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2 Feb 2011 by gegeshandong


									                                                         PBL 1 – BLOOD ON THE ROAD



   1. 1. Review senior first aid skills, including cardiopulmonary resuscitation and
      be able to demonstrate basic life support.

   2. Understand the principles of first aid as applied in burns, head injuries, spinal
      injury and bleeding lacerations.

Cardiopulmonary resuscitation (CPR)

CPR is the technique of chest compressions combined with rescue breathing. The
purpose of CPR is to temporarily maintain a circulation sufficient to preserve brain
function until specialised treatment is available (Australian Resuscitation Council,

Compression to ventilation ratio

Current consensus is that a universal compression-ventilation ratio of 30:2 (30
compressions followed by two ventilations) is recommended for all ages regardless of
the numbers of rescuers present (Australian Resuscitation Council, 2010).

Chest compressions only

If rescuers are unwilling or unable to do rescue breathing they should do chest
compressions only. If chest compressions only are given, they should be continuous at
a rate of approximately 100/min (Australian Resuscitation Council, 2010).

Steps of resuscitation

DRS ABCD (see Australian Resuscitation Council Basic Life Support Flow Chart below)

   -   Check for danger (hazards, risks, safety)
   -   Check for response (if unresponsive)
   -   Send for help
   -   Open the airway
   -   Check breathing
   -   Give 30 chest compressions (almost 2 compressions/ second) followed by two
   -   Attach an automated external defibrillator (AED) if available and follow the

                                                        PBL 1 – BLOOD ON THE ROAD


A burn is an injury caused by heat, cold, electricity, chemicals, gases, friction and
radiation (including sunlight). The aims of first aid treatment of burns should be to
stop the burning process, cool the burn (thereby providing pain relief) and cover the

Initial approach

   -    Ensure safety for rescuers, bystanders and the victim
   -    Do not enter a burning or toxic atmosphere without appropriate protection
   -    The victim should be removed to a safe environment as soon as possible
   -    Stop the burning process
            o Stop, drop, cover and roll
            o Smother any flames with a blanket
            o Move away from the burn source
   -    Assess the adequacy of airway and breathing
   -    Check for other injuries
   -    If safe, give oxygen to all victims with smoke inhalation or facial injury
   -    Call for an ambulance.

                                                         PBL 1 – BLOOD ON THE ROAD

General management principles

Immediate cooling of the affected area with flowing water may be necessary
depending on the cause of burn. Water is always the first choice for cooling a burn
injury. Hydrogel products are an alternative if water is not available.

If possible, remove all rings, watches, jewellery or other constricting items from
affected area without causing further tissue damage.

Where feasible elevate burnt limbs to minimise swelling.

Cover the burnt area with a loose and light non-stick dressing, preferably clean, dry,
lint free material e.g. plastic cling film.

   o   Do not peel off adherent clothing or burning substances
   o   Do not use ice or ice water to cool the burn as further tissue damage may result
   o   Do not break blisters
   o   Do not apply lotions, ointments, creams or powders other than hydrogel.

Head injuries

Injuries to the head may cause loss of consciousness, damage to the brain, eyes, ears,
teeth, airways and mouth or other structures. Severe head injuries may lead to death
or permanent brain damage.

The establishment and maintenance of a clear airway is the first priority in the care of
a head injury victim and takes precedence over the management of associated

Head injuries may be associated with:

   -   altered level of consciousness
   -   bleeding
   -   damage to the upper airway
   -   spinal and other injuries.


Victims of head injury may be:

   -   conscious
   -   unconscious
   -   subject to changing levels of consciousness.

An assessment by a medical practitioner is essential in all cases where a victim has
been unconscious. The victim who has not lost consciousness due to a head injury
requires urgent medical assessment if any of the following symptoms or signs are
displayed. The victim may:

   -   become unconscious, drowsy, vague
   -   have memory impairment
   -   appear agitated or irritable

                                                           PBL 1 – BLOOD ON THE ROAD

   -   have slurred speech
   -   show incoordination or loss of power in limbs
   -   complain of headache or giddiness
   -   vomit or complain of nausea
   -   have a seizure
   -   have bleeding or fluid discharge from ears, nose, mouth
   -   develop changes in size or shape of the pupils.

