough, often moist and “rattling” • Obvious breathing effort with pulling-in of the rib spaces.

Management Help the patient to rest

Follow-up care

• If improvement occurs, keep the patient at rest • Help the patient into a position of greatest until the skin colour is normal. If the patient is a comfort child, ensure that the parents are informed of the • Ideally, allow the arms to rest on a table to increase attack and advise a medical check with the family the rib spaces. doctor.

Assist with prescribed medication

• Help the patient take any prescribed "Reliever" medication as soon as possible. If a spacer is available, the patient should use it to take the medication, one puff at a time • Give six puffs of the medication and then repeat this dose after six minutes if no improvement has occurred. If the patient does not have any personal medication available, be prepared to borrow a reliever from another person.

Diagram of lung

Left lung

Air sacs

Call 111 for an ambulance. • Continue to assist the patient with six puffs every six minutes until an ambulance arrives.

Narrowed airway

MEDICAL MEDICALCONDITIONS CONDITIONS

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Seizures or Convulsions Signs and Symptoms • Jerking or twitching of the face and limbs

• Loss of control of bladder and/or bowel

• Foaming at the mouth

• Blue/purple skin colour and blue lips.

• Loss of consciousness

Management • Protect the patient from injury • Do not move or try to restrain the patient • Do not try to pad between the patient's teeth because this may cause damage to the tissues in the mouth • Stay with the patient • Reassure the patient • Loosen any tight clothing • Avoid giving anything to eat or drink until the patient is fully conscious

• Wait until the seizure is over before attempting any other care of the patient • Cover the patient lightly with a coat or blanket • Check that normal breathing has resumed • Allow patient to sleep until fully recovered, but check for a response every four minutes • If the patient does not wake up within 10 minutes, or is not breathing well, call 111 and ask for an ambulance.

Once seizure is over: • place on their side supported or in position of greatest comfort • reassure and comfort • seek medical attention if this is the first time the person has had a seizure.

Stroke A stroke is the sudden destruction of part of the brain caused by bleeding in the brain or a blood clot blocking an artery in the brain.

Signs and Symptoms • Tingling, weakness or numbness down one side of the body • Loss of muscle tone of the face muscles, with dribbling from one side • Blurred or double vision • Nausea

• Loss of bladder or bowel control • Loss of speech or the uttering of meaningless sounds • Loss of balance and coordination • Deteriorating conscious state or unconsciousness.

Management • Assess the patient's level of consciousness • If unconscious and breathing normally, or not fully alert, place the patient on the side in a supported position • Call 111 for an amulance • While waiting for the ambulance to arrive, observe the patient closely for any change in condition

• Care for a conscious patient – assist the patient into the position of greatest comfort • Reassure the patient that you will stay until an ambulance arrives • Observe the patient carefully for any change in condition, if any deterioration, turn the patient on their side in a supported position.

Remember! FAST: Face, Arms, Speech, Time. Recognise a stroke and get help FAST!

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MEDICALCONDITIONS CONDITIONS MEDICAL

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Severe Allergic Reaction (Anaphylaxis) Severe allergic reactions will result in either respiratory problems or severe shock; therefore emphasis needs to be on managing these conditions until the ambulance arrives. !NAPHYLAXIS IS A SEVERE REACTION TO ANY ONE OF A VARIETY OF ALLERGENS SUBSTANCES TO WHICH THE PATIENT IS SENSITIVE !,, ALLERGIC REACTIONS SHOULD BE TREATED SERIOUSLY AND FIRST AIDERS NEED TO quickly manage these patients until an ambulance arrives. Severe Allergic Reactions

Signs and Symptoms s 3WELLING OF THE FACE ESPECIALLY AROUND THE mouth, throat and eyes s 3WELLING OF THE AFFECTED AREA IF THERE HAS BEEN contact with a chemical or venom s 2EDNESS OF THE SKIN OR AN ITCHY RASH OVER THE chest and back

s .AUSEA AND OR VOMITING s "REATHING DIFFICULTY SIMILAR TO AN ASTHMA attack s $IZZINESS WEAKNESS OR COLLAPSE s $IARRHOEA

Management Stay with the patient and ensure total rest

Give any prescribed medication or treatment

s )F AN ALLERGIC REACTION IS DEVELOPING THE PATIENT may suddenly collapse and needs to be managed as an unconscious person. Sometimes CPR may be needed.

s 3OME PATIENTS CARRY PRESCRIBED MEDICATION with them in the form of a tablet, puffer spray or EVEN A SELF ADMINISTERED INJECTION OF ADRENALINE If necessary, assist the patient to ямБnd and administer their prescribed dose of medication.

