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CHAPTER-4
FIRST AID & EMERGENCY MANAGEMENT
FIRST AID
1. Introduction First aid means first help. First aid consists of essential emergency
treatment of sick or injured person before sending to a medical officer or hospital for further
necessary action.
2. Definition First aid is the first help which is provided to victim or casualty at
the place of occurrence before attending by the medical officer.
2 a. To save life.
3 b. To relieve pain.
4 c. To prevent injuries from becoming worse by treatment on the spot.
DROWNING
1. Definition: Immersion of the body under the surface of water causing
infiltration of water into the respiratory tract, digestive system and the other spaces of the
body is called drowning.
2. Types:
a. Sea water drowning.
b. Plain water drowning.
b. Plain water drowning Plain water drowning causes circulatory over load and
haemolysis (destruction of RBC).
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5. Management of drowning
HAEMORRHAGE
1. Definition The escape of blood from the blood vessels due to injury, trauma or
any other physiological causes is called haemorrhage.
OR
Extravasation of blood from the circulatory system is known as haemorrhage.
2. Types of haemorrhage:
10
11 a. According to the source:
d. According to duration:
e. According to severity:
4. Venous haemorrhage Escape of blood from the vein. Blood is dark red in
colour and flow is steady.
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a. Acute haemorrhage
(1) Patient pallor or anaemic.
(2) Tachycardia.
(3) Restlessness.
(4) Air hunger.
(5) Skin cold & clammy.
(6) BP-low.
(7) Thirsty.
(8) Temp-subnormal.
b. Chronic haemorrhage:
(1) If the bleeding is not stopped by first aid measure then followings are to
be carried out:
(a) Hot fomentation (1300F-1500F)
(b) Ligation of blood vessels.
(c) Twisting and crushing of vessels by forceps.
(d) Electrocautery by diathermy & biopolar
(e) Repair of wound by suture (with catgut & silk)
(1) Restoration of blood volume by I/V fluid or blood transfusion.
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SHOCK
1. Definition: Shock is defined as a profound haemodynamic and metabolic
disturabance characterised by failure of the circulatory system to maintain adequate perfusion
of the vital organs.
OR
Failure of haemodynamic system is known as shock.
a. Hypovolumic shock.
b. Normovolumic shock.
(1) Haemorrhage.
(2) Loss of fluid and electrolytes (Diarrhoea).
(3) Loss of plasma (Due to burn).
(4) Severe vomiting.
(5) Profuse sweating.
(6) Prolonged fasting.
(7) Severe diabetes.
a. Cardiogenic shock.
b. Neurogenic shock.
c. Septicaemic/Toximic shock.
d. Vaso-vagal shock.
e. Anaphylactic shock.
f. Emotional shock.
g. Electric shock.
6. According to trauma:
a. Traumatic shock.
b. Non-traumatic shock.
7. According to severity:
a. Mild shock.
b. Severe shock.
c. Irreversible shock.
FRACTURE
1. Definition Breach or break in the continuity of bone partial or completely due
to direct or indirect violence, muscular action or pathological cause is called fracture.
2. Causes of fracture
a. Direct violence.
b. Indirect violence.
c. Muscular action.
d. Fatigue or stress.
e. Pathological cause.
a. Complete fracture.
b. Incomplete fracture.
c. Pathological fracture.
5. Complete fracture
a. Comminuted fracture.
b. Impacted fracture.
c. Complicated fracture.
d. Crushed fracture.
e. Depressed fracture.
6. Incompleted fracture
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a. Greenstick fracture.
b. Fissured or crack fracture.
a. Transverse fracture.
b. Oblique fracture.
c. Short oblique fracture.
d. Spiral fracture.
e. Fissured fracture.
a. Head.
b. Ends.
c. Condyles.
d. Base.
e. Shaft.
f. Trochanter etc.
10. Sign & symptom of fracture
a. Severe pain.
b. Swelling.
c. Loss of function.
d. Deformity.
e. Tenderness.
f. Crepitation (cracking sound).
g. Irregular surface.
h. Shortening of the limb.
i. Bleeding (May or not).
j. Inability to move.
k. Unusual position.
11. First aid treatment of fracture
BANDAGE
1. Definition Bandage is a piece of cloth, calico, cotton, flannel, etc of various sizes
and shapes which is applied to some part of the body to retain a dressing or a splint to
support, compress, immobilize prevent or correct deformity.
a. Triangular bandage.
b. Roller bandage.
c. Special types of bandage.
4. Roller bandage These are made from various materials such as:- Cotton, Calico,
Woven, Flannel, Muslin, and elastic wearing roller bandages are following types.
a. 1"-6"
b. Crep bandage (Elastic weaving)
c. POP (Plaster of Paris) Muslin.
5. Special types of bandages: There are four types of special bandages. These are
as under.
a. T- Shaped bandage.
b. Four tailed bandage.
c. Many tailed bandage.
d. Suspensor bandage.
2. Manual artificial respiration method Apply by man such as mouth to mouth artificial
respiration, mouth to nose artificial respiration.
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a. Myocardial infarction.
b. Hypoxia.
c. Acid base upset.
d. Electrolytes imbalance.
e. Drug.
f. Hypothermia.
g. Haemorrhage.
h. Electrocution.
i. Drowning.
j. Shock (Drug reaction).
k. Embolism.
