Study Guide
HLTAID003 Provide first aid HLTAID003: Provide first aid
Contents INTRODUCTION ...... 3 WHAT IS THE DEFINITION OF FIRST AID? ...... 3 LEGAL AND ETHICAL CONSIDERATIONS ...... 4 ROLE OF THE FIRST AIDER ...... 6 PRINCIPLES OF FIRST AID...... 11
CHAIN OF SURVIVAL ...... 12
THE DRSABCD ACTION PLAN ...... 12 CPR ...... 19
RECOVERY POSITION ...... 22
SECONDARY SURVEY ...... 24 THE RESPIRATORY SYSTEM ...... 25
AIRWAY OBSTRUCTION ...... 26
ASTHMA ...... 27
HYPERVENTILATION ...... 29
CHOKING ...... 29
ALLERGIC REACTION ...... 32
DROWNING ...... 34 CIRCULATORY SYSTEM ...... 35
ANGINA ...... 36
HEART ATTACK ...... 37
HEART FAILURE ...... 38 WOUNDS AND BLEEDING ...... 39
NEEDLE STICK INJURIES...... 39
BLEEDING ...... 40
EMBEDDED OBJECTS ...... 42
NOSE BLEED (EPISTAXIS) ...... 43 SHOCK ...... 43 STROKE ...... 45 SEIZURES AND CONVULSIONS ...... 47
EPILEPSY ...... 47
ABSENCE SEIZURES ...... 49
FEBRILE CONVULSIONS ...... 49 ENVIRONMENTAL IMPACTS ...... 50
MUSCLE CRAMPS ...... 50
HEAT EXHAUSTION ...... 51
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HEAT STROKE...... 51
DEHYDRATION ...... 52
HYPOTHERMIA ...... 53
FROSTBITE ...... 55 DIABETES ...... 56
HYPOGLYCAEMIA ...... 56
HYPERGLYCAEMIA ...... 57 MUSCULOSKELETAL SYSTEM ...... 57
SPRAINS AND STRAINS ...... 58
DISLOCATION ...... 59
FRACTURES ...... 59 HEAD, NECK AND SPINE INJURIES ...... 62
HEAD INJURIES ...... 62
CONCUSSION ...... 63
COMPRESSION ...... 64
SPINAL INJURIES ...... 65
CRUSH INJURIES ...... 66 ABDOMINAL INJURIES ...... 67 EAR INJURIES ...... 68 EYE INJURIES ...... 68
GENERAL EYE INJURIES ...... 68
PENETRATING EYE INJURY ...... 69
FOREIGN OBJECT ...... 69
EMBEDDED OBJECT ...... 70 BURNS ...... 70
THERMAL BURNS ...... 72
CHEMICAL BURNS ...... 73
INHALATION BURN ...... 74 POISONING AND TOXIC SUBSTANCES ...... 75 ENVENOMATION ...... 76
BITES AND STINGS ...... 76
MARINE BITES ...... 79
SNAKES ...... 82
Study Guide V5.2 Page 2 of 85 HLTAID003: Provide first aid Introduction
In this unit you will learn the skills and knowledge required to provide a first aid response to a casualty in a first aid or emergency situation. These skills can be applied to a work, home or community setting. Areas include: • What is first aid • Infection control and standard precautions • How to respond to an emergency • How to respond to first aid situations • What is involved in communicating the details of first aid and emergency situations. This book has been developed to reflect the requirements of the unit of competency HLTAID003 Provide First Aid
What is the definition of first aid?
First aid is the initial care given to someone suffering from an injury or illness and is usually given by someone who is on the spot. It includes treatments such as giving over the counter medications, wound care, removal of foreign bodies for the eye using water or saline and giving fluids to a person suffering from heat stroke or dehydration. This differs from medical aid which is the treatment given by a health care professional such as a doctor, registered nurse or ambulance paramedic. This includes the administration of prescription medication, applying a cast to a fracture, suturing a wound prior to applying a sterile dressing, or administering fluids to a casualty suffering from dehydration through intravenous therapy. The Primary objectives of first aid are to: • Preserve life • Prevent deterioration of illness or injury • Promote recovery • Provide comfort to the ill or injured • Promote a safe environment A first aider should: • Assess the situation quickly • Identify the nature of the injury or illness as far as possible • Arrange for emergency services to attend • Manage the casualty promptly and appropriately • Stay with the casualty until able to hand over to a health care professional • Give further help if necessary
Study Guide V5.2 Page 3 of 85 HLTAID003: Provide first aid Legal and ethical considerations
There are several legal and ethical considerations to be aware of when providing first aid treatment. These include: • Duty of care • Negligence • Consent to first aid • Privacy and confidentiality • Respect • Stress management • Debriefing • Role of the first aider • Reporting and documentation • Workplace health and safety • Safe manual handling • Infection control and standard precautions
Duty of care ‘Duty of care’ refers to the legal responsibility to do whatever is necessary to ensure the safety of people in your care. As a first aider, you have a duty of care towards your casualty to exercise reasonable care and skill in providing first aid treatment to the best of your ability and level of training. If you see a first aid situation in the community, you are not obliged to assist or get involved, even if you hold a current first aid certificate. When you have made the decision to give first aid and have commenced treatment on a casualty, you have committed yourself to provide a duty of care to that casualty. This duty of care requires that you remain and provide first aid treatment until another trained first aider takes over, qualified help arrives, you are physically unable to continue, or the situation becomes unsafe to do so. If you are the first aid nominated person in the workplace then you are obliged to undertake first aid treatment again to your level of skills and knowledge. Health care professionals are under no obligation to provide first aid treatment in a community setting if the situation was not caused by them.
Negligence ‘Good Samaritan’ legislation (see below) may protect first aiders from being sued for things like negligence should they provide first aid in good faith. The following factors must all be present for a first aider to be found negligent: • A duty of care existed between the first aider and the casualty
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• The first aider did not exercise reasonable care and skill in providing the first aid • The first aider breached the relevant standard of care • The casualty sustained damage because of an act or omission of the first aider
Good Samaritan Laws in Australia Australian states and territories have in place good Samaritan legislation to ensure that people who step forward to provide emergency medical assistance are not held legally liable for their actions provided they act in good faith. Look up the relevant legislation for your state by following the following links: • Civil Liability Act 2003 (QLD) s 26 • Civil Laws (Wrongs) Act 2002 (ACT) s 5 • Civil Liability Act 2002 (NSW) s 57 • Personal Injuries (Liabilities and Damages) Act (NT) s 8 • Civil Liability Act 1936 (SA) s 74 • Civil Liability Act 2002(Tas) s 35B • Wrongs Act 1958 (Vic) s 31B • Civil Liability Act 2002 (WA) s 5AD.
Consent to first aid treatment Before you provide any first aid to a casualty, you must first gain their consent to begin the treatment. If the casualty is unconscious or non-responsive then consent is implied and you can commence treatment. With a child, the parent or guardian should be asked for permission. If they are not present and the injury/illness is life threatening, immediate first aid treatment should be given. In all situations, a written record of the first aid treatment must be kept. You only have the casualty’s consent to treat them for an illness or injury that affects their immediate health. You should not provide help for anything that goes beyond your knowledge of first aid. Consent may be implied or expressed. It is implied when a person attends a first aid room for treatment and cooperates with the first aider. Or when the first aider asks for permission to apply a dressing and the person verbally agrees to treatment. In some instances, such as in an emergency where the casualty is unconscious and not breathing, they will not be able to give consent to treatment. Therefore, as the first aider, consent is implied, and a qualified person may administer any necessary treatment to save the casualty’s life or to prevent serious illness or injury. Adults are entitled to refuse treatment. If any adult of sound mind, and able to decide, refuses your offer of treatment, even if that treatment is necessary to save their lives, you must not treat them. In these cases, stay within the vicinity and call 000 for assistance and directions. Treatment given without the person’s consent can be interpreted as an assault.
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Privacy and confidentiality In a first aid situation the privacy of the casualty is important. This includes covering the casualty with a blanket if appropriate, keeping crowds away or putting up screens if possible. It also relates to the personal information and first aid treatment of the casualty, and who and how you report this to. Disclosure of personal information without that person's written consent is unethical and, in some cases, illegal. Confidentiality of records and information must be maintained in line with statutory and/or organisational policies. Information should only be given to: • Healthcare professionals who are involved in the care process • Appropriate personnel if in a work situation, for example, an employer • Those investigating workplace illness or injury. Examples include a workplace inspection authority or the police. • In case of workplace incidents, the first aider can only handover information relating to the incident and treatment to the direct supervisor of the casualty.
Australian and New Zealand Resuscitation Council Guidelines (ANZCOR) ANZCOR is the Australian and New Zealand committee on Resuscitation, and through this, these countries interests are represented on the International Liaison Committee of Resuscitation (ILCOR). The Australian Resuscitation Council, which is part of this, is a voluntary body which represents all major groups involved in the teaching and practice of resuscitation. The Australian Resuscitation Council produces guidelines to meet its objectives in fostering uniformity and simplicity in resuscitation techniques and terminology. It also has guidelines on first aid management for several incidents such as bleeding, burns, head injury, shock, stroke, asthma, bites and stings, and anaphylaxis. https://resus.org.au/guidelines
Role of the first aider
When performing first aid it is vital that you only provide treatment within your level of skill and knowledge. The nominated first aid person at a workplace should have, as a minimum, training in HLTAID003: Provide first aid certificate. This should be updated every three years. Repeated refresher training is needed for all individuals who are not performing resuscitation or first aid on a regular basis. The Australian Resuscitation Guidelines state that people trained in cardio pulmonary resuscitation should refresh their skills at least annually. The current certificate for this is HLTAID001 - Provide cardiopulmonary resuscitation.
Respect A casualty requiring first aid may feel vulnerable and may react in an unpredictable manner. As a first aider you need to treat every casualty with respect irrespective of their injury or illness. Ways you can show respect include: • Be culturally aware • Communicating effectively
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• Be aware of impairments (example: hearing, sight, speech) • Be empathetic, sympathetic or sensitive • Respect all casualties as individuals • Speak calmly • Introduce yourself • Ask for consent to provide first aid • Reassure the casualty • Keep the casualty informed • Do not make judgements on the incident/illness/injury • Focus on the goal of providing first aid. A casualty may feel uncertain about being touched or treated by a stranger who is of a different age group, race or gender. They may be stressed and upset by the injury or illness or may be under the influence of alcohol or other drugs. If at any time the casualty’s behaviour poses a threat to you, withdraw from the scene and, if possible, monitor from a safe distance until help arrives.
Stress management and debriefing After witnessing and/or being involved in a first aid incident, some people may suffer an immediate or delayed emotional response. This is for both the person providing the first aid and for by- standers witnessing the incident. The way people respond might differ but symptoms such as anxiety, sleeping difficulties, headaches, feelings of guilt, anger, helplessness, experiencing flashbacks, nightmares, depression and a wide range of physical complaints may occur. If you have offered first aid, or witnessed an accident, it might be beneficial to undertake self-care and debriefing or even seek counselling. This would be particularly important if you suffer from any changes in your physical or emotional health. Examples could include exercising, social activities or calling help lines. Employee assistance counselling is often available via your workplace. Debriefing is one way of relieving the stress and should be carried out as soon as possible after the incident. This is not counselling but a voluntary discussion aiming to put the event into perspective. You could speak with your employer, a close friend or your medical practitioner. Remember- don’t disclose personal information. Benefits of debriefing include: • To improve future responses and reduce workplace hazards • Gives people involved the time and permission to review the incident and express their own point of view • Allows people to talk about the feelings they experienced at the time.
Reporting and documentation In the event of an emergency, a quick verbal report may be required to be given to your supervisor and/or medical assistant once they arrive on the scene. When giving a verbal report or handover ensure that the information that you give is factual, concise, relevant and clear.
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This verbal report should cover: • What happened (events leading up to the incident)? • How long ago did it happen? • What first aid management has been given? • What is the condition of the casualty now? • Have they improved or deteriorated in the first aiders care? • Casualty’s personal details (if known). In the workplace there is a legal requirement to document the first aid management of any casualty regardless of perceived seriousness of the condition of injury. In most cases, as a minimum, an incident form will need to be completed.
Some rules to consider when documenting the first aid scenario and treatment: • Ensure it is accurate and objective, not subjective • All documentation is to be completed in ink • All documentation is to be written at the time of treatment or as soon as possible after • Ensure it is clear and legible writing outlining: o The casualty details (correct spelling, legal name, address, contact number etc) o Details of the scenario o Summary of signs and symptoms o Summary of management carried out o Summary of outcome (what happened to the casualty) o Signed off (a copy to be provided to the casualty). If you make any errors, you are required to put a line through the error and initial the error. Do not use white out. All records of first aid situations should be kept in a locked cabinet or drawer for security and confidentiality reasons.
