1、Basic First Aid,Instructor Tim Winer Orange Coast College (714) 432-0202, Ext. 26677,The Key Emergency Principle,The key principle taught in almost all systems is that the rescuer, be they a lay person or a professional, should assess the situation for Danger. The reason that an assessment for Dange
2、r is given such high priority is that it is core to emergency management that rescuers do not become secondary victims of any incident, as this creates a further emergency that must be dealt with. A typical assessment for Danger would involve observation of the surroundings, starting with the cause
3、of the accident (e.g. a falling object) and expanding outwards to include any situational hazards (e.g. fast moving traffic) and history or secondary information given by witnesses, bystanders or the emergency services (e.g. an attacker still waiting nearby). Once a primary danger assessment has bee
4、n complete, this should not end the system of checking for danger, but should inform all other parts of the process. If at any time the risk from any hazard poses a significant danger (as a factor of likelihood and seriousness) to the rescuer, they should consider whether they should approach the sc
5、ene (or leave the scene if appropriate).,Principles for assessing an emergency,Once a primary check for danger has been undertaken, a rescuer is then likely to follow a set of principles, which are largely common sense. These assessment principles are the types of information that the emergency serv
6、ices will ask when summoned. This information usually includes number of Casualties, history of whats happened and at what time, location and access to the site and what emergency services are likely to be required, or that are already on scene. There are several mnemonics which are used to help res
7、cuers remember how to conduct this assessment, which include CHALET (Casualties, Hazards, Access, Location, Emergency Services, Type of Incident) and ETHANE (Exact Location, Type of Incident, Hazards, Access, Number of casualties, Emergency services required) For small scale medical incidents (one o
8、r two casualties), the rescuer may also conduct a first aid assessment of the patient(s) in order to gather more information. The most widely used system is the ABC system and its variations, where the rescuer checks the basics of life on the casualty (primarily their breathing in modern protocols).
9、 In larger incidents, of any type, most protocols teach that casualty assessment should not start until emergency services have been summoned (as multiple casualties are expected). Accurate reporting of this important information helps emergency services dispatch appropriate resource to the incident
10、, in good time and to the right place.,Summoning Emergency Services,After undertaking a scene survey, the rescuer needs to decide what, if any, emergency services will be required. In many cases, an apparent emergency may turn out to be less serious than first thought, and may not require the interv
11、ention of the emergency services. If emergency services are required, the lay person would normally call for help using their local emergency telephone number, which can be used to summon professional assistance. The emergency dispatcher may well give instructions over the phone to the person on sce
12、ne, with further advice on what actions to take.,Action whilst awaiting emergency services,The actions following the summoning of the emergency services are likely to depend on the response that the services are able to offer. In most cases, in a metropolitan area, help is likely to be forthcoming w
13、ithin minutes of a call, although in more outlying, rural areas, the time in which help is available increases. Actions may include: First Aid for casualties on scene Obtaining further history on the incident to pass on the emergency services Checking for further, previously unnoticed, casualties Or
14、 in instances where emergency assistance is delayed, actions may include: Moving any casualties away from danger Undertaking more advanced medical procedures dependant on training,Check the Patient,ABC (and extensions of this initialism) is a mnemonic for memorizing essential steps in dealing with a
15、n unconscious or unresponsive patient. It stands for Airway, Breathing and Circulation. Some protocols add additional steps, such as an optional “D“ step for Disability or Defibrillation. It is a reminder of the priorities for assessment and treatment of many acute medical situations, from first-aid
16、 to hospital medical treatment. Airway, breathing and circulation are vital for life, and each is required, in that order, for the next to be effective.,ABCs,The key part of the mnemonic is made up of the first three letters of the alphabet A, B and C. Together they are designed to remind practition
17、ers of the correct procedure (including the order) in which to deal with a non-breathing patient. A Airway If the patients airway is blocked, oxygen cannot reach the lungs and so cannot be transported round the body in the blood. Ensuring a clear airway is the first step in treating any patient. Com
18、mon problems with the airway involve blockage by the tongue or vomit. Initial opening of the airway is often achieved by a “head tilt chin lift“ or jaw thrust technique, although further maneuvers such as intubation may be necessary. (See Airway) B Breathing The patient is next assessed for breathin
