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Tantawi, 2017

First Aid

List of Contents

Title Page No.

Boxes highlight important information .......................................... 2


First aid issues ................................................................................ 3
Primary assessment ........................................................................ 8
Basic Life Support (BLS) .................................................. 24
...................................................... Error! Bookmark not defined.
First aid for chocking ................................................................... 20
First aid for bleeding .................................................................... 26
First aid for wounds ..................................................................... 31
First aid for burns ......................................................................... 33
First aid for environmental related injury ......................... 48
...................................................... Error! Bookmark not defined.
First aid for fractures .................... Error! Bookmark not defined.
First aid poisoning ........................................................................ 39

References ........................................................................ 72

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Boxes Highlight Important Information

Caution
This type of box highlights areas where additional caution is
needed.

Don't do this!
This type of box shows the reader a common mistake or
something that could harm the victim.

Best Practice
These boxes highlight a technique commonly used because it's
the best (or one of the best) ways of doing things or it is
something important to remember.

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First Aid Issues

First aid (( victim or injured person not patient ))


First aid is the provision of immediate care to a victim
with an injury or illness and performed within minimal or no
medical equipment and within a limited skill range. (( No need
for skilled person or hospitalization ))

VIP
Purposes of first aid
The key guiding principles and purposes of first aid are
MCQ
often given in the mnemonic "3Ps".

1. Prevent further injury. ((As cooling of burned area to absorb


the heat so prevent further injury ))

2. Preserve life. (( As prevent bleeding because loss high amount


of blood cause hypovolemic shock and death )) + (( spinal cord
injury move the victim carefully to preserve his life ))

3. Promote recovery. (( As in wounds prevent exposure to


bacteria to promote recovery and prevent septic wounds ))

Principles of First Aid


1. Any first aid provided must not be in exchange for any
reward or financial compensation.

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2. If first aid begins, the responder must not leave the scene
until:
Arrival of medical assistance.
Somebody of equal or higher ability can take over.
Continuing to give aid is unsafe. (( If the place is unsafe ))
3. The responder is not legally liable for the death,
disfigurement or disability of the victim.
First aid consent
Importance
The first aid provider should gain a permission to avoid
causing offense or distress. Most people and cultures involve
a certain respect for a person's personal space.

Gaining consent
The simplest way to gain consent is to ask the victim if
they will allow you to treat them. Talk to the victim, and build
up a rapport with them. During this conversation, it is
important to identify the following key points:
1. Who you are? - Start with your name, and explain that
you are a trained first aider.
2. Why you are with them? - They are likely to know they
have an injury or illness.
3. What you are going to do? - Some first aid procedures
can be uncomfortable (such as cleaning a wound with
saline). So, it is important to be honest with the victim
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about what you are doing, and if necessary, why it is
important.

Judgment of consent
The first aider may have to assess the level of judgment
in helping a victim who cannot give permission or initially
refuse for the following cases:
1. Unconscious victim or reduced level of consciousness.
2. Intoxicated.
3. Irrational (i.e. delusional and confused due to the
injuries).
4. Victim suffering from learning difficulties. First aid
protective precautions
I. Awareness of Dangers
Rushing into a situation without first checking for safety
may result in you also becoming injured which mean you will
not be able to help the other person, and you are now also a
casualty.

Types of dangers:
a. Environmental dangers: A danger in the surroundings,
such as broken glass, falling objects, electrical wires,
fast vehicles, fumes or chemicals
b. Human dangers: Danger from people at the scene
(including the victim) (( As infectious diseases )) which
can be intentional or accidental.
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Caution
Remember, if you get hurt you are not going to be able to help
anyone else.

If there are dangers you have three possible choices:


1. Get help and stay away from the danger.
2. Move the casualty away from the danger.
3. Eliminate the danger if you can do so safely (e.g.
open windows to expel fumes). II. Barriers Devices
One of the key dangers to a first aider is bodily fluids,
such as blood, vomit, urine and feces, which pose a risk of
infectious diseases such as hepatitis or AIDS.

1. Gloves
Gloves protect the hands and maintain safety. They protect
not only from bodily fluids, but from any dermatological
infections that the victim may have. ) (
M The first action should be taken by the first aider in case of
C
bleeding Gloves On
Q
Best Practice Remember GO to the victim
(Gloves On) Types of gloves:
Nitrile it is often purple or blue color. It is completely
impermeable to bodily fluids.

