FIRST AID

Dr Atul Aalok, M.D.

What is 1st AID?

- Basic support / initial procedures provided

to a victim till medical help arrives or the
person is shifted to Medical centre
- ‘On-the-spot’ treatment is provided at site of
incident
- Any trained person can provide it
1st AID required in (e.g.)..
 Accidents/Injuries
 Unconscious/Comatose person
 Acute illnesses
 Poisoning
 Burns
 Seizure (convulsion)
 Disaster situations etc
Why is its knowledge
necessary?
 Essential for every citizen ; Trained pool in
disaster situations
 Unexpected situations can confront anyone,
anytime
 To provide basic care till help arrives
 To keep the victim safe
 Job requirement e.g. Paramedical, Forestry
services, armed forces etc
 Medico-legal aspects
General Principles in management
of victim of accident or sudden
illness
 Important Considerations :-

- Do Not Panic
- Skill and speed required but ‘Haste makes waste’
- Perform ‘TRIAGE’
- Do not hesitate to call for local help
- Shift victim to the nearest health facility at the
earliest
General Principles in management
of victim of accident or sudden
illness…

- Keep yourself safe

- Maintain victim’s dignity
- Inform victim’s family at appropriate time
- Inform law enforcement agencies at the
earliest esp. burns, poisoning
- Keep record ; preserve victim’s clothes,
vomitus, urine etc for Forensic evidence
General Management of victim
of accident or sudden illness…

 Calm the victim

 Shift to a safe place ; firm surface
 Provide food, water, medicines, clothes etc
 Avoid food and water in unconscious person
 Remove offending clothing as necessary
 Avoid ‘Harsh’/Sudden movement of the
unconscious / COMA victim
 Perform Cardiopulmonary
Resuscitation – CPR if required
Perform CPR in…

 Cardio-Pulmonary Arrest
 Decompensated Shock
Diagnosis of CPA
 Cardiac Arrest
– Absence of pulse in major arteries
– Absence of heart sounds
- assess within 10 seconds

 Respiratory Arrest
– Assess for absent breathing or whether
breathing abnormally
CPR (1 Rescuer)
Cardiopulmonary
Resuscitation (CPR)
 It consists of a series of maneuvers by which
oxygenated blood supply to the brain and vital
organs is maintained during Cardio-
pulmonary Arrest – CPA

 Two levels of CPR

– BLS (Basic Life Support) : The elements of CPR
provided without additional equipment.
– ACLS : Provided in hospital setting with drugs and
equipment for assisting ventilation or circulation
CPR…

 CAB of CPR (2010 AHA guidelines)

C = Chest Compressions
A = Airway
B = Breathing
Chest Compressions
- Give External Cardiac Massage if no heart
beat or heart beat less than 60/min or
falling
- Rate of compressions at least 100/min
- Compress ‘Hard and Fast’
- Minimal interruptions during compressions
- Allow full recoil of chest after each
compression
- Depth at least 5, 5, 4 cm in adult, child or
infant respectively
CPR (1 Rescuer)
CPR…
 CAB of CPR (2010 AHA guidelines)

Assess Responsiveness and

Airway :
• Clear airway of blood, secretions,
foreign particles
• Perform ‘Head tilt’, ‘Chin lift’, ‘Jaw
thrust’
Head Tilt, Chin Lift, Jaw
Thrust
CAB of CPR
2. Assess Breathing :

• Determine absence of breathing

• Give mouth/nose/mask airway breath
- 8-12/min in adults.
CAB of CPR…

– In both cardiac and respiratory arrest :

Compression : Ventilation (Breaths) =
30:2 if 1 or 2 rescuers in adults
– 30:2 if 1 rescuer and 15:2 if 2 rescuers in
children
– Continue CPR till help arrives / condition
improves
– If unwilling/unable to give breaths then
continue giving only chest compressions
CPR (1 Rescuer)
Shock
 Shock is a state of acute circulatory
failure that leads to tissue hypoxia

 Classification :
1. Hypovolemic e.g vomiting, diarrhoea,
excess bleeding
2. Cardiogenic
3. Septic
4. Distributive or Vasogenic
Shock…
 SALIENT FEATURES :

1. Early Compensated shock :-

- Fast heart beat
- Cold, clammy skin
- Agitation, restlessness, ‘Sense of doom’

2. Decompensated shock :-
- Fall in BP manifestated as poor sensorium, poor
breathing, blue colour (cyanosis), decreased urine
output, cold pale skin

3. Irreversible shock :-
- Progressive organs failure inspite of medical treatment
Shock…
 MANAGEMENT :

– Always start with CAB of CPR

– Elevate legs
– Provide warmth
– Oral fluids in fully conscious person
– Shift immediately to a medical facility
Unconscious Person
 Causes

