Basic Life Support Training

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Basic Life Support Training Powered By Docstoc
					Basic First Aid Training
Darfur, Sudan Dec.2004 – March 2005



Subject matter compiled from various resource documents by Monika Hörling, RN/CRNA Stockholm, December 2004


First aid is the treatment of the sick and injured before professional medical help can be given. The aims of first aid are to prevent death or further injury, to counteract shock and to relieve pain. Certain conditions, such as unconsciousness, severe bleeding or burns require immediate treatment if the patient is to survive. In such cases even a few seconds delay may mean the difference between life and death. All team members should be prepared to administer first aid. You should have sufficient knowledge of first aid to be able to apply true emergency measures and decide when treatment can be safely delayed until more skilled personnel arrive. You must be able to recognize your limitations. Procedures and techniques beyond your ability should not be attempted. More harm than good may result. Serious trauma is most likely from road traffic accidents. Multiple injuries may be involved in this scenario. Other traumatic injuries are likely to be the result of gunshots, stab wounds, fire, or blasts from bombs and land mines.


2. ASSESSMENT OF LIFE THREATENING SITUATIONS Evaluate the three S´s: Safety Scene Situation

Safety – evaluate all possible threats and ensure that none still exist.
The conditions that caused the accident may still present further danger. Remember that you must put your own safety first. You cannot help others if you become a casualty yourself. If you cannot eliminate a life-threatening hazard, you must try to put some distance between it and the casualty.

Scene – evaluate the scene to determine what really happened and to ascertain how many
people are injured and in need of help.

Situation – assess if you have to deal with several casualties: the order in which you
treat them might be crucial to their survival. Who screams more is not necessarily the most critical, therefore attend first those who are unconscious!

Seek medical help immediately!
When you call for help, always remember to give the following information:     WHAT has happened WHERE it has happened How many victims If there are any other risks

Remember that you can only do your best; you are not expected to make life or death judgements, whatever aid you can give will be apppreciated.



(15 seconds evaluation according to the A-B-C method)

DANGER: Control DANGERS for SELF, bystanders and casualty. If you can’t control the danger try to move the casualty to a secure area. Do not put yourself in danger, do not become another victim! If there is any doubt whether a scene is safe, withdraw and await qualified help.

CHECK FOR CONSCIOUSNESS: Shake the casualty’s shoulders gently and shout loud and clear in his ear, ask him/her what happened or where he/she is hurting: · A casualty in a serious state of altered consciousness may mumble, groan or make slight movements; · A fully unconscious casualty will not respond at all. Scan the patient from head to foot looking for signs of bleeding.

If unresponsive or altered conscious state, the airway may be blocked - place the casualty in the recovery position.

PRIORITY: A–B-C After the A-B-C has treatment been performed, a full examination of each casualty should be made, starting at the head and working down the body. Check for a response if the casualty has altered conscious state. If the casualty is unconscious, the look-listen-feel routine should be followed. If the casualty is conscious he/she will be able to tell the First-Aider where they feel pain, etc.



An unconscious casualty’s airway may be narrowed or blocked making breathing difficult or noisy. This is due to the loss of the throat muscular control (as will happen to all muscles under unconsciousness). This causes the tongue to sag back and block the throat. Establishing and ensuring a free airway has top priority!


How to open the airway:
In non trauma patients: place two fingers under the point of the casualty’s chin, lift the jaw. At the same time, place your other hand on the casualty’s forehead and tilt the head well back. Open the mouth and look for solid or liquid foreign bodies; if found, try to remove solid bodies by using your free index finger as a hook. Remove liquid by turning the head to one side. In trauma patients: in case of suspected head, neck or facial trauma, the cervical spine should be kept in a neutral in-line position while opening the airway by the chin lift or the jaw thrust maneuver. Now open the mouth and look for solid or liquid foreign bodies; if found, try to remove solid bodies by using your free index finger as a hook. Remove liquid by absorbing it with a towel or gauze.

