basic first aid

Basic First AidBasic First Aid

Northwest Fire DistrictNorthwest Fire District

Feb 2010

Discussion ObjectivesDiscussion Objectives

Basic Airway Management and CPRBasic Airway Management and CPR How to use OHow to use O22

Chest Pain ManagementChest Pain Management Choking ManagementChoking Management Shock ManagementShock Management Eye InjuriesEye Injuries Impales ObjectsImpales Objects

Objectives Cont…Objectives Cont…

Bleeding ControlBleeding Control Burn ManagementBurn Management Heat Related EmergenciesHeat Related Emergencies Cold Related EmergenciesCold Related Emergencies CO PoisoningCO Poisoning

Basic Airway Management Basic Airway Management and CPRand CPR

Basic airway anatomyBasic airway anatomy Upper airwayUpper airway

Tongue Tongue OropharynxOropharynx NasopharynxNasopharynx LaryngopharynxLaryngopharynx NaresNares MouthMouth EpiglottisEpiglottis Larynx Larynx


Lower airway anatomyLower airway anatomy Vocal CordsVocal Cords TracheaTrachea Lungs Lungs BronchiBronchi BronchiolesBronchioles AlveoliAlveoli Diaphragm Diaphragm


Level of Level of consciousness consciousness (LOC) and ABCD’s(LOC) and ABCD’s Are they conscious Are they conscious

and maintaining and maintaining their own airway?their own airway?

Yes – support ABC’sYes – support ABC’s No – perform jaw No – perform jaw

thrust for trauma thrust for trauma victim or head tilt victim or head tilt chin lift for non chin lift for non trauma victimtrauma victim


Common causes of Common causes of airway obstructionairway obstruction

Tongue (due to Tongue (due to unconsciousness)unconsciousness)

Soft tissue swellingSoft tissue swelling Blood or vomitBlood or vomit Direct injuryDirect injury Teeth Teeth


Common sounds of an obstructed Common sounds of an obstructed airway include:airway include: Snoring – Due to obstruction of the upper Snoring – Due to obstruction of the upper

airway by the tongueairway by the tongue Gurgling – Due to obstruction of the upper Gurgling – Due to obstruction of the upper

airway by liquidsairway by liquids Wheezing – Narrowing of the lower airwaysWheezing – Narrowing of the lower airways Silent – Complete airway obstructionSilent – Complete airway obstruction


Are they breathing? Are they breathing? Look, listen, and Look, listen, and feel!feel!

Yes – Is it adequate?Yes – Is it adequate? Use a non-Use a non-

rebreather at 15 rebreather at 15 LPM O2LPM O2

No to either No to either question – Assist question – Assist

Use a BVM at 15 Use a BVM at 15 LPM O2LPM O2

Provide 2 rescue Provide 2 rescue breaths before breaths before checking pulsechecking pulse

Basic Airway Basic Airway Management and CPRManagement and CPR

Is there a pulse?Is there a pulse? Yes – Continue to Yes – Continue to

support respirations support respirations and reassess for pulse and reassess for pulse every 2 minutesevery 2 minutes

No – Perform 30 chest No – Perform 30 chest compressions after compressions after every 2 breaths every 2 breaths


Attach AED as soon at it Attach AED as soon at it arrives at the scene (after one arrives at the scene (after one round of CPR – Child under round of CPR – Child under age 8 or 55 lbs)age 8 or 55 lbs)

Follow AED commandsFollow AED commands After delivery of shock (if After delivery of shock (if

indicated) immediately indicated) immediately resume CPRresume CPR

Do NOT check for a pulse Do NOT check for a pulse until after 2 minutes of CPRuntil after 2 minutes of CPR

Only 1 shock will be deliverdOnly 1 shock will be deliverd Minimize interruptions in CPRMinimize interruptions in CPR


Insert airway Insert airway adjunct (oral adjunct (oral airway) if no gag airway) if no gag reflex is presentreflex is present

Measure from Measure from corner of mouth to corner of mouth to tip of eartip of ear

Insert upside down Insert upside down until it stopsuntil it stops

Rotate 180 degrees Rotate 180 degrees and continue to and continue to insert until the insert until the adjunct rests against adjunct rests against the teeththe teeth