– Head injury / multiple trauma, near drowning,

electrocution, etc
– Acute illness e.g. high fever, high or low BP, low
glucose levels, dehydration etc
– Acute reaction to drugs, poisoning
– Insect / animal bite
– Post seizure
– Overwhelming Psychological trauma
Unconscious Person…
 MANAGEMENT :
– Check vital signs, state of arousal first.
– Always start with CAB of resuscitation
– Shift to a safe place
– Keep victim in cool and quiet surroundings
– Provide warmth
– Avoid giving food and fluids
– Keep head tilted to one side
– Suspected Multiple/Head injury : Avoid sudden
movements. Always stabilise/immobilise neck, spine and
limbs before moving person. Hospitalize for observation.
Individual Clinical
Situations…
Wounds
 TYPES :

– Abrasion
– Incision
– Puncture
– Blunt (Contusion)
– Laceration
– Burns
– Compound wounds associated with other
injuries
Wounds…
 MANAGEMENT :

– CAB of CPR ; Elevate legs if in SHOCK

– Reassure victim
– Wash and clean area
– Remove superficial foreign bodies
– Do not ‘probe’ a puncture wound
– Dressing if required
Wounds (Management)…
– Immobilise limb with splint
– For pain relief – Paracetamol or Aspirin
– Avoid applying ash, lime powder etc on
open wounds
Management of Bleeding

 Control bleeding with direct pressure

 Pressure bandage
 Limb elevation
 Cold compresses/Ice application
 Torniquet application
Fractures

 TYPES :

– Simple

– Compound
Fractures…
 CLUES TO A FRACTURE :

– Asymmetry / discontinuity of affected

part
– Excessive mobility of limb
– Non mobility of limb
– ‘Crepitations’ at affected area
– Depression in a bone
– Do not try to ‘Diagnose’ a fracture
Fractures…
 MANAGEMENT :

– Fractures involving Head, neck, spine,

pelvis, mouth and jaw are of severe
types
– Always ensure CAB of CPR first
– Non severe associated injuries may be
managed later or simultaneously
Fractures (Management)…

– Avoid sudden and jerky movements

– Move person only after immobilising
the head, neck, spine or pelvis
– Do not massage the area
– Do not apply heat for pain relief
– For pain relief Paracetamol or
Aspirin
Fractures (Management)…
 Monitor for signs of shock
 Control bleeding with direct pressure
 Do not press on or move a bone that
sticks out
 Do not reset the bone
 Splint affected limb firmly. Use shoe laces,
belts, etc. to hold the splint in place
 Apply sling
In Suspected Head and Neck
Injury
Dislocation
 A dislocation is a displacement of a
bone from its joint
 Monitor for signs of shock
 Make a sling with a triangular piece of
cloth to support a limb
Sprain
– Crepe bandage. Apply sling
– Splinting
– Ice / cold compresses
– Anti-inflammatory ointment, spray
– Do not massage
– Avoid movements of affected joint
Burn and Scald
 TYPES OF BURNS :

– Dry heat/Thermal burn

– Wet heat (SCALD)
– Electric burn
– Chemical burn
– Sunburn/Solar radiation burn
Burn and Scald…

 Classifying burns :

– Depth : 1st, 2nd, 3rd degree

– Area of involvement : ‘Rule of Nine’
– Depth and area determine the severity of
burns and need for hospitalization
– Burns in children are more severe than
those in adults
Burn and Scald…
 MANAGEMENT :
– Always start with CAB of CPR
– Rescuer should keep one’s safety in mind esp.
electrical accidents
– Approach victim keeping a thick cloth/coat/blanket ready
– May roll person on ground to extinguish flames
– Shift to a safe, cool place
– Remove burning clothes only if it comes out easily.
– Pour copious cold water/submerge body part in water.
Caution needed in chemical burns
– Do not rupture blisters
– Provide fluids
Burn and Scald…
 For pain relief : cold sponges, Paracetamol
tab.
 Dressing with clean cloth or guaze and
Silver sulphadiazine cream etc
 Oral Antibiotics
 Oral scalds/chemical burns : give cold
water, ice-cream, cold milk, egg emulsion
etc
 Eye burns : gently flush for long time with
tap water
Frost Bite
 Caused by excessive cold and wet conditions
 Keep affected area dry
 Massage affected area
 Dip area in warm water - CAUTION
 Protect : Warm clothes, gloves, umbrella etc
 Warm fluids intake
 High calorie diet – peanuts, dry fruits, chocolates,
butter etc
 UV goggles in snow
Poisoning
 High degree of suspicion required especially
in children and unconscious person in
absence of any obvious disease
 Assess by familiar / unfamiliar odour on and
around victim
 Sudden onset of symptoms e.g. altered
behaviour, vomiting, weakness
 Assess mode of poisoning e.g. ingestion,
inhalational, absorption etc
Poisoning…
 MANAGEMENT :

