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1. Introduction to First Aid1.1 First Aid

An Initial treatment given to casualty before the arrival of ambulance/medical personal by

using anything around and with correct First Aid Principles.

1.2 Objectivea) To Save Lifeb) To Limit worsening of condition

c) To Promote Recovery

1.3 First Aiders Responsibilitya) To asses a situation quickly and safely, and summon appropriate helpb) To protect casualties & others at the scene from possible danger.c) To identify, as far as possible, the injury or nature of the illness affecting a casualty.d) To given each casualty early and appropriate treatment, treating the most serious

conditions first.

e) To arrange for the casualtys removal to hospital, into the care of a doctor, or to his home asnecessary.

f) If medical aid is needed, to remain with a casualty until further care is available.

g) To report your observations to those taking over care of the casualty, and to give furtherassistance if required.

h) To prevent cross-infection between yourself and the casualty as far as possible.

1.4 Primary SurveyD Danger

Look, Listen, Feel & Smell

R RespondTab on shoulder & call casualty

. Call for HELP!A Airway

Head-Tilt-Chin-LiftB Breathing

Look, Listen & Feel

C Circulation

Check for Signs of Life: Breathing Movement Cough

1.5 Secondary Survey - SAMPLEa) Signs are detail of a casualtys condition that you can see, feel, hear, or smell.

b) Symptoms are sensations that the casualty experiences and may be able to describe.c) The History is the story of how an incident happened, how any injury was sustained, or how

any illness began and continued.

d) If the casualty is unable to cooperate, or is unconscious, look for External clues about hiscondition. For example:

Needles, syringes Drug abuse Sugar lumps Diabetes Inhaler Asthma Medic Alert / SOS Talisman Medical warning information on a special locket,

bracelet, medallion, or key ring.

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Appointment card for hospital or clinic. A card indicating a history of allergy, diabetes, or epilepsy.

S Sign & Symptoms

A Allergy

M Medication taken

P Past illness

L Last Meal

E Event

e) Head-to-Toe Body check Head and face Gently palpate for depressions of skull and matted hair on the scalp Observe for facial symmetry; palpate facial bones Eyes: Are the pupils equal and reactive to light? Check for foreign bodies, contact

lenses, lacerations, and evidence of trauma and alterations in vision.

Ears : Bleeding or fluid Nose: Deformity, discharge, bleeding Mouth: Dentures, loose, chipped, or avulsed teeth; tongue; foreign objects

Neck Evaluate front and back of the neck. Look for vein distension, stomas, use ofneck muscles for respirations, altered voice, tracheal shift, or bruising.

Spine & back Palpate skin for wounds, deformities, tenderness or possible fracturesstarting from shoulders working toward buttocks

Shoulder / upper extremities Palpate both sides for wounds, fractures, and tenderness. Check for distal pulses, sensation, color, and needle marks Check for weakness by having the casualty squeeze your hands if no obvious

fracture present

Chest Auscultation for breath sounds Palpate clavicles Observe for equal chest expansion on both sides Gently press on lateral ribs to check for fractures Gently perform rib spring on sternum to check for pain

Abdomen Inspect for wounds, evisceration, distension and scars

Gently palpate for rigidity, tenderness, guarding, and pulsating masses

Pelvis, hips, and buttocks Palpate both sides for wounds, possible fractures, and tenderness Check for distal pulses, sensation, and color

Lower extremities Palpate for wounds, possible fractures, deformities, tenderness, and skin

discoloration Check for distal pulses, capillary refill, sensation, and movement

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Check for weakness by having the casualty push with foot against your hand if noobvious fracture present

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f) Glasgow Coma Scale a means of measuring and monitoring a casualtys level ofconsciousness by calculating a score based on the best verbal, motor, and eye response. The

lowest score possible is 3 and the highest is 15.

Best verbal Response

Oriented & talking 5

Disoriented & confused 4

Inappropriate words 3

Incomprehensible 2No response 1

Best motor response

Obey commands 6

Locates pain 5

Withdraws from pain 4

Flexes to pain 3

Extends to pain 2

No response 1

Eye response

Open spontaneously 4

Opens to voice 3

Opens to pain 2

No response 1

3 8 Severe head injury / Coma

9 12 Moderate head injury /E _ V _ M _13 15 Mild head injury

1.6 Casualty Handlinga) Leave the casualty in the position which you found themb) Move a casualty if he is in Dangerc) Make sure you are Safe first

1.7 Techniques & Equipment

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1.8 First Aid Kita) Glove l) Roller Bandage 3

b) Scissors m) Gauze 2 X 2

c) Forceps n) Gauze 4 X 4d) Galli Pot / Kidney Dish o) Cotton

e) CPR Face Shield p) Handyplast

f) Surgical Face Mask q) Surgical Tapeg) Penlight r) Antiseptic Lotion, 100ml

h) Pen & Notepad s) Antiseptic Cream, 30gmi) Triangular Bandage t) Medicated oil, 5ml j) Crepe Bandage u)Yellow solution, 100ml

k) Roller Bandage 2 v) Counter Pain

1.9 Telephoning for helpa) 999 / 112b) Your Name, IC & Telc) Types ofEmergencyd) Casualtys Condition (Number of Casualty)e) Location with landmark

f) Repeat informationg) ETA

2. Anatomy2.1 Respiratory System

This system comprises the mouth, nose, windpipe (trachea), lungs, and pulmonary blood vessels.