Chin lift: the jaw is pulled forward by grasping the chin and then lifting. Jaw thrust maneuver: the jaw is thrust forward by placing the thumbs on each cheekbone, just below the ears, placing the index and long fingers on the jaw and at the same angle, pushing the jaw forward. Both these techniques result in movement of the lower jaw and pull the tongue forward, away from, and so opening, the airway.


Check for breathing: put your face close to the casualty’s mouth. Look, listen and feel for breathing:   


Look for chest movements. Listen for sounds of breathing. Feel for breath on your cheek.

Look, listen and feel for ten seconds before deciding that breathing is absent. If this is the case, open the casualty’s airway, and then give two breaths of artificial ventilation.

Artificial ventilation:
1. Raise the chin slightly, pinch the nose and give 2 breaths (1-5 seconds/breath) in to the casualty´s mouth.

2. Evaluate effect by look, listen and feel.

Unconscious casualties should be placed in the recovery position. This position prevents the tongue from blocking the throat and allows liquid to drain from the mouth. 1. Kneeling beside the casualty, open the airway by tilting the head and lifting the chin. Straighten the legs. Place the arm nearest to you out at a right angle to the body, elbow bent, and with the palm uppermost. Bring the arm furthest from you across the chest and hold the hand, palm outwards, against the casualty’s nearer cheek. With your other hand, grasp the thigh furthest from you and pull the knee up, keeping the foot flat on the ground. Keeping the casualty’s hand pressed against the cheek, pull at the thigh to roll the casualty towards you and on to the side. Tilt the head back to make sure the airway remains open. Adjust the hand under the cheek, if necessary. Conscious casualties should be placed in a semi reposed (half sitting) position or in the position preferred by the casualty.

2. 3. 4. 5.


Circulation Bleeding
Bleeding is classified according to the type of blood vessel that is damaged: artery or vein Arterial bleeding: the blood is richly oxygenated. It is bright red and under pressure from the pumping heart, spurts from the wound in time with the heart beat. A severed artery may produce a jet of blood several feet high and can rapidly empty the body of blood. Venous bleeding: venous blood, having given up its oxygen, is dark red in colour. It is under less pressure than arterial blood. Since the vein walls are capable of great distention, blood may “pool” within them; thus blood from a severed major vein may flow profusely.


SEVERE EXTERNAL BLEEDING Massive external bleeding is dramatic and may distract you from the control of A-B-C priorities. Bleeding at the face and neck may obstruct the airway and needs urgent attention. Remember that shock may well develop and the casualty may lose consciousness. Your aims are: to control the bleeding to prevent shock

Treatment: Remove or cut clothing to expose the wound. Watch out for sharp objects, such as glass, that may injure you. 2. Apply direct pressure over the wound with your fingers or palm, preferably with a sterile dressing or clean pad – but do not waste time hunting for a dressing. If you cannot apply direct pressure – i.e. if an object is protruding – press down firmly on either side or squeeze the wound edges together around an object. 3. If the wounding body (i.e knife, bullet) is still present in the wound, do not extract it. Instead, fix it firmly to the tissues in order to stop it moving within the wound during transport. 4. Raise and support an injured limb above the level of the casualty’s heart. Handle limbs very gently if fractured. 1.


5. It may help to lay the casualty down. This will reduce blood flow to the site of injury, and reduce the effect of shock. 6. Apply a clean pad or sterile dressing. Bandage it firmly in place, but not so tight as to impede the circulation. If bleeding comes through the dressing, place another bandage firmly over the top. If there is a foreign body protruding, build up pads on either side of the object until they are high enough to bandage over the object, without pressing on it. 7. Secure and support the injured part, as for a broken bone. 8. Look for help and check periodically the circulation beyond the bandage.

Remember! Never use a tourniquet except on an amputated limb!

INTERNAL BLEEDING Bleeding within the body cavities may follow injury, such as a fracture or penetrating wound. Internal bleeding is serious; although blood may not be split from the body, it is lost from the circulation, and shock may develop.

