202475449 Standard First Aid[1]

SINGAPORE RED CROSS SOCIETY

RED CROSS TRAINING CENTRE (RCTC). 15 Penang Lane, Level 3, Singapore 238486. TEL: 6336 0269 FAX: 6337 6435 Website: www.redcross.org.sg 20102011

SINGAPORE

STANDARD FIRST AID

TRAINING NOTES

Standard First Aid

Briefing by Instructor During 1st lesson

Singapore Red Cross Society / Red Cross Training Centre / 20102011 Page 1

1. IMPORTANT INFORMATION

Materials included in Course Fee per trainee

Notes Face- shield

Roller Bdg

Triangular Bdg

SFA / CHFA / OFA / ROFA / WFA 1 3 1 1

RFA / RCHFA 1 2 1 1

BCLS / CPR+AED 1 1 - -

BFA 1 1 1 -

Items for Purchase Price Per Unit (with GST)

Face-shield, Triangular Bandage, Roller Bandage $2.50 each

English First Aid Manual (9th Ed) $35.00

Attendance • 100% attendance is compulsory to sit for the test.

• No make-up lessons will be arranged without submission of valid medical cert within 5 working days.

Medical Condition

• Medically fit to perform CPR (resuscitation); have no underlying medical heart, lung conditions or any physical disabilities such as knee, spinal or joints injury history that prevents them from performing CPR effectively.

• Pregnant ladies not allowed for safety precaution. • Declaration of Infectious diseases • SRC is not responsible for injuries & medical conditions occurred during

course

English Proficiency

• Trainees must be able to speak & read in English for courses conducted in English.

Materials to Bring

• Stationery for note-taking. • 1 NRIC-sized photograph (2.5cm by 3.5 cm) for card-size First Aid

certificate. • 2 photos required for OFA/ ROFA/ WFA trainees.

Attire Round-neck T-shirts & pants or jeans. For ladies, avoid applying lipstick.

No Parking For classes conducted at Red Cross, please do not park your vehicle on Red Cross premises as they are strictly reserved for ambulances & staff only.

Weekend Classes

For classes conducted at Red Cross, please walk to back of the building and enter through the back door

2. ELIGIBILITY CRITERIA TO ATTEND REFRESHER COURSE

Refresher Standard

First Aid (RFA Trainee must have a valid (not expired) Standard First Aid / Adult First Aid certificate issued by the Singapore Red Cross or St. John Ambulance.

Refresher First Aid for

Infant-Child Care

Personnel (RCHFA)

Trainee must have a valid (not expired) First Aid for Infant-Child Care Personnel certificate under NFAC approved training agencies. The list can be found in the Ministry’s Child Care Link website: www.childcarelink.gov.sg.

Refresher

Occupational First Aid

(ROFA)

Trainee must have a valid (not expired) Occupational First Aid certificate accredited by OSD under the accredited Training Provider certification scheme. Link to list of Accredited Training Providers: http://www.mom.gov.sg/workplace-safety-health/training/training-courses/Pages/occupational-safety-and-health-personnel.aspx#fa

Red Cross reserves the right to reject the application if the certificate has expired.

Standard First Aid

Briefing by Instructor During 1st lesson


3. TEST & ASSESSMENT

Comprises of Theory test (MCQ) & Practical assessment (2 scenarios)

Course Theory Test Passing Mark Duration

SFA / RFA : MCQ (60% to pass) 30 minutes

CHFA / RCHFA/ OFA / ROFA: MCQ (70% to pass) 30 minutes

BCLS / CPR+AED MCQ (80% to pass) 20 minutes

• Trainees must pass the theory test to proceed to practical test. Trainees, who failed the theory at their 1st attempt, are allowed a 2nd attempt on same day. If they fail 2nd attempt theory, re-test (Theory & Practical) would be on another day (within one month from 1st attempt), after attending a revision class.

• Trainees who failed the practical station would have to re-take the entire test (theory and

practical again). Trainees, who fail the test on the 3rd attempt (Theory or Practical), would have to re-take the entire course.

Re-Test Fee (with GST) Certification Course

$20.00 Standard First Aid (SFA), Occupational First Aid (OFA), First Aid Training for Infant/Child Care Personnel (ChFA), Perform Workplace First Aid (WFA)

$40.00 Occupational AED (OAED), Workplace AED (WAED) Basic Cardiac Life Support (BCLS), CPR+AED (AED)

4. CERTIFICATION

A card-size certificate (9cm by 5cm) will be awarded to trainees who have successfully passed the assessment.

Certification Validity Period from date of Issue

Certification Course

3 years • Standard First Aid (SFA), Occupational First Aid (OFA), • First Aid Training for Infant/Child Care Personnel (ChFA), • Perform Workplace First Aid (WFA)

2 years • Basic Cardiac Life Support (BCLS), • CPR+AED (AED), • Occupational AED (OAED), Workplace AED (WAED)

5. ISSUANCE OF CERTIFICATE CARD (*New with effect 1-Jan-2012)

Certificate Collection

Trainees can collect their card-size certificate on the spot from the examiner upon passing the assessment (unless requested by corporate class clients to send via registered mail within 14 working days)

Venue Red Cross Training Centre (RCTC) Office, Level 3 Opening Hours: Mon to Fri, 9am to 6pm (closed from 12.30pm to 2pm, Eve & PH)

Cert Replacement

• Reprint of cards for amendments not stated on the attendance or lost of card will be chargeable at a fee of $20.00.

• Issue an authorisation letter to a representative if you cannot collect personally.

Standard First Aid

Table of Contents


TABLE OF CONTENTS

LESSON 1:

Principles and Practice of First Aid Management of Medical Emergencies Introduction to Triangular & Roller Bandaging (Practical)

to 9

LESSON 2:

Respiratory System Breathing Difficulties Adult Foreign Body Airway Obstruction (Choking)

Page 10 to 19

LESSON 3

Circulatory System Perform Adult Cardiopulmonary Resuscitation Manage Shock Manage Bleeding Manage Different Types of Wounds

Page 20 to 36

LESSON 4

Nervous System Manage an Unconscious Casualty Manage a Casualty with Chest, Spinal and Abdominal Injuries

Page 37 to 49

LESSON 5

Musculoskeletal System Manage Fractures Manage Soft Tissue Injuries Manage Muscle Cramps

Page 50 to 65

LESSON 6

Skin Manage Burn Injuries Manage Bites and Stings Manage Poisoning Manage Heat Disorders Transport a Casualty

Page 66 to 77

LESSON 7 Types of Bandaging (Practical) - Triangular Bandaging - Roller Bandaging

Page 78 to 89

CPR (Practical) - CPR Checklist (for layperson) - One Man Adult CPR Practical Assessment Sheet

Page 90 to 92

Note Taking Page 93 to 94

Standard First Aid - Lesson 1

Principles and Practice of First Aid & Management of Medical Emergencies


STANDARD FIRST AID LESSON 1

Overview This lesson looks at the principles and practice of first aid, its aims, the responsibilities and duties of a first aider, ways to protect yourself, the management of medical emergencies and how to use a first aid kit.

Topics Outline for Lesson 1 1 PRINCIPLES & PRACTICE OF FIRST AID

a) Definition of First Aid b) Aims of First Aid c) Role of a first aider d) Your limitations e) Ways to protect yourself

2 MANAGEMENT OF MEDICAL EMERGENCIES

a) Emergency Action Plan

• Primary survey

• Secondary survey

• Recovery position

b) The First Aid Kit




1 PRINCIPLES & PRACTICE OF FIRST AID

Definition of First Aid

First aid is immediate help given to a person who is injured or has suddenly taken ill before medical

aid arrives.

a) Aims of First Aid

The four aims of first aid are:

1. To preserve/save life - Prolong the life of a casualty by ensuring the airway is clear and

rendering resuscitation when necessary.

2. To prevent the condition from worsening - minimise any complications by rendering first aid to

the casualty

3. To promote recovery - to ensure that the casualty is comfortable by monitoring his conditions

until the arrival of medical professional.

4. To provide comfort and relief.

b) Role of a first aider • Sustain life

• Observe casualty

• Get help

• Organise care

Take note 1. Your knowledge and skills have limitations. 2. Your responsibilities begin when you arrive at the scene and continue until medical aid

arrives or the casualty recovers. 3. Identify yourself, get permission to give care, and explain the help to be given. 4. Make sure you practice what you have been taught.




c) Ways to Protect Yourself It is important for a first aider to ensure that there is no cross-infection when rendering first aid. As

such, a first aider should avoid being in contact with a casualty’s bodily fluids by:

• Knowing the dangers eg. blood-borne pathogens

• Covering open wounds

• Using Personal Protective Equipment ( PPE ) - latex gloves and pocket mask

2 MANAGEMENT OF MEDICAL EMERGENCIES a) THE EMERGENCY ACTION PLAN

• Primary survey

• Secondary survey

• Recovery position

Primary Survey

[I] Assess the scene for Danger.

A first aider must be aware of any surrounding dangers and remove danger immediately if possible.

Remove the casualty from the danger as an alternative. Ask yourself these questions before

rendering assistance.

• Is there any danger to me?

• Can I rescue the casualty from danger?

• How do I deal with the danger?

• How many casualties are there?