Respiration involves the process of breathing and the exchange of gases (oxygen and carbon dioxide

in lungs and in cells throughout the body.We breathe in air in order to take oxygen into the lungs, and we breathe out to expel the waste gas

carbon dioxide, a by-product of respiration.

When we breathe, air is drawn through the nose and mouth into the airway and the lungs. In the

lungs, oxygen is taken from air sac (alveoli) into the pulmonary capillaries. At the same time, carbondioxide is released from the capillaries into the alveoli. This gas is then expelled as we breathe out.

An average mans lungs can hold approximately 6 litres (10 pints) of air, a womans lungs can holdabout 4 liters (7 pints).

The air we breathe contains 20% oxygen, and there is still 16% oxygen left in the air we breathe out;

this accounts for the effectiveness of mouth-to-mouth ventilation.

Respiration Rate (Inhale + Exhale = 1 Breath):

Adult : 12 20 bpm (breath per minute)

Child : 20 30 bpm

Infant : 30 50 bpm

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2.2 Circulatory SystemBasic Anatomy & FunctionThe circulatory system consists of the heart and the blood vessels. These structures supply the body

with a constant flow of blood with a constant flow of blood, which brings oxygen and nutrients tothe tissues and carries waste product away.

Blood is pumped around the body by rhythmic contractions (beats) of the heart muscle. The

blood runs through a network of vessels, divided into 3 types: arteries, veins and capillaries.The force that is exerted by the blood flow through the main arteries is called blood pressure. It

varies with the strength and phase of the heartbeat, the elasticity of the arteries walls, and the volumeand thickness of the blood.

Mechanism of circulation

When oxygen has been transferred to the blood cells, it has to be circulated to all the body tissues

(via blood vessels). The pump that maintains this circulation is the heart.

Oxygen-rich blood is carried from the lungs to the heart through the pulmonary veins. The heart

pumps the oxygen-rich blood to the rest of the body in blood vessels called arteries.

Other blood vessels called veins bring deoxygenated blood back from the tissues to the heart.The heart pumps this blood, via the pulmonary arteries, to the lungs, where it is oxygenated and

carbon dioxide is removed.

There are about 6 liters (10 pints), or 1 liter per 13kg of body weight (1 pint per stone), of bloodin the average adult body. If severe blood loss exceeds 1.2 liters (2 pints), which is about 1/5 of the

normal blood volume, shock will occur.

PulseEach beat of the heart creates a wave of pressure (the pulse) that passes along the arteries. It can

normally be felt where an artery passes close to the surface of the body.

* Do not use your thumb to check for casualtys pulse because you might feel your own pulse.* Do not check for carotid pulse both sides at the same time because you might block the blood

supply to the brain.

Radial : WristCarotid : Neck

Brachial : Babys upper arm

Pulse Rate:Adult : 60 80 bpm (beat per minute)

Child : 80 100 bpm

Infant : 100 120 bpm

2.3 Vital Signsa) Level of consciousness

A AlertV Verbal

P Pain

U Unresponsive

b) Pulse ratec) Breathing Rated) Skin color & temperature (37 C / 98.6F)e) Blood pressure (120/90)f) Pupil reaction

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3. Respiratory Problems3.1 Hypoxia

a) Definition insufficient oxygen reaches body tissues from the blood.

b) 5 Types: Hypoxia / Hypoxemic an inadequate supply of oxygen in blood. Cause by: a

reduction in partial pressure of oxygen; blockage of tongue; inadequate oxygentransport; inability of the tissue to use oxygen.

Hypoxic Hypoxia a reduction of oxygen entering the blood. Cause by: a reductionin oxygen pressure in the lungs; reduced gas exchange area; lung disease.

Hypemic Hypoxia reduction in the capacity of the blood to carry oxygen. Cause by:reduction of hemoglobin in the blood (blood donation, hemorrhage or anemia);

reduction in the number of red blood cell (drug, chemical, smoking, or carbon

monoxide exposure) Stagnant Hypoxia deficiency in oxygen due to poor blood circulation. Cause by: a

person sits or hangs, or is exposed to clod temperatures for prolonged periods of time.