#ALL FOR AN AMBULANCE s IF THE PATIENT IS KNOWN TO HAVE AN ALLERGY problem, or s IF THE REACTION INVoLVES ANY BREATHING difямБculty, or s IF THE PATIENT IS VERY UNWELL

If the reaction follows exposure to a chemical s 7ASH THE CONTACT AREA THOROUGHLY WITH COPIOUS amounts of running water.

Keep the patient at total rest

Observe the patient carefully

s 2EST CAN SLOW THE ONSET OF A SERIOUS REACTION AND allow time for an ambulance to arrive s !LLOW THE PATIENT TO REST IN THE POSITION OF greatest comfort. Often the patient will want to sit up if they have breathing difямБculties.

s 7HILE WAITING FOR THE AMBULANCE TO ARRIVE observe the patient closely for any change in condition s "E PREPARED TO BEGIN #02 IF NECESSARY

MEDICAL MEDICALCONDITIONS CONDITIONS

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Action PlAn for

An aphy l axi s

www.allergy.org.au

For use with EpiPen® adrenaline autoinjectors

Name: date of birth:

m i l d t o m o d E r At E A l l E r g i c r E A c t i o n • Swelling of lips, face, eyes • hives or welts • Tingling mouth • Abdominal pain, vomiting (these are signs of a severe allergic reaction to insects)

Photo

Action • For insect allergy, flick out sting if visible. Do not remove ticks. • Stay with person and call for help • locate EpiPen® or EpiPen® Jr • Give other medications (if prescribed) .................................... dose: .......................................................................................... • Phone family/emergency contact

confirmed allergens:

Mild to moderate allergic reactions may or may not precede anaphylaxis

Family/emergency contact name(s):

Watch for any one of the following signs of Anaphylaxis

AnAPHylAxis (sEvErE AllErgic rEAction)

work Ph: home Ph: mobile Ph:

• difficult/noisy breathing • Swelling of tongue • Swelling/tightness in throat • difficulty talking and/or hoarse voice • wheeze or persistent cough • Persistent dizziness or collapse • Pale and floppy (young children)

Plan prepared by: dr: Signed: date:

How to give EpiPen®

PlAcE oRANGE ENd against outer mid-thigh (with or without clothing).

PuSh dowN hARd until a click is heard or felt and hold in place for 10 seconds.

REmovE EpiPen®. massage injection site for 10 seconds.

Instructions are also on the device label and at www.allergy.org.au/healthprofessionals/anaphylaxis-resources

Form fist around EpiPen® and Pull oFF BluE SAFETY RElEASE.

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Action

1 Lay person flat. Do not allow them to stand or walk. If breathing is difficult allow them to sit. 2 Give EpiPen® or EpiPen® Jr 3 Phone ambulance*- 000 (AU), 111 (NZ), 112 (mobile) 4 Phone family/emergency contact 5 Further adrenaline doses may be given if no response after 5 minutes (if another adrenaline autoinjector is available) If in doubt, give adrenaline autoinjector After giving adrenaline: • Commence CPR if there are no signs of life • Give asthma medication if unsure whether it is asthma or anaphylaxis EpiPen® is generally prescribed for adults and children over 5 years. EpiPen® Jr is generally prescribed for children aged 1-5 years. *medical observation in hospital for at least 4 hours is recommended after anaphylaxis.

Additional information Note: This is a medical document that can only be completed and signed by the patient's treating medical doctor and cannot be altered without their permission.

MEDICALCONDITIONS CONDITIONS MEDICAL

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Diabetes Background condition in which is a failure of insulin production in the pancreas. Diabetes is a medical there The result is a failure to process carbohydrates, fats and proteins correctly and the patient loses weight, becomes very thirsty and passes large quantities of urine. The patient of diabetes is usually treated with a modified diet, tablets or daily insulin injections. However, if the correct diet is not followed, or if a severe infection occurs, this can lead to an insulin coma from too little sugar in circulation (hypoglycaemia). Unless prompt first aid with sugar plus follow-up medical care is available, death may occur.