Management of head injuries

Management of the unconscious victim should follow the Australian Resuscitation
Council Basic Life Support Flow Chart.

The rescuer should:

   -   turn the victim on the side and obtain a clear airway
   -   check for breathing
   -   check for and control bleeding and cover wounds
   -   arrange for transport to hospital by ambulance.
While waiting for transport to hospital, the rescuer should note any:

   -   change in the level of consciousness
   -   bleeding from the eyes, mouth, ears
   -   seizures.

While regaining consciousness after a head injury a victim may:

   -   vomit
   -   have blurred vision
   -   be irrational or uncooperative
   -   have memory lapse
   -   be dizzy
   -   unable to recall events surrounding the accident.

A victim should not be left alone. If consciousness returns, the victim should be given
reassurance, kept lying down at rest and transport arranged to hospital by ambulance
for assessment.

Spinal injury

The possibility of spinal injury must be considered in the overall management of all
trauma victims. Extreme caution must be taken when moving a suspected spinal
injury victim to minimise risk of further damage.

The principles of management of airway, breathing and circulation always take
priority in the care and management of suspected spinal injury.

Management of spinal injury

The conscious victim

If the conscious victim complains of pain, weakness or altered sensation in the neck or
related regions, tell the victim to remain still. Ideally, only rescuers trained in the

                                                          PBL 1 – BLOOD ON THE ROAD

management of spinal injuries should move the victim. If movement is necessary,
extreme care must be taken to minimise movement of the spine in any direction, and
the painful area must be fully supported throughout.

The unconscious victim

Airway management takes precedence over any suspected spinal injury. It is
acceptable to gently move the head into a neutral position to obtain a clear airway.

The airway guidelines must be followed if the victim is unconscious. It is preferable
that the victim be placed into the recovery position (see below).

Wherever possible the unconscious victim must be:

   -   handled gently with minimal movement of the head, neck and torso
   -   turned onto the side to ensure an adequate airway
   -   turned with spinal alignment maintained throughout.

Bleeding lacerations

Usually external bleeding can be controlled by the application of appropriate pressure
on or near the wound to stop further bleeding until help arrives. The main aim is to
reduce blood loss from the victim.

The use of direct, sustained pressure is usually the fastest, easiest and most effective
way to stop bleeding. However, in some circumstances, (e.g. embedded object)
indirect pressure may be used.

Direct pressure method

Where the bleeding point is identified control bleeding by applying pressure as

   -   Apply firm, direct pressure sufficient to stop the bleeding

                                                         PBL 1 – BLOOD ON THE ROAD

   -   Apply pressure using hands or a pad ensuring that sufficient pressure is
       maintained and that the pressure remains over the wound. If bleeding
       continues, apply another pad and a tighter dressing over the wound.

To assist in controlling bleeding, where possible:

   -   elevate the bleeding part
   -   restrict movement
   -   immobilise the part
   -   advise the victim to remain at total rest.

If major bleeding continues it may be necessary to remove the pad(s) to ensure that a
specific bleeding point has not been missed. The aim is to press over a small area and
thus achieve greater pressure over the bleeding point. For this reason an unsuccessful
pressure dressing may be removed to allow a more direct pressure pad and dressing
on the bleeding location.

Indirect pressure methods

Embedded objects:

   -   Do not remove the embedded object because it may be plugging the wound and
       restricting bleeding.
   -   Place padding around or above and below the object and apply pressure over
       the pads.


As a last resort and only when other methods of controlling bleeding have failed,
tourniquet may be applied to a limb to control life threatening bleeding e.g., traumatic
amputation of a limb or major injuries with massive blood loss.

A wide bandage (of at least 5cm) can be used as a tourniquet high above the bleeding
point. The bandage should be tight enough to stop all circulation to the injured limb
and control the bleeding. The time of application must be noted and passed on to
emergency personnel. Once applied, a tourniquet shout not be removed until the
victim receives specialist care.

A tourniquet should not be applied over a joint or a wound, and must not be covered
up by any bandage or clothing.


Australian Resuscitation Council Guidelines

PDF of these guidelines available from


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