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Latex - These are not used as widely as they once were
due to a prevalence of allergies to latex.

Vinyl - Vinyl gloves should primarily be used for



(( there are two types : with powder to facilitate wearing and without
touching victims who do not have external body fluids
duepowder
to the for person
glove's highwhich
breakhas allergy with powder ))
rate.
Dont forget heavy duty gloves

2. CPR Adjunct
The other key piece of protective equipment that should be in
every first aid kit is an adjunct for helping to perform safe
mouth-to-mouth resuscitation.

3. Safety Glasses
Prevents spurting or pooled fluid which could splay from
coming in contact with the eyes.

4. Apron or gown
Disposable aprons are common items in larger kits, and help
protect the rescuers clothing from contamination.

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Primary assessment

1. Protecting yourself
Dont place yourself in a situation which might put you
in danger.
2. What has happened?
a. Gain as much information as possible about the
incident.
b. Assess the Scene (place, causes of injury).
c. Be sure to listen - While working on a victim you may
overhear information from witnesses in the crowd.
3. Responsiveness
a. Check what is wrong with the person. e.g. are they
bleeding, conscious or unconscious, breathing or not
breathing, etc.
b. Assess the initial responsiveness of the victim by greeting
and question.

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c. The best response to this would be a victim looking at you
and replying. This means that the victim is alert.
Key indicators on the victim are their:
1. Eyes - Are they open spontaneously? Are they looking
around? Do they appear to be able to see you?
2. Response to voice - Do they reply? Can they obey
commands?
3. Response to Pain through:
Sternal rub - This involves digging your knuckle in to
the sternum, or breastbone of the victim (between the
nipples).
Nail bed squeeze - Using the flat edge of a pen or
similar object, squeeze in to the bottom of the victim's
fingernail (hard).
Ear lobe squeeze - using thumb and fore finger,
squeeze the victim's ear hard.
Best Practice
MCQ
If the victim is Unresponsive. You must check on key life
critical systems of breathing and circulation (ABC).

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Cardiopulmonary Resuscitation (CPR)


Introduction:
The breathing air travels to the lungs where oxygen is
picked up by blood and then pumped by the heart to the tissue
and organs. When a person experiences cardiac arrest -
whether due to heart failure or an injury. The heart goes from
a normal beat to an arrhythmic pattern and eventually ceases
to beat. This prevents oxygen from circulating throughout the
body, rapidly killing cells and tissue.
Cardiac arrest occurs due to cardiac problems as :
Pain Shock .. Pulmonary embolism .. Heart injury .. Arrhythmia .. trauma

..

Fig (1): The heart

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Cardio Pulmonary Resuscitation Cardio (heart)
pulmonary (lung) Resuscitation (revitalize) serves
as an artificial heartbeat and an artificial respirator.

To revitalize the cardiopulmonary functions

Sequence of CPR ))((

C Chest compressions
A Airway C -A-B
B Breathing

High-Quality CPR
1. A compression rate of at least 100/min (this is a change
from approximately 100/min).

2. A compression depth of at least 2 inches (5 cm) in adults

and a compression depth of at least one third of the


MCQ
anterior-posterior diameter of the chest in infants(1
inches = 4 cm) and in children (1 inches = 5 cm).
3. Allowing complete chest recoil, minimizing
interruptions in compressions, and avoiding excessive
ventilation.
MCQ
The ratio between compression and breath :
30 compressions : 2 breaths
But in one minute 100 compressions : 6 breaths

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Basic Life Support (BLS)

BLS consists of:


1. Chest compression. Essay question
2. Airway What are the components of BLS ?
3. Breathing
4. Defibrillation.

Initial Assessment of BLS

Unresponsive
No breathing
or only gasping

Activate
emergency
Response Get defibrillator

Check pulse

Check rhythm/
Start CPR
Push hard shock
Push fast If indicated repeat
Every 2 minutes

Assessment

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1. Check the victims pulse (take pulse for no more 10
seconds). MCQ
2. If you do not definitely feel pulse within ((10 seconds)),
perform 5 cycles of compressions and breaths (30:2
ratio), starting with compressions (C-A-B Sequence).