• Who to treat first? Follow the priority of treatment.

Priority of Treatment 1. Life threatening emergencies.

2. Bleeding wounds and

fractures.

3. Minor injuries.




[II] Assess casualty for Responsiveness

A first aider needs to determine the level of responsiveness by

• Gently tapping the casualty at the shoulder, and

• Asking if the casualty is alright.

[III] Observe the casualty’s level of responsiveness as follows:

• Alert – able to respond to simple questions and give answers.

• Voice – able to respond to voice by moving body.

• Pain – able to respond to pain.

• Unresponsive – no response or movement.

[IV] Shout for help

If there is no response from the casualty, shout for help and contact emergency service, call the

ambulance 995 immediately. Pass relevant information such as:

• Your name and telephone

• Casualty location and location landmarks

• Briefly what happened

• Number of casualties

• Casualty’s condition

• Other information e.g. traffic condition

[V] Open and check the Airway

• Head tilt chin lift, a technique to ensure clear airway.

[VI] Check for Breathing

• Look at the chest, listen to the air and feel the warm air for up to 10 seconds.

• If no breathing, commence CPR

[VII] Commence CPR

• Commence CPR and continue until casualty begins to breathe, ambulance arrives, AED is

available, rescuer gets exhausted or someone takes over.

• If breathing is present, check for signs of injuries.

# Footnote :

During your initial assessment, check also for severe bleeding, head and spinal injuries before ABC.




Secondary Survey

Once breathing is maintained, the first aider needs to conduct a head to toe secondary survey to

check whether there is any injury. The technique is perform in a systematic way :

C � Check for pain, any discomfort.

H � History – ask briefly what happened.

E � Examine head to toe for any missed injuries.

C � Compare opposite side for abnormality.

K � Keep monitoring vital signs.

Recovery Position

Once there is no injury, the first aider needs to place the casualty to the recovery position or rest

the casualty in the most comfortable position, depending on the condition of the casualty.

Purpose 1. Prevents casualty’s tongue from falling back and blocking his airway.

2. Prevents any vomitus or secretions from choking the casualty

During recovery – Monitor the Vital Signs

• Breathing

• Level of response / level of consciousness

The Recovery Position




b) Every home should have a First Aid Kit

Every home or workplace should have a first aid kit that must be readily available and accessible to

all. A well-maintained first aid kit will make the first aider more confident when rendering first aid.

A first aider must check for expiry dates on the items and replenish the items immediately.

Quantity Useful Addition Items 1 each Notepad and pen

1 each Torch and whistle

2 packets Instant cold pack

1 each Thermometer ( clinical or digital )

* This is only a suggested list.

END OF LESSON 1

Quantity Basic Items 10 pieces each Adhesive dressing plasters in assorted sizes

4 packets Sterile gauze of various sizes

6 pieces Triangular bandages

1 bunch Safety pins

2 pairs Disposable gloves

1 pair Scissor

1 roll Micropore or zinc oxide tape

2 packets Cotton balls

1 packet Antiseptic cleaning wipes ( 10 pieces/packet)

1 piece Face mask with one way valve

5 tubes Normal saline (10 cc)

2 rolls each Crepe bandage ( 2.5, 5, 7.5, 10 cm )

1 set Tweezers or forceps ( plastic or stainless steel )


Breathing Difficulties & Adult Foreign Body Airway Obstruction


STANDARD FIRST AID LESSON 2

Overview This lesson looks at the respiratory system, the mechanism of breathing, recognition of breathing difficulty, specific causes of breathing difficulty and how to clear foreign body airway obstruction of a conscious to an unconscious adult.

Topics Outline for Lesson 2 1 THE RESPIRATORY SYSTEM

a) The Structure of the Respiratory System b) Its Functions c) The Mechanism of Breathing

2 RESPIRATORY DISTRESS OR BREATHING DIFFICULTY

a) Recognition of Respiratory Distress

b) Some Causes of Breathing Difficulty

• Choking – abdominal and chest thrust

• Unconscious choking

• Drowning

• Hyperventilation

• Bronchial Asthma




1 THE RESPIRATORY SYSTEM a) Structure The respiratory system comprises of the:

• Nasal passage

• Larynx

• Trachea ( windpipe )

• Bronchial tubes

• Pleura

• Alveoli

• Diaphragm

b) Function The functions of the respiratory system are:

• To provide oxygen for use in the body.

• To excrete carbon dioxide. Respiration is the process in which the body takes in oxygen and expels carbon dioxide (a waste product from body tissues). The breathing process comprises the actions of breathing in (inspiration / inhalation), breathing out (expiration /

exhalation) and a pause.

c) Mechanism of Breathing • During inspiration (breathing in) the chest cavity is enlarged, 21% of oxygen is inspired.

• During expiration (breathing out) the lungs contract, the cavity returns to normal size and air is forced out, 16 % of oxygen is expired.

• Only 5% of oxygen is absorbed by the body.

• The exchange takes place in the lungs at the alveoli (air sacs); the oxygen that we breathe in is taken into the pulmonary capillaries; at the same time, carbon dioxide is released and expelled as we breathe out.

• The breathing rate of an adult is between12 to 18 breaths per minute.




Mechanism of Breathing

2 RESPIRATORY DISTRESS OR BREATHING DIFFIFULTY While normal breathing is effortless, steady, rhythmic, and occurs with little or no noise, abnormal breathing is noisy and requires much effort. The brain will suffer permanent damage if deprived of oxygen for more than four minutes. Breathing difficulty is a condition where the casualty is having laboured breathing or respiratory distress.

a) Recognition

• Difficulty in breathing and gasping for breath

• Anxiety, restlessness, confusion, disorientation

• Casualty’s skin is bluish in colour (cyanose)

• Leading to unconsciousness

b) Causes of breathing difficulty are: • Choking

• Fumes inhalation

• Drowning

• Hyperventilation

• Bronchial Asthma




Respiratory Arrest

Respiratory arrest means absence of spontaneous breathing. It is a life-threatening condition requiring immediate medical attention. Common causes

• Choking

• Heart attack

• Drug overdose

• Prolonged asthmatic attack

ADULT FOREIGN BODY AIRWAY

OBSTRUCTION (CHOKING)

Choking is a respiratory distress that occurs when the airway is partially ( mildly ) or totally ( severely ) obstructed by a foreign object or commonly the tongue when the victim becomes unconscious.

Causes

• Foreign body

• Tongue (when unconscious)

Recognition

• Difficulty in speaking, breathing & coughing

• Universal sign

• Cyanosis

Actions to take

• D R S A B C




Actions to take for a Conscious casualty (not pregnant or obese) Encourage the victim to cough until condition worsens.

STEP 1. ASSESS WHETHER VICTIM IS CHOKING

• Ask, “Are you choking? Are you pregnant?”(for female casualty only).

• If the victim is choking, the victim will not be able to speak, breathe or cough but may nod his head.

STEP 2. POSITION OF RESCUER

• If the victim is standing, the rescuer stands behind the victim.

• If the victim is sitting, the rescuer kneels down and positions himself behind the victim

STEP 3. LOCATION OF LANDMARK

• Put your arms around the victim’s abdomen.

• Place 2 fingers’ breath above the navel and well below the tip of the xiphoid process.

• Make a fist with one hand.

• Place the thumb-side of the fist against the abdomen, midline and above the 2 fingers’ spacing.




STEP 4. THE HEIMLICH MANOEUVRE

• Lean the victim forward with one hand, while maintaining the fist against the abdomen.

• Grasp the fist with the other hand.

• Give quick inward and upward thrusts in one motion into the victim’s abdomen until the foreign body is expelled or the victim becomes unconscious.

Actions to take for a Conscious casualty (pregnant or obese) Encourage the victim to cough until condition worsens. STEP 1. ASSESS WHETHER VICTIM IS CHOKING STEP 2. POSITION OF RESCUER

STEP 3. LOCATION OF LANDMARK

• Place arms under the victim’s armpits, encircling the chest.

• Make a fist with one hand.

• Place thumb-side of fist on the middle of the victim’s breastbone.

STEP 4. CHEST THRUST

• Grasp fist with the other hand and give quick

backward thrusts.

• Deliver each thrust firmly and distinctly with the intent of relieving the obstruction until the foreign body is expelled or the victim becomes unconscious.




Actions to take for an Unconscious casualty STEP 1. CHECK FOR DANGER STEP 2. ASSESS UNRESPONSIVENESS

STEP 3. SHOUT FOR HELP. ACTIVATE THE EMERGENCY MEDICAL SERVICE (EMS)

• Shout loudly for help and immediately call 995 for an

emergency ambulance.

STEP 4. PERFORM CHEST COMPRESSIONS

• Commence 30 chest compressions using the same location and technique used as chest compression (refer to Adult CPR).

STEP 5. OPEN THE AIRWAY

• Perform a Head-Tilt Chin-Lift maneuver




• Remove visible foreign body if seen by using the

index finger

• Do not perform blind sweeping.

STEP 6. CHECK BREATHING • Look, • Listen and • Feel for signs of breathing (up to 10sec). STEP 7. MOUTH TO MOUTH BREATHING • If breathing is absent, attempt one ventilation. • If chest does not rise, this indicates that the

airway is still blocked. • Reposition the victim’s head and re-attempt

to ventilate. • If 2nd ventilation fails, suspect that the victim

is still choking. STEP 8. CONTINUE CHEST COMPRESSIONS • If no foreign body seen, repeat Steps 4 to 7 until able to give two

successful ventilations, help arrives, or victim starts breathing, coughing, moving or talking.