Histotoxic Hypoxia inability of the tissues to use oxygen. Cause by: carbonmonoxide or cyanide poisoning, or from the use of certain narcotic, chewing tobacco

and alcohol.

c) Sign & Symptoms: Ashen (Grey-blue) tinge to the lips, earlobes, and nailbed Cyanose (Blue) Difficulty speaking and breathing Noisy breathing Flush (Red), puffy face Signs of distress from the casualty, who may point to the throat or grasp neck Flaring of the nostrils A persistent dry cough Fronting at mouth Loss of consciousness, Breathing and pulse may absent

d) Management: Clear the airway of any obstruction Open airway (Head-Tilt-Chin-Lift) Maintain Breathing Monitor Vital Sign

3.2 Inhalation of Fumesa) Definition inhalation of gases (carbon monoxide), or toxic vapors can be lethal

b) Source Fires; exhaust fumes of motor vehicles; emissions from defective gas or paraffinheaters; glues; cleaning fluids.

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c) Sign & Symptoms: Confusion Aggression Nausea & vomiting Incontinence Rapid, noisy, difficulty in breathing Coughing & wheezing Breathless

Headache Burning in the nose or mouth Unconscious DRABC

d) Management: Move casualty from danger DO NOT enter gas filled room unless you are properly equipped Ensure casualty gets plenty of fresh air

3.3 Penetrating Chest Woundsa) Pneumothorax (lung collapse) caused by chest wound

b) Sign & Symptoms: Difficult and painful breathing, possibly rapid, shallow and uneven Casualty feels an acute sense of alarm Features of hypoxia Coughed-up frothy, red blood A cracking feeling of the skin around the site of the wound, caused by air collecting

in the tissues Blood bubbling out the wound Sound of air being sucked into the chest as the casualty breathes in Veins in the neck becoming prominent

c) Management: Encourage casualty lean towards injured side Use palm of his hand to cover wound Place sterile dressing or non-fluffy clean pad Cover with a plastic bag, foil, or a kitchen film Secure firmly with adhesive tape on 3 edges, leave 4 th side untaped to allow air under

pressure during expiration to escape

Monitor vital sign

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3.4 Hyperventilationa) Definition an abnormal loss of carbon dioxide from the blood, leading excessive breathing

or over breathing of what body needs

b) Causes: Over breathing Bloating Passing excess gasses Pressure sensation in the abdomen

c) Sign & Symptoms: Unnaturally fast, deep breathing Spasms or cramps of the hands & feet Muscle twitching Chest pain Wheezing Attention seeking behavior Dizziness or faintness

d) Management:

Calm & reassure casualty Lead casualty to quite place As casualty to rebreathe own exhaled air from a paper bag

3.5 Asthmaa) Definition airway spasm, swell & narrowed.

Reliever Inhaler (Blue) & Preventer Inhaler (Brown / White)

b) Cause: Allergy A cold Drug Cigarette smoke Infection

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c) Sign & Symptoms:

Difficulty in breathing, speaking & whispering Wheezing Distress Cough Features of hypoxia, grey-blue tinge to the lip, earlobes, & nail beds (cyanosis) In severe attack, exhaustion. Rarely, the casualty loses consciousness and stop

breathingd) Management:

Calm & reassure casualty Comfortable position sit casualty up, slightly lean forward (DO NOT lie casualty

down)

Reliever Inhaler (Mild will ease within 3 mins, if not repeat every 5 10 mins.) Loosen tight clothing Monitor vital sign If unconscious, perform DRABC

3.6 Pneumoniaa) Definition a serious infection and /or inflammation of lungs

b) Causes: Breathe in infected air particles into lung Bacteria Viruses Mycoplasma Other infections agent such as fungi including pneumocystis Various chemicals

c) Sign & Symptoms: Cough Fever

Difficulty in breathing Shaking and teeth-chattering chills Chest pain Rapid pulse & breathing Nausea & vomiting Diarrhea

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d) Management: Sent to hospital Make casualty comfortable Loosen tight clothing Monitor vital sign

3.7 Chronic Obstructive Pulmonary Disease (COPD)a) Definition a long lasting obstruction of the airways that occurs with chronic bronchitis,

emphysema, or both. This obstruction of airflow is progressive in that it happens over time.

b) Causes: Cigarette smoke or tobacco smoke Air pollution

c) Sign & Symptoms: Cough Acute chest illness Breathing difficulty Wheezing

Cyanosis Anorexia and weight loss

d) Management: Make casualty comfortable Start CPR if necessary Give aspirin Call for ambulance

3.8 Dyspneaa) Definition air hunger or breathing difficulty

b) Causes: A collapsed lung Crush injuries to the chest or airway Congestive heart failure Heart disease Adjustment to high altitude An obstruction in the airway

c) Sign & Symptoms: Wheezing

Shortness of breath Confusion Weakness Dizziness Pale or bluish lips and fingernails Gurgling sounds in the chest Cough Anxiety Person clutching his/her throat or chest Coughing up blood

Casualty holding Spirometer thatis useful in assessing pulmonary

mechanics which become

abnormal in both obstructive &

restrictive ventilatory disorders

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d) Management: Dial 999 Check for Sign of life Monitor vital sign Do not let casualty to move around, eat or drink anything

3.9 Croupa) Definition severe breathing difficulty in very young children.

b) Causes: Inflammation in the windpipe and larynx Epiglottis was infected & swollen and may block the airway completely

c) Sign & Symptoms: A short, barking cough A crowing or whistling noise Skin cyanosis or ashen Child is sitting upright but is in respiratory distress -Epiglottitis