19、g. Common findings during an assessment of breathing may include normal breathing, noisy breathing, gasping or coughing. The rescuer proceeds to act on these based on his/her training. Generally at this point it will become clear whether or not the casualty needs supportive care (such as the recover
20、y position) or Rescue Breathing. C Circulation Once oxygen can be delivered to the lungs by a clear airway and efficient breathing, there needs to be a circulation to deliver it to the rest of the body. This can be assessed in a number of ways, including a pulse check, ECG analysis, or Capillary ref
21、ill time. Other diagnostic techniques include blood pressure checks or temperature checks on peripheral areas. Circulation is the original meaning of the C as laid down by Jude, Knickerbocker & Safar, but in some revised modern protocols, this step stands for Cardiopulmonary Resuscitation or more si
22、mply, Compressions, which is effectively artificial circulation. In this case, this step should only apply to those patients who are in Cardiogenic or other form of Shock, and therefore not breathing normally and with an unsatisfactory heart rhythm.,Recovery position,The recovery position or semi-pr
23、one position is a first aid technique recommended for assisting people who are unconscious, or nearly so, but are still breathing. It is frequently taught as part of classes in CPR (cardiopulmonary resuscitation) or first aid. When an unconscious person is lying face upwards, there are two main risk
24、s factors which can lead to suffocation: The tongue can fall to the back of the throat, due to loss of muscular control. The back of the tongue then obstructs the airway. Fluids, possibly blood but particularly vomit, can collect in the back of the throat, causing the person to drown. When a person
25、is lying face up, the esophagus tilts down slightly from the stomach towards the throat. This, combined with loss of muscular control, can lead to the stomach contents flowing into the throat, called passive regurgitation. As well as obstructing the airway, fluid which collects in the back of the th
26、roat can also then flow down into the lungs; stomach acid can attack the inner lining of the lungs and cause a condition known as aspiration pneumonia. Many fatalities occur where the original injury or illness which caused unconsciousness is not itself inherently fatal, but where the unconscious pe
27、rson suffocates for one of these reasons. This is a common cause of death following unconsciousness due to excessive consumption of alcohol. To a limited extent, it is possible to protect against risks to the airway from the tongue by tilting the head back and lifting the jaw. However, an unconsciou
28、s person will not remain in this position unless held constantly, and crucially it does not safeguard against risks due to fluids. If the person is placed in the recovery position, the action of gravity will both keep the tongue from obstructing the airway and also allow any fluids to drain. Also th
29、e chest is raised above the ground, which helps to make breathing easier.,Recovery position,When to use the Recovery Position,The recovery position is recommended for unconscious people, those who are too inebriated to assure their own continued breathing, victims of drowning, and also for victims o
30、f suspected poisoning (who are liable to become unconscious). It is suitable for any unconscious person who does not need CPR.,Putting a victim in the Recovery Position,Before using the Recovery Position, perform the preliminary first aid steps. First assess whether the scene is safe for the rescuer
31、. If not, leave. Assess whether the person is responsive to your voice by asking something like “hey, buddy, are you OK?“. If not, assess whether the person responds to painful stimulus by rubbing their sternum with your knuckles (this is not accepted practice in some countries). Assess whether the
32、victim has an open airway, is breathing and has a pulse (“airway, breathing, and circulation“ or “ABC“) . If the victim is alert and an adult, obtain consent before performing first aid. For children, attempt to obtain consent from a parent, guardian, or other responsible caregiver. If the victim is
33、 not alert, and is not breathing, check for a pulse. If there is no pulse, perform cardiopulmonary resuscitation. If there is circulation, perform Rescue breathing. The initial assessment should be done quickly, in a minute or less. Next, alert trained emergency medical personnel. Call the emergency
34、 telephone number or other emergency services.,Putting a victim in the Recovery Position,If no spinal or neck injury is indicated The correct position is called the “lateral recovery position.“1 Start with the victim lying on the back and with the legs straight out. Kneel on one side of the victim,
35、facing the victim. Move the arm closest to you so it is perpendicular to the body, with the elbow flexed (perpendicular). Move the farthest arm across the body so that the hand is resting across the torso. Bend the leg farthest from you so the knee is elevated. Reach inside the knee to pull the thig
36、h toward you. Use the other arm to pull the shoulder that is farthest from you. Roll the body toward you. Leave the upper leg in a flexed position to stabilize the body. Victims who are left in this position for long periods may experience nerve compression. Still, that is a more desirable outcome f