Signs and Symptoms s %XTREME TIREDNESS AND LOSS OF CONCENTRATION s 3EVERE THIRST

s 2APID LOSS OF CONSCIOUSNESS IF NOT TREATED promptly

s !BDOMINAL PAIN s .AUSEA OR VOMITING

s 0ERSISTENT HEADACHE

s $IZZINESS AND LOSS OF COORDINATION

s 3UNKEN EYES AND PARCHED LIPS

s %RRATIC OR ARGUMENTATIVE BEHAVIOUR

s #AN APPEAR DRUNK

s &LUSHED OR PALE FACE

Management Give the patient some sugar

Obtain medical advice

s )F THE PATIENT IS STILL FULLY CONSCIOUS AND ABLE TO swallow, give a sweetened drink, chocolate or glucose sweets to suck

s )F THE PATIENT HAS IMPROVED WITH THE INTAKE OF carbohydrate, medical advice is still necessary because a further deterioration may occur at any time. The patient needs to see a doctor

s )F THE PATIENT IS ABLE TO COOPERATE AND SWALLOW safely, an improvement usually occurs within minutes s 7HEN THE PATIENT IS MORE ALERT OFFER A MORE substantial carbohydrate meal of a sandwich or several sweet biscuits. Give frequent reassurance during recovery because the patient may be confused until fully recovered.

If the patient does not improve after swallowing the sweet food or drink, or if further deterioration occurs and swallowing becomes difďŹ cult, call 111 for an ambulance s 7HILE WAITING FOR THE AMBULANCE TO ARRIVE observe the patient closely for any change in condition. Do not try to give the patient a dose of insulin because this can be dangerous unless a medical assessment has been carried out and the patientâ&#x20AC;&#x2122;s blood sugar level tested.

MEDICAL MEDICALCONDITIONS CONDITIONS

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Activity Heart Condition 1. What is a cardiac arrest?

2. Tick the symptoms that could indicate a heart attack. Tightness of chest

Skin hot and red

Chest discomfort

Skin cold and pale

Unequal pupils

Feeling sick

Like indigestion

Unable to move legs

Fluid from the ears

Sweating

Tingling down arms

Anxious

3. What could you give a conscious patient suffering a diabetic emergency? (List 3 things) • • • 4. How could you help a person who is having a severe allergic reaction? • • • 5. List four contributing factors to heart disease. • • • •

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MEDICALCONDITIONS CONDITIONS MEDICAL

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Other Medical Conditions 1. If an asthma attack is severe, why is it important to call 111 and ask for an ambulance as soon as possible?

2. Draw a line between the appropriate pairs that indicate signs of asthma: Breath

Chest

Tightness

Medication

Inhaler

Shortness

3. Tick the following symptoms that indicate a stroke: Headache

Speech difficulty

Feet bruising

Confusion

Collapse

Central chest pain

Paralysis

Sunburn

Acetone breath

Airway problems

Unequal pupils

Altered consciousness

MEDICAL MEDICALCONDITIONS CONDITIONS

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Environmental Conditions

Hypothermia occurs when brain and muscle functions are impaired as a result of the lowering of the body’s core temperature. Heat exhaustion is characterised by general weakness, loss of appetite, nausea, vomiting and dizziness. The patient’s level of consciousness is normal. Heat stroke is an absolute medical emergency because the patient who is experiencing heat stroke has an altered level of consciousness. People suffering from heat stroke are unable to get rid of excessive heat. Student Activity: By the end of the session you will be able to correctly demonstrate: • the ability to manage a patient suffering hypothermia and heat-related conditions. Resources

Methods

• gloves • blankets, ice packs, towels and other props.

• • • •

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discussion and questioning demonstration experience self-assessment.

MEDICALCONDITIONS CONDITIONS MEDICAL

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Hypothermia Hypothermia is the general cooling of the body core, which can be a serious problem for the elderly.

Signs and Symptoms

Management

Mild Hypothermia:

• protect yourself and patient from wind, rain and cold, wet ground

• cold to the touch and shivering violently • increased tiredness • person may fall behind others • clumsiness and uncoordinated • changes in mood, irritability • abnormal behaviour and a resistance to help • slow responses.

• remove wet clothing and wrap patient in warm, dry clothing or a space blanket • if possible, put patient in a warmed sleeping bag • if patient is conscious give warm fluids to drink • seek medical aid. DO NOT:

• give alcohol • try to warm the patient in front of a fire • massage the patient.

Severe Hypothermia:

• handle with care or the heart could stop

• shivering may decrease and stop – CRITICAL SIGN

• give CPR if necessary

• very clumsy and may fall

• remove clothing from patient and two first aiders

• slurred speech and blurred vision • may lose consciousness • breathing slow.

• get into shelter, with the patient

• wrap patient and first aiders in dry blankets to warm • replace first aiders as required to maintain their warmth • if patient regains consciousness give warm fluids to drink • call 111 and ask for ambulance.

DO NOT:

• give alcohol • try to warm the patient in front of a fire • massage the patient.

MEDICAL MEDICALCONDITIONS CONDITIONS

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Immersion Hypothermia Rapid heat loss as a result of being submerged in water that is too cold. Management: • • • •

get patient out of water dry clothing give warm sweet drinks – seek shelter if the patient has been in the water for a prolonged period, use appropriate hypothermia treatment. • seek medical aid. Heat Exhaustion Heat exhaustion is characterised by generalised weakness, loss of appetite, nausea, vomiting and dizziness. The patient’s level of consciousness is normal.