Dont compress on the ribs to avoid its fracture and injury of the lung
which then cause bleeding
Dont compress on

I. Assess circulation (C)


"C" is for CIRCULATION.
1. Assess the victim's heart beating by place two fingertips
on his/her ((carotid artery)) and apply slight pressure
for several seconds.

Fig. (2) Assess carotid pulse


2. If there is no pulse, perform chest compressions.

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3. When performing chest compressions, position yourself
at the victims side.
4. Make sure the victim is lying face up on a firm, flat
surface.
5. Put the heel of one on the center of the victims chest on
the lower half of the breast bone
6. Put the heel of your other hand on the top of the first
hand.
7. Straighten your arms and position your shoulders
directly over your hands.

Fig. (3): correct hand position


8. Push hard and fast, compress the victim's chest. The
depth of compressions should be at least 2 inches -
remember: 2 hands, 2 inches

Squeezing
the heart
between back
bone and
chest bone
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Fig. (4): cardiac compression
9. Count aloud as you compress 30 times at the rate of
about 3 compressions for every 2 seconds or
approximately 100 compressions per minute.
10.Chest compressions will supply blood flow to the heart
and the brain but if victim remains unresponsive you
will need to check their airway.
II. Assess Airway (A) If no raising of chest during chest recoil .. should
open the airway by two methods
"A" is for AIRWAY.
1. With the victim lying flat on his back, place your hand
on his forehead and your other hand under the tip of the
chin (the head tilt- chin lift maneuver).

Dont use this method in spinal cord injury ((cervical trauma))


which caused by car or motor accidents

2. Gently tilt the victim's head backward. In this position


the weight of the tongue will force it to shift away from
the back of the throat, opening the airway.

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Fig.(5): head tilt- chin lift maneuver


3. If the victim has a head injury and you suspect a spine
injury, you can use another method to open the airway:
a jaw thrust without head tilt.
4. Place one hand on each side of the victims head, resting
your elbows on the surface on which the victim is lying.
5. Place your fingers under the angles of the victims lower
jaw and lift with both hands, displacing the jaw forward.
6. If the lips close, push the lower lip with your thumb to
open the lips.

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III. Breathing (B)
"B" is for Breathing.
1. If the person is still not breathing on his own after the
airway has been cleared, you will have to assist him
breathing.
2. Pinch the victim nose with your finger tips to prevent air
from escaping once you begin to ventilate and place
your mouth over the victim's, creating a tight seal.
3. Give two full breaths. Between each breath allow the
victim's lungs to relax - place your ear near his mouth
and listen for air to escape and watch the chest fall as
the victim exhales. (( In children put mouth to mouth
and nose ))
4. Deliver air over 1 second to make the victims chest rise.

Fig (6): mouth- to- mouth breath

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Child / Infant BLS

I. Child BLS
The child BLS sequence and skills are similar to the
sequence for adult BLS. The key differences between the child
and adult BLS are:
1. Compression-ventilation ratio for lone rescuer is 30
compressions to 2 breaths when giving CPR to victims
for all ages except newborns. In case of two rescuers
CPR give 15 compressions to 2 breaths.
2. Compression depth: for children, compress at least one
third the depth of the chest, approximately 2 inches
(5cm).
3. Compression technique: may use 1- or 2 handed chest
compressions for very small children.

II. Infant BLS


The infant BLS sequence and skills are very similar to
the sequence for adult and child BLS. The key differences for
the infant BLS are:
1. The location of pulse check: brachial artery.
2. Technique of delivering compressions (fig. 7): 2
fingers method or 2 thumb-encircling hands methods.

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Fig. (7) Infant chest compression technique


3. Compression depth: at least one third of the chest
depth, approximately 1 inches (4 cm).
4. Compression-ventilation rate: the same for the child.
(( 15 compressions between 2 breaths ))

When to Stop CPR

You should continue giving the victim CPR until:
essay
1. The victim starts breathing or vomiting spontaneously.
2. Qualified help arrives.
3. You are unable to continue
4. You put yourself in danger by continuing.