1. Clear airway if obstructed 2. Seal open sucking wounds with hand or other airtight material DO NOT try to remove any objects that might be sticking out of the wound

1. Cover wound with dressings 2. Lay patient on back, with knees up and head and shoulders raised DO NOT remove debris from the wound DO NOT push in protruding intestines DO NOT give food, drink or painkillers


The preferred method to detect the pulse on a casualty is on the neck.

If the heart is beating properly, it will generate a pulse in the neck (the carotid pulse) where the main carotid arteries pass up to the head. These arteries lie on either side of the larynx (throat), between the Adam’s apple and the strip of neck muscle that runs from behind the ear across the neck to the top of the chest. How to check for the carotid pulse: 1. Feel for the Adam’s apple with two fingers. Slide your fingers back and into the gap between the Adam’s apple and the neck muscle. Feel for the carotid pulse. 2. Feel for ten seconds before deciding that the pulse is present or absent. 3. If it is absent, proceed at once with C.P.R

When a casualty has no pulse and is not breathing, this is called a cardiac arrest. The treatment is chest compression, combined with artificial ventilation. This is the sequence known as cardiopulmonary resuscitation – CPR In case of a cardiac arrest; the first minutes are crucial for the survival of the casualty!    If pulse is present and breathing not active, continue administering ventilations for one minute (ten ventilations), before again checking the carotid pulse. If pulse is absent, proceed with above described CPR (15/2 compressions/ventilations). If pulse is present check for breathing and ensure free airway.


CPR-technique (One or Two First-Aiders):
1. Identify the correct position for the hands – from the level of the lowest rib, measure upwards a distance of 2 fingers along the chest bone. Place the ball of the hand on this postion and add the other hand on top. 2. Give 15 chest compressions. The compressions should be performed at a pace of at least 80 per minute. The depth of the compressions should be 1,5 – 2 inches. 3. Return to the mouth of the casualty and give two ventilations. Then give a further 15 compressions to the chest. (One artificial breath should take about 2 seconds) 4. Evaluate the effect of CPR after 10 sessions. If pulse still absent; continue CPR until help arrives.

If there are two first-aiders, the one giving the chest compressions should set the rythm by counting out loud the pace (1,2,3. etc...)

Clinical shock occurs when there is reduced amount of blood circulating through the body. The main cause of shock is substantial loss of blood, which results in an inadequate supply of oxygen to the body tissues. A person suffering from shock must always be given immediate attention. Recognition: there may be pallor, cold and clammy skin, rapid and weak pulse, pain, thirst, confusion, restlessness and irritability - possibly leading to collapse and unconsciousness.      Place the casualty in a semi-prone position with the legs elevated. This improves the flow of blood to the vital organs. Ensure an unobstructed airway. Keep the casualty warm to prevent further heat loss. Always act calmly and reassuringly. Be gentle with the casualty. Stress and pain aggrevate shock. Never give anything to drink.


Other Injuries:
Burns can be caused by fire and also from a variety of other causes; dry heat, corrosive substances and friction. Scalds are caused by wet heat, hot liquids and vapors. 1. 2. 3. Extinguish the burn with large amounts of liquid. Thorough cooling may take 10 minutes or more. While cooling the burn, check the airway, breathing and pulse of the casualty. Be prepared to resuscitate if necessary. Gently remove any rings, watches, belts, shoes, or smoldering clothing from the injured area, before swelling begins. Carefully remove burned clothing unless it is sticking to the burn. Cover the injury with a sterile burns sheet or other suitable material such as: a portion of freshly laundered sheets or pillow case plastic kitchen film a clean plastic bag for a burned hand or foot. Secure it with a bandage or strapping over the plastic, not directly onto the burned skin. Do not drain any blister Keep the casualty warm.