High fever

d) Management: Calm & reassure child Create steamy atmosphere (run hot tap / shower) Encourage to breath in steam Dial 999

4. Heart & Circulatory Problem4.1 Shock

a) Definition insufficient blood supply to the vital parts of the body

b) 7 Types: Hypovolemic caused by blood loss or loss of plasma from burn Cardiogenic deals with heart shock, the heart failing to pump enough blood

through out the body

Neurogenic deals with nerve shock. Something goes wrong with the nervoussystem

Anaphylactic dealing with allergy, a life-threatening reaction when the patient isextremely allergic drugs, food, and etc.

Psychogenic is fainting, with factors such as fear, causing the nervous system toreact by rapidly dilating the blood vessels.

Metabolic is body fluid shock, with loss of body fluids

Septic is bloodstream shock, caused by infection.

c) Sign & Symptoms: Restlessness or combativeness Becomes unresponsive Profuse bleeding Breathing shallow and rapid Pulse rapid and weak Weakness Nausea with possible vomiting Thirst

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Dizziness Restlessness and fear

d) Management: Treat any possible cause of shock Lay casualty down Elevate leg Loosen tight clothing

Keep casualty warm Monitor vital sign Do Not give anything by mouth

4.2 Angina Pectorisa) Definition a constriction of the chest

b) Causes: Arteries become narrowed, cannot supply sufficient blood to meet increased in

demand Increased in blood flow demand due to exercise or excitement

c) Sign & Symptoms: Shortness of breath Pain easing with rest (pain rarely last more than 10mins) Cyanosed Skin Ashen Lips may become blue Nausea Feeling of anxiety

d) Management: Sit casualty down in most comfortable position (1/2 sitting) Loosen tight clothing around neck, chest, & waist. If symptom persist, arrange removal to hospital Nitroglycerin (Place under the tongue) tablets are prescribed to persons subjected to

angina attacks.

Monitor vital sign

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4.3 Heart Attack (Myocadial Infarction)a) Definition Occurs when the blood supply to part of the heart muscle is suddenly obstructed

b) Causes: Clot in a coronary artery (coronary thrombosis) Can happen without wary or when person resting

c) Sign & Symptoms:

Severe pain in chest, may radiates to both shoulders & arms, throat or jaw & to theback

Difficulty in breathing Collapse without any warning Sudden faintness or dizziness A sense of impending doom Ashen skin, and cyanosed at the lips Rapid, weak, or irregular pulse Profuse sweating Nausea Anxiety / fear

May go to stage of shock

d) Management: Make casualty comfortable ( Half sitting position with knees bent) Call for ambulance & own doctor Loosen tight clothing Assist casualty in taking medication

Aspirin tablets (300mg) Chew GTN tablets / pump-action / aerosol spray

Monitor vital sign

4.4 Cardiac Arrest (Heart Stop)a) Definition sudden, abrupt loss of heart function. It also called sudden cardiac arrest or

unexpected cardiac arrest, it occurs within minutes after symptoms appear.

b) Causes: Myocardial Infarction Abnormal hear rhythms Severe blood loss from traumatic injury or internal bleeding Electrical shock Lack of oxygen supply from events like choking, drowning, or a severe asthma attack Cardiogenic shock (heart failure because of inadequate heart pumping function)

Stroke (sudden loss of blood supply in the brain)

c) Sign & Symptoms: Loss of consciousness Completely collapse No Breathing, No Circulation Skin pale & clammy

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d) Management: Start CPR Call for ambulance Rapid defibrillation using an AED (Automated External Defibrillator)

4.5 Faintinga) Definition loss of consciousness caused by a temporary reduction of the blood flow to the

brain

b) Causes: After long periods of long physical inactivity (blood pool in the legs, reducing the

amount of blood reaching the brain.

Standing still, especially in a warm atmosphere When coughing very hard Fear, severe pain or emotional distress A sudden drop in blood pressure Stand up very suddenly from a lying position Taking of certain medication

c) Sign & Symptoms: Skipped Beat Fluttering Slow Heartbeat Rapid Heartbeat

d) Management: Lie casualty down Elevate leg Loosen tight clothing Promote air ventilation

5. Wounds & Bleeding5.1 Types of wounds

5.2 Severe Bleeding Wear glove Apply direct pressure Elevate injured part Arrange immediate transport to hospital

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5.3 Foreign Object in wound Do not remove the object Stop bleeding (Compress & Elevate) Monitor vital sign Send to hospital

5.4 Amputation Wear glove

Stop bleeding (Compress & Elevate) Fingers

Put in a plastic bag Separate with ice Label

Monitor vital sign

5.5 Eye wound Lie casualty on her back Hold her head to keep it as still as possible

Ask casualty to keep both eyes still (movement of the good eye will causemovement & further damage of the injured one)

Apply sterile dressing Send to hospital

5.6 Bleeding from Ear Help casualty into a half sitting position Tilt head to the injured side to allow blood to drain away

5.7 Nosebleed Tilt casualtys head forward to allow blood drain from nostrils

Pinch at soft part of the nose Ask casualty to breathe through mouth Advise casualty not to speak, swallow, cough, spit or sniff. Release after 10mins If nosebleed is severe or last longer then 30 mins, send casualty to hospital.