Calling 000 When seeking assistance from 000 it is important to give them all the information you can. This should include: • Which emergency service you require. Ask for an ambulance first, then police if required • The type of incident • How many casualties involved • The status of all casualties – type and extent of injuries known • Any dangers • What happened (events leading up to incident)
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• How long ago did the incident occur • What first aid management has taken place • Location: o To nearest cross street or intersection o Street name o Suburb and state o If rural, distance from intersection, landmark, roadside number o This information may be available via GPS. At all times keep your mobile phone on so that the emergency services can track you and give you further instructions as required. If you are calling emergency services from a mobile phone, you can use the secondary emergency service number of 112 which can only be dialled from a digital mobile phone. This service is available even if outside your service coverage area. If you are hearing or speech impaired, you can call 106 - Text emergency relay service also known at TTY (teletypewriter or textphone)
Workplace health and safety In an emergency you may need to undertake the role of the workplace health and safety person as well as the first aider. A calm, controlled manner will assist and ensure that the management of the scene, casualty and bystanders are handled effectively and efficiently. Work health and safety issues in a first aid situation include: • Assessing and removing any potential dangers (if possible) • Preventing new dangers • Ensure you do not put yourself or others in danger • Protecting the casualty from further injury • Protecting any other first aiders and bystanders from injury • That there is easy access for emergency services to approach and attend the scene • Priorities for casualty management are assessed. Dangers could include fire, fumes, spilt fuel or chemicals, electricity, violent bystanders or casualties. A risk assessment should be undertaken in all situations prior to entering the scene to ensure that it is safe to do so. If the assessment suggests there is a risk factor within the workplace, employers are obliged to establish appropriate procedures to minimise or eliminate the hazard/risk. These could include: • Employee training • Establishing first aid facilities including safety showers and eye wash stations • Provision of personal protection equipment, and
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• Developing and communicating emergency procedures and evacuation procedures for the workplace. Legislation covering safety requirements in the workplace vary between States and Territories. Each State has its own Occupational and Workplace Health and Safety Act. Refer to your State or Territory Act for guidelines. Outlined below is a hierarchy of control in relation to minimising work place hazards:
Safe manual handling In an incident where you are required to provide first aid, you may have to lift or move the casualty to a suitable position or location. An awareness of safe manual handling techniques can prevent injury to yourself. When moving a casualty or heavy object: • Have a wide base of support. This includes keeping your feet apart, pointing your feet in the direction you are going to move and having your knees slightly flexed. This avoids using the small muscle in the back and uses the thigh muscles. • Keep the object close to the body. • Keep the object close to your hip and pelvic area as this keeps the weight of the load close to your centre of gravity. • The line of gravity should always be vertical and should remain perpendicular to the ground. In other words, keep your back straight while lifting and carrying. • Always plan your lift, and the route if you are moving the patient. • It is easier to push or slide an object than lift. • Size up the load to be carried and get help, (human or mechanical) if the load is too big, heavy or awkward.
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Infection control and standard precautions Infection control refers to a series of actions taken to minimise or control the spread of diseases. In a first aid situation, microorganisms can be spread through mouth to mouth resuscitation, contact with open wounds and/or body fluids. To minimise this, first aiders should: • Wear disposable gloves whenever practicable • Use a face shield when performing mouth to mouth resuscitation • Undertake hand hygiene after any first aid procedure and between casualties • Wear eye goggles as required • Use gloves when disposing of waste. Anything that has been in contact with blood or body fluids should be disposed of in a biohazard bag or bin • Dispose of sharps safely and not recap needles • Cover all wounds • Treat all casualties as infectious and act accordingly.
Principles of first aid
Early recognition is a key step in initiating early management of an emergency and/or first aid situation. You can recognise an emergency by: • Sight • Smell • Sound • Unusual behaviour. The rescuer should: • Assess the situation: • Ensure safety for the rescuer, casualty and bystanders • Send for help. If there is more than one casualty, the care of an unconscious casualty has priority. If the casualty is unresponsive, not breathing or not breathing normally, then the basic life support action plan should be followed.
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Chain of survival The Chain of Survival is a series of interlinked actions which when followed is the key to improving the survival rate of casualties in cardiac and/or respiratory arrest.
• Early access. Get help as soon as possible. Triple 000 must be called immediately to ensure that early defibrillation and advanced life support can commence without delay. • Early CPR: If CPR is begun within four minutes of the heart stopping, this will maintain oxygenation of vital organs such as the brain. • Early Defibrillation: If a defibrillator is applied within eight to 12 minutes of the heart stopping, this will significantly improve chance of survival. Each minute without defibrillation reduces the chances of survival by nine percent. • Early advanced care: This is definitive treatment provided by paramedics, doctors and hospital care.
The DRSABCD action plan This action plan is used in assessing whether the casualty has any life-threatening conditions and if any immediate first aid is necessary. D: danger R: response S: send for help A: airway B: breathing C: compression D: defibrillation. Using the DRSABCD plan will help you ascertain the following facts: • What dangers are present (if any) • How many casualties are involved • What immediate first aid is required • Is assistance is required
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• What caused the injury • Is the casualty is conscious or unconscious • Is the casualty is breathing • Is resuscitation is needed. If the casualty is able, you should gain as much information as possible from them. Relevant information can be easily remembered with the use of Mnemonics S A M P L E and D O L O R: • Symptoms such as pain or nausea • Allergies or sensitivities the casualty is aware of • Medications that the casualty is on and if they are carrying them • Past medical history • Last meal • Events leading to the incident. • Description • Onset • Location • Other signs/symptoms • Relief Casualties can be: • Conscious: they respond normally to your questions, make eye contact, obey commands (for example, take a deep breath for me, which they do). • Semi-conscious: they may respond with some sounds, inappropriate answers, may or may not respond to commands. • Unconscious: no response from the casualty verbally or physically.
Danger • Check for danger by using all your senses. These include look, listen touch, smell and taste. • Is it safe for you, bystanders and the casualty? • If there are any dangers, can you remove or isolate them? • If you cannot, send for help and ensure no one else places themselves in danger. • Dangers include electrical wires, gasses, toxic chemicals, other vehicles: o Leave things such as live power lines to the experts • Do not become a casualty.
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Response • Is the casualty conscious or unconscious? • Check for responses by talking to the casualty, for example, “what’s your name?” • Gently squeeze the casualty’s shoulders looking for signs such as any facial movements when you apply pressure • If there is a response and they can be left in the position you found them, then go onto performing a secondary survey If there is no response to any of the above, the casualty is deemed unconscious.
Another useful Mnemonic for response is C O W S
• Can you hear me?
• Open your eyes
• What’s your name?
• Squeeze my hands
Send for help Send for help as soon as possible. Preferably ask another person to do so. Called 000 and cooperate with the operator to the best of your ability, including answering the questions as accurately as you can. Leave your phone on so that they can continue to give you further directions. If there is a possibility of and AED being available send a bystander to collect it.
Airway Common causes of airway obstruction in an unconscious casualty include: • Tongue • Food • Vomit.
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In an unconscious casualty, care of the airway takes precedence over any injury, including the possibility of a spinal injury. To check the airway: • Open the mouth: o Obstruction can be caused by the tongue falling back, foreign material such as vomit, blood or food or swelling or injury of the airway • Only if foreign material is present, place the casualty in the recovery position and clear with two of your fingers • Use of personal protective equipment (PPE), or a barrier before placing fingers in patient’s mouth is recommended. You could utilise a plastic bag clothing or the casualty’s own fingers • Only remove dentures if they are loose • Then tilt the head to open the airway and check for breathing.
Breathing Check for normal breathing using the ‘look, listen and feel’ method for at least 10 seconds: • Look for rise and fall of chest and or upper abdominal movement • Listen for sounds of air escaping from the casualty’s nose and/or mouth • Feel for air from the nose and or mouth by putting your cheek close to the casualty’s face Gasping or occasional gasps often referred to as agonal breathing and are not considered normal breathing. Other indications of abnormal breathing include slow breaths, wheezing, gurgling and shrill breaths. These would need further investigation and evaluation. If the casualty is unresponsive but breathing normally: • Roll the casualty into the recovery position • Continually check the casualty’s condition until medical aid arrives and takes over • Be ready to turn the casualty onto their back and start CPR if breathing stops. If the casualty is unresponsive and not breathing normally, commence cardiopulmonary resuscitation (CPR).
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Compression Cardiopulmonary resuscitation (CPR) Cardiopulmonary resuscitation, or CPR, is the technique of undertaking compressions of the chest by pushing down on the lower half of the casualty’s sternum (breastbone), this is followed by inflating the casualty’s lungs by breathing into the casualty’s mouth and/or nose. CPR is given to a casualty who is unresponsive and not breathing normally. The sequence for CPR is: • Give 30 compressions • After 30 chest compressions, tilt the head and lift the chin • Give two breaths • Return your hands immediately to the correct position on the sternum • Give a further 30 compressions and breaths in a ratio of 30:2 at approximately five cycles in two minutes at a rate of 100-120 per minute. Compressions applied too high are ineffective and if too low may cause regurgitation and/or damage to internal organs.
Giving Compressions Compressions should be performed with the casualty on a firm surface such as the floor.
To give compressions: • Kneel beside the casualty, one knee level with their head and the other with the casualty’s chest • Locate the lower half of sternum (breastbone) which is in the centre of the chest • Place the heel of one hand on the lower half of the sternum and place the heal of your other hand on top of your first hand • Interlock the fingers of both hands so your fingers are away from the casualty’s ribs and upper abdomen • Position yourself vertically above the casualty’s chest
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• With arms straight, press down on the sternum • Compression depth should be 1/3 the depth of the chest wall • Release the pressure • Perform compressions at a rate of 100 to 120 compressions per minute (almost two compressions per second). This is followed by:
Rescue Breaths (Mouth to mouth) Do these using a pocket mask if available: • Leave the casualty on their back • Kneel beside the casualty’s head • Open the airway: o Place one hand on the casualty’s forehead or top of the head o Tilt their head (not neck) backwards o Pinch the soft part of the nose closed with your index finger, or seal their nose with your cheek • Maintain the chin lift by placing your thumb over the casualty’s chin below their lip and support the tip of the jaw with your middle finger, this is referred to as the ‘pistol grip’. • Open the casualty’s mouth • Take a breath and place your lips over the casualty's mouth ensuring a good seal • Blow normally • Watch for the casualty's chest to rise out of the corner of your eye • Maintain the head tilt and chin lift • Turn your mouth away from the casualty’s mouth and watch for their chest to fall o Listen and feel for signs of air being expelled • Take another breath and repeat the sequence. Note: If the chest does not rise: • Recheck the mouth and remove any obstruction • Ensure there is adequate head tilt and chin lift • Ensure there is an adequate seal around mouth Repeat the sequence of chest compressions and rescue breaths. Mouth to nose:
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The mouth to nose method may be used when: • The rescuer chooses • The casualty’s jaws are tightly clenched, or • When resuscitating infants and small children. The technique for mouth to nose is the same for mouth to mouth except sealing the airway: • Close the casualty’s mouth with your hand supporting the jaw and push the lips together with your thumb • Take a breath and place your opened mouth over the casualty’s nose • Blow to inflate the casualty’s lungs • Lift your mouth from the casualty’s nose and look for the fall in the chest; listen and feel for the escape of air from the nose and mouth. NOTE: If a first aider is unwilling or unable to perform rescue breathing, compressions only can be performed.
Defibrillation A defibrillator is a machine that can analyse the casualty’s heart rhythm and then deliver a current of electricity (shock) to stop the arrhythmia. This occurs when the heart is beating with an irregular or abnormal rhythym preventing it from pumping blood around the body and effectively causting it to stop beating. The electric shock restores the heart’s electrical activity. The quicker a defibrillator is accessed, applied and utilised the increased chance of a casualty surviving. For every minute defibrillation is delayed, there is approximately 10% reduction in survival. An automatic external defibrillator (AED) can be used by anyone with or without training. The voice prompts will direct the person how to use it. Adult AED’s deliver shocks of 150 joules. They can be used on pregnant women, on wet and/or metal surfaces as long as the usual safety rules are observed. How to defibrillate: • Follow DRSABCD • Establish that the casualty is unresponsive, not breathing normally and not moving • Call 000 for an ambulance • Commence CPR • Gain access to a AED • Attach pads to the casualty’s chest: (as per diagrams on pads): o One pad to the casualty’s right chest wall, just below collarbone o One pad to the casualty’s left chest wall, below their armpit
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• Ensure pads adhere to the skin • Attach the cable to the machine (if applicable) • Press the 'on' button • Follow the prompts • When the AED is analysing it will state: o Stop CPR o Ensure everyone is clear of casualty • The AED will then determine and inform you whether a shock is advised • Press the 'shock' button or stand clear for an automatic shock • Once this has occurred, the AED will prompt if CPR is to be recommenced. Note: • If the casualty is wearing a bra, remove or cut it to remove it before placing the defibrillator pads • Remove any excess moisture prior to placing the pads • Remove any excess chest hair so the pads will adhere to the skin • Avoid placing pads over implantable devices such as a pacemaker. If there is an implantable device, place pads eight centimetres away • Remove medication patches and wipe the area before attaching an electrode pad. Continue following the prompts of the AED and performing CPR until: • Medical assistance arrives and takes over • The casualty responds and starts breathing normally (If this occurs place them into the recovery position) • You become too exhausted to continue • A health care professional such as a medical officer directs that CPR be ceased.
CPR
CPR for infants Infants are defined as younger than one year of age, and DRSABCD should be followed immediately. Airway In an infant, the upper airway is easily obstructed because of the narrow nasal passages and narrow entrance to the windpipe (trachea and voice box). The windpipe is soft
Study Guide V5.2 Page 19 of 85 HLTAID003: Provide first aid and pliable and may be distorted by excessive backward head tilt or jaw thrust. Therefore, in an infant the head should be kept neutral and maximum head tilt should not be used. The lower jaw should be supported at the point of the chin while keeping the mouth open. There must be no pressure on the soft tissues of the neck. If these manoeuvres do not provide a clear airway, the head may be tilted backwards very slightly with a gentle movement. To clear the airway: • Lay the infant face down on your forearm with their head supported • Clear the mouth with your little finger. Breathing: • Look, Listen and Feel. Compressions: • Place the infant on a firm surface such as a table • Position yourself vertically above the infant’s chest • Place two fingers (index and middle) over the lower half of the sternum (breastbone) • Press down on the sternum to depress about 1/3 of the chest and then release the pressure. The compressions and release should take equal amounts of time • Repeat to complete 30 compressions at a rate of approximately 100- 120 per minute.
Rescue breaths: • Keeping the head in the neutral position and seal the mouth and nose with your mouth • Give one puff using air from your cheeks
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• Watch for rise and fall of their chest • Repeat the sequence.
CPR for children • A child is from one to eight years old • They are managed as per adults • Use one or two hands for compressions • An adult AED and adult pads can be used for children over the age of eight years
Defibrillation Ideally for children under 8 years of age, paediatric pads and an AED with a paediatric capability should be used. These pads are placed as per the adult pads and the pads come with a diagram of where on the chest they should be placed. If the AED does not have a paediatric mode or paediatric pads, then it is reasonable to proceed with standard adult AED pads. Ensure the pads do not touch each other on the child’s chest. Apply the pad firmly to the bare chest in the anterior-lateral position as shown for adults. If the pads are too large and there is a danger of pad-to-pad arcing, use the front-back position (antero-posterior). This is where one pad is placed on the upper back (between the shoulder blades) and the other pad is placed on the front of the chest, if possible slightly to the left. The AED for infants delivers shocks at 50 Joules.