• If breathing is present, check for injuries. • Position the victim in the recovery position if no injuries.

• Continue to monitor the victim’s breathing and level of response every few minutes.




Drowning

Death by drowning usually occurs not because the lungs are full of water, but because throat spasms prevent breathing.

Causes

• Fatigue

• Poor swimming skills

• Strong currents and waves

Actions to take

• D R S A B C

• Keep casualty warm

• Seek medical attention

Hyperventilation

Hyperventilation is a condition of over-breathing, which causes an excessive loss of carbon dioxide from the blood, leading to a tingling sensation and numbness of the hands and legs.

Recognition

• Unnaturally fast, deep breathing.

• Dizziness, faintness, trembling or tingling in the hands.

• Cramps in the hands and feet.

• Seek medical attention

Causes

• Anxiety

• Hysteria

• Panic attack

• Fright Actions to take

• Lead casualty to a quiet place.

• Ask casualty to breathe slowly.

• Let him re-breathe his own expired air covering mouth and nose.




Bronchial Asthma Bronchial asthma is a condition where there is difficulty in breathing due to the muscles of the air passages going into spasm

Causes

• Environmental triggers like cold air, pollen, cigarette smoke and perfumes.

• Occupational exposures such as dust, fumes and industrial smoke. Recognition

• Difficulty in breathing.

• Wheezing during expiration.

• Blueness of the skin (cyanosis).

• Distress and anxiety.

• In severe attacks, the effort of breathing will tire out the casualty. Actions to take

• Let the casualty adopt the position that he finds most comfortable, which is often sitting up. Do not lie down.

• Ask him to breathe slowly and deeply.

• Ask him about any asthma medication. Assist him to use the inhaler.

• If condition worsens, rush victim to the nearest doctor or hospital or call ambulance 995.

END OF LESSON 2

Standard First Aid – Lesson 3

The Circulatory System, Perform Cardiopulmonary Resuscitation, Shock, Bleeding and Wounds


STANDARD FIRST AID

LESSON 3

Overview This lesson covers the circulatory system, shock, bleeding, wounds and cardiopulmonary

resuscitation.

Topics Outline for Lesson 3

1 THE CIRCULATORY SYSTEM

a) Structure of the circulatory system

b) The Heart

c) Blood Pressure

d) The Pulse

2 MANAGEMENT OF SHOCK

a) Causes of Shock

b) Recognise the signs and symptoms of shock and how to manage shock.

3 ADULT CARDIOPULMONARY RESUSCITATION (CPR)

a) Heart Attack and Cardiac Arrest

b) Importance of the Chain of Survival Concept

c) Steps in performing CPR

4 MANAGEMENT OF BLEEDING

a) Recognise and manage different types of bleeding.

5 MANAGEMENT OF DIFFERENT TYPES OF WOUNDS

a) Recognise and manage different types of wounds including nose bleed.

b) Recognise and manage special types of wounds - embedded foreign body.




1 THE CIRCULATORY SYSTEM




a) Structure

The circulatory system is made up of the heart and blood vessels. Four to six litres of blood

circulate around the body to distribute oxygen and nutrients to the tissues and carry waste

products away.

• Blood Vessels

There are three types of blood vessels: arties, veins and capillaries.

Arteries – Strong, muscular, elastic-walled vessels which carry blood away from the heart

towards the tissues.

Veins – Thin-walled vessels which carry blood back to the heart. Blood is squeezed through the

veins by action of the surrounding muscles, and is kept flowing towards the heart through one-

way valves.

Capillaries – Arteries subdivide to form a dense network of fine, thin-walled vessels called

capillaries within the body tissues. The thin capillary walls allow for exchange of gases and other

materials between cells of the body and the blood. The capillaries then rejoin to become veins.

b) The Heart

The functions of the heart are to pump:

• Deoxygenated blood to the lungs for

oxygenation.

• Oxygenated blood to all parts of the body.

Pulmonary artery carries

deoxygenated blood to

Pulmonary vein carries

oxygenated blood from lungs




c) Blood pressure

The heart’s pumping action makes the blood exert

pressure against the walls of the artery. This is called

blood pressure. As the artery walls are elastic, they

can expand or contract to maintain blood pressure at

normal levels. Blood pressure is a measurement of

your risk for hypertension and heart disease.

Blood Pressure (BP) is described by two numbers,

for example, if your BP is 120/80, the systolic BP

is 120mmHg and the diastolic BP is 80mmHg.

The systolic range for adult is 100 – 140 mm

Hg

The diastolic range for adult is 60 – 90 mm Hg

d) The Pulse

This is the pressure wave along arteries, generated by the contraction of the heart. It can be felt

where the artery is close to the surface of the body.

Pulse rate for a normal adult = 60 to 100 beats per min.

Pulse rate for an infant ≤ 1 yr is = 100 to 160 per minute

Pulse rate for a child is = 80 to 120 per minute

The pulse for an adult can be felt at the:

1. Wrist (radial pulse) 2. Neck (carotid pulse).

Pulse – Normal versus Abnormal

Normal Abnormal

Rate 60 to 100 beats per min > 100 ( fast heart rate or tachycardia )

< 60 ( slow heart rate or bradycardia )

Rhythm regular irregular

Strength strong weak ( in shock )




2 MANAGEMENT OF SHOCK

Shock may be defined as failure of the circulatory system to perfuse tissues of the body.

Shock is defined as a life-threatening condition which may be progressive and may lead to the

collapse of the circulatory system. Life in danger

Causes Types

• Severe blood loss eg. bleeding � Hypovolemic shock ( volume failure )

• Fluid loss eg. burns � Hypovolemic shock ( volume failure )

• Severe pain � Neurogenic shock ( spinal injuries )

• Infection or poisoning � Septicaemia shock ( vasodilation )

• Heart attack or heart failure � Cardiogenic shock ( pump failure )

• Severe allergic reaction � Anaphyalactic shock ( vasodilation )

Recognition

• Extreme thirst

• Anxiety

• Mental state changes

• Rapid & shallow breathing

• Rapid & weak pulse

• Pale cold & moist skin

The signs and symptoms vary with the degree of severity of shock. Table below illustrates the

response of the body to blood loss.

Volume Signs & Symptoms

300 to 500 ml of blood loss • Little or no effect

1500 to 2000 ml of blood loss 1. Increased pulse rate

2. Shallow and rapid breathing

3. Sweating

4. Cold and clammy skin

5. Pallor

6. Nausea

7. Drowsiness

More than 2000 ml

of blood loss

1. Pulse becomes undetectable

2. Loss of consciousness

3. Breathing may cease and heart may stop, impending

death.

Actions to take

• Reassure the casualty. Call ambulance 995.

• Lay casualty down or put him in a comfortable position.

• Elevate legs above level of heart (unless fractured).

• Treat cause (e.g. stop bleeding).

• Loosen visible tight clothing.

• Monitor vital signs – breathing & response.




3 ADULT CARDIOPULMONARY RESUSCITATION (CPR)

a) Heart attack

A heart attack occurs when there is an

insufficiency of blood supply to the heart

muscle.

Recognition

• Chest pain / discomfort

• Shortness of breath

• Sweating

• Nausea

Action to take

• Reassure the victim.

• Call ambulance 995 and get the Automated

External Defibrillator (AED) if available.

• Ask him if he has any medication to relief

the pain.

• If so, ask him to take the medicine.

• Monitor the victim.

• Perform CPR if victim is not breathing and

is unconscious.

b) Cardiac Arrest

Cardiac arrest is a sudden cessation of heartbeat. When this occurs, the heart will stop pumping

and the circulation will also stop.

The casualty may have chest pain and may collapse suddenly, or he may be found unconscious

because his heart has stopped




c) The Importance of the Chain of Survival Concept

Early Access Early CPR Early Defibrillation Early Advanced

Cardiac Care

The chain of survival concept highlights the importance of understanding the four inter-

connected links that lead to the rapid recovery of cardiac arrest casualty.

The four links are:

• Early Access – the first aider must recognise the symptoms and signs of life-threatening

conditions, such as chest pain and shortness of breath, which warrants a call to 995 before

the casualty collapses.

• Early Cardio Pulmonary Resuscitation – it is a temporary intervention that provides

oxygen to the heart, brain and other vital organs. If no oxygen reaches the brain for 4

minutes, the casualty may become brain dead.

• Early Defibrillation – the external electric shock ‘defibrillation’ will restore regular heart

rhythm. It improves survival rates for out-of-hospital cardiac arrest casualty.

• Early Advance Cardiac Life Support – medical care provided by the ambulance medical

personnel that includes supporting ventilation, establishing intravenous access,

administering drugs, controlling arrhythmias and preparing the casualty for transport to

hospital.




d) Steps in performing CPR

STEP 1. CHECK FOR DANGER

STEP 2. ASSESS UNRESPONSIVENESS

• Call, tap or gently shake the person

• “Hello! Hello! Are you OK?”