5.8 Abdominal Wound Lie casualty down Loosen tight clothing Apply dressing Call for ambulance

5.9 Vaginal Bleeding - most likely to be menstrual bleeding, miscarriage, pregnancy, recent abortion orchildbirth, sexual assaulted, internal disease or infection.

Arrange for screening to be set up around her (give privacy) Find a sanitary pad or a clean towel and give it to her Make casualty as comfortable as possible If casualty has been assaulted, it is vital to preserve the evidence if possible.

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5.10 Bleeding from Varicose Vein Lie casualty down Stop bleeding (Compress & Elevate) Remove garments Put large padding Call for ambulance

6. Burns & Scalds6.1 Types of Burns

Dry Burn Flames, contact with hot objects, such as domestic appliance or cigarettes,friction (rope burns)

Scald Steam, hot liquids, such as tea, coffee or hot fat Electrical burn Low-voltage current, as used by domestic appliances, High-voltage

currents, as carried in mains overhead cables, lighting strikes.

Cold injury Frostbite, contact with freezing materials, contact with freezing vapours, suchas liquid oxygen or liquid nitrogen

Chemical burn Industrial chemicals, including inhaled fumes and corrosive gases,domestic chemicals and agents, such as paint stripper, caustic soda, weed killers, bleach,

oven cleaner, or any other strong acid or alkali. Radiation burn Sunburn, over-exposure to ultraviolet rays from a sunlamp, exposure to a

radioactive source, such as an X-ray

6.2 Degree of Burns

6.3 Burns that need hospital treatment All full-thickness burns All burns involving the face, hands, feet & genital area All burns that extend right around an arm or a leg

All partial- thickness burns larger than 1% of the body surface (an area the size of the palmof the casualtys hand)

All superficial burns larger than 5% of the casualtys body surface (equivalent to 5 palmareas)

Burns with a mixed pattern of varying depths

6.4 Management Running water (at least 10 mins) Remove jewellery, watch, etc. (burn area begins to swell) Cover burn area Send to hospital

1

Superficial- Luaran

2

Partial-thickness- Separa-Tebal

3

Full-thickness- Tebal-Penuh

1

Superficial- L

2

Partial-thic

3

Full-thickness-

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7. Fracture & Dislocation7.1 Types of Fracture

7.2 Sign & Symptoms Deformity, swelling and bruising Pain, and difficulty in moving the area Shortening, bending, or twisting of a limb Difficulty in moving Bone protruding Signs of shock

7.3 General Rules for Management Prevent movement on injured part Support & immobilize injured part Send to hospital Check capillary refill every 10mins

* do not allow casualty to eat, drink or smoke as a general anesthetic may be needed.

8. Soft Tissue Injuries

8.1 Sprain due to a sudden or unexpected wrenching motion that pulls the bones in the joint too farapart and tears the surrounding tissues.

8.2 Strain occurs when muscle & tendon overstretched and maybe partially torn.

DISLOCATION- Terkehel

Improvised SlingAnduh yang Diubahsuai

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8.3 ManagementR Rest

I Ice

C Compress

E Elevate

8.4 Cramp

A sudden, painful spasm. Develop after strenuousexercise, due to a build-up of chemical waste productsin muscles or excessive loss of salt and fluids from the

body through sweating.

Management Relived by stretching and massaging Cramp in the Foot help casualty to stand with

his/her weight on the front of his/her foot, massage

the affected area

Cramp in the calf straighten casualtys knee andsupport the foot, flex the foot towards the shin to

stretch the calf muscles & massage the affected area Cramp in the thigh lie casualty down, raise the

leg & straighten the knee. Bend the knee if cramp in

the front, support & massage thigh muscle.

9. Nervous System Problem9.1 This is the body information gathering, storage, and control system. It consists of a central

processing unit the brain and a complex network of nerve cells and fibres.There are 2 main parts to the nervous system: thecentral nervous system, consist of the

brain and spinal cord, and theperipheral nervous system, which consists of all nerves connecting

the brain and the spinal cord to the rest of the body.

In addition, theautonomic (involuntary) nervous system controls body functions such asdigestion, heart rate, and breathing. The central nervous system receives and analyses information

from all parts of the body. The nerves carry messages, in the form of high-speed electrical impulses,between the brain and the rest of the nervous system. Nerves comprise bundles of nerve fibres that

can relay both incoming (sensory) and outgoing (motor) signals.