CPR for pregnant women If a woman is obviously pregnant, the uterus causes pressure on the major abdominal vein (anterior vena cava) when they lay flat, reducing venous return to the heart. The pregnant woman should be positioned on her back with her shoulders flat and sufficient padding placed underneath her right buttock to give an obvious pelvic tilt to the left. This moves the weight of the uterus off the major blood vessels in the abdomen.
Two-person CPR This can occur when two first aiders are present or if a second person arrives to help. Changeover should be done frequently, recommended every two minutes. Changeover should occur as quickly as possible so that the chest compressions are not interrupted. The second person should stop compressions while other first aider performs breaths.
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How to carry out a seamless changeover: • Two first aiders A and B in position to provide CPR face each other over the casualty • When first aider A, who is currently applying compressions, bends down to give the two breaths of the fifth cycle in their two minutes of CPR, first aider B gets ready to commence compressions by placing their hands in the correct position on the casualty’s chest • As soon as first aider A completes the second breath, first aider B begins their two minutes of CPR • First aider A removes their face shield or resuscitation mask from the casualty’s face and replaces it with the face shield or resuscitation mask that first aider B would be using.
Recovery Position Once the casualty is breathing normally, they are placed into the recovery position. This will ensure that the open airway is maintained, and any vomit or fluid will drain away. Casualties should be handled gently, and every effort made to avoid any twisting or forward movement of the head and spine in case there are neck or spinal injuries. How to place a casualty into the recovery position: • Kneel beside the casualty • Place the casualty’s farther arm at a right angle to the body • Place the casualty’s nearer arm across their chest • Lift their nearer leg to you at the knee so it is fully bent upwards • Roll the casualty away from you onto their side while supporting their head and neck • To prevent the casualty from rolling onto their face, keep the leg at right angle with the knee touching the ground • Turn their chin slightly down so secretions can drain from the casualty’s mouth • Check their airway and continue monitoring • If they stop breathing, turn them back onto their back and recommence CPR. For an infant: The most suitable recovery position is lying face down on an adult’s forearm with the head supported by your hand.
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For a heavily pregnant woman: place them on their left side. This prevents compression of the major blood vessesls by the uterus.
Recovery position and spinal injuries If you think they could have a spinal injury: • Try to keep their neck as still as possible. Instead of tilting their neck, use the jaw thrust technique: o Place your hands on either side of their face and with your fingertips gently lift the jaw to open the airway, avoiding any movement of their neck • To roll them onto their side, use the normal technique but do your best to keep their spine as straight as you can. If possible, get up to four helpers, two on each side, to help you keep their head, upper body and legs in a straight line at all times as you roll the body over. H.A.IN.E.S Position for suspected spinal injury The modified H.A.IN.E.S. Recovery Position (H.A.IN.E.S. is an acronym for High Arm IN Endangered Spine), offers an even better alternative for airway and spinal protection for the ‘Unconscious, Suspected Spinal Injured’ casualty. This *clinically researched position not only protects the casualty’s airway, but also significantly reduces the amount of side-ways movement (lateral flexion) of the head and neck. 1. Kneel beside the patient. Place furthest arm palm up, bedside head. 2. Place closest arm across chest. 3. Bring closest knee up, foot on ground. 4. Slip your arm beneath closest shoulder with your hand under neck to stabilise. 5. DO NOT push or lift head or neck. 6. Roll the patient onto side by gently pushing on both their shoulder and raised knee. 7. Ensure head is kept on raised arm, while supporting neck, place fingers under armpit. 8. Check that the airway is clear and breathing is normal. 9. Stay with the patient and monitor until help arrives. Warning: Once the casualty is placed into the H.A.IN.E.S. Recovery Position, use airway manoeuvres such as ‘Jaw Thrust’ (lifting the jaw ‘forward’ and upward, whilst avoiding pressure on the neck) first, in preference to head tilt in order to further reduce movement to the neck.
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Recovery position and vomiting If the casualty regurgitates/vomits during CPR: • Turn the casualty into the recovery position • Clear the mouth • Check for breathing • If breathing is present, leave in the recovery position and monitor • If not, once airway is clear, turn casualty back onto their back and recommence CPR.
Secondary survey Once the casualty is in the recovery position you should then undertake a secondary survey. This is a more detailed and thorough examination to identify illnesses and or injuries and to prioritise the first aid treatment required according to the severity of the injuries. For a conscious casualty, always inform them what you are doing and ask questions about pain and discomfort in each area as you go. You can also find out the history, signs and symptoms of the incident. For an unconscious casualty, complete a physical assessment of the casualty using your hands to feel for abnormalities and fluids. Where possible, look under or cut clothing for visual abnormalities. A secondary survey is completed by starting at the head and working your way down the neck, arms, chest, back, abdomen and legs looking for further injury. Things you would look for include: • Bleeding • Tenderness • Abnormalities of limbs, for example, breaks, deformities, abnormal alignment. Things you should specifically look for: • Skin: note the colour and temperature • Head: check for blood, bruising, swelling • Face: check if the pupils are of equal size and reacting; compare one side of the face to the other; look for any loose teeth • Neck: check collarbones for breaks • Spine: gently put your hands under their back and check for any swelling or soreness. If they have lost movement or sensation in their legs and/or arms do not move them. • Shoulders, arms and hands: check for any non-alignment or fractures; check the full length of each arm; check for swelling and to ensure that the casualty has feeling in their fingers
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• Chest: look to see if it expands easily and evenly. Ask if there is any pain when breathing • Abdomen: check if it is tender, stiff or swollen. Ask if a gentle press on the abdomen cause pain • Pelvis and buttocks: push the tops of the hips towards each other and ask the casualty if this causes pain. Check for evidence of wet pants or blood from the genital or anus area • Legs: check their ankles and feet for any abnormal alignment. Check also for fractures and for sensation. Physical alerts such as alert jewellery can notify you of pre-existing medical conditions.
The respiratory system
The respiratory system comprises of the lungs, trachea bronch (two tubes branching off the trachea), bronchioles (smaller tubes branching off the bronchi), alveoli and daiaphargm. The primary functions of the respiratory system are to supply the blood with oxygen to enable the blood to delivery oxygen to all parts of the body and to remove the body of waste gases such as carbon dioxide. Breathing/respiration is achieved with the mouth, nose, trachea, lungs and diaphragm. Air enters through the nose or mouth down the trachea (windpipe) which branches into two bronchi which take the air to the lungs. Each bronchus divides forming the bronchial tubes which in turn divide into many smaller tubes which connect to tiny elastic sacs called alveoli. The inhaled oxygen passes into the alveoli and then diffuses through the capillaries. The walls of the alveoli and capillaries which surround them, are so thin that oxygen and carbon dioxide exchange through them. Meanwhile, the waste-rich blood releases its carbon dioxide into the alveoli via the capillaries. The carbon dioxide follows the same path out of the lungs when you exhale. This gaseous exchange is vital to life. The process of breathing (respiration) is divided into two distinct phases, inhalation and expiration. During inhalation, the diaphragm contracts and pulls downward while the muscles between the ribs contract and pull upward. This increases the size of the thoracic cavity and decreases the pressure inside. As a result, air rushes in and fills the lungs. During expiration, the diaphragm relaxes, and the volume of the thoracic cavity decreases, while the pressure within it increases. As a result, the lungs contract and air is forced out.
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Airway Obstruction
Airway obstruction due to body position When providing first aid for an unconscious casualty or casualty with an altered consciousness it is important to ensure their body position does not compromise their airway. The DRSABCD action plan ensures the airway is cleared of any blockage and if conscious that the casualty is placed in the recovery position which maintains an open airway.
Positional asphyxia Positional asphyxia is a form of respiratory distress and occurs when the body position prevents someone from breathing adequately from an upper airway obstruction or a limitation in chest wall expansion. Examples include due to steering wheel compression or an unconscious casualty flopped forward in a car. A person suffering from positional asphyxia is unable to move position to alleviate pressure and restriction. Signs and symptoms include: • Breathing difficulty or absent breathing • Rapid pulse • Blue around the lips, ear lobes and fingertips • Convulsions • And if left untreated cardiac arrest and death.
Management: • Follow DRSABCD • Lift the chin and move the jaw forward which will open the airway, or • From behind with each of your hands holding the casualty’s head firmly on both sides, tilt their head to open their airway. • Be aware of any potential spinal injuries but remember an open airway comes first • Remove the cause or obstruction if possible • Resuscitate if necessary • Seek urgent medical assistance
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Asthma One Australian dies every day from asthma. In an asthma attack the lining of the lungs and airway become inflamed and swollen. Excess mucus is produced, causing the person to have great difficulty in breathing. Usually it is the expiration (breathing out) phase that is difficult, and a varying volume of wheeze (high pitched whistling sound during breathing) is audible. The reduction in the volume of the wheeze or cessation does not necessarily mean that the casualty is recovering. Factors triggering an asthma attack may include: • Exercise • Respiratory infections • Allergies (to pollen, foods, food colourings, bee stings etc) • Exposure to sudden changes in weather conditions especially cold air • Anxiety, stress • Irritants such as smoke (cigarette, woodfire or bushfire), occasionally perfumed or cleaning products. Signs and symptoms of a mild asthma attack A casualty may present with:
• Shortness of breath • A dry irritating or persistent cough particularly in the early morning or evening or after exercise. • Chest tightness • Wheeze. Signs and symptoms of a severe asthma attack • Gasping for breath (may have little or no wheeze) • Severe chest tightness • Inability to speak more than one to two words per breath • Distress and anxiety • Confusion and/or exhaustion • Sucking in of the throat and around the lips • Pale and sweaty skin. In this situation, 000 must be called immediately and first aid treatment commenced.
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Management 1. Follow DRSABCD 2. Assist the casualty, if conscious, into a comfortable position (usually sitting upright with arms supported on surface) 3. Be reassuring and ensure there is adequate fresh air for the casualty 4. Reassure the casualty. 5. If the casualty has an asthma plan and it is available, follow this. If not, complete steps six to 16 of this list 6. Assist with prompt administration of reliever medication: four by four by four (4 x 4 x 4) 7. Shake the puffer 8. One puff of blue/grey reliever via spacer device 9. Four breaths 10. One puff of blue/grey reliever 11. Four breaths 12. One puff of blue/grey reliever 13. Four breaths 14. One puff of blue/grey reliever 15. Four breaths 16. Wait for four minutes and if no improvement, repeat the four by four by four cycle 17. If there is still no improvement call an ambulance immediately 18. Continue giving reliever medication until assistance arrives. Call an ambulance immediately if: • The casualty is not breathing • The casualty’s asthma suddenly becomes worse or is not improving • The casualty is having an asthma attack and a reliever is not available • If you are not sure if it is asthma. No harm is likely to result from giving a reliever inhaler to someone without asthma. It is also safe to administer to a pregnant woman.
Spacers These are recommended for all people (adults and children) during an asthma attack. When cleaning the spacer device, dismantle, wash in warm water with detergent, drain and air dry. DO not rinse or use a cloth to dry the spacer. Using a cloth can result in static building up on the inside of the spacer which makes the medication stick to the sides.
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For further information refer to the Asthma Foundation in your state or Asthma Australia: https://www.asthmaaustralia.org.au/wa/home
Hyperventilation Hyperventilation is a result of involuntary over-breathing due to excitement, hysteria, stress or other emotions. Signs and symptoms There are several signs and symptoms which can help you to distinguish hyperventilation from other breathing disorders such as asthma. • Shallow, rapid breathing • Rapid pulse • Feeling of choking or suffocation • Dizziness • Pins and needles in hands, feet and face.
Management • Follow DRSABCD • Calm the casualty and, if necessary, move them to a quiet, private place • Encourage slow, regular breathing by slowly counting their breaths aloud • Seek medical aid.
Choking A person is deemed to be choking when the airway is partly or completely blocked. The casualty usually has trouble breathing out and if the obstruction is complete cannot breathe at all. Signs and symptoms will vary and depend on the cause and severity of the condition. Airway obstruction can occur gradually or suddenly. The most common causes of choking are: • Eating or drinking too quickly at the same time • Not chewing food sufficiently • Swallowing small bones • Swallowing small objects. In a conscious casualty who has a partial obstruction signs and symptoms include: • Anxiety, agitation • Gasping sounds • Breathing is laboured • Breathing may be noisy
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• Coughing • Having difficulty speaking or swallowing.
Management The aim is to dislodge the object and clear the airway. The simplest way to assess the severity of an airway obstruction is to check whether a cough is effective or ineffective. If the casualty has an effective cough, then:
• Reassure the casualty • Encourage the casualty to keep coughing to expel the object • If the object is not relieved or expelled, call 000 for an ambulance. If there is total obstruction, signs and symptoms include: • Distress • Clutching of the neck • No efforts at breathing • No sound of breathing • Collapse and/or becoming unconscious This is an emergency; a life-threatening situation. The first aid aim is therefore to dislodge the object obstructing the airway, because if this is not done, the person could die.
Management If the casualty is conscious: • Call 000 for an ambulance • Have the casualty sit in a chair, supported • Perform up to five sharp back blows with the heel of one hand in the middle of the casualty’s back, between the shoulder blades • Between each back blow, check to see if the obstruction has been relieved. If back blows are unsuccessful, perform 5 chest thrusts: • Place one hand in the middle of the casualty’s back for support • Place the heel of your other hand in the middle of their chest in the same position as you would for CPR • Give five chest thrusts • Chest thrusts are like chest compressions but sharper and delivered at a slow rate • With each thrust, check to see whether the airway obstruction has been relieved. If the obstruction is still not relieved, and the person remains responsive, continue alternating five back blows and five chest thrusts.
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If the casualty is unconscious: • Call 000 for an ambulance • A finger sweep can be used if solid material is visible in the airway • Commence CPR.
Choking in an infant Infants and small children love to put things in their mouths. This can result in choking. Peanuts, hard sweets and small toys are especially dangerous for children under five.