STEP 3. SHOUT FOR HELP. ACTIVATE EMERGENCY

MEDICAL SERVICE (EMS)

• If victim does not respond, shout for help.

• Call ambulance 995 and get the first aid kit and AED if

available.

STEP 4. POSITION THE CASUALTY

• For CPR to be effective, the victim must lie on a firm, flat

surface.

• If the casualty is lying face down, or on his / her side, you

will need to roll the casualty over onto his /her back.




STEP 5. OPEN THE AIRWAY

• Perform a head-tilt chin-lift manoeuvre.

STEP 6. CHECK FOR BREATHING

LOOK at the chest movement

LISTEN for breathing sounds, and

FEEL for warm air against your cheek for signs

of breathing (up to 10sec).

Gasping is considered not breathing.

Airway blocked

Tongue falls back

With head-tilt chin lift, the airway is clear.




STEP 7. COMMENCE CPR. LOCATE HAND POSITION FOR CHEST COMPRESSIONS

• Maintain head tilt-chin lift.

• Run your middle finger from the lower margin

of victim’s rib cage to sternal notch.

• Place index finger next to middle finger

( landmark is lower half of the breastbone ).

STEP 8. PERFORM CHEST COMPRESSIONS

• Interlace fingers, and lift fingers off the chest

wall.

• Straighten and lock elbows.

• Position you shoulder directly over the

casualty’s chest

• Use your body weight to compress down to a

depth of at least 5 cm and count loudly;

1 and 2 and 3 and 4 and 5 and,





1 and 2 and 3 and 4 and 30 and

followed by 2 ventilations.

SStteerrnnaall

NNoottcchh




STEP 9. FOLLOWED BY MOUTH TO MOUTH

BREATHING • Followed by 2 ventilations.

• Maintain a head-tilt chin-lift.

• Pinch nose and give 2 quick ventilations ( 400-

600 ml/sec per breath ).

• Watch chest rise and release the pinch after

each breath.

• Continue good quality CPR.

Guidelines recommended by National Resuscitation Council ( NRC )

• For layperson, no reassess.

• To give effective chest compressions, rescuer should “push hard and push fast”.

• Locating the correct hand position for chest compression should be done quickly.

• The ratio of compression and ventilation is 30 : 2

• Perform chest compression rate at 100 per minute.

• Continue CPR till ambulance arrives or until AED is attached to casualty or the victim starts

breathing or rescuer becomes exhausted.

• If breathing is present, check for injuries and position the victim in the recovery

position ( if no injuries ).

• Continue to monitor victim’s vital signs every few minutes.




B C

A

RECOVERY POSITION

STEP 1. POSITION THE VICTIM

STEP 2. ROLL THE VICTIM TOWARDS STEP 3. FINAL RECOVERY

THE RESCUER POSITION




4 MANAGEMENT OF BLEEDING

Types of Bleeding

Recognition

Arterial Venous Capillary

1. Bright red, oxygenated

blood.

2. Spurts out, flowing under

pressure

1. Dark red, deoxygenated

blood

2. Gushes profusely

1. Blood loss usually slight

2. Causes a bruise if bleeding is

into tissues

3. Slow ooze

• External Bleeding

1. Protect yourself. Use disposable rubber or

plastic gloves.

2. Control bleeding with direct pressure.

3. Elevate affected part.




4. Do not apply a tourniquet.

5. When bleeding cannot be stopped by direct

pressure, apply Indirect Pressure.

• Brachial pressure point

• Femoral pressure point

6. Rest the affected part. Elevation slows bleeding.

• Internal Bleeding

1. Reassure casualty

2. Lay casualty down

3. Elevate legs above level of heart (unless fractured)

4. Loosen visible tight clothing

5. Give nothing by mouth

6. Monitor vital signs – breathing & response




5 MANAGEMENT OF WOUNDS

Types of Open Wounds

Recognition and Actions To Take

Abrasions (Graze)

• Superficial wound resulting from a sliding fall or a friction

burn.

• Often embedded with dirt that may result in infection.

• Remove debris.

• If dry, leave open; if wet cover with dry gauze dressing

(not cotton wool ).

Incised Wound

• A clean cut by a sharp edge.

• Vessels may be cut.

• Control bleeding.

• Seek medical attention.

Laceration

• Tear in skin from example a barbed wire.

• Edges are irregular.

• Often contaminated and danger of infection is high.



Puncture / Stab Wound

• A deep wound caused by a nail or a sharp pointed object.

• Risk of infection is high.

• Do not remove any impaled object.





Avulsion (Tearing Wound)

• Caused by machinery or explosive devices.

• Skin and underlying tissue torn off or left hanging.

• Severe bleeding may occur.



Amputation

• Body part is cut or torn off and bleeding may be severe.

• Control bleeding

• Take all amputated parts to the doctor.

• Preserve amputated body parts correctly

Preservation of an amputated finger

Nose bleed

Causes

• Spontaneous bleeding

• After an injury, sneezing or blowing hard on the nose

Spontaneous bleedi After an in

Actions to take

• Casualty to be seated

• Pinch soft part of nose and lean forward

• Breathe through the mouth

• Release after 10 minutes

• If bleeding has not stopped, reapply pressure for two

further periods of 10 minutes each

• Seek medical attention if bleeding persists

1. Wrap amputated part

in clean dry gauze to

absorb moisture.

2. Put wrapped

amputated body

part in plastic bag.

3. Place bag with the

wrapped part in another

bag of ice.




Special types of wounds:

Embedded Foreign Body

Recognition: Actions to take:

Gravel, broken glass, plastic,

metal / wooden splinters or

a sharp metal object may be

embedded in the skin.

1. Do not attempt to remove a penetrating foreign body.

2. Place padding around the object or place a ring pad over

the object, and bandage over the ring pad.

End of Lesson 3


Nervous System, Manage Unconscious Casualty, Chest, Spinal & Abdominal Injuries


STANDARD FIRST AID

LESSON 4

Overview This lesson covers the brain and the nervous system, disorders of consciousness

including head, orofacial, chest, spinal and abdominal injuries


1 MANAGEMENT OF AN UNCONSCIOUS CASUALTY

a) The Nervous System

b) Structure of the Brain

c) Definition of Unconsciousness

d) Recognize the different causes of Unconsciousness

- Head and Facial Injuries

- Fits

- Fainting

- Stroke

- Diabetes

2 MANAGEMENT OF CASUALTY WITH CHEST, SPINAL AND ABDOMINAL

INJURIES

a) Recognize spinal injuries

b) Recognize a penetrating chest injury

c) Recognize an abdominal injury




1 MANAGEMENT OF UNCONSCIOUS CASUALTY

a) THE NERVOUS SYSTEM

The Nervous System consists of the:

1. Central Nervous System, mainly the

• Brain

• Spinal cord

2. Peripheral Nervous System, consisting of the

• motor nerve moving from the spinal cord

• sensory nerve going into the spinal cord

3. Autonomic nervous system which carries signals to and from the internal organs (e.g.

heart, stomach, intestines) and the brain.

b) Structure of the Brain

Function of the brain is to control bodily functions. Disorder of the brain results in

unconsciousness.

The brain and spinal cord are covered by protective membranes (meninges).

The brain and spinal cord are bath in cerebrospinal fluid (CSF).




c) Definition of Unconsciousness

Unconsciousness is defined as impairment of awareness. It can range from drowsiness and

confusion to total lack of response. It is a total or partial loss of ability to respond to external

stimulus like voice or pain.

The main causes of impaired consciousness are structural damage to the brain or a lack of

nutrients, oxygen and glucose (sugar) from reaching the brain. The first aider can assess

consciousness by checking the casualty’s level of responsiveness as follows:

a. Alert – able to respond to simple questions and give answers

b. Voice – able to respond to voice by moving body

c. Pain – able to respond to pain

d. Unresponsive – no response or movement

d) Causes of Unconsciousness

• Alcohol intoxication

• Epilepsy

• Insulin coma

• Overdose of drugs eg. sedatives

• Ureamia ( renal failure )

• Trauma ( head injury )

• Infection

• Psychiatric condition eg. Hysteria

• Stroke / Shock

Action to take

• Apply Emergency Action Plan

DO NOT

• Give anything by mouth.

• Move the casualty unnecessarily.

• Leave an unconscious casualty unattended at any time.




HEAD INJURY

A head injury may be caused by a direct or indirect force resulting in a scalp laceration, brain

concussion, brain compression, or skull fracture.

Types of head injuries Recognition & Its First Aid

Scalp laceration

.

1. Apply direct pressure if

underlying skull fracture is

not suspected.

2. If a skull fracture is suspected,

apply pressure round the

edges of the wound. Use a

ring pad to do this.

3. Secure the dressing with a

scalp bandage.

4. Seek medical attention

Concussion

A concussion is a

“shaken brain” resulting

in a partial loss of

consciousness.

1. Brief or partial loss of

consciousness

2. Dizziness, nausea or vomiting

3. Loss of memory

4. Generalised headache

Compression ( Contusion )

Compression is

pressure exerted on

the brain

e.g. by a blood clot.

1. Headache intensifies.

2. Breathing slow & noisy

3. Vomiting

4. Pupils unequal or dilated

5. Some weakness or paralysis




Types of head injuries Recognition

Skull fracture

A fracture of the skull

is the break, either

partly or completely of

a skull bone. A large

force is necessary to

cause such as injury

e.g. road traffic

accidents or a fall from

a height.