Signs and Symptoms

Management

• sweating profusely

• cease all exertion and ensure patient rests

• generalised weakness

• move to cool shaded area

• loss of appetite

• begin oral re-hydration if the patient is not nauseous or vomiting

• dizziness • the consciousness level is normal.

• patients who cannot take oral fluids need medical attention.

Heat Stroke Heat stroke is an absolute medical emergency. People suffering from heat stroke are unable to get rid of excess heat.

Signs and Symptoms

Management

• sweating may be absent

• call 111 and ask for ambulance

• confusion

• move patient to a nearby cool place

• lack of coordination

• patient at rest

• delirium

• keep patient cool

• seizures

• give sips of water (if fully conscious)

• may become unconscious.

• if patient is unconscious, assess ABC and place on side (supported) if possible, or in recovery position.

p. 34

MEDICAL CONDITIONS

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Activity Environmental Conditions SCENARIO 1

An employee was working in the yard on a hot summerâ&#x20AC;&#x2122;s day, stacking timber. After a couple of hours the employee comes into the smoko room complaining of a headache and thirst. You notice they have been sweating profusely, and their face is pale. 1. What heat-related condition do you think they may be suffering from?

2. How would you manage this patient?

SCENARIO 2

An employee was working in a boiler room for several hours before staggering out and collapsing. You find the employee has hot dry skin and is unconscious. 1. What heat-related condition do you think they may be suffering from?

2. How would you manage this patient?

SCENARIO 3

A fellow worker has been working in the rain for most of the day and has come inside cold, wet and shivering violently. You observe that they appear clumsy and confused. 1. What condition do you think they may be suffering from?

2. How would you manage this patient?

Continues next page

MEDICAL CONDITIONS

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Poisoning

A poison is any substance that, if taken in sufficient quantities, causes temporary or permanent damage to the body. Student Activity You will be able to correctly describe: • the signs and symptoms of poisoning. You will be able to correctly demonstrate: • the general management of poisoning.

Poisons Poisons enter the body through: • the mouth – ingested or swallowed • the lungs – inhaled or sniffed • the skin – absorbed • the blood – injected. Poisons may be: • solid • liquid • gas and vapour fumes.

p. 36

And come in the form of, for example: • medicines • industrial products • household substances.

MEDICAL CONDITIONS

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Activity 1. What are four ways poison can enter into the body? • • • • 2. List five common signs and symptoms of poisoning. • • • • • 3. Complete the following sentences regarding safety of poisons: • use

caps

• store poisons • poisons should be placed • leave poisons in 4. If a person has swallowed something poisonous should you make them vomit? YES / NO 5. If a person has taken a drug overdose, what information do you need to find out? • • • • •

MEDICAL CONDITIONS

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Poisoning Poisoning

Background Check the patient’s of may enter A poison is a substance that causes injury, illness or death if it enters the body.level Poisons the body the form ofthat liquids, solids or gas and vapourresponsiveness fumes. A poison is ainsubstance causes injury, illness or death if it enters Poisons can enter by: the body. Poisons If unconscious may enter the body in the form of liquids, solids • ingestion through the mouth and digestive system or gas and vapour fumes. • If breathing normally, turn the patient on the • inhalation of fumes through the lungs side in a supported position to open and clear Poisons can enter • absorption of by: a chemical or plant extract through the theskin airway. • Ingestion through the mouth and • injection of drugs of abuse. • If there are no signs of life begin digestive system CPR resuscitation. • Inhalation of fumes through the lungs Call ambulance. Signs and • Absorption of aSymptoms chemical or plant extract through the skin Depending on the substance involved and entry route, the following may occur: If conscious

• Injection of drugs of abuse. • nausea or vomiting

• diarrhoea Possible symptoms and signs

• • seizures If the mouth has burns from a corrosive

• breathing difficulty poison, wipe the area with a moist cloth or

• abdominal pain • altered tissues.or changed behaviour Depending on the substance involved and unconsciousness or deteriorating entry• route, the following may occur: level of responsiveness. Call the National Poisons Information Centre • Nausea or vomiting

• Diarrhoea

Call 0800 764 766 for specific advice on the first aid management required. Follow all • Abdominal pain Management instructions concerning medical advice or • Unconsciousness or deteriorating level 1 Check for safety before approaching the patient ambulance transport to hospital. of responsiveness • ensure safety for yourself, the patient and any others before approaching to give first aid. If

• Seizures

• While waiting for the ambulance to arrive, observe the patient closely for any change in • Breathing difficulty • note any information about the nature of the poisoning incident, e.g. tablets, berries, burns condition. • Altered or changed behaviour. safe and necessary, remove the patient to a safer area around the mouth etc.