Back blows: • Place the infant in a head downwards position prior to delivering back blows. The infant should be laid across your lap or downwards on your forearm. Support their head and shoulders with your hand • Hold the infant's mouth open with your fingers • Give up to five sharp blows with the heal of one hand to the back between the infant’s shoulders • Check after each back blow to see if the obstruction is relieved • You may need to turn the infant on their back, open their mouth and remove any foreign material. If the blockage has not cleared, then you need to do chest thrusts. For chest thrusts: • Place the infant in a head downwards position on their back across your thigh or on a firm surface such as a bench or table • Place two fingers in the CPR compression position • Give five chest thrusts slower but sharper than CPR compressions
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• Check after each chest thrust to see if the obstruction relieved • If the obstruction not cleared, continue alternating five back blows and five chest thrusts.
Allergic reaction An allergic reaction occurs when the person’s immune system reacts to something in the environment. The triggers can be medication, insect stings, dust mite, pet’s saliva, pollens, mould, foods and chemicals. Hay fever is the commonest form of allergic reaction. Signs and symptoms include: • Swelling of face, lips, eyes • Hives or welts • Rash • Itching • Tingling mouth • Watery eyes • Vomiting or abdominal pain.
Management • Follow DRSABCD • Stay with the casualty • Remove the casualty from the irritant if possible • For an insect sting allergy, flick out the sting if it is visible • For a tick allergy, freeze dry the tick (if possible) and allow it to drop off • Call for help if required • Have the casualty take medications such as antihistamines if prescribed and/or available • Watch for any increase in signs or symptoms that may lead to an anaphylactic response.
Anaphylaxis Anaphylaxis is a severe allergic reaction and is potentially life threatening. It requires urgent management and medical attention. It usually involves swelling of the face, throat and can cause difficulty with breathing. The first aid management is the administration of a bolus dose of adrenaline which is given with an auto-adrenaline device. This device can be administered by a lay person without training. If possible, the casualty should administer this themselves. Triggers include: • Food: nuts, peanuts, shellfish, eggs, wheat, milk, soy • Insects: bees, wasps, jack jumper ants • Latex.
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Signs and symptoms: • Difficulty and/or noisy breathing • Swelling of the tongue • Swelling/tightness in the throat • Swelling of the face and tongue • Wheeze or persistent cough • Difficulty talking and or hoarse voice • Persistent dizziness or collapse • Abdominal pain and vomiting • Hives, welts, body redness • Pale and floppy body and limbs (young children).
Management If the casualty’s symptoms and signs suggest anaphylaxis the following steps should be followed: • Lay the casualty flat; do not stand or walk. If breathing is difficult, allow them to sit (if able). • Prevent further exposure to the triggering agent if possible. • Administer adrenaline (epinephrine) via intramuscular injection preferably into the lateral thigh: o Child less than 5 years - 0.15 mg
o Older than 5 years - 0.3 mg.
• Call 000 for an ambulance. • You may administer oxygen, if available and you are trained to do so. • Give asthma medication for respiratory symptoms. • A second dose of adrenaline (epinephrine) should be administered by autoinjector to a casualty with severe anaphylaxis whose symptoms are not relieved by the initial dose. The second dose is given if there is no response five minutes after the initial dose. • If allergic reaction or anaphylaxis has occurred from an insect bite or sting, follow the management guide for these. • If the casualty becomes unresponsive and not breathing normally, give resuscitation. • If the casualty is unconscious, follow DRSABCD. • If the casualty has an anaphylaxis plan, then it should be followed. • Note the time of the adrenaline autoinjector and inform the ambulance officers.
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There is only one brand of adrenaline auto injector currently in Australia - EpiPen. It is available in an adult dose or a junior dose All EpiPen®s should be held in place for three seconds regardless of instructions on the device label. For further information refer to the Australasian Society of Clinical Immunology and Allergy: https://www.allergy.org.au/patients/about-allergy/anaphylaxis
Drowning Drowning is the process of experiencing respiratory impairment from submersion/immersion in liquid. Drowning occurs when water comes into contact with the larynx (voice box). After an initial gasp, there is a period of voluntary breath holding. This is followed by the spasm of the larynx in an attempt to close and prevent more water from entering. However, this also prevents air from going in and results in decreased levels of oxygen in the blood stream and unconsciousness. Early rescue and resuscitation by trained first responders or first aiders at the scene offer the casualty the best chance of survival. It is rare that a person is found thrashing in water. Instead, most drownings are unwitnessed, and the person is found floating or submerged in the water. An average of 30 children under the age of five years have drowned in Australia each year for the past 10 years. Signs and symptoms: These vary widely. Some do not show any symptoms. Others may present with: • Coughing • Frothy sputum • Blue lips and tongue • Shortness of breath • Vomiting • Chest pain • Clenched teeth • Unconscious • Not breathing.
Management • Follow DRSABCD • Remove the casualty from the water as soon as possible • Call 000 for an ambulance • In minor incidents, removal from the water is often followed by coughing and spontaneous resumption of breathing
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• Assess the casualty on the back with the head and the body at the same level, rather than in a head down position. This decreases the likelihood of regurgitation and vomiting and is associated with increased survival • The casualty should not be routinely rolled onto their side to assess their airway and breathing. The exceptions to this would be where the airway is obstructed with fluid (water or blood) or particulate matter (sand, debris, vomit). In these instances, the casualty should be promptly rolled onto their side into the recovery position to clear the airway. The mouth should be opened and turned slightly downwards to allow any foreign material to drain using gravity • If breathing, the casualty is placed in the recovery position with the appropriate head tilt • In more serious incidents, assess the casualty. If unconscious or not breathing normally, commence resuscitation • Vomiting and regurgitation often occur during the resuscitation of a drowned casualty. Do not empty a distended stomach by applying external pressure. Do not attempt to expel or drain clear water or frothy fluid that may re-accumulate in the upper airway during resuscitation. Casualties who appear to have been successfully rescued and resuscitated require close monitoring to prevent a relapse into cardiopulmonary arrest. This can occur in the minutes or hours following the return of spontaneous circulation and breathing due to persisting lung damage and hypoxic injury to the heart. Even in the case of a successful rescue, the casualty still needs to be medically assessed and monitored. Hypoxemia causing brain damage is the major complication in drowning casualties who do not die. Direct lung tissue damage caused by water aspirated into the lung can also occur and may lead to pneumonia.
Circulatory system
The circulatory system comprises of the heart, blood and blood vessels (veins, arteries and capillaries). It is a complex circuit which enables blood to circulate throughout the entire body, transporting oxygen and nutrients to every cell in the body and collecting waste for elimination. The heart provides the pumping action to keep blood flowing throughout the body. The heart is a muscular organ about the size of a fist which acts as a two-sided pump, first relaxing and filling up with blood and then contracting to pump the blood to the arteries. Blood is made up of: • Plasma – About 55% of our total blood volume is plasma, it is a watery straw-coloured fluid in which the cells are suspended. • Red blood cells – carry oxygen • White blood cells –fight bacteria • Platelets – form clots to stop bleeding. Blood vessels
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• Arteries have thick, muscular elastic walls, they carry blood rich in oxygen and nutrients away from the heart. Arteries branch off forming arterioles with thinner walls that then become capillaries. If a wound lead to an artery or an artery is pierced, the blood is bright red and spurts in time with your heartbeat. • Veins have thin muscular walls and one-way valves that help move blood toward the heart. They carry blood low in oxygen and high in carbon dioxide from the cells back to the heart where it is pumped to the lungs so that the blood can pick up more oxygen. Venules are smaller veins that receive blood from capillaries. • Capillaries are microscopic vessels that surround the cells of the body and facilitate the movement of oxygen and nutrients into the cells and carbon dioxide and waste products away from the cells.
Angina Temporary chest discomfort that typically comes on with exercise or emotional stress. Usually lasts only a matter of minutes. Angina occurs because the narrowed coronary arteries are unable to supply the additional oxygen-carrying blood needed when the heart’s activity increases. Causes include exercise or emotional stress. Signs and symptoms: • Feeling of pressure, tightness or squeezing pain in the centre of the chest • Pain can be mild to severe • Pain or discomfort may spread to the either or both shoulders, back, neck, jaw and arms, or down the arm.
Management • Follow DRSABCD • Encourage the casualty to stop what they are doing and rest • Support the casualty to sit or lie down (whichever is more comfortable) • Ask them to describe their symptoms • Loosen any tight clothing • If rest alone does not bring rapid or effective relief, assist the casualty to take their prescribed medication (examples include Anginine table or Nitrolingual Spray) • Repeat the dose of medication if symptoms are not relieved in five minutes • If pain persists for longer than 10 minutes or the pain gets worse or is severe, call 000 for an ambulance • Don’t hang up; stay with the casualty until the ambulance arrives • Monitor breathing and be prepared to start CPR.
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Heart Attack A heart attack occurs when there is a sudden partial or complete blockage of one of the coronary arteries that supply the heart muscle. Because of the interruption of the blood supply, there is an immediate risk of life-threatening changes to the heart rhythm that may stop the heart beating effectively. This is a life-threatening emergency and action must be taken immediately by ringing 000. If the situation is not corrected quickly there is a risk of serious permanent heart muscle damage. A heart attack is different from, but may lead to, cardiac arrest. Cardiac arrest is a cessation of heart action. Signs and symptoms Can occur in a casualty without chest pain or discomfort as one of their symptoms. These casualties often present with shortness of breath, a choking feeling or their arms feel 'heavy' and ‘useless'. Some casualties believe that they have indigestion. In most casualties: • Chest pain or discomfort is persistent which may be sudden or come on slowly over minutes • Chest pain may be mild, moderate or severe • Chest pain is often described as tightness, heaviness, fullness or squeezing OR a crushing sense of pressure or burning the centre of the chest • Pain may spread to back, neck and arms • Sweating, shortness of breath • Nausea and or vomiting • Pale • Feeling dizzy or light headed. A typical chest pain does not have a heaviness or squeezing sensation or usual location. Those who often describe these are: • The elderly • Women • Persons with diabetes • Australian Indigenous population • Maori and Pacific Island people.
Management If the casualty has chest pain or discomfort similar to angina, but the pain is not relieved by medication and rest, the first aider should manage the casualty as having a heart attack.
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• Follow DRSABCD • If the casualty is conscious, get them to stop what they are doing and rest • Call 000 if symptoms get worse or last longer than 10 minutes. Don’t hang up • Support them in a sitting or lying position • Ask them to describe their symptoms • Loosen any tight clothing • Assist the casualty to take their prescribed medication • Stay with the casualty until the ambulance arrives • Assist the casualty to take 300 mg (1 tablet) of aspirin if available (unless they are allergic to this). If the casualty is unconscious and breathing place them in the recovery position.
Cardiac arrest A cardiac arrest happens when someone’s heart stops pumping blood around their body. They will lose responsiveness almost immediately and show no other signs of life, such as breathing or movement. It is a cessation of the electrical impulses of the heart. Cessation of heart action recognised by the absence of response, absence of normal breathing and absence of movement. If you see someone having a cardiac arrest, you need to act quickly as they’ll only have a chance of surviving if they receive lifesaving first aid immediately
Heart Failure Heart failure is an ongoing condition in which the heart cannot pump normally. It usually develops because of age or chronic heart disease. Signs and symptoms: • General feeling of tiredness • Breathlessness when exercising • Swollen feet, ankles, legs, abdomen and veins • Coughing and wheezing • Blue lips and extremities.
Management • Follow DRSABCD If the casualty is conscious: • Place in a sitting position • Reassure the casualty and loosen any tight clothing If the casualty becomes unconscious, follow DRSABCD and call 000 for an ambulance.
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A wound is an injury to the body that typically involves a laceration or breaking of a membrane such as the skin and usually damage to the underlying tissues. There are several different types of wounds including: • Abrasion: an open wound often caused by skin being scraped across a solid surface. The outer layer of skin and tiny underlying blood vessels are usually left exposed. • Laceration: an open wound where the skin and underlying tissue is damaged. This type of wound can be caused by machinery or bites. • Incision: a cut usually made by something sharp like a knife. It can cause the skin, tissue and muscles to be severed. • Puncture: is caused by a blunt or pointed instrument which affects the skin and underlying tissue. Regardless of the type of wound, the same management steps apply: • Control the bleeding • Clean the wound if possible and apply a non-adhesive dressing to prevent infection • Seek medical if necessary or if in doubt. If a wound is not bleeding, clean the wound thoroughly with soap or water or with sterile gauze soaked in saline or cooled boiled water if available. Then apply a non-adhesive dressing. Dirty, penetrating or open wounds should be examined by a doctor as tetanus or other serious infections may result.
Needle stick injuries Needle stick injuries are penetrating injuries caused by needles that puncture the skin and enter a tissue of the body, creating an open wound. If a needle stick injury has occurred at work, follow your workplace protocols. Immediate first aid response following needle stick injury: • Wash wound and skin sites that have been in contact with the needle stick with soap and running water • Do not squeeze or rub the injury site • Apply an antiseptic and a sterile dressing as necessary • Apply pressure through the dressing if bleeding is still occurring • Report the incident immediately to your supervisor or manager or notify your medical practitioner
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• Dispose of the needle/syringe safely.
Stay calm, do not squeeze Wash wounded area with warm Pat dry and apply antiseptic and Seek medical advice the wound water and soap dressing
If this has occurred at work, then you are required to document the incident as per organisation procedures. Bloods may be taken for hepatitis B, C, HIV and a Tetanus shot may be given. After any exposure incident involving blood and other body fluids/substances or contaminated materials, medical advice should be sought as soon as possible. A registered medical practitioner will assess the risk based on the risk factors and advise on the testing, treatment, counselling and follow up actions. High risk or complicated cases will be assessed by an infectious disease consultant.
Bleeding This is the loss of blood from the blood vessels. This can be external or internal (inside the body). With open wounds and blood loss the bleeding must be stopped, and the possibility of shock and infection must be considered. Bleeding from the major types of blood vessels: • Arteries - bright red and spurts o Management will include: rest, apply direct pressure, call 000 • Veins - dark red and flows o Management will include: rest, apply direct pressure, seek medical assistance • Capillaries – red and oozes o Management includes: wash and cover with a non-stick dressing.