3. Procedure of CPR
a. Place the patient on hard bed or floor in supine position with neck extended.
b. Primary breathing and circulation- check & clear.
c. Put on airway.
d. One first aider will take place on right side of the patient who will give
artificial respiration by Ambu bag or mouth to mouth.
e. Another first aider will sit in kneeling position on Lt side of the victim and put
his Lt palm on the sternum just above the xiphoid and right hand over the Lt hand.
f. Cardiac massage will be given with a pressure to depress the chest at least 1½''
–2''. At a time 15 massages to be given.
g. Soon after completion of cardiac massage one inspiration of artificial
respiration will be given by ambu bag (if ambu available).
h. If Ambu bag is not available mouth to mouth artificial respiration to be given
by the following method- keep right hand on the patient's chin to open the mouth and
Lt hand on the nose. Nose should be closed during artificial respiration and blowed by
mouth in the patient mouth to expand his chest. On completion close the mouth and
open the nose.
i. Ratio of cardiac massage and artificial respiration will be 15:2.
j. This process will continue till regain the normal function of heart and lungs or
declared death by the Medical Officer.
PULSE FOUND
Give 1 breath every 5-6 seconds until NO PULSE
breathing resumes Landmark and begin chest compressions
(DO NOT GO TO STEPS 5 AND 6) (GO TO STEPS 5 AND 6
Landmark for
hand position.
Run fingers up lower edge of rib cage to
notch where ribs meet breast bone.
Place middle finger on
notch, index finger next to it.
Put heel of other hand next
to fingers. Place hand you
located notch with on top or
interlace fingers. Keep
fingers up off chest.
Chest compressions.
Place shoulders and weight directly over hands, keeping elbows
movements, compress chest cavity 1½-2 inches at a rate of 80-100
15 2
compressions breaths
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HEAT STROKE
1. Definition Heat stroke is a condition developed on man due to exposure to heat
in which the body temperature may be dangerously elevated. It is followed by dry skin
vertigo, headache thirst, nausea and muscular cramp.
or
Heat stoke is hyperpyrexia due to inhibition of heat regulating mechanism in conditions of
high temperature or high humidity or because of sweating interfered with.
HEAT EXHAUSTION
j. Faint.
k. Unconsciousness.
l. Thirsty and severe dehydration.
m. Restlessness.
a. Place the victim in supine position with shoulder and legs side raised which are
supported by pillows or roll of blanket.
b. This process will relax body muscles and prevent to come out of abdominal
contents.
c. If abdominal contents come out that should not push back or replace. Injured
area to bed covere with large dressing or clean bed sheet
d. Inj- Morphine/Pethidine to be given to prevent pain, shock.
e. Nothing by mouth.
f. I.V line to be established.
g. Crowding or gathering to be avoided.
h. Inj- TT. 0.5 ml to be given IM state.
i. Re-assurance for his life (if conscious).
j. Evacuate the casualty to hospital.
k. Inform surgical spl and also Anesthesiologist immediately.
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HYPERPYREXIA
1. Definition: High temp or temp above 105 0 F of the human body is called
hyperpyrexia.
SNAKE BITE
1. Management of snake bite
1. Definition Chemical burn of eye causes due to contact with chemicals in the
form of solid, Liquid, Powder or dust in home, industry or Lab.
a. Acid burn:
(1) Wash the injured eye by normal saline or distilled water which is available.
(2) Then send the patient to Medical Officer for further management.
b. Alkali burn:
(1) Wash the affected eye by normal saline or distilled water to neutralize
the alkali.
(2) If particle left behind, remove by swab sticks.
(3) Necrotic tissues of conjunctiva should be removed and
(4) Atropine/ steroid/ antibiotic drop should be given as directed.
2. Types of stretcher: There are four types of stretcher, these are as follows.
3. Uses:
1. There are several ways of handling a casualty in the confined spaces of a ship.
The two main methods are manual and by stretcher. Both methods of transport require
practice if they are to be carried out correctly without discomfort and anxiety to the injured
man and with the least amount of exertion on the part of the bearers
a. Fireman’s lift.
b. Pick-a-back.
c. Human crutch.
d. Fore and aft carry.
e. Two-handed seat.
f. Three-handed seat.
g. Four-handed seat.
h. Ordinary manhandling.
i. Manhandling down a gangway.
j. Drag carry.
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With the exception of sharks and barracuda, most marine animals will not deliberately
attack. The most frequent injuries from marine animals are wounds by biting, stinging, or
puncturing. Wounds inflicted by marine animals can be very painful, but are rarely fatal.
a. Sharks, Barracuda, and Alligators. Wounds from these marine animals can involve
major trauma as a result of bites and lacerations. Bites from large marine animals are
potentially the most life threatening of all injuries from marine animals. Major wounds from
these animals can be treated by controlling the bleeding, preventing shock, giving basic life
support, splinting the injury, and by securing prompt medical aid.
b. Turtles, Moray Eels, and Corals. These animals normally inflict minor wounds. Treat by
cleansing the wound(s) thoroughly and by splinting if necessary.
TRIAGE
Definition: It is a system of evaluation and classification of casualty for the purposes of
treatment and evacuation.
Or
Triage: A system where by a group of causalities or other patients are sorted according to the
seriousness of their injuries or illness so that treatment priorities can be allocated between
them.
In emergency situation it is designed to maximize the number of survivors.
Triage consists of:
a. The immediate sorting of casualty according to their types, seriousness and
likelihood (M¤h pñha) of survival.
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Group-3: Category includes casualty who may require self aid or from a comrade
(comrade=pqLjÑ£,p¡b£,A¿¹l‰ pwN£) Patients in this category are not evacuated
to a medical treatment facility.
Priorities of evacuation:
Evacuation means conveying the casualty after first aid to the nearest medical treatment
center using the safest, quickest and the most comfortable means available.
.
Priority-I: Urgent evacuation is required as soon as possible but not later than 2hrs so
save life. This category includes treatable casualty where condition can not be considered.
Priority-II: Evacuation is required within 4 hrs or the casualty medical condition could
worsen.
Priority-III: Evacuation within 24 hrs casualty require additional care but evacuation is not
immediate critical.
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