General management poisoning 2 Check the patient’sof level of responsiveness

If unconscious

Do not give the patient anything to eat or drink or try to cause vomiting unless told to do so by the National Poisons Information Centre consultant.

Check for safety before approaching • if breathing normally, turn the patient on the side in a supported position to open and clear the patient the airway Ingested (swallowed) poisons • Ensure safetyare fornoyourself, patient and any • if there signs of the life begin CPR resuscitation. others before approaching to give first aid. If Call ambulance.

In addition to the general treatment for poisoning, keep any evidence to go to hospital safer tablets, containers, • ifarea. the mouth has burns from a corrosive poison, with wipethe the patient, area withe.g. a moist cloth or tissues. berries etc. • Note any information about the nature of the 3 Call the National Poisons Information Centre poisoning incident, e.g. tablets, berries, burns Call 0800 764 766 for specific advice on the first aid management required. Follow all around the mouth etc. safe necessary, remove the patient to a If and conscious

instructions concerning medical advice or ambulance transport to hospital.

• while waiting for the ambulance to arrive, observe the patient closely for any change in condition. Do not give the patient anything to eat or drink or try to cause vomiting unless told to do so by the National Poisons Information Centre consultant.

p. 38

MEDICAL CONDITIONS

auses injury, body. Poisons m of liquids, solids

th and

h the lungs plant extract

involved and y occur:

rating level

our.

poisoning

pproaching

he patient and any

to give first aid. If

the patient to a

t the nature of the ets, berries, burns

12 1:50 PM

Check the patient’s level of 2 responsiveness If unconscious • If breathing normally, turn the patient on the side in a supported position to open and clear the airway. Absorbed poisons Inhaled poisons • If there are no signs of life begin Check for safety before approaching Check for safety before approaching CPR resuscitation.

1 the patient

Call ambulance.

• If poisonous fumes are present in a confined the patient needs to be moved into If space, conscious fresh air soon as possible. The first aider Inhaled as poisons • may If theneed mouth has burns fromif athe corrosive to enter the space patient is poison, wipe the area with a moist cloth or unconscious and must drag them to safety. Check for safety before approaching tissues. However, the first aider should take no the patient undue risks the National Poisons • If Call poisonous fumes are present in a confined • When it is safe to do so, check the patient’s Information Centre space, the patient needs to be moved into level of responsiveness and give general care fresh air as soon possible. first aider Call 0800 764 766asfor specificThe advice on the for poisoning. may need to enter therequired. space if the patient first aid management Follow all is unconscious and must drag them to safety. Whenconcerning moved intomedical fresh air, advice the patient instructions or However, the first aider should take no may recover fully from inhaled gases or ambulance transport to hospital. unduefumes. risks. However, some toxic chemicals

1 the patient

• Help the conscious or semi-conscious patient to remove any contaminated clothing and wash all affected areas of the skin surface. Absorbed poisons The first aider should avoid contact with the discarded clothing and skin of the patient, Check for safety before approaching especially when agricultural chemicals are the patient involved. • Help the conscious or semi-conscious patient Call to ambulance remove any contaminated clothing and wash all affected surface. If the patient is veryareas sick, of callthe theskin National The first aider should avoid contact with766 the Poisons Information Centre on 0800 764 clothing and skin thecalled patient, asdiscarded soon as the ambulance has of been for especially when agricultural chemicals are specific advice on first aid management. involved.

............

Prior

............

Chai

............

Whilecan for to arrive, serious problems once Call ambulance •• When itwaiting is cause safe to dothe so,ambulance check the patient’s observe the patient closely for any change in into the lungs andgeneral promptcare level ofinhaled responsiveness and give If the patient is very sick, call the National condition. medical assessment and treatment for poisoning. Poisons Information Centre on 0800 764 766 are required. Do notmoved give the anything to eat as soon as the ambulance has been called for When intopatient fresh air, the patient specific advice on first aid management. or drink or try to from causeinhaled vomiting unless may recover fully gases or fumes. toxic chemicals told to However, do so by some the National Poisons can cause serious problems once Information Centre consultant. inhaled into the lungs and prompt medical assessment and treatment Ingested (swallowed) poisons are required. National Poisons Centre In addition to the general treatment for Provide oxygen This service operates 24 hoursto per 365 days per year based in Dunedin. poisoning, keep any evidence goday, to hospital

with the patient, e.g. tablets, containers, berries The 24 hour poisons telephone number is 0800 POISON / 0800 764766. etc. National Poisons Centre This service operates 24 hours per day, 365 days per year based in Dunedin. The 24 hour poisons telephone number is 0800 POISON / 0800 764766.

