FIRST AID

RUBY GRACE D SABINO-DIANGSON, M.D.,

Ll.B.
Police Superintendent

HISTORY

The earliest instances of recorded

first aid were provided by religious
knights, such as the Knights
Hospitaller, formed in the 11th
century, providing care to pilgrims
and knights, and training other
knights in how to treat common
battlefield injuries

The practice of first aid fell

largely in to disuse during
the Dark Ages, and
organised societies were not
seen again until in 1859
Henry Dunant organized
local villagers to help
victims of the Battle of
Solferino, including the
provision of first aid.

Four years later, four

nations met in Geneva
and formed the
organization which has
grown into the Red
Cross, with a key stated
aim of "aid to sick and
wounded soldiers in the
field

This was followed by the formation

of St. John Ambulance in 1877, based
on the principles of the Knights
Hospitaller
* to teach first aid, and numerous
other organisation joined them, with
the term first aid first coined in 1878
as civilian ambulance services
spread as a combination of 'first
treatment' and 'national aid in large
railway centres and mining districts
as well as with police forces.

First aid training began to spread

through the empire through
organisations such as St John,
often starting, as in the UK, with
high risk activities such as ports
and railways

AIMS

Preserve life - the overriding aim of all

medical care, including first aid, is to
save lives
Prevent further harm - also sometimes
called prevent the condition from
worsening, this covers both external
factors, such as moving a patient away
from any cause of harm, and applying
first aid techniques to prevent worsening
of the condition, such as applying
pressure to stop a bleed becoming
dangerous.

Promote recovery - first aid also

involves trying to start the recovery
process from the illness or injury,
and in some cases might involve
completing a treatment, such as in
the case of applying a plaster to a
small wound.
N.B. : First aid training also involves
the prevention of initial injury and
responder safety, and the treatment
phases.

KEY SKILLS
Certain

skills are considered

essential to the provision of first
aid and are taught ubiquitously.
Particularly, the "ABC"s of first
aid, which focus on critical lifesaving intervention, must be
rendered before treatment of less
serious injuries. ABC stands for
Airway, Breathing, and Circulation

Much of first aid is common

sense. Basic principles, such as
knowing to use an adhesive
bandage or applying direct
pressure on a bleed, are often
acquired passively through life
experiences. However, to
provide effective, life-saving first
aid interventions requires
instruction and practical
training.

 This

is especially true where it

relates to potentially fatal illnesses
and injuries, such as those that
require cardiopulmonary
resuscitation (CPR); these
procedures may be invasive, and
carry a risk of further injury to the
patient and the provider

As with any training, it is

more useful if it occurs before
an actual emergency, and in
many countries, emergency
ambulance dispatchers may
give basic first aid instructions
over the phone while the
ambulance is on the way

Training is generally provided by

attending a course, typically
leading to certification. Due to
regular changes in procedures and
protocols, based on updated
clinical knowledge, and to
maintain skill, attendance at
regular refresher courses or recertification is often necessary.

 First

aid training is often available

through community organizations
such as the Red Cross and St.
John Ambulance, or through
commercial providers, who will
train people for a fee. This
commercial training is most
common for training of
employees to perform first aid in
their workplace.

MEDICAL
EMERGENCIES

CARDIOVASCULAR COLLAPSE
AND SUDDEN DEATH
Unexpected

CV collapse and
death most often results from
venticullar fibrillation in patients
with underlying CAD, with or
without MI.

 Myocardial

ischemia
Asystole or severe bardycardia
Massive pulmonary embolism
Severe aortic stenosis
Ruptured aortic aneurysm
Aortic dissection

WHAT TO DO :
Open mouth of patient and remove
visible debris or dentures.
2. Tilt head backwards, lift chin, and begin
mouth-to-mouth respiration
N.B.:the lungs should be inflated once
every 5 sec. when 2 persons are
performing resuscitation or twice in
rapid succession every 15 sec when
one
person performs both ventillation and
chest compression.
1.

3. If carotid pulse is absent, perform

chest compressions by depressing

the sternum 3-5 cm) at rate of 80100/ min.
- For one rescuer/first aider, 15
compressions are performed before
returning to ventilating twice

SHOCK
Condition

of severe
impairment of tissue
perfusion. Rapid
recognition and treatment
are essential to prevent
irreversible damage.

Acute Myocardial Infacrtion

VSD
Arrhythmia
Tension penumothorax
Hemorrhae
Volume depletion (i.e., severe
diarrhea, diuretic usage

 sepsis
Toxic

overdoses
Anaphylaxis
Spinal cord injury
Ascites
Pancreatitis
Intestinal obstruction

CLINICAL MANIFESTATION
Hypotension
Tachycardia
Tachypnea
Pallor
Restlessness
Altered

sensorium

 Weak

pulses
Cold clammy extremities
Oliguria
N.B. in septic shock, vasodilatation
predominates and extermities are warm

WHAT TO DO
1.