Major bleeding causes These vary and include internal haemorrhage, trauma, car accidents, machinery, knives. Signs and symptoms: • Obvious blood (if external) • Faintness or dizziness • Restlessness • Nausea • Thirst
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• Weak, rapid pulse • Cold, clammy skin • Rapid, gasping breathing • Pallor • Sweating • Progressive loss of consciousness, (drowsy, irrational or unconsciousness).
Management • Follow DRSABCD • Use standard precautions including gloves • Control the bleeding • Lie the casualty down • Apply pressure on and around the wound to restrict the flow of blood and allow normal clotting to occur (use pad or dressing) • Call 000 for an ambulance • Maintain pressure on the pad (by hand, or by use of triangular bandage) • If bleeding continues apply a second pad and a tighter bandage over the wound • Restrict movement of the casualty • Minimise shock • Minimise the risk of infection – cover the wound with a sterile bandage if available • Check circulation below the dressing if on a limb to ensure that the bandage is not too tight. This could occur as swelling of the limb can make the bandage tighter • If there is impaired circulation such as paleness, blueness or coldness of fingers or toes, pins and needles or pain loosen the bandage. • Arterial tourniquet may be used for life threatening limb bleeding that is not controlled with pressure (ANZCOR guideline 9.1.1) According to the ARC there is no evidence that elevating a bleeding part will help control bleeding and there is the potential to cause more pain or injury.
Internal bleeding Internal bleeding can be difficult to recognise but should always be suspected where there are signs and symptoms of shock. Severe internal bleeding can result from injuries caused by a violent blunt force such as a car accident or fall from a height. It can also occur when an object, such as a knife, penetrates the skin and damages internal organs. Some conditions such as stomach ulcers can also result in internal bleeding.
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Signs and symptoms: • Pain • Tenderness • Sometimes swelling over or around the affected area • Rigidity of abdominal muscles • Coughing up red, frothy material • Shock – pale, sweating, faintness, cold, clammy skin • Bruising may be visible as the blood accumulates under the skin.
Management • Call 000 for an ambulance • Lie the casualty down or if the casualty is coughing up frothy blood, half sitting will be more comfortable • Raise the legs or bend the knees • Loosen any tight clothing • Do NOT give the casualty anything to eat or drink • Reassure the casualty • Manage shock.
Embedded Objects • If there is an obvious embedded object causing bleeding, use pressure around the object • Do not try to remove the embedded object because it may be plugging the wound and restricting bleeding • Do not apply pressure over the object • Apply padding around or on each side of the protruding object, with pressure over the padding • Seek medical aid and call 000 for an ambulance.
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Nose Bleed (Epistaxis) Nose bleeds can have various causes such as a blow to the nose, excessive blowing, high blood pressure or may have no obvious cause.
Management • The casualty should be sitting up with their head slightly forward to avoid blood flowing down the throat. This could cause choking. • Ask the casualty to breathe through their mouth • Pressure must be applied equally to both sides of the nose, over the soft part below the bony bridge (usually between the thumb and index finger) • Encourage the casualty to spit out blood rather than swallow it as blood is emetic and irritates the stomach, and may cause vomiting which can worsen the bleeding • The casualty should remain seated at total rest for at least 10 minutes • On a hot day or after exercise, it might be necessary to maintain pressure for at least 20 minutes • If bleeding continues for more than 20 minutes seek medical assistance.
Shock
Shock is caused by a lack of circulating blood volume. Causes include: • Loss of circulating blood volume (hypovolaemic shock) o Severe bleeding (internal and/ or external)
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o Major or multiple fractures or major trauma o Severe burns or scalds o Severe diarrhoea and vomiting o Severe sweating and dehydration. • Cardiac causes: o Heart attack o Dysrhythmias (abnormal heart rhythm). • Abnormal dilation of blood vessels o Severe infection o Allergic reactions o Severe brain/spinal injuries o Fainting. The physical injuries may not appear to be severe but if the blood volume is too low to meet the body’s needs and to remove the waste products, then it may result in life threatening consequences. Signs and symptoms: These may develop progressively depending on the severity of the injury, continuation of fluid loss or the lack of effective management. • Dizziness • Thirst • Anxiety • Restlessness • Nausea • Breathlessness • Feeling cold • Collapse • Rapid breathing • Rapid pulse which may become weak or slow • Cools, sweaty skin that may appear pale • Confusion or agitation • Decreased or deteriorating level of consciousness.
Management • Follow DRSABCD • Reassure the casualty
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• Call 000 for an ambulance • Have the casualty lie down • Treat any other wounds • Loosen any tight clothing at the neck, chest and waist • Maintain the casualty’s body warmth with a blanket or similar. Do not use any source of direct heat • Give small amounts of water frequently to the casualty who doesn’t have abdominal injuries and is unlikely to require an operation in the immediate future • Monitor and record breathing, pulse and skin colour at regular intervals • Place the casualty in the recovery position if there is breathing difficulty or the casualty become unconscious or is likely to vomit. The ANZCOR guidelines do not advocate raising the casualty’s legs as doing so may only be beneficial for a brief period of time (less than seven minutes).
Stroke
Previously known as a cerebrovascular accident, stroke is the second most common cause of death after heart disease. A stroke occurs when the supply of blood to the brain becomes blocked or ruptures. Brain cells are damaged, and functions controlled by that part of the brain become paralysed. Although many people make a good recovery, a stroke can be fatal. People most at risk of a stroke are those who are elderly, have a family history of stroke and/or have high blood pressure. Men are more likely to have a stroke than women.
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A stroke is a life- threatening emergency. Recognition: • Facial weakness: can the person smile? Has their mouth or eye drooped? • Arm weakness: Can the casualty raise both their arms? • Speech difficulties: can the casualty speak clearly and understand what you stay? • Time to act fast: seek medical attention. • Call 000 for an ambulance. Signs and symptoms: • Numbness of face, arm or leg on either side of the body • Difficulty swallowing • Dizziness, loss of balance or an unexplained fall • Loss of vision, sudden blurred or decreased vision in one or both eyes • Headache, usually severe and of abrupt onset or unexplained change in the pattern of headaches • Drowsiness • Confusion • Reduced level of consciousness.
Symptoms of stroke may appear similar to other conditions such as epilepsy, migraine or diabetes with low blood sugar. If in doubt over the diagnosis, the victim should be managed as having a stroke until proven otherwise.
Management • Follow DRSABCD • Call 000 for an ambulance for any casualty who has shown signs of stroke, no matter how brief or if symptoms have resolved. • Do not give anything to eat or drink • Provide reassurance • If conscious: o Support head and shoulders o Loosen tight clothing o Maintain body temperature
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o Wipe away secretions from the mouth o Ensure airway is open and clear and maintained • If unconscious: o And breathing place casualty into recovery position and monitor o If not breathing commence CPR.
Seizures and convulsions
Epilepsy Epilepsy is a disorder of brain function that involves recurring seizures. About four percent of the population will have epilepsy at some stage of their life and it presents as unique to every person. A seizure is a sudden, uncontrolled electrical discharge in a group of brain cells (neurons). During a seizure, neurons can fire up to five hundred times a second – more than six times the normal rate and for a brief period, this can cause strange sensations, emotions and behaviour or convulsions and loss of consciousness. Epilepsy and seizures are not the same thing! Epilepsy simply means that a person has a tendency to have recurrent (more than one) seizure. • Around 10% of people can expect to have at least one seizure in their lifetime, of these one third will later receive a diagnosis of epilepsy • Close to one percent of the population currently have epilepsy and four percent of people will be diagnosed with epilepsy at some time in their lives • One in 200 children live with epilepsy • The highest incidences of new diagnosis are in the over 60 age range and one in four people with a disability are likely to live with epilepsy • 65% of diagnosis of epilepsy have no known cause • Approximately 50% of people who have a seizure will not have another • 60-70% of people with epilepsy can expect seizure control with medication. Seizures may affect all or part of the body. Seizure activity may take many forms, and symptoms may include: • A cry or groan caused by air being forced past the vocal cords • Sudden spasm of muscles producing rigidity. If standing the victim will fall • Jerking movements of the head, arms and legs in a symmetrical rhythmic movement • Shallow breathing or breathing may stop temporarily • Dribbling from the mouth; the tongue may be bitten leading to bleeding • The casualty may become incontinent. (urine and/or faeces)
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• Changes in conscious state from being fully alert to confused, drowsy, or loss of consciousness • Changes in behaviour where the victim may make repetitive actions like fiddling with their clothes. These seizures (tonic-clonic seizures also known as Grand mal seizures) usually last from one to three minutes.
Management • Protect the casualty from injury by moving any hard objects from the area • Protect the casualty's head by placing something soft under their head and loosen any tight clothing • Stay with the casualty until the seizure ends and calmly talk to the casualty until they regain consciousness, usually within a few minutes • Gently roll the casualty on their side in the recovery position as soon as possible after the seizure or if they have vomited or have food or fluid in their mouth and maintain an open airway • Reassure the casualty that they are safe • Time the seizure. Do not: • Restrain the casualty’s movements • Force anything into their mouth • Move the casualty unless they are in danger • Give the casualty water, pills or food until fully alert • Disturb the casualty if they fall asleep. You will need to continue to monitor them. Call 000 for an ambulance if: • The seizure continues for more than five minutes • Another seizure quickly follows • The person has been injured • The person has diabetes or is pregnant.
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Absence seizures Previously called petit mal seizures, these are a brief, non-convulsive event, usually occurring in the young, and involves the whole brain. With this type of seizure, the person’s awareness and responsiveness are impaired. They simply stare, and their eyes might roll back or their eyelids flutter. It can be difficult to tell the difference between absence seizures and daydreaming. However, absence seizures start suddenly, cannot be interrupted, last a few seconds, and then stop suddenly and the person resumes what they were doing. Although these seizures usually last less than ten seconds, they can occur many times daily, and thus be very disruptive to learning. Transient symptoms can occur, such as loss of awareness or consciousness and disturbances of movement, sensation (vision, hearing and taste), mood or mental function and behaviour. Not all seizures are epileptic. Some seizures can be caused by head injury, high fever, brain tumour, poisoning (including drug overdose), serious infections or severe impairment of oxygen or blood to the brain.
Febrile convulsions Convulsions, usually brief, lasting no more than five minutes, may occur in infants and young children. A rapid rise in body temperature to even as little as 38.5 C T can cause them in infants and young children from six months to five years. Causes include illnesses that cause a rapid rise in temperature. Illnesses may include: • Middle ear infections • Flu • Chickenpox • Tonsillitis. Often the seizure is the first sign of a fever, so it is very difficult to prevent these convulsions. Signs and symptoms: • Fever • Muscle stiffening • Twitching or jerking of face or limbs • Eyes rolling upwards • Blue face and lips • Unconsciousness.
Management During the convulsion: • Place child on their side for safety • Do not restrain the child
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• Remove any objects that could cause harm After the convulsion: • Follow DRSABCD • Remove any excess clothing or wrappings • Seek medical aid, call 000 for an ambulance. Do not cool the child by sponging or bathing but remove excess clothing or wrappings.
Environmental impacts
Exposure to heat The body works efficiently only if it remains at a constant temperature between 36 C and 37 C. if the body temperature drops or rises more than a few degrees it cannot function properly. Factors which may contribute to heat induced illness include: • Excessive physical exertion • Hot climatic conditions with high humidity • Inadequate fluid intake • Infection (particularly a viral illness) • Inappropriate environments (e.g. unventilated hot buildings) • Wearing unsuitably heavy, dark clothing on hot days • Drugs that affect heat regulation.
Muscle cramps Muscle cramps are sudden and involuntary contractions of one or more of your muscles. Most cramps occur during exercise, at rest or at night. Causes include losing too much water and salt through sweating, dehydration, prolonged and overuse of the certain muscles and because of chronic neck and back pain.
Management • Ask the casualty to stop the activity and rest in a cool environment • Gently stretch the affected muscle • Massage gently if this assists in relieving pain • Place an ice pack on muscle area • Give cool water to drink.
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Heat Exhaustion Results from being physically active in a hot environment without taking the right precautions. Fluid loss through sweating reduces the amount of water in the body so that the blood volume falls, increasing blood flow to the skin. This in turn makes the blood volume even less effective, reducing blood flow to vital organs. The body goes into a mild form of shock. Signs and symptoms: • Feeling hot, exhausted, weak and fatigued • Persistent headache • Thirst • Nausea and or vomiting • Malaise • Giddiness and faintness • Rapid breathing and shortness of breath • Pale, cool, clammy skin • Rapid, weak pulse.
Management • Lie the casualty down in a cool place with circulating air • Loosen tight clothing and remove any unnecessary garments • Sponge the casualty with cold water, damp cloths or atomizer sprays • Give the casualty cool water in small amounts if conscious • Seek medical aid if the casualty vomits or does not recover promptly • The casualty's conscious state will become normal once they are lying down.
Heat Stroke Heat stroke is an uncommon but life-threatening complication of grossly elevated body temperature with exercise in heat stressed settings. The brain and other vital organs, such as the kidneys and heart, begin to fail. Those most at risk of heat stroke include infants left in closed cars on warm to hot days, athletes attempting to run long distances in hot weather, the elderly and the sick. Risk is highest with high temperatures and/or high humidity and/or vigorous activity. Signs and symptoms: • In a heat stressed setting always suspect heat stroke if a person becomes acutely unwell or collapses, especially if they don’t recover promptly by lying flat with the legs elevated. Whilst there are many possible causes of such an acute illness or collapse, heat stroke is one of the most important.
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• The first signs of heat stroke show in the function of the brain and the nervous system. Look for any of: confusion, incoherent speech, abnormal walking, coma or seizures. • The person’s skin may feel dry and hot, or sweaty—so the feel of the skin is not a useful sign. Similarly, on-field temperature measurement is unreliable, so don’t use this as a measure of heat stroke. First aid: If an ill person in a heat-stressed setting hasn’t rapidly responded to lying flat in the shade, there is no harm in assuming heat stroke is the problem and starting first aid. Early recognition and rapid first aid cooling are the keys to recovery from heat stroke.