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First Aid for Chocking

Chocking:
Choking is usually caused by a piece of foreign matter
such as food becoming lodged in a person's airway. Because a
choking victim is fully aware that he cannot breathe normally,
a sense of panic may overcome them. It is important to try and
keep the victim calm to determine whether your assistance is
truly necessary or if the victim's own coughing reflex is
sufficient.
1. Start by asking the person if he is choking (A choking
victim will not be able to speak, he can do gesture or point
to his throat and you notice his face starting to turn blue).
2. Ask them if you can help.
3. Perform the Heimlich maneuver immediately.
Heimlich maneuver
VIP 1. Start by finding the proper stance - behind the victim with
one of your feet planted firmly between the victim's feet.
2. Wrap one of your arms around the victim and place your
hand in a closed fist just slightly above his belly button.
3. Place your other hand directly on top of the first.
4. Squeeze the victim's abdomen in quick upward thrusts as
many times as it is necessary to dislodge the foreign
object (chest thrusts if they are big or pregnant).
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5. If the food comes out make them comfortable and
activate ambulance if they need it.
6. If you fail to clear the victim's air passage, dial 1-2-3
immediately and continue to perform the Heimlich
maneuver until help arrives.

The Heimlich maneuver


7. If the person become unconscious:
Lay them down.
Call for an ambulance.
Check their mouth for the food.
Follow the A, B, Cs.
Notes
The thrusts need to be quick and forceful (if
unsuccessful, the force needs to be increased).

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If they are visibly pregnant, or you cant get your arms
around their abdomen then you must do chest thrusts on
the breastbone.
If they are considerable shorter than you, such as a child,
kneel down behind them and do the exact same thing.
Never pick up a child to put them on a table or a chair
simply because you dont want to kneel down.
After wards, this person should go see a doctor to make
sure there was no internal damage done during the
procedure.

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Infant Chocking

1. Kneel or sit with the infant on your lap.


2. Remove clothing from the infants chest.
3. Hold the infant facedown with the head slightly lower than
the chest, resting on your forearm. Support the infants
head and jaw with your hand. Take care to avoid
compressing the soft tissues of the infants throat. Rest
your forearm on your lap or thigh to support the infant.
4. Deliver up to 5 back slaps forcefully between the infants
shoulder blades, using the heel of your hands. Deliver each
slap with sufficient force to attempt to dislodge the foreign
body.
5. After delivering up to 5 back slaps, place your free hand on
the infants back, supporting the back of the infants head
with the palm of your hand. The infant will be adequately
cradled between two forearms, with the palm of one hand
supporting the face and jaw while the palm of one hand
supporting the face and jaw while the palm of other hand
supports the back of the infants head.
6. Turn the infant as a unit while carefully supporting the head
and neck. Hold the infant face up, with your forearm resting
on your thigh. Keep the infants lower than the trunk.

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7. Provide up to 5 down ward chest thrusts on the midline of
the chest over the lower half of breastbone. Deliver chest
thrusts at a rate of 1 per second, each with the intension of
creating enough force to dislodge the foreign body.
8. Repeat the sequence of up to 5 back slaps and 5 chest
thrusts until the object is removed or the infant becomes
unresponsive.

Back slaps Cardiac compression

Don't do this!

Do not perform blind finger sweeps in infant and children


because sweeps may push the foreign body back into the
airway, causing further obstruction.

Reliving chocking in unresponsive infant


1. If the infant become unresponsive, stop giving back slaps
and begin CPR.

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2. Call for help and activate the emergency response system.
Place the infant on a firm, flat surface.
3. Begin CPR with 1 extra step: each time you open the
airway, look for the obstructing object in the back of the
throat. If you see an object and can easily remove it,
remove it.
4. After approximately 2 minutes of CPR, activate the
emergency response system.

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First Aid for Bleeding

Bleeding refers to cutting the blood vessels and/ or the


skin and blood is escaping the body. It can be internal or
external.
Causes of external bleeding
Damage to the skin caused by:
1. Abrasion It is caused by transverse action of a foreign
object against the skin, and usually does not penetrate below
the epidermis.
2. Laceration Irregular wound caused by blunt impact to
soft tissue overlying hard tissue or tearing.
Different types of wounds

Rough Laceration Smooth laceration Abrasion

Recognition of bleeding
N.B. If there is large amount of bleeding, this means life-
threatening.
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Caution

Put gloves on before coming into contact with any blood or


body fluids.