1. Progressive deterioration in

LOC

2. Blood & CSF coming out from

nose or ears usually indicates

a base of skull fracture.

3. Vomiting

4. Blood shot eyes

FACIAL INJURIES

• Cheekbone and Nose fracture

Causes

• Trauma

• Fights

Regconition

• Bloodshot eyes

• Deformity and swelling around cheek,

jaw or nose.

• Pain

• Severe bruising

• Loose or missing teeth

Actions to take

• Apply cold compress

• Pinch nose foe nose bleed

• Seek medical treatment




Eye Injury

Injuries to the eye by trauma, fall, cut , flying objects or foreign

body can lead to pain, tearing, irritation, bleeding redness

or loss of vision

Recognition

• Pain, visual loss and bleeding may be present.

Actions to take

• Foreign body in the eye - Do not rub your eye

• Cuts of the eye and lid -Cover with a sterile, dry pad over the

affected eye and bandage.

• Tell the casualty to keep both eyes still.

• Seek medical help immediately

• Chemical burns - Flood the eye with water immediately




FITS ( Seizures/Convulsions )

A fit is a sudden loss of consciousness followed by uncontrolled movements of the limbs. It

generally lasts a few minutes and it cannot be stopped.

1. Tonic phase

(stiffening of the body)

2. Clonic phase

(the body jerks)

3. Post-convulsive phase

(exhaustion)

Causes

• Head injury

• High fever

• Stroke

• Brain tumour

• Infection

• High/low blood sugar

• Epilepsy ( recurrent seizures )

Recognition Actions to take DO NOT

1. Sudden loss of

consciousness

2. Shaking of limbs

3. Clenching of

teeth, up-rolling

of eyes

4. Foaming around

the mouth

5. Drowsy, dazed or

confused

1. If your casualty is falling - support or ease

his fall.

2. Make space around him - ask bystanders

to move away. Prevent self-injury.

3. Loosen tight clothing around the neck.

4. Roll casualty onto his side to drain

secretions.

5. After the fit is over, if casualty is drowsy,

place in the recovery position.

6. Call the ambulance 995.

1. Move the casualty

unless there is

immediate danger

2. Use force to

restrain him

3. Put anything in his

mouth




Fainting ( Syncope )

Fainting is a brief loss of consciousness due to a temporary reduction in the blood flow to the

brain. Recovery is usually rapid and complete.

Causes Actions to take

1. Fright

2. Hunger

3. Exhaustion

4. Severe pain

5. Emotional upset

6. Prolonged standing

1. Lay the casualty down.

2. Loosen tight clothing.

3. Check ABC.

4. Raise the casualty’s legs.

5. Ensure plenty of fresh air.

6. Advise the casualty to seek medical attention.




Stroke

A stroke is a condition in which the blood supply to part of the brain is suddenly impaired by a

blood clot ( blockage ) or a ruptured vessel.

Blood clot Ruptured vessel

Recognition Actions to take

1. Altered level of consciousness.

2. Slurred or garbled speech.

3. Loss of movement, weakness and

feeling, usually on one side of the

body.

4. Severe headache.

1. Call for an ambulance 995.

2. Reassure the casualty.

3. Ensure the ABC is present if he is unconscious.

4. Monitor vital signs every five minutes till the

ambulance arrives.




Diabetic coma ( diabetes mellitus )

Insulin is a hormone produced by the pancreas that allows your body cells to use blood glucose

(sugar) for energy. Food is converted into glucose before it is absorbed into our bloodstream.

The pancreas then releases insulin to move the glucose from the bloodstream into the body cells

for use or storage.

People with diabetes are unable to fully use the glucose in their bloodstream due to:

- lack of insulin in the body

- insulin is ineffective

Loss of consciousness in diabetes can be due to low blood sugar or hypoglycaemia or excessive

blood sugar or hyperglycaemia.

HYPOGLYCAEMIA HYPERGLYCAEMIA

Recognition

1. Rapid loss of Consciousness.

2. The casualty has not taken any

food following diabetes

medication or injection.

3. Overdose of insulin injection.

1. The casualty has been unwell

over the last few days.

1. Dry mouth and lips.

2. Undiagnosed diabetes mellitus.

3. Failure to take medications or

insulin.

Actions to take

Give a sweet drink if the casualty is

able to drink.

Seek medical attention immediately.




2 MANAGEMENT OF SPINAL, CHEST AND ABDOMINAL INJURIES

a) Spinal Injuries

Causes:

- Falling from a height.

- Diving into shallow waters.

- Being thrown off a horse or a motorcycle.

- Sudden deceleration in a motor vehicle.

- A hit across the back by a heavy object or force.

- An injury to the head or face

Recognition Actions to take:

1. Inability to move the lower

limbs.

2. Abnormal / loss of sensation.

3. Limb weakness / paralysis.

4. Difficulty in breathing if the

injury is high up in the neck.

Do not move the casualty unless there is presence of

danger.

For a conscious casualty:

1. Reassure the casualty and advise him not to move.

2. Steady and support his head in the neutral position

(head injury).

3. Call for an ambulance 995.




b) Penetrating Chest Wound


A wound with or without a

penetrating injury (entrance

and/or exit). A crackling feeling

may be felt in the skin around the

wound.

1. Call for an ambulance – dial 995.

2. Cover the wound immediately with the casualty’s own

hand or the palm of your gloved hand.

3. Place a sterile dressing or clean pad over the wound, and

cover the pad with a plastic bag or cling wrap film.

4. Secure firmly with adhesive strapping on four sides.

Leave a gap at the fourth side untapped to allow air

under pressure during expiration to escape.

5. Support the conscious casualty in a comfortable position,

inclined towards the injured side.

Position of the casualty after treatment

Keep the uninjured lung uppermost




c) Abdominal wounds


An open or closed wound to

the abdomen. The intestines or

other organs may be exposed.

1. Call for ambulance 995.

2. Lay the casualty down, bending and supporting his knees

if possible.

3. Put a large dressing over the wound, and secure it lightly

in place with a bandage or adhesive strapping.

4. Cover any exposed abdominal contents with a polythene

bag or cling wrap film.

5. Alternatively, use a sterile dressing.

6. Treat for shock and monitor the vital signs.

End of Lesson 4

RRaaiissiinngg aanndd ssuuppppoorrttiinngg

tthhee kknneeeess mmaayy eeaassee

ssttrraaiinn oonn tthhee iinnjjuurryy


The Musculoskeletal System, Fractures, Soft Tissue Injuries & Muscle Cramps

Singapore Red Cross Society / Red Cross Training Centre / Oct 2011 Page 50

STANDARD FIRST AID

LESSON 5

Overview This lesson covers the musculoskeletal system, fractures and soft tissue injuries.


1 THE SKELETAL SYSTEM

a) Structure

b) Joint

2 MANAGEMENT OF FRACTURES

a) Definition of fracture

b) Types of Fracture

c) Open and Closed Fracture

d) Specific Bone Fractures

3 MANAGEMENT OF SOFT TISSUE INJURIES

a) Sprain and Strain

4 MANAGEMENT OF MUSCLE CRAMPS

a) Causes and Actions




1 THE SKELETAL SYSTEM

a) Structure

The skeleton consists of 206 bones.

Functions

• Protection

• Locomotion

• Support

• Formation of blood cells




b) A JOINT

A joint is the place where two bones come together. There

are three types of joints classified by the amount of

movement they allow: immovable, slightly movable, and

freely movable.

The structure of a movable joint consists of:

• Ligament

• Capsule

• Bone

• Cartilage

• Synovial fluid (joint fluid)

An example of a freely movable joint

is a ball-and-socket joint of the

shoulder.

An example of a slightly movable

joint of the spine.

Another example of a freely movable

joint is a hinge joint of the elbow.




2 MANAGEMENT OF FRACTURE

The human body contains more

than 650 individual muscles

which are attached to the

skeleton, which provides the

pulling power for us to move

around. The main job of the

muscular system is to provide

movement for the body.

a) Definition of a fracture

Fractures are breaks or disruptions in bone tissue. These can be complete or partial breaks in

the bone.

b) Types of Fractures

All fractures can be broadly described as:

1. Closed (Simple) fractures 2. Open (Compound) fractures

are those in which the skin is intact involve wounds that communicate with

the fracture.




Other types of fracture

• Complicated

• Greenstick

• Comminuted

• Spiral

• Transverse

Causes

• Direct force

• Indirect

• Muscular contractions

Recognition

• Deformity or shortening of the affected limb.

• Open injuries or internal bleeding, (manifested as shock if severe).

• Pain and tenderness of the injury site.

• Swelling and bruising – from internal bleeding.

• Loss of function of the limb.

Footnote :

The signs and symptoms of fractures can also be summarise as PLASTICS – Pain, Loss of

Function, Abnormality, Swelling, Tenderness, Infection, Crepitus and Shock.




Actions to take:

1. Lay the casualty down and minimise movement

2. Support the injured limb until it is immobilised.

3. Cover the wound ( for open fractures ) with a clean pad and apply pressure with a

bandage.

