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First Aid Urgent Priorities and General Management

General Management

The first aider has to act decisively, quickly, calmly and correctly in order to give efficient first aid. This is achieved by following the measures given below.

  1. A calm and controlled approach.
  1. Giving one’s identification before taking charge of the situation if there are no doctors, nurses or other trained persons.
  1. Avoiding placing oneself in danger when approaching the casualty.
  1. A quick assessment of the situation and the casualty.
  1. A correct diagnosis of the condition based on the history of the incident, symptoms and signs.
  1. Immediate and appropriate treatment of any conditions.
  1. Proper disposal of the victim depending on his condition.

How to assess the situation?

Any further damage to the victim and any risk to self and to bystanders are minimized as follows.

   Situation                                                    Measures

Road accidents  –Instruct a bystander to control the traffic, keeping it away from oneself and the victim.Switch off the ignition of the vehicles concerned.Watch out for risk of fire from petrol spillage

 Electrical contact – Break the contact.Take the necessary measures to prevent further contact.

Gas and poisonous fumes – Cut off the source.

Fire- Moves the victim to a safe place immediately.

Collapsing building – Move the victim to a safe place immediately.

How to obtain help from others?

Bystanders should be asked to perform the following tasks.

l .Control traffic.

  1. Stand with their backs to the victim to give privacy and keep others away.
  2. Telephone for assistance.
  3. Telephone for ambulance to shift the victim.
  4. Perform tasks outlined under assessment of situation.
  5. Help control bleeding or apply splints.

How to determine the priorities of treatment?

The following checks should be done immediately.

A – Airway – The airway is checked to confirm that it is not blocked.

B- Breathing – The victim’s breathing is checked to see that it is normal.

C- Circulation – Presence and adequacy of the pulse and heart beat are confirmed.

C- Consciousness – If the victim is unconscious, he is placed in the recovery position, unless there is risk of spinal injury

H- Hemorrhage   – Any severe bleeding is looked for and controlled. 

Based on the findings of the history, these factors, and clinical examination, the priority list is as follows.

Priority level      Conditions

First –        Respiratory arrest

                   Airway obstruction

                   Cardiac arrest

                   Open chest wound

                   Unconsciousness

                   Severe head injuries

                   Severe shock

Second –    injuries to spine

                   Severe burns

                   Moderate bleeding

                   Head injury, victim conscious

                   Multiple fractures

Third –       Minor bleeding

                   Minor burns 

1.If a number people are hurt, it is important that one quickly decides which people to teat first.

2.Treat first who are having life threatening injuries.

3.If more than one victim is having life threatening injuries treat only the life threatening injuries of the first victim before moving on to the second one.

How to call for assistance?

  1. Make a decision about the type of assistance required first, e.g. ambulance, fire brigade, police.

2.Send for it immediately as soon as the decision is made.

3.Get a bystander to go to the nearest phone and make the necessary calls.

4.Give the following information accurately.

  • Exact location of the victim.
  • The type and severity of the condition.
  • The number of victims.

How to make a diagnosis?

Symptoms and Signs of Injury or Illness

              Symptoms and signs                                          Examples

Pain, heat, cold, anxiety, loss of

The victim may tell you about                         sensation, loss of movements, thirst, nausea, vomiting, abnormal sensation, tingling, faintness, loss of consciousness,   weakness, dizziness.

You may observe these

You may feel these

You may hear these

You may smell these

Painful expression, sweating, burns, abnormal chest movements, wounds, bruising, bleeding from orifices, abnormal skin color, foreign bodies, muscle spasm, swelling,          deformity, incontinence, coma.

A bnormal body temperature, dampness, swelling, tenderness, irregularity, deformity, grating bone ends.

Wheeze, groaning, sucking sounds, response to speech, response to touch.

Alcohol, kerosene, turpentine, burning, gas, acid fumes, urine, feces.

Details of how the Incident occurred should be obtained, if possible from the victim or from those present at the time of the occurrence. The symptoms described by the victim should be noted carefully. These include pain, vomiting, giddiness, sensation of heat or cold, loss of motor power etc. Signs are elicited using one’s sensations of sight, touch, hearing and smell. These include the following.

l . Vital parameters: pulse rate, respiratory rate per minute. is judged by touching the victim’s forehead with the back of the hand. Respiratory rate is counted by observing the chest wall movements. Pulse rate is counted by feeling the pulsations at the wrist.

2.Level of consciousness.

3.Paleness (pallor): indicates anemia or acute blood loss.