9.2 UnconsciousA fully conscious person is awake, alert, and aware of his / her surroundings. Sleep is a normal state

of lowered consciousness, but unconsciousness is an abnormal state in which the bodys control

mechanisms are impaired or lost.When a person is asleep, vital functions such as breathing take place automatically. If a

person is unconscious, muscle control is lost, so if the person is lying on his / her back, the tonguefalls towards the back of the throat and may block the airway.

There is no absolute line between consciousness & unconsciousness. People may be fully

aware and awake (conscious), completely unresponsive to any stimulus (unconscious), or at any

level between these 2 extremes. For example, a casualty may be groggy or respond only to loud

sounds or to pain.Impaired consciousness is the term used when a casualty is anything less thanfully conscious.

* All Unconscious casualties should also be treated for a neck injury.

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9.3 Cause of Unconsciousness - FISH SHAPED

F - Fainting

I - Infantile Convulsion

S - ShockH - Head Injuries

S - StrokeH - Heart Attacks

A - Asphyxia

P - PoisoningE - Epilepsy

D - Diabetic Emergency

9.4 Head Injurya) Definition trauma to the head can cause serious injury to the skull, face, brain or spine,

leading to significant neurological impairment. Careful management and care of these

casualties are critical to preventing further injury. Any casualty sustaining head trauma is

suspected of having injuries to the neck & spine requiring proper immobilization.

b) Sign & Symptoms: Altered level of consciousness; combative, aggressive, or irrational behavior External evidence of trauma Abnormal respiratory pattern and rateSevere pain or swelling at both site of injury Deformity of skull & face Bruising or swelling behind the ear Black eyes or discoloration of soft tissues under both eyes Blurred vision and sensitivity to light Slurred speech or saying things that dont make sense

Bleeding or clear fluid drainage from ears or nose Battle signs or bruising behind the ears Unequal pupils Irregular pulse rate & rhythm Narrowing blood pressure (systolic & diastolic pressures move closer together,

120/90 120/100)

Paralysis, loss of sensation Rising blood pressure with slow pulse Posturing either decorticate or decelerate Seizure activity Nausea and/or vomiting

c) Management: Ensure airway open (Jaw Thrust) Immobilize head & neck Control bleeding Elevate head backboard 30 or 12 Evaluate foe hidden injuries if shock present

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9.5 Concussiona) Definition Brain Shaken. Produce widespread but temporary disturbance of normal brain

activity.

b) Causes: Traffic incidents Falls

Blows received in fights

c) Sign & Symptoms: Brief period of impaired consciousness following a blow to the head Dizziness or nausea on recovery Loss of memory of events at the time of, or immediately preceding, the injury Mild, generalized headache

d) Management: Treat the casualty as for impaired consciousness Monitor and record vital signs

Place casualty in the care of a responsible person Advise casualty to go to hospital

9.6 Cerebral Compressiona) Definition Compression of the brain. Very serious & almost invariably requires surgery.

b) Causes: An accumulation of blood within the skull or swelling of injured brain tissues Head injury Stroke Infection

Brain tumor

c) Sign & Symptoms ( may develop immediately, or a few hours, or few even days later) Deteriorating level of response may become unconscious History of a recent head injury Intense headache Noisy breathing, becoming slow Slow, yet full & strong pulse Unequal pupil size Weakness and/or paralysis down 1 side of the face or body High temperature, Flushed red

Drowsiness Noticeable change in personality or behavior, such as irritability or disorientation

d) Management: Call for ambulance If conscious, keep casualty supported in a comfortable resting position & reassure If unconscious - DRABC

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9.7 Skull Fracturea) Definition casualty has a head wound. Serious because there is a risk that the brain may be

damaged either directly by fractured bone from the skull or by bleeding inside the skull.

b) Causes: Head injury

c) Sign & Symptoms: Wound or bruise on the head Soft area or depression on the scalp Bruising or swelling behind 1 ear Bruising around 1 or both eyes Clear fluid (cerebrospinal fluid) or watery blood coming from the nose or an ear Blood in the white of the eye Distortion or lack of symmetry of the head or face Progressive deterioration in the level of response

d) Management:

Lie casualty down Control bleeding If there is discharge from ear, cover ear with clean pad & bandage Monitor vital signs If unconscious - DRABC (Jaw Trust)

9.8 Strokea) Definition can be fatal. Ruptured artery of brain (Cerebral Hemorrhage) or blood clot in

artery (Cerebral Thrombosis)

b) Causes:

Occur more commonly in later life People who suffer high blood pressure or some other circulatory disorder

c) Sign & Symptoms: A sudden, sever headache Impaired speech / swallow / vision Confusion and/or dizziness & disoriented Loss of function or paralysis of extremities (usually one side of body) Numbness (usually limited to one side of body) Collapse Facial flaccidness & loss of expression (often to one of face)

Unequal pupil size Rapid, full pulse Difficulty respiration, snoring Nausea Convulsions Coma Loss of bladder and bowel control Dibbling saliva Anxious & weeping

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d) Management:

i. For an Conscious patients: Lay casualty down with head & shoulder slightly raised. Inclines head to one side Place towel to absorb any dribbling Keep patient calm Administer high concentration of oxygen

Monitor vital sign Loosen constricting clothing that might interfere with breathing. Transport in semi-reclined position Give nothing by mouth Treat for shock Sit in front of patient, keep eye contact, and speak slowly and clearly

ii. For Unconscious patients DRABC Maintain open airway Provide high concentration of oxygen

Monitor vital sign Transport in lateral recumbent position/recovery position Keep affected limbs underneath patient, use protective padding

9.9 Seizurea) Definition Convulsion or fits. Consists of involuntary contractions of many of the muscles

in the body. Due to abnormal in the electrical activity of the brain. In young child (febrile

convulsion), are most often result of raised body temperature associated with a throat or earinfection or other disease.