4. Immobilise the injured part with a splint or to the body.

5. Elevate the injured part, if possible.

6. Seek medical attention.

DO NOT

• Press down directly on a protruding bone.

• Move the casualty until the injured part is secured and supported.

• Let the casualty eat or drink anything.

Types of splints

Splints can be made from many different materials.

1. Improvised splint: folded newspapers, magazines

2. Commercial splint: SAM splint™ (moldable splint), air splint, wooden splints

3. Self splint: The injured part is tied to an uninjured body part




c) Specific Bone Fracture

• Upper limb

Collar bone (Clavicle) fracture


1. History of fall ( direct or indirect )

2. Pain, swelling and deformity

3. The casualty supports the elbow on the

injured side to relieve pain

4. Head inclined to injured side

1. Support the arm of affected collar bone in

an elevation sling.

2. Secure the arm to the chest with a broad

bandage.


Upper arm (humerus) fracture


1. History of fall directly on to the shoulder

or on to the outstretched hand

2. Pain and swelling

3. Difficulty in raising the arm

1. Support the injured arm in an arm sling.

2. Secure the arm to the chest with 2 broad

bandages.




• Dislocations

Displacement of a bone at a joint caused by strong force wrenching the bone out of its joint,

or by a violent muscle contraction is called a dislocation.

Dislocated shoulder


1. History of fall

2. Acute pain, swelling and flattening of

shoulder.

3. The casualty’s head inclined to the

injured side.

4. Inability to raise the arm.

1. Sit casualty down.

2. Apply a large arm sling to the affected arm.

3. Immobilise the sling with a broad bandage.





Fracture elbow

Actions to Take:

For an elbow that can be bent: For an elbow that cannot be bent:

1. Treat as for a fracture of the upper arm.

2. Check for sensation at the affected wrist

every 10 minutes.

3. If no sensation, gently straighten the

elbow until it returns and immobilise it in

that position.


1. History of fall on elbow.

2. Severe pain, swelling and deformity, unable

to bend elbow.

3. Do not attempt to forcibly bend or

straighten the elbow.

4. Lay the casualty down and place the injured

limb on his trunk.

5. Secure arm to the trunk of the body with 3

broad bandages.





Fractures of the forearm and wrist

Recognition

• History of fall on outstretched hand.

• Pain, swelling and dinner fork deformity.

Actions to take:

SPLINT METHOD ( Picture A ) SPLINTLESS METHOD ( Picture B )

1. Place a splint on the injured side.

2. Or use a newspaper / magazine as an

improvised splint.

3. Secure the splint with a narrow bandage.

4. Support the arm in an arm sling.


bandage.


1. Place a soft padding around injured

wrist/forearm

2. Support the arm in an arm sling.


bandage.




Fracture of the hand and fingers


1. Pain and tenderness at the fracture site.

2. Swelling and bruising.

3. Deformity.

1. Place soft padding around the

hand.

2. Support the injured arm in an

elevation sling.

3. Secure the arm to the chest

with a broad bandage.





• Lower limb

Fracture of the thigh (femur)


1. Severe pain, pallor and sweatiness.

2. Bruising and swelling of fracture area.

3. An outward turning of the knee and foot.

4. Shortening of the leg.

5. Inability to stand.

6. Signs of shock.


2. Call ambulance 995.

3. Bring the sound leg alongside the injured

leg.

4. Place soft padding between the legs.

5. Slide 4 broad bandages under the legs

and secure both legs at the ankle, knee,

below and above the fracture.

6. Tie the knots at the uninjured side.


Fracture of the pelvis


1. History of road traffic Injury with a direct

force on the pelvis

2. Pain and inability to stand

same as a fracture femur




Fracture of the lower leg (tibia/fibula)


1. Deformity and shortening of the limb.

2. An open injury.

3. Severe pain and tenderness at the

fracture site.

4. Swelling and bruising.



3. Bring the sound leg alongside the injured leg.

4. Place soft padding between the legs.

5. Slide 4 broad bandages under the legs and

secure both legs at the ankle, knee, above and

below the fracture.

6. Tie the knots at the uninjured side.


Fracture of the Ankle


1. History of severe twisting force

2. Pain and inability to put weight on

injured foot

3. Swelling

4. Deformity if there is a displaced

fracture

1. Help casualty to lie down

2. If a fracture is not suspected, apply the RICE

procedure

3. If a fracture is suspected, immobilise the

fracture





Fracture of the jaw - Injuries to the face may break the jaw.


1. Pain when moving the jaw and

swallowing.

2. Distortion of the teeth and

dribbling.

3. Swelling, tenderness and bruising.

4. A wound or bruising within the

mouth.

1. Sit the casualty up.

2. Place a soft pad to support the jaw.

3. Secure the jaw with a

broad bandage or

roller bandage as

shown.


Fracture of the Ribcage

Causes

• Direct or indirect force.

• May be complicated by a penetrating wound or a “flail

chest” injury where breathing may be severely impaired.


1. Pain at the fracture site.

2. Pain on taking deep breaths or

coughing.

3. Shallow breathing.

4. Air being “sucked” into the chest

cavity.

5. Shock.

2. Reassure the casualty.

3. Place a soft padding on the injured rib and secure

with a broad bandage.

4. Support the limb on the injured side in an elevation

sling.

5. Secure the sling with a broad bandage.





3 MANAGEMENT OF SOFT TISSUE INJURIES

Sprain: Strain

A sprain is the over- stretching and / or tearing

of ligaments of a joint.

Recognition:

1. Acute pain and tenderness at the joint.

2. Swelling around the joint.

3. Limited movement.

A strain is an over stretching and / or tearing

of muscle or tendons attached to the muscle.

Recognition:

1. Sudden sharp or severe pain

2. Tenderness when the area is touched.

Actions to take - R.I.C.E. PROCEDURE

1. Rest injured area.

2. Ice area for 15 min @ 2-3 hr for first 24-48 hr.

3. Compress area for 24-48 hr.

4. Elevate area for first 24-48 hr.

5. Seek medical attention if pain and swelling persist.

EElleevvaattee RReesstt IIccee CCoommpprreessss

Support & elevate the Injured part

An ice pack helps relieve pain

Compression counteracts swelling, and gives the injured part support

Elevation reduces swelling.




Cramps

A cramp is a sudden and very painful contraction of a muscle or a group of muscles.

Cramps in legs are very common.

Causes

• Exercise soon after a meal

• Chilled muscles

• Sudden vigorous activity

• Poor muscular coordination

• Loss of body fluids and salt

• During pregnancy

Actions to take

• Gently stretch the contracted muscles e.g.

cramp in the calf

• Straighten knee and pull the foot up towards

the shin.

End of Lesson 5


Burn Injuries, Poisoning, Bites and Stings, Heat Disorders and Transport a Casualty


STANDARD FIRST AID

LESSON 6

Overview This lesson covers the Integumentary system or the Skin, bites and stings, poisoning,

heat disorders and transportation of casualties.


1 MANAGEMENT OF BURN INJURIES

a) Structure and Function of the Skin

b) Classification of Burns

c) Causes of Burn Injuries

d) Depth of Burn

e) Severity of Burn

f) Extent of Burn

g) Burns in Special Areas

• Burns to the Mouth and Throat

• Chemical burn

• Electrical Burn

2 MANAGEMENT OF POISONING

a) Common Routes of Poisoning

b) First Aid for Poisoning

3 MANAGEMENT OF BITES AND STINGS

a) Bee and Wasp Sting

b) Scorpion Sting

c) Jellyfish and other marine stings

d) Dog and cat bites

e) Snake Bites

4 MANAGEMENT OF CASUALTY WITH HEAT DISORDERS

a) Types of Heat Disorder

b) Heat cramp

c) Heat exhaustion

d) Heat stroke

5 TRANSPORTATION OF CASUALTY

a) One first-aider method

b) Two first aiders method

c) Three first aider methods




Epidermis

Dermis

Subcutaneous

1 MANAGEMENT OF BURN INJURIES

a) Structure of the Skin

Functions

1. Protects from injury

2. Protects from infections.

3. Regulates body temperature.

b) Burns can be classified by:

1. Causes ( types ) of burn

2. Depth of burn

3. Severity of burn

4. Area of burn

c) Causes ( Types ) of burn injuries

• Dry burns

• Scalds

• “Cold” burns

• Chemical burns

• Electrical burns

• Radiation burns

Scalds

Chemical

Electrical




d) Depth of Burn

Depth of Burn Recognition

• Superficial burn

1. Injury involves only the outer layer

of the skin.

2. Redness, swelling, tenderness and

pain are present.

Depth of Burn Recognition

• Partial-thickness burn

1. Injury affects the deeper layers of

the epidermis.

2. Formation of blisters.

3. Pain is present.

• Full-thickness burn

1. Injury involves all layers of the skin;

damage may extend to nerve, muscle

and fat.

2. The skin appears pale, waxy and

sometimes charred.

3. Pain free.




e) Severity of burn

The severity of a burn depends on:

• Burn depth

• Burn size

• Burn site

• Infant, child or adult

f) Extent of burn

• The extent of a burn is expressed in terms of a percentage of the body’s total surface area.

• The “rule-of-nines”.

Immediate Medical Attention for

severe burn injury

• A partial-thickness burn of 9% or

more may lead to shock.