4.Ability to move the limbs.

5.Features of injury: bleeding, external wounds, features of fractures and dislocations.

6.Pupils: size, equality on both sides, reaction to light. The pupils should be equal, small, and should constrict when light is shone over them.

Abnormal Pulse Rate

Abnormality                causes

Rapid, good volume – Anxiety, fear, heat stroke, overexertion, early stage of hemorrhages.

Slow , good volume – stroke, fracture of skull

Rapid, weak        –        Severe hemorrhage, shock, diabetic coma.

Absent                 –        cardiac arrest.   

 

Abnormal Respiration

Observation                                          Causes

Rapid, shallow – Shock, heart disease, heat exhaustion, insulin shock.

Deep, gasping,   Airway obstruction, chest injury, lung injury, heart failure, lung disease, diabetic coma.

Snoring       –    Stroke, fractured skull, alcohol, drugs abuse.

Gurgling      –    Fluid in airway, lung diseases.

Coughing blood –Chest wound, fractured rib, lung puncture, heart disease.

Abnormalities of Pupils

Abnormality       causes

Unequal – Head injury, hemorrhage within skull, stroke.

Dilated – Alcohol intoxication.  

Dilated, not responding to light – Coma, cardiac arrest, drug toxicity.

Constricted, responding to light -not Damage to brain, drug toxicity.

Various levels of consciousness are as follows.

  1. Conscious: normal.
  2. Restless

3.Stuporous: apparently sleeping, but can be woken up by giving painfill stimuli.

4.Coma (unconsciousness): apparently sleeping, but cannot be awakened even by giving painful stimuli..

5.Abnormalities of skin color may be due to any of the causes shown in the following table.

Abnormalities of Skin Temperature

Abnormality causes

Hot, dry – high fever, heat stroke.

Hot , moist – infection.

Cool, dry – exposure to cold.

Cool, clammy – shock.

 Abnormalities of skin color

Abnormality           causes

Red – high blood pressure, heart attack, heat stroke

Cheery red – carbon monoxide poisoning.

Blue – heart failure, airway obstruction , lung diseases.

Pale – shock , bleeding , heart attack , fright

Inability to move

Type               causes

All four limbs – injury to cervical spinal cord.

Lower –           injury to thoracic or lumbar spinal

Single limb – fracture of the limb bones.

One side limbs- stroke. 

 How to remove clothing

Footwear

l . Support the ankle and remove the shoe carefully.

  1. Slit long shoes down the back seam with a sharp knife.

Socks

l . Pull them off gently.

  1. If that cannot be done, lift each one away from the leg with a finger passed into it and cut it with scissors.

Trousers

l . Pull up the trouser leg gently and expose the calf and knee.

  1. Pull the trouser down from the waist to expose the thigh.

Sweater

  1. Remove the victim’s uninjured are from its sleeve.

2.Ease the sweater from his head without disturbing the injured arm

3.Support the injured arm and slip off the sweater.

Shirt or coat

l . Unbutton it.

2.Remove the uninjured arm from its sleeve first.

3.Pull the shirt/coat round the injured side.

4.Support the injured arm and slip the shirt/coat off the arm

How to remove protective helmet

If the victim can do so, get him to remove it himself. If he cannot do so, it is best left on, and is removed only if absolutely necessary, e.g. for performance of artificial ventilation. Two persons are required to remove it. One should support the victim’s head and neck. The other should remove the helmet.

Open-face helmet

1.Align the victim’s head with his spine in neutral position.

2.Unfasten the buckle or cut through the chinstrap.

3.If the helmet has sides, grip it from above and force the sides apart to take the pressure off his head.

4.Lift the helmet upwards and backwards gently and remove it.

Full-face helmet

  1. Align the victim’s head with his spine in neutral position.

2.Unfasten the buckle or cut through the chinstrap.

3.Working from the base of the helmet, ease the fingers of both of your hands under the rim.

4.Support the neck with one hand and hold the lower jaw firmly.

5.Ask your helper to work from above. Get him to tilt the helmet backwards without moving the head and lift the front clear of the chin gently.

6.Continuing to support the neck and jaw, get the helper to tilt the helmet forwards slightly so that it can be passed over the back of the head. Then get him to lift it straight off the victim’s head.

After observation of these important abnormalities, a detailed examination should be done from the head to toe. Any abnormalities should be noted and recorded carefully. Based on the diagnosis, appropriate treatment should be given, as discussed in the subsequent chapters. An observation chart should be made as shown below.

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