5/09/12 1:50 PM

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MEDICALCONDITIONS CONDITIONS MEDICAL

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> 4 Trauma ......................................................................................................................................................................................

Bleeding

Burns

Fracture and Soft Tissue Injuries

p. 40

TRAUMA TRAUMA

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Bleeding

A wound is an injury that results in damage to blood vessels allowing blood to escape from the circulation. Student Activity By the end of the session you will be able to recognise: â&#x20AC;˘ manage a patient who is bleeding.

TRAUMA TRAUMA

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External Bleeding External bleeding occurs when a blood vessel has been punctured through a variety of ways, whether this is as a result of a laceration, amputation or crushing, and blood can escape from the body. Management: • assess scene and dangers • apply direct pressure to wound • raise injured part • if a foreign body is embedded in the wound, do not remove it • place patient at total rest in the position of greatest comfort • apply dressing and bandage • check control of bleeding; if not controlled, apply a second bandage on top of first, or for major uncontrolled bleeding, quickly remove the blood soaked pads and the bandage and replace with a fresh bulky pad and bandage • reassure patient • do not give anything to eat or drink • monitor and arrange for medical aid.

Internal Bleeding Internal bleeding is often the result of serious injury and may be associated with fractures, penetrating foreign bodies or crushing of tissues. Trauma to the body may leave no external evidence of injury but may result in serious damage to underlying organs. Internal bleeding may also result from various medical conditions such as perforated stomach ulcers and malignant tumours. Causes:

Possible symptoms and signs of internal bleeding

• medical

• cold, pale, sweaty skin

• trauma.

• rapid and gasping breath

Management:

• increasing thirst

• call 111 and ask for ambulance

• signs of internal bleeding with frothy red blood coughed up from lungs, blood stained vomit like ‘coffee grinds’, red or rust coloured urine or dark ‘tar-like’ faeces

• monitor.

• “Looks sick, is sick.”

• lay patient down • complete rest

p. 4242

TRAUMA TRAUMA

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Activity 1. What do you do for a bleeding nose? Tick the correct answer. Place your finger gently up the nostril Pinch the soft part of the nose, with head forward Allow it to bleed to dislodge bacteria Place a splint of foil over the bridge 2. Why is it important not to remove an embedded object?

3. Before using saline to clean a minor wound, what needs to be checked?

4. What should you do with grazes/abrasions?

5. What would you do to care for an amputated finger?

TRAUMA TRAUMA

p. 43

Burns

Burns are an injury to the skin. They are most commonly caused by heat but can be caused by extreme cold (such as dry ice), electric shock and chemicals. Burns result in the loss of skin and deeper tissue; this causes fluid loss and raises the risk of infection. Student Activity By the end of the session you will be able to correctly demonstrate: • how to manage yourself and others when clothing is on fire • general management of burns • specific management of thermal, electrical and chemical burns. Resources

Methods

• gloves • water/blankets/other props.

• • • •

discussion and questioning demonstration experience self-assessment.

General management of burns: • • • •

remove dangers call 111 and ask for ambulance early unless burn is tiny cool for up to 20 minutes with cool (not ice cold) water after required cooling period, cling wrap may be used as a dressing if help is delayed, or cover the burn with a clean, non-stick dressing • reassure the patient.

p. 44

TRAUMA TRAUMA

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REMEMBER: • do not put ointments or creams over burns • loosen any constrictive clothing, and any jewellery such as bracelets or rings, before swelling occurs • be aware that burns to the face and neck can cause breathing difficulties • in the case of severe burns, do not give the patient anything to eat or drink • do not try to remove any fabric stuck to a burn • do not break blisters or remove peeled skin. Type, Management and Causes of Burns

Type of Burn

Management

Common Causes

Thermal Burns

• cool for 20 minutes

• exhaust pipe on cars/ motorbikes

• cover • use other drinks if water is not available as a coolant

• fire

• do not break blisters

• hot fat, barbeques

• do not pull stuck clothing off the burn

• heaters

• cover burn with sterile dressing or cling wrap to reduce infection.

• soldering irons

• hot water

• hot glue guns • cryogenic – ice, LPG, CNG • compressed gases.

Electrical Burns

• make area safe

• faulty appliances

• cool for 20 minutes

• high voltage/low voltage

• cover

• cutting through cables.

• because of the hidden nature of internal burns, seek medical evaluation.