• A full-thickness burn of any size.

• Burns to the neck, nose or mouth.

• Burns to the eye.

• Any partial-thickness burn of 1%

or more (covering an area

approximating to that of the

casualty’s palm).




Superficial and Partial Thickness Burn

Actions to take

1. COOL the burn - Do not

apply anything to the burn.

2. CONSTRICTORS – remove

if any.

3. COVER the burnt area.

Full-thickness burn

Actions to take:

1. Cover the burnt area with a clean cloth for protection.

2. Treat the casualty for shock if present.

3. Perform DRABC. Watch for breathing difficulty involving burns on the face and neck.

4. Call for ambulance 995.

Important points to note

DO NOT

1. Apply butter or oils on a burn.

2. Apply ice or cool to near-freezing temperatures.

3. Neutralise a chemical burn with a reciprocal chemical.

4. Disregard an electrical burn.




g) Burns in Special Areas

• BURNS TO THE MOUTH AND THROAT

Actions to take:

1. Call for ambulance 995

2. Take steps possible to facilitate the

casualty’s breathing.

3. Be prepared to resuscitate!

• CHEMICAL BURN

This occurs when caustic or corrosive substances come into contact with the skin.

Actions to take:

1. Flush the area immediately with copious amounts of water for 15 – 20 minutes or

longer.

2. Remove the casualty’s contaminated clothing whilst flushing.

3. Cover the burned area with a dry clean dressing.

4. Seek immediate medical attention.

• ELECTRICAL BURN

Actions to take:

1. Check DRSABC.

2. Check for fractures and spinal injury.

3. Treat the casualty for shock.

4. Cover entry and exit burns.

5. Seek immediate medical attention.




2 MANAGEMENT OF POISONING

a) Common routes of poisoning :

1. Ingestion - taken by mouth

2. Inhalation - breathed in

3. Absorption - through skin

4. Injection - needles, stings & bites

Actions To Take :

• If swallowed, do not induce vomiting.

• If inhaled, move to well-ventilated and open spaces.

• If absorbed, wash with lots of water.

• Seek medical treatment immediately.

• Identify the poison if possible.




3 MANAGEMENT OF BITES AND STINGS

Bee and wasp sting Actions to take:

They are dangerous in these cases:

1. People who are allergic to

stings.

2. Stings in the mouth and throat.

3. Multiple stings can result in

death.

1. If the stinger is in the wound (this applies to a bee

sting only), flick it out with the edge of a card or knife.

2. Apply a cold compress.

3. For a sting in the mouth, give the casualty ice to suck

on or cold water to sip.


Scorpion sting Actions to take:

This causes severe pain and

burning sensation around the site,

followed by numbness or tingling

from the neurotoxin in the sting

1. Apply cold compress to relieve pain.

2. Immobilise the injured part.

3. Monitor for difficulty in

breathing.


Jellyfish and other marine stings Actions to take:

The venom is contained in special

stinging cells of the jellyfish that

stick to the skin. The aim is to

inactivate the stinging cells before

they release their venom.

1. Sit the patient down. Pour copious amounts of vinegar

or sea water to stop the stinging cells from releasing

venom.

2. Dust a dry powder over the affected skin. The stinging

cells stick to the powder.

3. Then brush off the powder with a clean pad.

4. Monitor the casualty for difficulty in breathing.


Dog and Cat Bites Actions to take:

For superficial bites

1. Wash wound.

2. Cover with a clean dressing


For deeper bites

1. Control bleeding - direct pressure.

2. Cover the wound.





Snake Bites Actions to take:

Some poisonous snake venoms

causes bleeding in tissues and

organs (anticoagulant toxin eg

viper ) and paralysis of muscles (

neurotoxin eg cobra, krait).

Poisonous snakes usually bite only

in defense.


2. Lay casualty down

3. Tell the person to keep calm and still.

4. Not all bites from poisonous snakes contain venom

(called ‘dry bites’).

5. If there are no symptoms of poisoning, roller

bandaging is not needed.

6. A dry dressing over the wound will be enough.

7. If it is a suspected poisonous bite then apply a

roller bandage above the wound with the same

tightness as for a sprained ankle.

8. Do not use a tourniquet.

9. Immobilise the bitten leg.

10. Monitor vital signs.

Recognition

1. Look for fang marks (pair of puncture marks)

2. Symptoms that may suggest poisoning:

3. Redness and swelling, oozing of blood (viper).

4. Nausea and vomiting, laboured breathing and

disturbed vision (cobra, krait).

5. Muscle aches and blood in urine (sea snake).

FFaanngg mmaarrkkss




4 MANAGEMENT OF CASUALTY WITH HEAT DISORDERS

Three stages of progressive severity:

Disorder

Symptom

Actions to Take

a. HEAT CRAMP is painful

cramps due to excessive

sweating from a strenuous

activity. If the person

continues, heat exhaustion

may result.

1. Muscle cramp.

2. Excessive sweating.

1. Sit in cool place.

2. Drink enough water.


2. HEAT EXHAUSTION is

severe tiredness due to loss

of body fluid through

excessive sweating from

strenuous activity. If the

person continues, heat

stroke may result.

1. Tiredness.

2. Excessive sweating.

3. Muscle cramps.

4. Rapid pulse and breathing.

1. Lay casualty in a cool

place.

2. Elevate the legs.

3. Give plenty of water

4. Monitor vital signs.


3. HEAT STROKE occurs

when the body is unable to

control its temperature.

When temperature rises,

the sweating mechanism

fails, and the body is

unable to cool down. It is a

life-threatening condition.

1. Confused.

2. Hot flushed and dry skin.

3. Body temp more than 40

degree Celsius.

1. Check DRABC.


3. Move the casualty to a

cool place.

4. Cool the casualty

rapidly with water.

HEAT CRAMP HEAT EXHAUSTION HEAT STROKE




5 TRANSPORTING A CASUALTY

Introduction

• Move the casualty ONLY if the casualty is in immediate danger.

• Do not move the casualty unnecessarily.

• Do not leave the casualty alone.

Methods of transportation

• Support

• Hand seats

• Chair

• Blanket

• Stretcher

• Wheelchair

Methods of Carrying

a) ONE FIRST AIDER METHOD

• Shoulder Drag

• Crouching Drag

• Blanket Pull

• Human Crutch

• Cradle Carry

• Fireman’s Lift

• Pick-A-Back Carry

Shoulder drag

Crouching drag

Blanket pull

Pick-A-Back Fireman’s Lift Cradle Carry Human Crutch

Principles of lifting

• Know your capabilities.

• Keep your back straight and bend your knees.

• Apply a safe grip. Use as much of the palms as

possible.

• Position your feet, shoulder width apart for

balance, with one foot in front of the other.

• When lifting, do not twist your back; pivot with

your feet.




b) TWO FIRST AIDERS METHOD

• Two- Handed Seat Carry

• Four-Handed Seat Carry

• Fore-and-Aft Carry

• Chair Carry

c) THREE FIRST AIDERS METHOD

• Three-person Carry

End of Lesson 6

(i) (ii) (iii)

CChhaaiirr CCaarrrryy

FFoorree--aanndd--AAfftt CCaarrrryy

FFoouurr-- HHaannddeedd

SSeeaatt CCaarrrryy

TTwwoo-- HHaannddeedd

SSeeaatt CCaarrrryy

Practical

Types of Bandaging


TYPES OF BANDAGING

Triangular Bandaging

• Broad and Narrow Bandage

• Use as a ring pad

• For dislocation of shoulder

• For upper arm fracture

• For wrist / lower arm fracture

• For collarbone fracture

• For finger fracture

• For elbow fracture

Roller Bandaging

• Applying on a wound

• Hand, Foot, Elbow (for holding dressing or supporting sprains)

• Knee

• Eye

• Head

1

TRIANGULAR TRIANGULAR

BANDAGINGBANDAGING

All Rights Reserved. This document belongs to the Singapore Red Cross Society / Red Cross Training Centre (RCTC)

15 Penang Lane / Level 3 / Singapore 238486 / Website: www.redcross.org.sg / Tel: 63360269 / Fax: 63376435.

2

11

22

33

44

BROAD BANDAGEBROAD BANDAGE

NARROW BANDAGENARROW BANDAGE

1st Fold1st Fold

ApexApex

BaseBaseSideSideSideSide

2nd Fold2nd Fold

3rd Fold3rd Fold



3

Narrow BandageNarrow BandageStoring Storing

and and

folding to folding to

a pressure a pressure

padpad



4

Use as a ring padUse as a ring pad

Wrap a narrow bandage Weave remainder Finished ringpad.

round your fingers a few of bandage around Used over an embedded

times to form a loop. and around the loop. foreign body.