4. -


A fracture is a break or crack in a bone. Considerable force is required to break a bone. Injuries to bone and soft tissue are often regarded as being of secondary importance, since they are seldom life-threatening. Fracture recognition:  The casualty may have suffered a recent violent blow, or a fall  Difficulty in moving a limb normally, or at all  Pain at or near the site of injury made worse by movement. Pain felt over a bone, if gently touched  Local distortion, swelling and bruising  Shortening, bending, or twisting of the limb, compared to the opposite one  Signs of shock


Closed fracture treatment: 1. 2. 3. 4. 5. Do not move the casualty until the injured part is secured and supported, unless he/she is in danger. Tell the casualty to keep still and steady. Support the injured part with your hands until it is immobilized. Immobilize joints on both sides of a fracture site with a splint. Pad the limb when splinting and fill hollows. Elevate the limb. Check regularly the fit of the splint and the pulse beyond the fracture point.

For upper limb fractures
Always support the arm against the chest with a sling and, if necessary, with bandaging. For a fractured collar bone, dislocated shoulder, severe shoulder sprain, fractured upper arm, injuries around the elbow or to the forearm and wrist, proceed as follows: 1. Sit the casualty down gently. Steady and support the injured site across the chest in the position that is most comfortable 2. Ask the casualty to support the arm 3. Support the arm in a sling and secure the limb to the casualty’s chest 4. Transport the casualty in a sitting position

For lower limb fractures:
Injuries to the hip, thigh or lower leg: 1. Lay the casualty gently down. Ask another helper to steady and support the injured limbs. 2. Gently bring the casualty’s sound limb alongside the injured one. Immobilize the limb by splinting it to the uninjured limb.

Open fracture treatment: If possible, get help to support the limb while you work on the wound. Cover the wound and apply pressure to control the bleeding. If bone parts are protruding, build up pads of soft, non fluffy material around the bone until you can bandage over the top of the pads. Hold the pads in place with a roller bandage. Do not press down directly onto a protruding bone end. 3. Immobilize as for a closed fracture. Keep the injured part elevated, if possible. 5. Check the circulation beyond the bandaging every 10 minutes 1. 2.


Accidents can result in situations where people’s lives are in danger. Examples of this include road accidents and fires. Your first task on such occasions is therfore to move all casualties, injured or unscathed alike, to a safe place away from a life-threatening situation. Casualties who are unconscious or those whose injuries prevent them from moving themselves must be helped. There are a number of basic rules governing how you should lift and move casualties, depending on their injuries.

Remember! Never move a casualty with suspected spinal injury unless
assisted by medical personnel.
Exeptions:  Life-threatening situation  At a mass-casualty incident  If the original position of the casualty prevents you from establishing and ensuring a free airway

Proceed with extreme caution if you suspect a neck or spinal injury!


One First Aider carries:

The human crutch:

1. 2.

Stand on the casuaty´s weaker side; pass his arm around your neck and grasp his hand or wrist with your hand. 2. Pass your other arm around the casualty´s waist. Grasp his waistband, or clothing, to support him. 3. Move off on the inside foot. Take small steps, and walk at the casualty´s pace. Raise the casualty into a sitting position Stand behind the casualty, slip your arms under the casualty´s armpits and get a firm grip with your hans linked across the casualty´s chest and pull.

This method can be uncomfortable or painful for casualties suffering arm, chest, neck or spinal injuries, so you must move them as gently as possible.

Two First Aiders carries:

The Pope´s throne:

Squat facing each other on either side of the casualty. Each first aider grasps his own left elbow with the right hand and then grasps the right elbow og the other with his left hand. 2. The casualty, conscious, but not able to walk, seats on the so crossed first aider´s arms passing his forearms around their necks

Two-man lift:

One person lifts the upper body under the arms, the other one lifts the legs.

Three or more First Aiders carries:
The clothing lift:
Lifting by means of a casualty´s clothing is suitable when there are several of you doing the lifting. You must first ascertain that the clothing is strong enough. 1. With the casualty lying on the ground, squat down on the same side. 2. The person nearest to the head slides one arm under the neck to support the head, whilst the other hand takes a firm grip of the clothing in the middle of the chest. Gather the clothing as tight as possible for the securest grip. 3. The person at the feet takes a firm grip with one hand on the clothing below the knees, and on the waistband or just below the waist with the other.