Chemical Burns

• brush or wash off chemicals

• oven cleaners

• remove contaminated clothing if not stuck to skin

• paint strippers

• cool for 20 minutes

• cement, fertilisers.

• most chemicals will require continual flushing with water.

Flood the burnt area with water for 20 minutes.

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Activity Thermal Burns 1. List four things around your home or workplace that could cause thermal burns. • • • • 2. When dealing with someone whose clothing is on fire, we need to use the STOP, DROP AND ROLL plan. Why do we need these steps? STOP DROP ROLL 3. List the steps you would take when managing a person who has been rescued from a burning house and is suffering from smoke inhalation. • • • • • • •

p. 46

TRAUMA TRAUMA

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Fractures and Soft Tissue Injuries When a bone is broken it is said to be fractured. This fracture may be through the full thickness of the bone or partially through it. The fracture is usually as a result of an unusual force being applied to the bone. Soft tissue injuries are sprains and strains. Student Activity By the end of the session you will be able to correctly demonstrate: • the ability to assess and manage a patient suffering from a fracture and soft tissue injury • the ability to assess and manage a patient with a complicated fracture. Resources

Methods

• gloves • bandages • furniture and other props.

• • • •

discussion and questioning demonstration experience self-assessment.

Fractures Key points to remember are: • do not move the fractured limb unnecessarily • stabilise the fracture • support the limb and transport or call 111 and ask for ambulance. Types of Fractures

Closed fracture.

Open fracture.

A closed fracture has no wound associated with it, whereas an open fracture has a wound.

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Fractures Signs and Symptoms

Management

• Pain (severe or moderate, depending on the location of the injury)

• Control any bleeding with direct pressure

• Swelling

• Apply padding around the wound, or above or below the wound

• Deformity of the injured area (when compared with the uninjured side of the body)

• Apply a clean dressing loosely over the injured part

• Loss of normal function of the injured part

• Call 111 for an ambulance

• Discolouration of the skin or bruising

• Immobilise the injured part

• A wound if it is an open fracture

• Make the patient comfortable by helping them into the position of greatest comfort without unnecessary movement. Use blankets, pillows or clothing for general support.

• Altered sensation, e.g. “pins and needles” if a nerve is under pressure, or a grating sensation if injured bone ends are rubbing together.

Dislocations A dislocation is where a bone has been displaced from its normal position at a joint. Dislocations occur when bones are forced out of their natural alignment. Dislocation can result in the tearing of ligaments and other supporting structures so are often accompanied with pain and tenderness. Signs and symptoms are similar to those of a fracture. Dislocation

Normal shoulder.

Dislocated shoulder.

Management: • all movement of the part should be discouraged and first aid confined to providing soft padding and support in the position chosen by the patient • do not try to relocate the bone • support the area of dislocation or rest the injured limb • seek medical assistance • for serious dislocations, call 111 and ask for ambulance. Strains and Sprains Muscle strains occur during physical activity when muscles are stretched excessively or muscle fibres are torn, commonly in the calf, thigh or lower back. A sprain is an injury that involves the ligaments and other soft tissues around the joint, such as an ankle or wrist.

p. 48

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Possible symptoms and signs of strains and sprains: • • • •

pain at the site of the injury, often severe with a sprain or a strain loss of power in the injured area, especially with a sprained joint swollen joint and tender to touch swelling of the injured area.

Management: Apply the RICE treatment at regular intervals during the first 24–48 hours.

Management with RICE

Rest

Rest for up to 24 hours is helpful, but gentle mobilisation of the affected joint should be encouraged after that time

Ice

Apply ice if pain is significant. An ice pack can be applied for 10 -20 minutes at a time and repeated every 1 - 2 hours if pain persists

Compression

Application of a bandage is not routinely recommended, as there is no evidence to support it. Consider applying a compressing bandage if there is visible bruising

Elevation

Keep the injured area elevated and at total rest and arrange for medical advice

Do not apply the ice directly to the skin, and if any step in the RICE treatment is not available then the other steps should still be done. • If pain is severe, arrange for prompt medical assessment of the injury • If symptoms get worse or do not improve within a day or two, seek advice from a doctor or physiotherapist • If the patient is in severe pain or unable to be assisted to a car for transport, call 111 for an ambulance • If the injury involves lower back or neck, an ambulance is the best form of transport to avoid the risk of further injury or stress.

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Head Injuries Signs and Symptoms

Management

• altered conscious state, often deteriorating

• assess patient's conscious state

over time • blurred or double vision

• if unconscious, place the patient on their side on a supported position

• a thumping or pounding headache

• check that the airway is clear and for signs of life

• nausea or vomiting • loss of balance and hand-eye coordination • altered sensation in the fingers or down one side of the body • loss of short-term memory, e.g. the memory of recent events • noisy breathing

every few minutes • if conscious, help patient into position of greatest comfort • give care until arrival of the ambulance • observe the patient closely for any change of condition • maintain body heat.