5

11 22 44

DISLOCATION OF SHOULDERDISLOCATION OF SHOULDER

(OPEN ARM SLING)(OPEN ARM SLING)

55

33

66

Place the triangular

bandage against the

chest with Apex

towards the elbow

Bring the other end

of the bandage to the

other shoulder

Secure the sling with a

knot on the opposite

side of the injury

Twist the end to

secure the elbow

region

Immobilize the Open

Arm Sling with a

broad bandage to

prevent movement



6

11

FRACTURE UPPER ARMFRACTURE UPPER ARM

Apply an Open Arm Sling and

immobilize it with two broad

bandages :

1 - below the Fracture

1 - above the Fracture

FRACTURE

SITE

22



7

11 22 33 44

FRACTURE WRIST / LOWER ARMFRACTURE WRIST / LOWER ARM

(WITH SPLINT)(WITH SPLINT)

55

Place a splint on the

injured site Secure the splint with a narrow bandage

Immobilize the

fracture with a Broad

Bandage

SPLINTLESS METHOD

OPEN ARM SLING

AND

IMMOBILISATION

WITHOUT USING A

SPLINT



8

COLLARBONE FRACTURE COLLARBONE FRACTURE

11 22 33 44

55 66

77 88

Place a Triangular

bandage on the

elevated arm, with

Apex towards the

elbow

Place the arm on the

uninjured site

Tuck in the hand first Tuck in the rest of

the bandage

Do a fold to secure

the elbow region

Twist at the elbow region

Bring the rest to the back of victim and

secure a knot and a immobilization

99



9

11 22 33 44

55 66 77 88

FRACTURE FINGERSFRACTURE FINGERS

Place a pad over the

affected finger

Elevate the affected

arm

Tuck in the hand first Tuck in the rest of

the bandage

Do a fold to secure

the elbow region

Twist at the elbow region Bring the rest to the back of victim and

secure a knot and a immobilization

99



10

ELBOW FRACTURE (UNABLE TO BEND)ELBOW FRACTURE (UNABLE TO BEND)

11 22 33

Place a Broad

Bandage across the

chest

Place a 2nd Broad

Bandage below the

elbow

Place a 3rd Broad Bandage

around the wrist region



11All Rights Reserved. This document belongs to the Singapore Red Cross Society / Red Cross Training Centre (RCTC)


STEP 1STEP 1 STEP 2 STEP 2

STEP 3 STEP 3 STEP 4

1.1. APPLYING ON A WOUNDAPPLYING ON A WOUND



13

STEP 5 STEP 5



14

2. HAND / FOOT ( for holding dressing or supporting sprains )2. HAND / FOOT ( for holding dressing or supporting sprains )

STEP 1 STEP 1 STEP 2 STEP 2

STEP 3STEP 3 STEP 4 STEP 4



15

STEP 5 STEP 5



16

FOOT FOOT



17

3. ELBOW ( for holding dressing or supporting sprains )3. ELBOW ( for holding dressing or supporting sprains )

STEP 1STEP 1 STEP 2STEP 2




18

4. KNEE4. KNEE



19

5. EYE5. EYESTEP 1STEP 1 STEP 2STEP 2




20

STEP 5STEP 5



21

6 .HEAD 6 .HEAD





22

STEP 5STEP 5



23

GENERAL RULES OF APPLYING

A ROLLER BANDAGE• Choose the appropriate and correct size of bandage, different parts of the body require different

widths of a roller bandage.

5.0 cm ( 2’’ ) Head, ear, eye

7.5cm ( 3 - 4’’)Forearm, arm, hand, foot, leg

10.0cm ( 4’’ ) Thigh, knee

15.0cm ( 6’’ ) Trunk

• Always position yourself towards the front of the casualty at the injured side.

• Support the injured part in the position in which it will remain after bandaging.

• Hold the head or barrel of the bandage facing up.

• Place the tail of the bandage below the injury.

• Work from inside of the limb outwards.

• Make two straight turns with the head of the bandage to anchor it in place.

• Make a series of spiraling turns.

• Wind from inside to outside of the limb.

• Make sure that each turn covers between a half and two-thirds of the previous layer of bandaging.

• Finish off with one straight turn and secure the ends.

• Check circulation to extremity of the injured limb regularly.

• If there is swelling and bandage becomes too tight, undo the bandaging again.

• Do not use bandaging around the neck.

Practical

CPR


CPR Checklist

For Lay Person

a. Adult Foreign Body Airway Obstruction (Conscious)

b. Adult Foreign Body Airway Obstruction (Unconscious)

c. One-Man Adult CPR

One-Man Adult CPR Practical Assessment Sheet

CPR CHECKLIST (FOR LAYPERSON)

(A) Adult Foreign Body Airway Obstruction

CONSCIOUS

(B) Adult Foreign Body Airway Obstruction

UNCONSCIOUS (C) One-Man CPR

1. Ask: “Are you choking?”

2. Position:

• Stand behind victim, arms around

abdomen;

• Perform abdominal thrust; Place thumb-

side of fist against abdomen in the

midline, 2 finger above the navel, grasp

fist with the other hand;

3. Perform inward & upward thrusts (5 sets)

until foreign body is dislodged or victim

becomes unconscious.

Pregnant or Obese Person

1. Ask: Are you choking?”

2. Position:

• Stand behind victim, arms around

victim’s chest;

• “ Place thumb-side of fist inwards on

mid sternum; Grasp fist with the other

hand and press with quick backward

thrust;

3. Give successive backward thrusts (5 sets),

repeat thrusts until effective or victim

becomes unconscious.

Once the victim become unconscious:

1. Place victim on his/her back on a flat firm

surface.

2. Check Response, gently shake and tap the

shoulder of victim and Shout: “Are you OK?”

3. No response: ‘Call ambulance 995”.

4. Commence 30 chest compressions.

5. Open the Airway, head tilt-chin lift. Remove

visible foreign body by using the index finger.

6. Check for Breathing: look, listen and feel

(up to 10 seconds).

7. If NO BREATHING, attempt 2 ventilations. (1

sec / breath)

- If 1st attempt unsuccessful:

- Re-position head, attempt 2 nd

ventilation.

8. If 2nd

ventilation unsuccessful – SUSPECT

CHOKING.

9. Commence 30 Chest compressions

10. Repeat ( 5 ) to ( 9 ).

11. If breathing is present, check for external

injuries.

12. No injuries, place victim in Recovery Position.

1. Check scene for Danger.

2. Check Response, gently shake and tap the

shoulder of victim and Shout: “Are you OK?”

3. No response: ‘Call ambulance 995”.

4. Place victim on his/her back on a flat firm surface.

5. Open Airway, use head tilt-chin lift.

6. Check for Breath!ng: look, listen and feet (up to 10

seconds)

7. If NO BREATHING

8. Commence Cardiopulmonary Resuscitation

(CPR)

• Correct body & hand position, compress

vertically at least 5cm downwards. Say

“1&2&3&4&5 &1&2&3&4&10 &1&2&3&4&15,

1&2&3&4&20 &1&2&3&4&25 &1&2&3&4&30”

follow by 2 breaths (1 sec / breath)

• 30 Compression : 2 Ventilation

8. Continue CPR till ambulance arrives, the victim

starts breathing or rescuer becomes exhausted.

9. If breathing is present, check for external injuries, no

injuries, place victim in recovery position.

PULSE CHECK FOR TRAINED HEALTHCARE PROVIDERS ONLY.

All Rights Reserved. This document belongs to the Singapore Red Cross Academy (SRCA) Red Cross Training Centre / 15 Penang Lane / Level 3 / Singapore 238486 / Website: www.redcross.org.sg / Tel: 66640500 / Fax: 63376435.

CPR PERFORMANCE PRACTICAL ASSESSMENT SINGAPORE RED CROSS SOCIETY / RED CROSS TRAINING CENTRE (2011 Aug)

1

Name:

Course Ref No:

NRIC/Passport No:

Signature:

One Man Adult CPR

Critical Performance Attempt Remarks

1 2 3

Check for Danger, if no danger approach casualty.

1.

Assess Responsiveness

• Call, tap or gently shake the person & shout “Hello! Hello! Are you Ok?”

2.

No response - Shout for help,

• Call for ambulance 995

• Get AED

3.

Open the Airway • Perform a head-tilt chin-lift manoeuvre.

4.

Check for Breathing

• Look, Listen and Feel for up to 10 seconds.

• Gasping is considered not normal breathing.

5.

Commence CPR. Locate landmark for chest compression for CPR

• Maintain head-tilt chin-lift

• Run your middle finger from the lower margin of victim’s rib cage to sternal notch.

• Place index finger next to middle finger.

CPR PERFORMANCE PRACTICAL ASSESSMENT SINGAPORE RED CROSS SOCIETY / RED CROSS TRAINING CENTRE (2011 Aug)

2

Critical Performance Attempt Remarks

1 2 3

6.

Demonstrate proper technique of compression • Correct body and hand position

• Compression depth at least 5cm vertically

downwards

• Say mnemonic (1-5, 1-10, 1-15, 1-20, 1-25, 1-30)

7.

Followed by 2 mouth to mouth breathing

• Maintain a head tilt-chin lift.

• Pinch nose and give 2 quick ventilations (400-600ml per sec/breath) and

• Watch chest rise and

• Release the pinch after each breath.

• The ratio is 30 compressions and 2 breaths per cycle ( 30:2 )

8.

• Continue CPR till ambulance arrive or the victim starts breathing

• If breathing is present perform secondary survey.

• Place victim in the recovery position and monitor the vital signs.

Results : [P] = Pass [F] = Fail

PASS / FAIL

Name of Examiner :

Signature of Examiner :

Date:

Notes


Notes

202475449 Standard First Aid[1]

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Transcript of 202475449 Standard First Aid[1]