Management Actions to take in this order are: • PLACE the person in a cool environment • STRIP the person of as much clothing as possible • SOAK with any available water • FAN vigorously by whatever means possible—improvise e.g. use a clipboard, bin lid • MOISTEN the skin with a moist cloth or atomiser spray and fan repeatedly • APPLY wrapped ice packs to neck, groin and armpits • CALL 000 to summon emergency services but do so once you are certain first aid cooling is being implemented. Remember it is early recognition and first aid in heat stroke that is critical to save a life.
Dehydration Dehydration is the loss of water and essential electrolytes in the body and happens when someone loses more fluid than they take in. Young children and older people are likely to get dehydrated more easily, so it’s especially important for them to drink plenty of water. If left untreated, someone with dehydration can develop heat exhaustion, which is more serious, so it’s important to make sure they rehydrate themselves as soon as possible. Dehydration can result from: • Severe diarrhoea and/or vomiting • Water deprivation • Burns • Heat exhaustion • Sweating a lot (e.g. athletes, being in extremely hot conditions or fever). Signs and symptoms: • Thirst • Dry lips and mouth
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• Headache • Dizziness and confusion • Cramp and tightness in muscles • Reduction in amount and frequency of urine • Urine is dark in colour.
Management • Assist the casualty into a cool, shaded place • Get casualty to stop all physical activity • Sit the casualty down • Check their conscious state • Gain their consent • Give clear fluids to sip if the casualty is conscious • If the casualty is vomiting, give ice chips/icy pole to suck • If suffering from cramps, stretch and massage the affected muscles • Reassure the casualty • Medical aid is required if the casualty is severely dehydrated and unable to take any fluids.
Exposure to cold To conserve body heat, blood vessels in the skin shut down to prevent the body’s core heat escaping. Wind and wet skin increases the effect of cold air, cooling the body even further. The body loses heat by radiation especially from the head, evaporation, breathing, conduction and convection. Certain groups of people are particularly prone to cold-inducted conditions. These include the elderly, babies and young children and anybody weakened by disease/ illness, starvation, fatigue or injury.
Hypothermia Occurs when the body’s warming mechanism fail or are overwhelmed, and the body temperature drops below 35 C. It has the potential to develop into a serious condition if not recognised and treated at an early stage. It occurs when a casualty is exposed to extended periods of exposure to cold conditions.
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Sometimes hypothermia is mistaken for other conditions such as drunkenness, a stroke or drug abuse. Signs and symptoms: When body temperature first drops, the signs are: • Feeling cold • Shivering • Pale, cool skin • Impaired coordination • Slurred speech • Apathy and irrational behaviour.
As the body temperature continues to drop:
• Shivering usually ceases • Increasing muscle stiffness • Slow, irregular pulse • Hypotension • Level of consciousness continues to decline.
Management • Follow DRSABCD • Call 000 for an ambulance • Move the casualty to a warm, dry place • Handle the casualty gently, avoiding activity or movement • Maintain the casualty in a horizontal position lying flat • Avoid excess activity or movement • Remove wet clothing if alternatives are available • Dry the casualty • Wrap the casualty in blanket or space blanket • Cover their head to maintain body heat • Give the casualty warm drinks if they are conscious • Provide warmth to the casualty: o Direct with body to body o Indirect; hot water bottles, external heating applied to neck, armpits, groin (caution must be taken to avoid burns)
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• Remain with the casualty until assistance arrives. The aim to is stabilise the core temperature rather than attempt rapid rewarming. If the casualty starts shivering, take measures to prevent further heat loss. • Rub the affected area • Use a radiant heat source such as fire or electric heaters • Give the casualty alcohol • Place the casualty in a warm bath.
Frostbite Frostbite occurs when the skin and underlying tissues become frozen as a result of exposure to below-freezing temperatures. This requires rapid but careful rewarming of the tissues. (A ‘cold’ burn is actually tissue damage from extreme cold and, accordingly, treatment is different from other burns. An example is when the skin touches and sticks to an extremely cold surface (eg. metal, ice) or comes into contact with liquefied gases (eg. LPG) resulting in rapid frostbite.) Signs and symptoms: When body temperature first drops, the signs are: • ‘Pins and needles’ to begin with • Paleness, followed by numbness • Hardening and stiffening of the skin • Change in skin colour: first white, then blotchy and blue. On recovery, the skin may be red, hot, painful and blistered. If they get gangrene, the tissue may become black due to the loss of blood supply and death of the tissue
Management • Follow DRSABCD • Move the patient to a warm, dry place. If the feet or legs are affected do not let the patient walk. • Gently remove the patient’s clothing and jewellery from the affected limb. Handle the frozen tissue very gently to prevent further tissue damage. • As soon as possible, put the whole affected limb in a bath of warm water between 0°C–42°C, for 15–30 minutes. The aim is to minimise tissue loss. Lower water temperature will be less beneficial to tissue survival; higher water temperatures may produce a burn wound and increase the injury. • Keep adding warm water to maintain a constant temperature. During rewarming, ask the patient to gently move the injured limb. Do not massage the affected area. • Keep the limb in the water until it is pink or does not improve any more. This may take up to 40 minutes and may be painful.
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• Keep the limb warm. Do not allow the limb to become refrozen. DO NOT break any blisters that form. • After rewarming, cover the injured area with a light, loose nonstick dressing, preferably clean, dry, nonfluffy material (eg plastic cling film). • Check the patient for shock, and treat if necessary
Diabetes
Is caused by a disorder of the pancreas. The pancreas produces insulin which converts the sugars absorbed into the bloodstream. The sugars are a result of the breakdown of foods by the digestive system. So, if the insulin production and function are impaired, sugar builds up in the blood and the cells do not get the energy they require. Diabetes is managed by diet and medication in the form of tablets or insulin injections. The administration of insulin is a specific skill. Most people living with diabetes have a glucometer which is a machine that measures the blood glucose level from a drop of blood. There are two types of diabetic emergencies. Very high blood sugar called hyperglycaemia and very low blood sugar called hypoglycaemia. The more common and immediately dangerous emergency is hypoglycaemia. It can develop quickly, and some people may not be aware of the early signs. It is commonly caused by a missed or delayed meal after the casualty taking their diabetic medication but can be due to too much medication and not enough food, incorrect type of food or unaccustomed exercise. Alcohol consumption also increases the likelihood of a ‘hypo’.
Hypoglycaemia There will normally be a fast onset of symptoms. Signs and symptoms: • Paleness • Hunger • Fatigue and weakness • Sweating • The casualty can appear to be drunk or even mimic the symptoms of a stroke • Even when there is alcohol on the casualty’s breath always consider the possibility of a ‘hypo’ if the level of consciousness is altered • Confusion • Aggression.
Management If the casualty is unconscious: • Follow DRSABCD
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• Give nothing by mouth • Call 000 for an ambulance • Place the casualty in the recovery position. If the casualty is conscious: • Give them sweet food or drink (not diet or sugar free) every 15 minutes until the casualty recovers or medical aid arrives • Follow these sweet foods with a sandwich or other food • If no improvement, call 000 for an ambulance. Any abnormal signs and symptoms in a person with diabetes should be considered as possibly caused by low blood sugar and sugar should be given. If the casualty has a high blood sugar emergency, then giving a sweet drink will not do undue harm.
Hyperglycaemia With hyperglycaemia there will normally be a slow onset of symptoms. It may result from the stress of another illness, such as a chest infection, or failing to take insulin correctly. Signs and symptoms: • Excessive thirst • Frequent need to urinate • Acetone smell on the breath of the casualty • Drowsiness • Hot, dry skin.
Management • Call 000 for an ambulance • If assistance is delayed, encourage the casualty to drink sugar free clear fluids • If unconscious: o Follow DRSBABCD o Give the casualty nothing by mouth o Call 000 for an ambulance o Place the casualty in the recovery position.
Musculoskeletal system
The musculoskeletal system consists of bones, muscles, ligaments and tendons which support the body, protect the internal organs and allow the various parts of the body to move. Musculoskeletal injuries that require first aid include:
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• Sprains and strains • Dislocation • Fractures.
Sprains and strains A sprain occurs when the ligaments holding a joint together are stretched and torn. This happens when a joint is forced to move beyond its normal range. A strain is where the fibres of a muscle or tendon are stretched and torn. Signs and symptoms: • Pain from a sprain may be intense • The casualty’s ability to move the joint is restricted • Swelling around the joint • Bruising develops quickly.
Management Follow DRSABCD and apply R.I.C.E:
• Rest the casualty and the injured part • Apply an ice pack wrapped in a damp cloth or a cold compress for 15 minutes, every two hours for 24 hours, then for 15 minutes every four hours for 24 hours • Apply a Compression bandage firmly to extend well beyond the injury • Elevate the injured part • If the application of the ice pack does not help, seek medical aid • Refer the casualty to a medical professional for follow up treatment.
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Dislocation A dislocation occurs when one or more bones are displaced at a joint, most commonly at the shoulder, elbow, kneecap and fingers. It occurs when a strong force acts directly or indirectly on the joint and wrenches the bone into an abnormal position. It always results in tearing of the ligaments which normally hold the joint in the connected position. At times, the force may be strong enough to cause a fracture and damage nearby nerves and blood vessels. Signs and symptoms: • Pain at or near the site of the injury • Difficult or impossible to move the joint • Loss of power • Deformity or abnormal mobility • Tenderness • Swelling • Discoloration and bruising.
Management • Follow DRSABCD • DO NOT attempt to reduce the dislocation • Call 000 for an ambulance if alignment is required or the circulation below the dislocation is impaired • Rest and support the limb using soft padding and bandages • Apply icepacks directly on the injury/joint if possible • IF IN DOUBT, manage as a fracture.
Fractures A fracture is a break in the continuity of bone and is defined according to the type and extent. Types of fractures: • Complete: A complete fracture is where the bone is broken into at least two parts and may be transverse, spiral or oblique • Greenstick: The fracture may extend only partway through the bone, splitting the bone on one side and bending it on the other. These occur in children when the bones are soft and pliable • Comminute: is a fracture where there are more than two fragments
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• Open/Compound. The skin over the bone will be broken and on occasions the bone may be protruding from the skin. There is a danger of infection from this type of fracture; • Closed: When a fracture is closed, the skin over the bone is not broken but there may be bleeding in the underlying tissue. Damage may occur to muscles and blood vessels as the area may swell due to internal bleeding; • Complicated: Both open and closed fractures may be complicated when there is injury to major nerves, blood vessels, or organs e.g. a broken rib puncturing a lung. Causes: Fractures are caused by either direct or indirect force. If a bone breaks at the point where it received the blow, it is a direct fracture. An indirect fracture would be where the force of a blow travels through a part of the body and cause a fracture elsewhere. An example is if you fall and use your hand to break the fall, the force may travel along your arm and fracture your elbow or collarbone. These can also occur when a muscle pulls violently on a bone, separating a fragment. Complications: Any fracture can be complicated by injury to adjoining muscles, blood vessels, nerves and organs. Fractures of large bones usually result in considerable blood loss and shock. Signs and symptoms: • Pain at or near the site of injury • Swelling • Tenderness at or near site of fracture • Redness • Loss of function • Deformity • The casualty feels or hears the break occur • Coarse grating sound is heard or felt as the bones rub against each other (crepitus). Aims of Fracture Management: • Immobilise the injured part to lessen the pain • Reduce serious bleeding and shock • Prevent further internal or external damage • Prevent a closed fracture from becoming an open fracture.
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Management
Splints Splints are used to restrict or immobilise the movement of an injured limb to prevent further injury. General principles are: • Splint the injury as closely as possible to the anatomically correct position • Make sure the splint extends beyond the injured area in both directions • Apply broad bandages above and below the injured area • Immobilise the joints above, and below, the injured area • Pad the splints to reduce discomfort and prevent further injury • Check the casualty‘s circulation regularly. For example, for a fractured forearm, cardboard, newspaper or magazines can be used. These can be placed under the fracture as a means of support. Place the limb in a full arm sling. A fractured finger can be splinted by taping to the next finger.
Management: • Follow DRSABCD • Assist the casualty to remain as still as possible • Control any bleeding and cover any wounds • Check for any other fractures • Immobilise the fracture with broad bandages to prevent movement at the joints above and below the fracture by: o Supporting the limb carefully pass bandages under the natural hollows of the body o Placing a padded splint along the injured limb o Place padding between the splint and the natural contours of the body and securing firmly o For a leg fracture, immobilise the foot and ankle. • Watch for signs of loss of circulation to foot or hand by checking the circulation for colour and warmth • Check that the bandages are not too tight every 15 minutes. Abnormal colour such as pallor or blue tinge and toes or fingers being cooler than the other arm or leg are indications that the bandages are too tight • Handle gently • Observe the casualty carefully • Manage shock and seek medical aid.
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Slings Slings are used to support broken bones in the upper limbs. Collar and cuff Using a narrow bandage or sling for fractures of upper arm or an injured hand or to stabilise a shoulder: • Make a clove hitch using a narrow bandage • Put the loops over the wrist of the injured arm • Gently elevate the injured arm against the casualty’s chest • Tie the bandage ends together around neck using a reef knot positioned in the hollow of the collarbone. Full arm sling These slings are used to support a fractured forearm or wrist: • Place an open triangular bandage between the chest and injured arm, with one end of the base length over the uninjured shoulder and the other end pointing towards the ground. The point of bandage should be near the elbow • Bring the injured forearm slightly above the horizontal position • Tie the lower end of the bandage to the upper end in the hollow above collarbone on the injured side • Carefully arrange the bandage so that the casualty's fingers are showing • Bring the point of the bandage to the front of the elbow of the injured arm and secure with a safety pin • Check the circulation of the casualty's fingers. Improvised slings • If no sling or bandage is available, then the bottom of a jacket or shirt, belt or neck tie can be used, or • Place the hand of the casualty inside a partially buttoned up shirt or jacket.