First Aid of external bleeding


All external bleeding is treated using three key techniques,
which using the acronym mnemonic 'RED':
Rest
Elevation ( To prevent loss of blood )
Direct pressure ( to promote coagulation)
1. Rest
Less movement of the wound facilitates healing process
(start with formation of blood clots).
2. Elevation
Direct pressure is usually enough to stop most minor
bleeds, but for larger bleeds, it may be necessary to
elevate the wound above the level of the heart for
decreasing the blood flow to the affected area (limbs and
head), and assisting clotting.
N.B. Elevation is not appropriate for body wounds.

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3. Direct Pressure
Refers to placing direct pressure on the wound in order to
stop the flow of blood. This is best done using a dressing,
such as a sterile gauze pad or any suitable material.
If the blood starts to come through the dressing, add
additional dressings to the top, to a maximum of three.
If you reach three dressings, you should remove all but the
one in contact with the wound itself (as this may cause it
to re-open) and continue to add pads on top.
Repeat this again when you reach three dressings.

Wounds of balm of hand


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If the wound is transverse : close the hand
If the wound is longitudinal : open the hand
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Nose Bleed or Epistaxis


VIP
1. If a person has nosebleed, reassure the victim.
2. Place the victim head in a neutral position, but never tilt the
head back. Tilting the head forward ensures that blood isn't
ingested.
3. Instruct the victim to breathe through the mouth.
4. Pinch the soft part of the nose firmly between thumb and
forefinger, just below the end of the bone. ( 5 MINUTES)
5. If you are unsuccessful at stopping the bleeding after 10
OR 15 minutes of direct pressure, you should assess the
blood flow. If the blood flow is minor, you could consider
using an ice pack on the bridge of the nose.
6. If the nose continues to bleed with a fast flow, you should
seek medical assistance, probably from the ambulance.

: 3


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Internal Bleeding

Internal bleeding is bleeding which occurs inside the
body causing blood loss and shock. Sometimes the blood leaks
from inside the body through natural openings. Other times the
blood stays inside the body.
Causes:
Internal is more dangerous
Falls
than external because cant
Motor car accidents
Gunshot wounds see it
Injures from explosions
Impaled Objects
Surgery Warning signs:
Blood comes out of the nose or mouth (severe head
trauma).
Blood or clear fluid comes out of the ear (severe head
trauma).
Blood is in the stool.
Blood is in the urine.
Fresh bright red blood or blood like 'coffee-grounds', in the
vomit.
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First Aid for Wounds

Wound:
It is a break in the continuity of the tissues of the body either
internal or external usually caused by an act or accident?
VIP Wound Classification:
I. Closed wound as: II. Open wounds as:
Contusion Abrasion.
Laceration
Puncture
I. Closed Wound
It is damage to underlying tissues without breakdown of
the skin or mucous membranes.
Causes:
They are usually caused by a blunt force striking the body
such as: fall, in proper handling of a closed fracture and hitting
with a hammer.
Signs and Symptoms:
1. Immediate swelling and pain due to blood leakage into
the tissue.
2. Hematoma -------- localized redness. - Tenderness.
3. Shock due to blood loss (if sever).

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First Aid for Closed Wound: (COLD WATER)
1. If swelling and discoloration are evident, indicating
internal bleeding. The use of cold compresses is
recommended.
2. A bandage, such as roller gauze, may be applied to
provide pressure to help control the bleeding.
3. After 24 hours hot compresses applied to enhance
absorption.
4. Administer analgesic if necessary.
5. First aid care for shock should be administered if any of
the symptoms of shock are present (This is if the wound
is sever).
II. Open Wounds ( COLD WATER)
It is a break of the continuity of the skin or mucous
membrane. It is obvious and subject to bleeding, infection and
shock, tissue and nerve damage can occur.

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First aid for Burns

Burn is damage to the skin or underlying tissue caused by heat.