• leaking fluid from the nose or one ear.

Spinal Injuries Signs and Symptoms

Management

Conscious patient with suspected spinal injuries

• call 111 and ask for ambulance early

Examine for any loss of movement or sensation in the arms and legs Ask the patient if they experience: • pins and needles • pain in the spinal region • limb stiffness • clumsiness

• if patient is awake and can move, let the patient determine their own position, but minimise unnecessary movement if possible • if patient is awake but cannot move, leave them in their current position unless they are in danger. If they are in danger move them, but minimise unnecessary movement • if they are unconscious place them on their side (supported), if possible • if the patient requires CPR, this takes precedence over any suspected spinal injury.

• heaviness. Check for secondary injuries.

Unconscious patient with suspected spinal injuries Check for: • a change in breathing pattern • no chest movement • secondary injuries.

p. 50

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5 Major Incidents A major incident can be described as a multi-casualty emergency trauma situation, for example: a serious road accident involving a number of vehicles and people; or a blast in a factory where a number of people are injured. Note: First aiders should keep all patients together, do not let them wander off. Student Activity By the end of the session the student will be able to correctly: • assess a major incident scene • understand how to prioritise casualties • assist in managing a major incident. Resources • adult, child and infant manikins • gloves • alcohol wipes • face shields.

Methods • discussion and questioning • demonstration • experience • self-assessment.

Major Incidents Differences to the other first aid incidents: • the scale of the incident • the type of injuries • the number of casualties involved • the types of dangers • the information requirements for emergency services.

MAJOR INCIDENTS

p. 5 1

First aid priorities: • • • •

keep yourself and others safe call 111 and ask for an ambulance DRSABC for each patient gather information for emergency services.

Key points at a major incident: • • • • • • • • •

protect the incident from escalating call 111 and ask for emergency services as required manage immediate dangers secure the scene triage patients provide first aid account for all of the people injured encourage injured people to remain at the scene hand over to emergency services.

Resources: • • • • •

people at the scene materials on the site vehicles environment telephones.

Potentially life-threatening hazards: • • • • • • • • • •

fire gas and toxic fumes electricity falling objects machinery chemicals water and other fluids lack of air space confined space DRSABC for each patient.

Information for emergency services: • • • • • • •

p. 52

exact location a description of the accident number of casualties hazards other emergency services required initial patient assessment name and telephone number.

MAJOR INCIDENTS

Major Incident Activity SCENARIO

You are working on a building site. A large scaffold has been erected around one side of the building. There are seven people working on the scaffolding. A front-end loader is working close to the building removing excess dirt and rubbish. The driver swings the loader around, not realising how close he is to the scaffolding. A person on top of the scaffolding calls out to the driver, and as he looks up, he swipes the end of the scaffolding with the bucket. The scaffolding sways, then comes crashing to the ground. The people working on it are thrown to the ground, and land amongst the crumpled mess of piping and planks. The driver of the loader is trapped in his vehicle. You, and a group of work mates, rush to the site: Patient information Patient A: • driver of the loader trapped in the cab • calling and waving • trying to get the door open • calls out he is okay. Patient B: • trapped under a plank • four ribs broken on right side of chest • unconscious • lips are a blue colour • noisy/difficult breathing. Patient C: • lying outside the tangled mess • not wearing a safety helmet • hit on the head with a plank • neck injury/bruising to the right forehead • unconscious. Patient D: • trapped within the mess of pipes and planks • neck injury/bruising to the front of the forehead • conscious. Patient E: • lying within the pipes and planks • large open wound on the left leg • obvious broken right arm • conscious. Continues next page

MAJOR INCIDENTS

p. 5 3

Patient F: • sitting on top of the pipes • obvious fractured right ankle • requesting help noisily. Patient G: • walking around a little dazed • large head wound with blood all over their head and front of their clothes • suspected sprained ankle • in great amount of shock. Patient H: • trapped by the chest within the tangled mess by planks • difficulty breathing • large bleeding wounds to the arms and legs • obvious broken legs • unconscious.

1. In what order would you treat the patients and give your reasons? (One being high priority and eight being least). Patient order 1.

p. 54

MAJOR INCIDENTS

Reason

Notes:

MAJOR INCIDENTS

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Name Course Date Completed

Once you are in a Gold group you can ask your Divisional manger to download the pre-course work book for the Day 1 and Day 2 First Responder Course which can be found on the hub, you need to complete the workbook before you attend a First Responder Course.