Head, Neck and Spine injuries
Head injuries The skull may be fractured by either a direct force (a blow to the head) or indirect force such as a fall from a height where the casualty lands heavily on their feet. Severe injuries may cause multiple cracking (an ‘eggshell’ fracture) which may extend to the base of the skull.
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When a casualty has a serious head injury, the neck or spine may also be injured. A casualty with a head or spinal injury, including any injury to the neck, must receive urgent medical aid. A casualty may sustain a significant head injury without loss of consciousness or loss of memory (amnesia). Therefore, loss of consciousness or memory loss should not be used to define the severity of a head injury or to guide management of the injury. The initial first aid for a victim with head injury includes assessing and managing the airway and breathing, whilst caring for the neck until expert help arrives.
The Alert, Voice, Pain, Unresponsive, Treat (AVPU) Scale The AVPU scale is a system you can use to measure and record the level of consciousness of casualties with head injuries. It is commonly used by health professionals. • Alert: Is the casualty alert? Are their eyes open and do they respond to questions? • Voice: Does the casualty respond to your voice and can they answer simple questions and respond to instructions? • Pain: If the casualty is not alert or responding to your voice, do they respond to pain? • Unresponsive: Does the casualty respond to questions or a gentle shake? • Treat the casualty as per their response.
Concussion This is an altered state of consciousness usually caused by a blow to the head or neck. The casualty may become unconscious, but this is often momentary. Common causes include care accidents, falls and sports injuries. Signs and symptoms: • Dazed • Confused • Headache • Dizziness.
Management • Follow DRSABCD • Check for loss of consciousness and mental awareness • Keep the casualty awake • Be aware that complaints can subside only to appear later. The casualty usually recovers quickly but there is always the possibility of serious brain injury.
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Compression This is excess pressure on a part of the brain. It may be caused by a depressed skull fracture where the broken bones put pressure on or directly damage the brain, or by a build-up of blood inside the skull. If a blow to the head causes bleeding in the brain, or on the surface of the brain, and the blood cannot drain from the closed space, it builds up and puts pressure on the brain.
Assessment of Head Injuries It is often very difficult to make an accurate assessment of the severity of a head injury. Therefore, no head injury should be disregarded or treated lightly. As there is the possibility that complications will develop later, the casualty should always be advised to seek medical aid. The cause of the injury is often the first indication of its severity. If the casualty temporarily loses consciousness, but does not have any apparent after effects, the first aider should assume the potential for hidden injury and advise the casualty to seek medical aid promptly. Signs and symptoms: • Headache • Loss of memory (particularly of the event) • Confusion • Altered or abnormal responses to commands and touch • Wounds to the scalp or face • Nausea and/or vomiting • Dizziness. In more complicated injuries, signs include: Blood or clear fluid escaping from nose or ears. If the base of the skull is fractured there may be no obvious sign or injury, but cerebrospinal fluid or blood may escape through the ears, and/or: • Pupils becoming unequal in size • Blurred vision • Loss of vision • Altered or abnormal responses to commands and touch
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Management • Follow DRSABCD • Call 000 for an ambulance if there has been a loss of consciousness or altered consciousness at any time, no matter how brief • If conscious, place the casualty in a comfortable position with their head and shoulders slightly raised • Support the casualty’s head and neck in a neutral alignment during any movement and avoid any twisting movement • If the casualty is unconscious, place in them in the recovery position: o Clear and open the airway o Monitor the casualty's breathing • Control any bleeding but do not apply direct pressure to the skull if you suspect a depressed fracture • If blood or fluid comes from the ear, cover the ear with a sterile dressing and lie the casualty on their injured side (only if possible) to allow the fluid to drain • Call 000 for an ambulance. Note the casualty’s condition so that you can report it to the paramedics.
Spinal injuries The spine is a flexible column of 33 separate bones which surround and protect the spinal cord. Cerebrospinal fluid surrounds and cushions the spinal cord against the stresses of movement. Injuries to the spine may impact on the spinal cord which can result in complete and permanent loss of feeling and paralysis below the point of injury. If this occurs, the casualty may become a paraplegic or quadriplegic. Causes of spinal injuries include falls from a height, a direct blow to the spine, diving or surfing accidents and car or motorcycle accidents. Spinal injuries are always serious and must be treated with great care. Incorrect handling of a casualty with a spinal injury can result in paralysis. Signs and symptoms: • Pain at or below the site of injury • Tingling, numbness in the limbs and area below the injury • Tenderness over the site of injury • Weakness or inability to move the limbs (loss of function) • Headache or dizziness • Head or neck in an abnormal position
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• Altered conscious state • Signs of an associated head injury • Change in muscle tone, either flaccid or stiff.
Management • Call 000 for an ambulance • Manage the casualty's airway, breathing and circulation • Immobilising the spine is the priority for any casualty with a suspected spinal injury • Support the head and neck in a neutral position by placing your hands on either side of the casualty’s head • If the casualty is unconscious, the airway takes priority and must be kept open. Place the casualty into the recovery position supporting the head, neck and spine in a neutral position at all times Consider the H.A.IN.E.S. technique. o The modified H.A.IN.E.S. Recovery Position (H.A.IN.E.S. is an acronym for High Arm IN Endangered Spine), offers an even better alternative for airway and spinal protection for the ‘Unconscious, Suspected Spinal Injured’ casualty. This *clinically researched position not only protects the casualty’s airway, but also significantly reduces the amount of side-ways movement (lateral flexion) of the head and neck. • Otherwise DO NOT move the casualty unless they are in danger of further injury.
Neck injuries As the neck is part of the upper spine, all management points for spinal injuries are also relevant for neck injuries. Manage neck injuries as you would manage spinal injuries.
Crush injuries A crush injury may result from a variety of situations including vehicle entrapment, industrial accident or when something large and heavy strikes or falls on a person. The damage these injuries may cause include internal bleeding, fractures, rupture of internal organs and impairment of the blood supply, and therefore are potentially life-threatening.
Management • Follow DRSABCD • Call 000 for an ambulance • Ensure your OWN safety • Remove the crushing object as soon as possible (if safe and you can to do so) • Control any bleeding • Manage other injuries
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• Keep the casualty warm • Comfort and reassure the casualty. Although the casualty may appear to be alert and not distressed, there is a risk of deterioration, so ongoing reassessment of the casualty’s condition is essential. A casualty may not complain of pain and there may be no external signs of injury. All victims who have been subjected to a crush injury, including their own body weight, should be taken to hospital for immediate investigation. DO NOT leave the victim except if necessary to call an ambulance. DO NOT use a tourniquet for the first aid management of a crush injury.
Abdominal injuries
Organs in the abdomen can easily sustain an injury because there is no bone structure to protect them. The liver, spleen and stomach tend to bleed easily and profusely, so injuries to them can be life-threatening. Injury to the bowel may result in the contents being spilled into the abdominal cavity, causing infection. An injury to the abdomen can be open or closed. Both are serious as even in a closed wound an organ can be ruptured, causing serious internal bleeding and shock. With an open injury, abdominal organs can protrude through the wound. Signs and symptoms: • Severe pain • Nausea and/or vomiting • Bruising and tenderness around the wound • Shock or unnatural paleness • External bleeding • Blood in the urine • Distension/swelling of the affected area • Protrusion of intestines through an abdominal wound • Signs and symptoms of internal bleeding.
Management • Follow DRSABCD • Place the casualty on their back with their knees slightly raised and supported (a pillow may be used under the knees and head for comfort) • Loosen clothing
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• Cover any protruding organs with aluminium foil or plastic food wrap or a large non-stick sterile dressing soaked in sterile saline (clean water if saline is not available) • Secure dressings with a broad bandage (not tightly) • Call 000 for an ambulance. DO NOT give the casualty anything to eat or drink. DO NOT try to push organs back into the abdomen. DO NOT apply direct pressure to the wound.
Ear injuries
Ear injuries can be sustained by a variety of causes. Incidents such as sports injuries and falls can cause bleeding, while a direct blow to the head or pushing something into the ear may result in internal injury to the ear drum. If the external area of the ear is bleeding control this by applying direct pressure. If there is bleeding from within the ear:
Management • Follow DRSABCD • Allow fluid to drain freely • Place the casualty on their side with the affected ear down • Place a sterile pad between the ear and the resting surface • Call 000 for an ambulance. DO not plug the ear canal. Do not administer drops of any kind.
Eye injuries
General eye injuries Causes of eye injuries may include: • Blunt blows • Trauma from fingernails • Cuts from paper • Foreign objects such as dust or grit • Damage from burning chemicals or fluids. Examination of the eye may be difficult because of spasm, swelling or twitching, discharge or injuries to eyelid or face.
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Management • Wash your hands thoroughly and put on gloves. Remove any powder from the gloves by washing them • DO NOT attempt to remove an embedded object in the eye, or is protruding from the eye • Cover the injured eye with one or more sterile pads, avoiding touching any protruding object • Never put direct pressure on the eyeball • Seek medical aid quickly • Warn the casualty of a reduced depth of sight perception due to one eye being covered • The casualty should avoid driving.
Penetrating eye injury Usually caused by a sharp object which has gone inside the eye or is protruding from the eye. The injury may cause serious damage and infection if not managed appropriately. If the casualty vomits, the severity of the injury is increased by the pressure caused by vomiting. Management • Follow DRSABCD • Lie the casualty on their back • DO NOT attempt to remove the object • Place pads around the object or paper cup over the injured eye • Bandage the dressing in place • Call 000 for an ambulance. DO NOT give food or drink to the casualty. Ensure there is no pressure on the eyeball.
Foreign object Foreign objects include eyelashes, grit, glass, cosmetics, metal particles and insects.
Management • Warn the casualty not to rub their eye as this may damage the cornea or other parts of the eye • DO NOT remove any foreign object if the injury is severe. If the object is small, it may be washed out by natural tears. If tears do not rid the eye of the foreign object: • Ask the casualty to look up
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• Gently draw the lower lid down and out • If the object is visible: o Remove the object by using the corner of a clean, moist, cloth, gauze or cotton bud If the object is not visible: • Ask the casualty to look down • Gently grasp the lashes of the upper eye lid and pull the eye lid down and over lower lid • If unsuccessful: o Wash the eye with a gentle stream of sterile saline or clean water • If all unsuccessful: o Manage as an embedded object. DO NOT remove a foreign object from a cornea. DO NOT remove any object embedded in, or protruding from, the eye. DO NOT persist in examining the eye if the injury is severe.
Embedded object This is an object that cannot be easily removed by flushing the eye. DO NOT try to remove the object.
Management • Follow DRSABCD • Cover the injured eye with an eye pad or clean dressing • Call 000 for an ambulance.
Burns
Burns are injuries to the skin and underlying tissues caused by heat, extreme cold, chemicals, corrosive substances, electricity, friction, radiation or sunlight. Burn injuries are usually extremely painful and the risk of infection is high. Although there is no bleeding, burn injuries result in fluid loss, loss of temperature control and damage of varying degrees to underlying layers of tissue and nerves. There may also be damage to the casualty’s respiratory system and eyes. The probability of the casualty going into shock is very high. Besides the obvious physical damage, burns also cause psychological damage as they can disfigure and disable the casualty resulting in an altered body image.
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Various causes of burns: https://resus.org.au/guidelines/ 9.3.6 Radiation Thermal Friction Electrical Chemical Most common is Fire (flame) or steam Heat generated when Electrical energy from Most common sunburn skin rubs on materials the mains or lightning chemicals in the home Hot objects or liquids in such as rope or carpet can produce very that cause burns are: direct contact with the serious burns. pool acid, caustic soda, body bleach, paint strippers, Can produce entry and garden chemicals exit wounds . The definition of a significant burn is: • Burns greater than 10% of total body surface area (TBSA) • Burns to specific areas such as the face, hands, feet, genitalia, perineum, and major joints • Full-thickness burns greater than 5% of TBSA • Electrical burns • Chemical burns • Burns with an associated inhalation injury • Circumferential burns of the limbs or chest • Burns in the very young or very old • Burns in people with pre-existing medical disorders that could complicate management, prolong recovery, or increase mortality • Burns with associated trauma. All infants and children with burns should be medically assessed.
Management • DO NOT apply lotions, ointments or oily dressings • DO NOT prick or break blisters • DO NOT give alcohol • DO Not overcool the casualty (particularly if young or if the burn is extensive) • DO NOT use towels, cottonwool, blankets or adhesive dressings directly on the wound • DO NOT remove clothing stuck to burn area. When to seek medical aid • The burn involves the airway • The burn involves hands, face, feet or genitals • The burn is deep, even if the casualty does not feel any pain
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• You are unsure of the severity of the burn • The superficial burn is larger than a 20-cent piece.
Thermal burns Initial approach: • Ensure safety for rescuers, bystanders and the casualty • Do not enter a burning or toxic atmosphere without appropriate protection • Stop the burning process (Stop, Drop, Cover and Roll) • Smother any flames with a blanket • Move away from the burn source to a safe environment as soon as possible • Assess the adequacy of the casualty's airway and breathing • Check the casualty for other injuries.
Management The aim of first aid treatment of burns should be to stop the burning process, cool the burn and cover the burn. This will provide pain relief and minimise tissue loss. • Follow DRSABCD • Remove the casualty from the fire • Stope the casualty moving around • Drop the casualty to the ground and wrap in a blanket, coat etc. o Do not use anything made of nylon or other synthetic materials o Roll the casualty along the ground until the flames are smothered • IMMEDIATELY cool burns with cool running water for a minimum of 20 minutes • Remove all rings, watches, jewellery or other constricting items from the affected area without causing further tissue damage • Remove wet, non-adherent clothing as clothing soaked with hot liquids retains heat • Cover the burnt area with a non-adherent dressing, plastic wrap, clean dressing or loosely applied aluminium foil • Cover the unburnt areas and keep the rest of the casualty warm to reduce the risk of hypothermia • Where feasible, elevate the burnt limbs to minimise swelling • DO NOT peel off adherent clothing or burning substances • DO NOT use ice or iced water to cool the burn as further tissue damage may result • DO NOT break blisters • DO NOT apply lotions, ointments, creams or powders other than hydrogel
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• Seek medical aid urgently.