Causes:
Electricity
Radiation (sun)
Thermal (something hot)
Chemical
Classification of Burn
I. First Degree o Involves epidermis only o
Erythematous and painful skin o Looks like sunburn
II. Second Degree (Partial Thickness)
A. Superficial partial thickness
Extends beyond epidermis superficially
into dermis
o Red and weepy appearance
o Very painful
o Formation of blisters
B. Deep partial thickness
C. o Extends deep into dermis
D. o May appear mottled o Dry
and pale appearance

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III. Third Degree (Full Thickness) o Extends through
epidermis, dermis, and into
subcutaneous tissues.
o Dry, leathery appearance
o May be charred, mottled, Or
white
o If red, will not blanch with
pressure
o Painless in the center of the burn

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Assessment of Burn Area


Rule of Nines
vip It is a quick method of estimating medium to large burns
in adults. The body is divided into areas of 9%, and the total
burn area can be calculated. It is not accurate in children.

Rule of nine for adult person


First aid:
The aims of first aid should be to stop the burning process,
cool the burn, provide pain relief, and cover the burn.
For 1st and 2nd degree burns you should cool the area
immediately with gently running cold water for about
10-15 minutes, or until it has cooled off. Do not break
any blisters as this will make the wound worse.

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For 3rd degree burns do not put anything on the burn,
seek medical help immediately and treat for shock. 3rd
degree is extremely life threatening even when a small
body part is affected. If there is clothing on the burn do
not remove it as this may also remove skin. There is a
very high risk of infection from this kind of burn.

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First Aid for Fractures

Signs and Symptoms


Obvious deformity (in alignment, contour, orlength)
Local and/or point tenderness that increases in severity
until splinting
Localized ecchymosis
Edema
Crepitus (grating sound) on palpation
False movement (unnatural movement at fracture site)
Loss of function related to pain Types of bone
fractures:

First Aid:
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Assess and document:
o Alignment o Warmth o Tenderness
o Sensation
o Motion
o Circulatory status distal to injury o
Intactness of skin
Cover open fractures with a sterile dressing.
Remove rings from fingers immediately if upper

extremity is involved (progressive swelling may make


it impossible to remove rings without cutting).

Splint injured extremity.


N.B. Never attempt to force bone or tissue back into wound.
Elevate injured extremity and apply ice (do not apply
ice directly to skin).
Assess for and document frequently the five Ps:
o Pain o Pulselessness o Pallor o
Paralysis
o Paresthesia (e.g., sensation of
numbness, burning, tingling)

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All rights reserved to the authors dr Bothayna N. Sadek and Dr. Hayam S. Tantawi, 2017

First Aid for Poisoning

A poison is any substance , when ingested , inhaled ,


absorbed , applied to the skin or produced within the body in
relatively small amounts , injuries the body by its chemical
action .poisoning from inhalation and ingestion of toxic
materials , both intentional and unintentional , constitutes a
major health and emergency situation .

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All rights reserved to the authors dr Bothayna N. Sadek and Dr. Hayam S. Tantawi, 2017

First Aid:
Remove or inactivate the poison before it's absorbed.
Provide supportive care in maintaining vital organ
function
Administer a specific antidote to neutralize specific
poison
To implement treatment that hastens the elimination of
the absorbed poison
1) Ingested poisons:

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All rights reserved to the authors dr Bothayna N. Sadek and Dr. Hayam S. Tantawi, 2017
Corrosive poisons include alkaline and acids agents that can
cause tissue destruction. After coming in contact with mucous
membranes. Alkaline products include lye, drain cleaners,
toilet bowl cleaners, bleach. Acid products include toilet bowl
cleaners, pool cleaners, metal cleaners, rust removers and
battery acid.
First aid:
Measures are instituted to remove the toxin or decrease
its absorption.
2) Carbon Monoxide Poisoning :
May occur as a result of industrial or house -held incidents or
attempted suicide. Carbon monoxide exerts its toxic effect by
binding to circulating hemoglobin and thereby reducing the
oxygen carrying capacity of the blood. Hemoglobin absorbs
carbon monoxide 200 times more readily than it absorbs
oxygen.
Signs and Symptoms
Progress rapidly to coma. Skin color, which can range
from pink or cherry red to cyanotic and pale, is not a
reliable sign.

First aid for :


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First aid for


All rights reserved to the authors dr Bothayna N. Sadek and Dr. Hayam S. Tantawi, 2017

Good Luck

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