Stage 1:

Headache / light headacheness

Blurred vision / spots before eyes Strange smell / taste

Stage 2:

Loud cry caused by sudden chest contraction

Stage 3: Becomes rigid followed by involuntary movement of head, limbs & body

(can froth at mouth, lose control of bladder / bowel)

Cyanosed

Stage 4: Person becomes very relaxed Breathing becomes normal Fall into deep sleep

b) Causes: Head injury Brain damaging disease Shortage of oxygen or glucose in the brain Intake of certain poisons (including alcohol)

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c) Sign & Symptoms:

Sudden unconsciousness, often letting out a cry Rigidly & aching of the back Convulsive movements (jaw clenched, noisy breathing, saliva / blood stain appear,

loss of bladder or bowel control)

d) Management:

Control falling, put in recovery position Make space around, put soft padding around Note time when the seizure started Protect head (place soft padding) Loosen tight clothing Child: Sponge skin with tepid water, start from forehead & work down his body.

9.10 Meningitisa) Definition A disorder in which the linings that surround the brain and spinal cord (the

meninges) become inflame caused by bacteria or viruses can occur at any age. Very serious,

casualty may deteriorate very fast. May causes permanent disability (deaf / brain damage)

b) Sign & Symptoms: High temperature / fever Vomiting, which often violent, or loss of appetite Severe headache Neck stiffness (the casualty cannot touch his chest with his chin) Joint or muscle pains Drowsiness Confusion / disorientation Dislike of bright light Seizure

Skin rash of small red/purple pin prick spots that may spread to look like freshbruising (difficult to see in dark skin, does not fade when the side of a glass is pressed

against it.

In babies & young child: drowsiness / restless & high-pitched crying, reluctance tofeed, slight tenderness & swelling of the soft parts of the skull (in babies)

c) Management: Call ambulance / sent to hospital Reassure casualty

9.11 Spinal Cord injury

a) Definition damage to the spinal cord that causes loss of sensation (feeling) & motor(muscular) control.

b) Causes: Exerted substantial force on back or head Accidents Mountain climbing Roller-blading Bike riding

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c) Sign & Symptoms:

Severe pain at neck or back Unable to move the neck Complaints of weakness, numbness or paralysis or lack of control of limbs, bladder or

bowel

Neck or back is twisted or position oddly

d) Management: Do not move casualty unnecessarily Support & immobilize neck, head & back Send to hospital

9.12 Migrainea) Definition severe sickening headaches

b) Causes: Allergy Stress

Tiredness Lack of sleep Missed meals Alcohol Food (cheese, chocolate, etc)

c) Sign & Symptoms: Warning period, with disturbance of vision in form of flickering lights and/or a blind

patch

Intense throbbing headache (sometimes just on 1 side of the head) Abdominal pain, nausea & vomiting

Inability to tolerate bright light or loud noise

d) Management: Help casualty in taking medication Lie casualty down/ sleep, in quiet, dark room Provide towels & container ( in case vomits) Advise to see doctor if it is the first attack

10 Medical Emergencies10.1 Diabetic Emergencies

The cells of the body need glucose as source of energy. Insulin must be present so that blood sugar

can enter bodys cells and be used effectively.Without insulin cells can be surrounded by glucose and still starve for sugar. If for some

reason insulin production decrease, glucose remains in circulation, increase in concentration and

eventually spills over into the urine.

Diabetes (Diabetes Myelitis) is a condition that arises when there is a disturbance in the

way the body regulates the sugar concentrations in the blood. This can result in too much sugar inthe blood (Hyperglycemia) or too little sugar in the blood (Hypoglycemia).

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a) Hyperglycemia (Diabetic Coma)

Definition too much sugar but very little insulin in the blood

Causes: Diabetics condition not been diagnose and /or treated Has not taken his insulin

Overeaten, excess of carbohydrates Suffers infection that affects glucose-insulin balance

Sign & Symptoms: Gradual onset of signs & symptoms, over a period of days Dry mouth and intense thirst Abdominal vomiting Restlessness, confusion, followed by stupor Coma with:

i. Signs of air hunger deep sighing & respirationii. Weak, rapid pulse

iii. Dry, warm skiniv. Breath smell of acetone sweet nail polish remover

Management: If casualty conscious, get as much information from victim as possible.