Radiation burns Sunburn is the most common type of radiation burn. Other radiation burns may be caused by therapeutic treatment, x-rays, welding equipment and radioactive material.
Management of severe sunburn: • Rest the casualty in a cool place • Place the casualty under a cold shower, in a cold bath or sponge them with cold water • Apply cool gauze to the burn area • Give cool drinks • Seek medical aid for young babies and casualties with blisters.
Chemical burns Chemical burns are often caused by chemicals used in industry but can also result from chemical agents used in the home. Safety Data Sheets (SDS), also known as Material Safety Data Sheets (MSDS), should be available for all chemicals used in an industrial area. These documents include first aid information specific to the chemical and include information relevant to eye contact, skin contact, inhalation and ingestion. A caustic chemical will continue to burn while in contact with the skin. Therefore, it is very important to remove the chemical from the skin as quickly as possible. Chemical burns to the eyes can cause permanent damage and loss of sight. If a chemical is splashed into the eyes, gently irrigate with running water for 20 minutes.
Management The aim of first aid for chemical burns is not to cool the burn but to dilute the chemical. • Avoid contact with any chemical or contaminated material by using appropriate personal protection equipment (PPE) • Remove the casualty to a safe area • Remove the chemical and any contaminated clothing and jewellery as soon as practical • Brush powdered chemicals from the skin • Without spreading the chemical to unaffected areas, IMMEDIATELY run cool running water directly onto the area for up to one hour or until the stinging stops • Apply a non-adherent dressing even if no burn mark is obvious • Refer to instructions on the container for further specific treatment • If available, refer to the SDS or MSDS for specific treatment (in hard copy or on the internet)
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• Call the Poisons Information Centre for further advice on 131126. This is a central phone number and is open 24 hours a day seven day a week • DO NOT attempt to neutralise either acid or alkali burns because this will increase heat generation which may cause more damage • DO NOT apply cling wrap or hydrogel dressings to chemical burns • If the chemical enters the eye: o Tilt the casualty's head back o Protect the uninjured eye o Open and flush the affected eye(s) thoroughly with water for as long as can be tolerated (minimum 20 minutes) o Keep the eye open with fingers o Cover the eye with a sterile or clean non-adherent dressing o Refer the casualty for urgent medical attention o If only one eye is affected, flush with the head positioned so the affected eye is down to avoid the spread of the chemical to the unaffected eye o The flushing of the eye is more important than immediate transfer for medical care.
Inhalation Burn Always assume an inhalation injury if there are burns to the face, nasal hairs, eyebrows or eyelashes, or if there is evidence of carbon deposits in the nose or mouth. Coughing up of black particles in sputum, a hoarse voice and/or breathing difficulties may indicate damage to the airway. An inhalation burn should be suspected when an individual is trapped in an enclosed space for some time with hot or toxic gas, steam or fumes produced by a fire, chemicals, etc. An inhalation injury may also result from irritant gases such as ammonia, formaldehyde, chloramines, chlorine, nitrogen dioxide or phosgene. These agents produce a chemical burn and an inflammatory response. Do not assume the burn casualty is stable following an inhalation injury simply because the casualty is breathing, talking and able to stand and walk. Some agents produce delayed pulmonary inflammation which may develop up to 24 hours later.
Management • Remove the casualty to fresh air • Assess and manage the casualty's airway • Give oxygen to the casualty if available and if you are trained to do so • Call 000 for an ambulance.
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A poison is a substance (other than an infectious substance) that is harmful to human health. They may be found in medication, household substances and industrial products. Poison may enter the body by: • Ingestion • Inhalation • Absorption • Injection Recognition of poisoning may be obvious from the circumstances of the incident, but this is not always true. A person may complain of physical symptoms without realising these are due to a poison. Alternatively, they may exhibit abnormal behaviour, which may be misinterpreted as alcoholic confusion or psychiatric disturbance. Poisons may have a rapid effect, but their effects may also be delayed. Speed of effect is determined by the nature of the poison, the concentration, and the time of the exposure. It is important to seek medical assessment or advice after significant exposure to a poison, even if symptoms are initially mild or absent. Signs and symptoms: The signs and symptoms of poisoning depend on the nature of the substance and in some cases, how it entered the body. Any of the following may occur: • Abdominal pain • Burning pain from mouth to stomach • Burns around and inside the mouth • Altered consciousness • Nausea and/or vomiting • Bite or sting marks • Contamination of the skin • Odours on the breath • Change of skin colour (including blueness around lips) • Difficulty breathing • Headache • Sudden collapse • Seizures.
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Management • Follow DRSABCD • Call 000 for an ambulance • Call the fire services if the atmosphere is contaminated with smoke or gas • With a conscious casualty, listen to the history of the incident and give reassurance • Determine the nature of the substance, and if possible, record the details
• Call the Poisons Information Centre for further advice on 131126. This is a central phone number and is open 24 hours a day, seven days a week. If poison is swallowed: • Give the casualty a sip of water to wash out their mouth • Do NOT let them swallow the water, make them spit it out • DO NOT try to make them vomit. If the poison is inhaled: • Immediately get the casualty to fresh air, without placing yourself at risk • Avoid breathing fumes. Special breathing apparatus may be required, for example, with cyanide or agricultural chemicals poisoning. If the poison enters the eye: • Flood the eye with saline or cold water from a running tap or other vessel • Continue to flush for 15 minutes, holding the eyelids open If the poison contacts the skin: • Remove any contaminated clothing, taking care to avoid contact with the poison • Flood the skin with cold running water • Wash the area gently with soap and water and rinse well. Note: DO NOT try to induce vomiting. If the casualty does vomit, you should send as much of the vomit to the hospital with the casualty. Note: DO NOT give the casualty anything to eat or drink.
Envenomation
Envenomation is the process by which venom is injected into a person by the bite or sting of a venomous animal. These include insects, spiders, snakes and some marine life.
Bites and stings Bites and stings fall into four main categories: INSECTS SPIDERS - SNAKES MARINE
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Management • Follow DRSABCD • Lie the casualty down • Calm the casualty • Apply management as outlined below: o Vinegar: used for box jellyfish, irukandji jelly fish, tropical marine jellyfish and stings of unknown origin. Pour for at least 30 seconds. Use a wrapped icepack if vinegar is not available. Never use freshwater
o Hot water: used for stings from blue-bottle jellyfish, bullrout fish, catfish, crown of thorns starfish, stingray, stonefish and non-tropical minor jellyfish
o Pressure immobilisation: used to treat stings from blue-ringed octopus, sea snakes, cone-shells, mouse spiders and funnel web spiders
o Cold compress or ice: used for bees, wasps, ants, ticks, scorpions, centipedes, redback spiders and all other spiders.
Funnel web spiders Signs and symptoms: • Pain at the bite site, but little local reaction • Tingling around the mouth • Profuse sweating • Copious secretions of saliva • Abdominal pain • Muscular twitching • Breathing difficulty • Confusion leading to unconsciousness. NOTE: life threatening effects may occur within 10 minutes.
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Management • Call 000 for an ambulance • Use the pressure immobilisation bandage technique (outlined below) • Antivenom is available for funnel web spider envenomation.
Redback spider Signs and symptoms: • Immediate pain at the bite site • The bite site becomes hot, red and swollen • Nausea, vomiting • Abdominal pain • Profuse sweating especially at the bite site • Swollen and tender glands in the groin or armpit of the envenomated limb.
Management • Keep the casualty under constant observation • Apply a cold compress or ice to lessen the pain (for periods no longer than 20 minutes) • Transport the casualty to a medical facility, preferably by ambulance • Seek medical aid promptly • The pressure immobilisation bandage technique is not used as the venom acts slowly and any attempt to retard its movement tends to increase local pain • Antivenom is available for Redback spider envenomation.
Bees, wasps, ticks Single stings from a bee, wasp or ant, while painful, seldom cause serious problems except for persons who have an allergy to the venom. Multiple insect stings can cause severe pain and widespread skin reaction. Stings around the face can cause serious inflammation and difficulty breathing even if the person is not known to be allergic. It is important to remember that bee stings with the venom sac attached continue to inject venom into the skin, whilst a single wasp or ant may sting multiple times.
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Signs and symptoms: • Minor: o Immediate and intense local pain o Local redness and swelling • Major: o Allergic reaction/anaphylaxis o Abdominal pain and vomiting
Management • Follow DRSABCD • Apply a cold compress to the affected area • If severe allergic reaction occurs: o Call 000 for an ambulance o If the casualty is carrying medication such as an EpiPen, it should be used immediately.
Bee stings • Remove the sting. Scrape the sting sideways with a fingernail or the side of a sharp object (such as the edge of a credit card).
Ticks: Allergic reactions to ticks range from mild, with swelling and inflammation (at the site of a tick bite), to severe (anaphylaxis). To prevent allergic reactions to ticks it is important that ticks are not forcibly removed or touched. Disturbing a tick may cause more allergen-containing saliva to be injected by the tick. To avoid health problems associated with tick bites, leave the tick in place and seek medical assistance to remove the tick. ANCOR Guideline 9.4.3 states “In the case of tick bite, if there is no history of tick allergy, immediately remove the tick. If the victim has a history of tick allergy, the tick must be killed where it is, rather than removed
Marine bites Australia’s tropical waters contain many animals whose stings can be life-threatening. These include jellyfish, blue ringed octopus, cone-shells, sea snakes, scorpions, stingray and stonefish.
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Box jellyfish
Management • Follow DRSABCD • Call 000 for an ambulance • Calm the casualty if required • Flood the sting area with vinegar for at least 30 seconds to neutralise the stinging cells and to prevent further envenomation • DO NOT wash the area with fresh water as this will cause additional nematocyst (a minute capsule containing an ejectable thread that causes a sting) discharge • If no vinegar is available: o flick off any remnants of the tentacles with a stick o wash the area well with seawater • Remain with the casualty until medical aid arrives • Keep the casualty at rest to decrease absorption of the toxin. NOTE: After flooding the area in vinegar for 30 seconds, apply a cold pack to provide pain relief. (Do not apply hot water.)
Blue bottle Signs and symptoms: • Stings cause immediate pain usually lasting 30 minutes • Typical oval-shaped blanched wheals • Surrounding redness of the skin • Possible envenomation syndrome with muscle pains, nausea and vomiting.
Management • Pick off any adherent tentacles with fingers (this has been shown not to be harmful to the rescuer) • Rinse the stung area well with seawater to remove invisible stinging cells • Place the casualty’s stung area in hot water for 20 minutes • If local pain is unrelieved by heat, or if hot water is not available, apply a cold pack.
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Blue-ringed octopus Bites usually occur when the octopus is removed from the water and is in contact with exposed skin. Not every bite result in envenomation. Signs and symptoms: • May not be painful • A spot of blood on the skin may be the only sign • Tingling around the mouth • Mild weakness • In severe cases, paralysis including respiratory paralysis
Management • Follow DRSABCD • Calm the casualty if required • Use the pressure immobilisation bandage technique (outlined below) • Splint the affected limb • Ensure the casualty does not move • Call 000 for an ambulance.
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Snakes
Many of the snakes found in Australia are capable of lethal bites to humans. These include Taipans, Brown snakes, Tiger snakes, Death Adders, Black snakes, Copperhead snakes, Rough Scaled snakes and many sea snakes. Snakes produce venom in modified salivary glands and the venom is forced out under pressure through paired fangs in the upper jaw. Signs and symptoms: • The bite may be painless and without visible marks. • Paired fang marks, but often only a single mark or a scratch mark may be present (localised redness and bruising are uncommon in Australian snake bites) • Headache • Nausea and vomiting • Occasionally, initial collapse or confusion followed by partial or complete recovery • Abdominal pain • Blurred or double vision, or drooping eyelids • Difficulty in speaking, swallowing or breathing • Swollen or tender glands in the groin or the armpit of the bitten limb • Limb weakness or paralysis • Respiratory weakness or respiratory arrest. Note: Life-threatening effects may not be seen for hours. However, when massive envenomation occurs, especially in children, symptoms and signs may appear within minutes.
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Management • Keep the casualty at rest • Use the pressure immobilisation bandage technique (outlined below) • Splint the bandaged limb • Either call 000 for an ambulance or transport the casualty to a medical facility • Write down the time of the bite and when the bandage was applied. DO NOT wash the venom off the skin as it can be used to identify the type of snake that bit the casualty. DO NOT cut the bitten area. DO NOT try to suck the venom out of the wound. DO NOT use a constrictive bandage or tourniquet. DO NOT try to catch the snake. DO NOT wash or suck the bite or discard clothing as identification of venomous snakes can be made from the venom present on clothing or skin.
Pressure immobilisation bandage technique The pressure immobilisation (bandage) technique (PIT) is recommended for application to bites and stings for the following creatures: • Snakes • Funnel-web spiders and mouse spiders • Blue-ringed octopus • Cone-shells. This technique is not recommended for: • Other spider bites including redbacks and white tails • Bees, wasps • Ticks • Jellyfish stings • Fish stings including stonefish bites • Scorpions, centipedes or beetles. How to apply a pressure immobilisation bandage: • If on a limb, apply a broad pressure bandage over the bite as soon as possible. Elasticised bandage (about 10-15 cm wide) are used in preference to crepe bandages. Only use other material, such as clothing, if these are not available. • The bandage should be firm, tight to the point where you cannot easily slide a finger between the bandage and the skin.
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• Note: If the bite is not on a limb, apply firm, direct pressure to the bite site. • Apply a further firm, heavy crepe or elasticised roller bandage starting at the fingers or toes and moving upwards as far as can be reached up the limb. Ensure you cover the bite site. • The bandage should be applied over existing clothing. • Apply tightly without stopping the blood supply to the limb. • Splint the limb including the joints to both sides of the bite to restrict limb movement. For an upper limb a sling can be used. • Check the casualty’s fingers or toes for circulation (blood supply). • Keep the casualty and the limb at rest. • Bring transport to the casualty, not the casualty to the transport. • Call 000 for an ambulance • DO NOT remove the splint or bandage once applied • Do not allow the casualty to move.
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