37、or the victim than choking to death. If spinal or neck injuries are possible When the injury is apparently the result of an accidental fall, collision or other trauma, the risk of spinal or neck injuries should be assumed. Normally, only trained medical personnel should attempt to move a victim with
38、 neck or spinal injuries.2 Such movements run the risk of causing permanent paralysis or other injuries. Movement of spinal-injured victims should be minimized. Such victims should only be moved to a recovery position when it is necessary to drain vomit from the airway. In such instances, the correc
39、t position is called the “HAINES modified recovery position.“ HAINES is an acronym of High Arm IN Endangered Spine. In this modification, one of the patients arms is raised above the head (in full abduction) to support the head and neck.34 There is less neck movement (and less degree of lateral angu
40、lation) than when the lateral recovery position is used, and, therefore, HAINES use carries less risk of spinal-cord damage.5,Choking,Choking is the mechanical obstruction of the flow of air from the environment into the lungs. Choking prevents breathing, and can be partial or complete, with partial
41、 choking allowing some, although inadequate, flow of air into the lungs. Prolonged or complete choking results in asphyxiation which leads to hypoxia and is potentially fatal. Choking can be caused by: Introduction of a foreign object into the airway, which becomes lodged in the pharynx, larynx or t
42、rachea. Respiratory diseases that involve obstruction of the airway. Compression of the laryngopharynx, larynx or trachea in strangles.,Choking,Foreign objects The type of choking most commonly recognized as such by the public is the lodging of foreign objects in the airway. This type of choking is
43、often suffered by small children, who are unable to appreciate the hazard inherent in putting small objects in their mouth. In adults, it mostly occurs whilst the patient is eating. Symptoms and Clinical Signs The person cannot speak or cry out. The persons face turns blue (cyanosis) from lack of ox
44、ygen. The person desperately grabs at his or her throat. The person has a weak cough, and labored breathing produces a high-pitched noise. The person does any or all of the above, and then becomes unconscious.,Choking,Treatment Choking can be treated with a number of different procedures, with both
45、basic techniques available for first aiders and more advanced techniques available for health professionals. Many members of the public associate abdominal thrusts, also known as the Heimlich Maneuver with the correct procedure for choking, which is partly due to the widespread use of this technique
46、 in movies, which in turn was based on the widespread adoption of this technique in the USA at the time, although it also produced easy material for writers to create comedy effect. Most modern protocols (including those of the American Heart Association and the American Red Cross, who changed polic
47、y in 20061 from recommending only abdominal thrusts) involve several stages, designed to apply increasingly more pressure. The key stages in most modern protocols include: Encouraging the victim to cough This stage was introduced in many protocols as it was found that many people were too quick to u
48、ndertake potentially dangerous interventions, such as abdominal thrusts, for items which could have been dislodged without intervention. Also, if the choking is caused by irritating liquids (alcohol, spice, mint, gastric acid, etc.) or anything without a solid shape, and if conscious, the patient sh
49、ould be allowed to drink water on their own to try to clear the throat. Since the airway is already closed, there is very little danger of water entering the lungs. Coughing is normal after most of the irritant has cleared, and at this point the patient will probably refuse any additional water for
50、a short time.,Choking,Abdominal thrustsA demonstration of abdominal thrusts Abdominal thrusts, also known as the Heimlich Maneuver (after Henry Heimlich, who first described the procedure in a June 1974 informal article entitled “Pop Goes the Cafe Coronary,“ published in the journal Emergency Medici
51、ne. Edward A. Patrick, MD, PhD, an associate of Heimlich, has claimed to be the uncredited co-developer of the procedure, and has been quoted calling it the Patrick maneuver.4 Heimlich has objected to the name “abdominal thrusts“ on the grounds that the vagueness of the term “abdomen“ could cause th
52、e rescuer to exert force at the wrong site.citation needed Performing abdominal thrusts involves a rescuer standing behind a patient and using their hands to exert pressure on the bottom of the diaphragm. This compresses the lungs and exerts pressure on any object lodged in the trachea, hopefully ex
53、pelling it. This amounts to an artificial cough. Due to the forceful nature of the procedure, even when done correctly it can injure the person on whom it is performed. Bruising to the abdomen is highly likely and more serious injuries can occur, including fracture of the xiphoid process or ribs.5 S
54、elf treatment with abdominal thrusts A person may also perform abdominal thrusts on themselves by using a fixed object such as a railing or the back of a chair to apply pressure where a rescuers hands would normally do so. As with other forms of the procedure, it is likely that internal injuries may result.,