SAMPLE

If in doubt whether the victim is suffering from insulin shock or diabeticcoma, give him a sweet drink first as this will not do further harm to thecasualty entering a diabetic coma but sugar may improve the condition of a

casualty suffering from insulin shock or hypoglycemia.

If casualty unconscious arrange urgent removal to hospital

b) Hypoglycemia (Insulin Coma) Definition very low blood sugar level but too much insulin in the blood

Causes: Take too much insulin Not eaten enough to provide normal sugar intake Over exercised or overexerted, reducing blood glucose level Has vomited a meal

Sign & Symptoms:

Rapid onset of symptoms and signs, over a period of minutes A diabetic may feel faint, fizzy and light headed He may be confused and disoriented Abnormal, hostile or aggressive behavior Skin pale, cold and clammy; with profuse sweating Pulse rapid & full Breathing becomes shallow and breathe odorless Limbs may begin to tremble Casualtys level of responsiveness may deteriorate rapidly

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Management:

Restore the sugar insulin balance as soon as possible If casualty unconscious arrange urgent removal to hospital

10.2 Panic Attacka) Definition a sudden bout of extreme anxiety.

b) Causes: Distress Any intense fear (phobia) Stressful

c) Sign & Symptoms: Hyperventilation Muscular tension, producing headache, backache, and a feeling of in the chest Extreme apprehension & fear of dying Trembling, sweating, & dry mouth High pulse rate & sometimes palpitation

d) Management: Try to find out & remove the cause of the fear. Take casualty to a quite area Reassure casualty Encourage the casualty to breathe more slowly

10.3 Hiccupsa) Definition sudden, involuntary contractions of diaphragm causing noisy intake of breath

b) Causes:

Overeating Trapped gas Gulping Swallowing hot food/irritants

c) Sign & Symptoms: May be prolonged, tiring & painful

d) Management: Advise casualty to sit quietly & hold breath for as long as possible Drink a lot of water

If hiccups persist, advise casualty to place paper bag over the nose & mouth and torebreathe the expired air for a few mins

10.4 Fevera) Definition A sustained body temperature above the normal level of 37C (98.6F). Fever

above 40C (104F) can be dangerous.

b) Causes: Bacterial or viral infection May be associated with measles, chicken pox, meningitis, earache, sore throat

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c) Sign & Symptoms:

Raised temperature Initial pallor A chilled feeling goose pimples, shivering & chattering teeth Later, hot, flushed skin, & sweating Headache Generalized aches & pain

d) Management: Keep casualty cool & comfortable Give casualty plenty of cool, bland drinks to replace body fluids lost through

sweating

10.5 Disturbed Behaviora) Definition Behave in an abnormal or aggressive way

b) Causes: Alcohol or drug abuse or physical disorder (hypoglycemia, epilepsy or head injuries)

Mental disorders (anxiety, psychosis & dementia)

c) Management: Talk calmly to the casualty and, if you can, try to find out the cause of the problem Call doctor (if possible, the casualtys own

10.6 Ear achea) Definition Common condition results from inflammation of the tissues inside the ear or

from blockage in the ear. May be accompanied by partial or total hearing loss.

b) Causes:

Ear infection associated with a cold, tonsillitis or flu Pain can also be caused by a boil, a foreign object stuck in the ear canal An abscess in a nearby tooth An airplane journeys due to changes in cabin pressure during ascent & descent

c) Management: Make casualty comfortable Give a source of heat, such as hot-water bottle wrapped in a towel, to hold against the

affected ear

Advise casualty to see doctor Valsalva Manoeuvre (Air Travel):

Shut mouth Pinch nostrils Blow out through closed mouth

10.7 Abdominal Paina) Definition has a relatively minor cause (Food Poisoning), can occasionally be assign of a

serious disorder affecting the organ

b) Sign & Symptoms: Colic-pain that comes & goes in waves Double up in agony

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Vomiting

c) Management: Make casualty comfortable Give container (vomiting) Give hot-water bottle wrapped in towel Do not give medicine or allow food, drink or smoke because general aesthetic may be

needed

* Appendicitis

a) Definition an inflamed appendix (appendicitis)

b) Sign & Symptoms:

Pain (often starting in the centre of the abdomen & moving to the lower right-hand

side) Nausea Vomiting Bad breath Fever

d) Management: Urgent surgical removal of the appendix

* Winded Casualty

A blow to the upper abdomen may stun a local nerve junction, causing a temporary breathing

problem called winding. To treat a winded casualty, help him to sit down, and loosenclothing at the chest and waist. The casualty should recover rapidly.

10.8 Herniaa) Definition a soft swelling in the abdomen or the groin

b) Causes: A small loop of intestine, or other tissue, pushes through a week area of muscle in the

abdominal wall

c) Sign & Symptoms:

Bulge or swelling in abdominal wall or groin, which may disappear when casualtylies flat

Dragging or arching sensation in the abdomen or groin Pain in the abdomen or groin Vomiting

d) Management: If casualty is in pain, help him to sit down and support him in the position he finds

most comfortable