Tissue perfusion must be

restored immediately, obtain
history for underlying cause

N.B.: this should include known

history of cardiac disease(CAD,
CHF, pericarditis)

 History

of recent fever or infection

Drug intake
Possible bleeding sites, particularly
from GIT

Treatment is aimed at
improvement of tissue
hypoperfusion and
respiratory impairment

2.Serial measurement of BP,

continous ECG monitoring, urine
output, electrolytes, creatinine,
BUN, ABGs, Na concentration
3. Augment systolic BP
- place patient in TRENDELENBURG
position

3. Administer 100 % oxygen

- intubate with mechanical
ventillation
4. Identify and treat underlying
cause of shock
- in septic shock, start antibiotic
therapy

INCREASED ICP AND

HEAD TRAUMA

A limited volume of extra tissue,

blood, CSF or edema fluid can be
added to the IC contents without
raising the ICP.

Patients will deteriorate and may

die when ICP reaches levels that
compromise cerebral perfusion or
causes a shift in IC contents that
distorts vital brainstem centers.

CLINICAL MANIFESTATION
Headache
Nausea
Drowsiness
Diplopia
Blurred vision
Papilledema
Abnormal respirations
hypertension

WHAT TO DO
Hypertension should be treated
Careful intubation
Administer mannitol
Give Lasix
Patients head should be
eleevated to 45 degrees.
Treat fever aggressively

HEAD TRAUMA
Head trauma can cause
immediate loss of consciousness.
Prolonged alterations in
consciousness may be due to
parenchymal, subdural or epidural
hematoma
Skull fracture should be suspected
in patients with CSF rhinorrhea,
hemotympanum and periorbital or
mastoid ecchymoses

Spinal cord trauma can cause

transient loss of function or a
permanent myelopathy with loss
of motor, sensory and autonomic
function below the damaged
spinal level

POISONING

Poison exposure results in an

estimated number of 10 million
annually.

Suicide attempts account for most

serious or fatal poisonings.

About 5 % results to ICU

admissions and 30 % psychiatric
admissions

HOW TO DIAGNOSE

The diagnosis must be considered

in any patient who presents with:
- coma
- seizure
- acute renal failure
- acute hepatic failure
- bone marrow failure

CLINICAL MANIFESTATION

INITIAL ASSESSMENT
1. STIMULANTS
(amphetamines,cocaine)
- dilated pupils
- warm, sweaty skin
- headache
- seizures
- hypertension
- tachyarrythmia

2. ANTICHOLINERGICS
(Antihistamines,antidepressants)
- dilated pupils
- dry, hyperthemic skin
- hallucination
- coma
- tachycardia
- hypertension

3. CHOLINERGIC DRUGS
(Organophosphates, insecticides)
- small pupils
- excessive sweating
- anxiety
- bradycardia
- excessive salivation
- weakness

4. NARCOTICS
- small pupils
- cold, clammy skin
- respiratory depression
- hypotension
- somnolence
- coma

WHAT TO DO

Goals of therapy includes:

- support of vital signs
- prevention of further
absorption
- enhancement of elimination
- administration of specific
antidotes
- prevention of re-exposure

SUPPORTIVE CARE
Airway protection
- oxygenation/ventilation
- Treatment of arrhythmias
- hemodynamic support
- treatment of seizures
- correction of temperature
abnormalities
-

PREVENTION OF FURTHER
ABSORPTION
- GI decontamination
- syrup of ipecac
- gastric lavage
- dilution
- whole bowel irrigation

ENHANCEMENT OF POISON
ELIMINATION
- multiple-dose activated charcoal
- forced diuresis
- extracorporeal removal
- peritoneal dialysis
- hemodialysis
- hemoperfusion

ADMINISTRATION OF
ANTIDOTES
- neutralization by antibodies
- neutralization by chemical
binding
- metabolic antagonism
- physiologic antagonism

PREVENTION OF RE-EXPOSURE
- adult education
- child-proofing
- notification of regulatory
agencies (National Poison
Control
at PGH)
- psychiatric referral

DROWNING
10-20 % of deaths are due to
asphyxia.
Most impt. is anoxia or hypoxia,
bronchospasm, laryngospasm,
aspiration of particulates
Aspiration of freshwater

CLINICAL MANIFESTATION
Cough
Tachypnea
Pulmonary edema
Organic brain syndrome
Fever
ARDS

WHAT TO DO

ON SCENE
- mouth-to-mouth
resuscitation
- establish airway

IN THE HOSPITAL
- monitor ABGs, pH,
electrolytes
- treat metabolic acidosis
- treat pulmonary infection
- maintain fluid and
electrolyte
balance

THANK YOU!