– CAB of resuscitation
– Removal of poison from the person e.g.
washing with soap and water, shower etc
– For inhaled poison shift person to open
surroundings, loosen clothing
– Unconscious victim should be put lying to his
side
– Restrain person e.g. opioid / narcotic abuse,
alcoholism
Poisoning (Management)…
– Focus on removal of ingested poison early
– Do not waste time
– Induce vomiting except in corrosive
poisoning, swallowed petroleum
products, small children and
unconscious person
– Dilute any leftover poison – Milk
– Absorb any leftover poison – charcoal
powder, burnt bread
– Preserve vomitus, urine sample for
Medicolegal purpose
National Poison Information
Centre

 AIIMS, New Delhi

– 011-26593677, 26589391, 26593282
– Fax 011-26588663, 26589691
Dehydration
 Caused by excessive fluid loss from body
and/or its inadequate replacement

– Excessive vomiting, ‘motion sickness’

– Diarrhoea, ‘Food poisoning’
– High environmental temperature
– High insensible losses in disease states e.g.
Pneumonia, Diabetes
– Assess by looking at tongue, eyes, skin pinch
Dehydration…
 MANAGEMENT :

– Shift person to cool environment. Avoid fan

– Fluids therapy is mainstay e.g. water, rice water,
coconut water, ‘lassi’, ‘shikanji’ etc
– ORS ; Any fluid containing BOTH sugar and common
salt
– Banana, ‘Moong dal khichdi’
– Avoid juices, ‘cold’ drinks, carbonated drinks
– Hospitalization required for persisting vomiting, severe
weakness, altered sensorium, low intake, decreased
urine output
Heat stroke

 Excessive core body temperature

> 41°C
 Hot, flushed face and skin
 Dehydration, No sweating
 Altered sensorium, dizziness, low BP
 Poor urination
 Fast, shallow breathing
Heat Exhaustion
 Occurs in heat conditions due to lack
of water and/or salt.
 Profuse sweating
 Temp. never crosses 40.6°C (105°F)
Heat Exhaustion / Heat
stroke...
 MANAGEMENT :

– Immediate body cooling required

– Remove from hot environment
– Remove clothes
– Fanning
– Sponge whole body with cool water ; tub of ice
water monitor temp. every 5 minutes
– Oral fluids if tolerated
– Shift to hospital immediately
Hypothermia
 or Exposure, occurs when a person’s core
body temperature falls below 33.7°C
(92.6°F).
 Re-warming is mainstay
 Give warm food and drink
Choking

 Choking is the mechanical

obstruction of the flow of air from
the environment into the lungs.
Choking

Management :

 Back slaps
 Heimlich maneuver (Abdominal
thrusts)
 Finger sweeping (in unconscious
person)
Near Drowning / Asphyxia

 Fall in ponds, river, swimming pool, bath

tubs etc
 Choking on food, foreign body etc
 Smoke, fumes
 Chest trauma
Near Drowning /
Asphyxia…
 MANAGEMENT :

– Always start with CAB of CPR

– Shift to a safe place
– Keep head tilted to one side and at lower
level than legs
– Clear mouth
– Provide warmth, remove wet clothing
– Avoid giving food and fluids
Snakes (Types)
 Elapidae
 Viperidae
 Hydrophidae
 Colubridae
Identification of poisonous
snake

 Large belly scales

 Triangular head (Viper)
 Small scales on head
 Pit between eye and nostril (Pit viper)
 Big scales in the central row on back
 Compressed tail
 Two fang marks
Effects of toxin

Local effects
Cardiotoxic
Neurotoxic
Bleeding and tissue necrosis
Myotoxic
Snake Bite
 MANAGEMENT :

– Reassure person
– Keep the victim warm and at rest
– Splint the limb
– For pain relief Aspirin or Paracetamol may be given
– Tourniquet can be applied
– Wash bite area and cover loosely with clean cloth or
gauze
– Avoid incision, applying ice locally
– Shift to hospital as fast as possible. Catch the snake,
if possible, for identification
Animal Bite
Dog, Monkey, Cat, etc

 MANAGEMENT :

– Reassure victim
– Wash with soap and copious amounts of water
– Apply antibiotic ointment
– Avoid incising wound, applying ash, mud,
cow-dung, turmeric etc
– Anti-rabies and TT vaccine
Insect Bite
Bee, Wasp, Scorpion, Spider, Ants etc

 MANAGEMENT :

– Remove sting carefully

– Wash bite area ; immobilise limb
– Apply antiseptic ointment ; calamine lotion
– Apply cold sponges/ice locally e.g. ant bite,
scorpion bite
– Torniquet can be applied e.g. Scorpion bite
– Hospitalization in case of bee, wasps and
poisonous scorpion bite
Miscellaneous
 Chest pain/Suspected ‘Heart attack’
 Eye injury
 Seizure
 Hypoglycemia (Low Sugar)
 THE END
Keep Safe, Be Safe!
 1st aid kit
 Chest pain
 Abdomen pain