Cricoid pressure (Sellick’s Cricoid pressure (Sellick’s Maneuver)Maneuver) Gentle pressureGentle pressure Releasing pressure could Releasing pressure could

precipitate vomitingprecipitate vomiting Reduces gastric inflation by Reduces gastric inflation by

closing the esophagus and closing the esophagus and bringing the trachea in-linebringing the trachea in-line

BURP method (Backward BURP method (Backward Upward Rightward Upward Rightward Pressure)Pressure) Similar to criciod pressureSimilar to criciod pressure


Single rescuer adult and child CPR ages Single rescuer adult and child CPR ages 1 and up get 30:2 compression to 1 and up get 30:2 compression to ventilation ratioventilation ratio

Two rescuer CPR age under 8 gets 15:2 Two rescuer CPR age under 8 gets 15:2 compression to ventilation ratiocompression to ventilation ratio

Child breaths every 2-3 secondsChild breaths every 2-3 seconds Adult breaths every 4-5 secondsAdult breaths every 4-5 seconds Compression rate of 100 per minute Compression rate of 100 per minute

Bee Gees “Stayin’ Alive”Bee Gees “Stayin’ Alive” Queen “Another One Bites the Dust”Queen “Another One Bites the Dust”

How to Use O2How to Use O2

Open tankOpen tank Select O2 delivery deviceSelect O2 delivery device Set flow rate to 15 LPMSet flow rate to 15 LPM Connect tubing to the tankConnect tubing to the tank Fill oxygen reservoirFill oxygen reservoir

Chest Pain ManagementChest Pain Management

REST!!!!REST!!!! Apply O2 via non-Apply O2 via non-

rebreatherrebreather Request EMSRequest EMS Prepare an AED in case Prepare an AED in case

of sudden cardiac arrestof sudden cardiac arrest Dispatcher may request Dispatcher may request

you to administer 324 mg you to administer 324 mg of Aspirin if the patient of Aspirin if the patient has no allergieshas no allergies

Chest Pain ManagementChest Pain Management

Signs and symptoms of a heart Signs and symptoms of a heart attack (Myocardial Infarct)attack (Myocardial Infarct) Chest discomfort, pressure, squeezing, Chest discomfort, pressure, squeezing,

fullness or painfullness or pain Discomfort in other areas of the upper Discomfort in other areas of the upper

body such as pain or discomfort in one or body such as pain or discomfort in one or both arms, the back, neck, jaw or stomachboth arms, the back, neck, jaw or stomach

Shortness of breath may occur with or Shortness of breath may occur with or without chest discomfortwithout chest discomfort

Other signs may include breaking out in a Other signs may include breaking out in a cold sweat, nausea or lightheadedness cold sweat, nausea or lightheadedness

Choking ManagementChoking Management

Heimlich maneuver until person becomes Heimlich maneuver until person becomes unresponsive or limpunresponsive or limp

Place supine on hard surfacePlace supine on hard surface Look in mouth for obstructionLook in mouth for obstruction Blind Blind finger sweep for adults onlyfinger sweep for adults only Remove object if it can be seenRemove object if it can be seen Give rescue breathGive rescue breath

If it does not go in reposition head and try If it does not go in reposition head and try againagain If it does not go in continue on to next stepIf it does not go in continue on to next step

Choking ManagementChoking Management While still supine on hard surface, give While still supine on hard surface, give

5 abdominal thrusts adult/child5 abdominal thrusts adult/child Infant use 5 back blows and 5 chest Infant use 5 back blows and 5 chest

thrusts alternatelythrusts alternately Pregnant or Pregnant or obese – Use chest thrusts obese – Use chest thrusts

instead of Heimlich / abdominal thrustsinstead of Heimlich / abdominal thrusts Repeat steps until rescue breaths make Repeat steps until rescue breaths make

chest risechest rise Once chest rise is achieved, check Once chest rise is achieved, check

pulsepulse If pulse present – Rescue breathing onlyIf pulse present – Rescue breathing only If absent – CPRIf absent – CPR

Shock ManagementShock Management

Signs of shockSigns of shock Fast, weak pulse (rate 110 per minute or greater)Fast, weak pulse (rate 110 per minute or greater) Low blood pressure (hypotension); systolic less Low blood pressure (hypotension); systolic less

than 90 mmHg.than 90 mmHg. PalePale SweatySweaty Fast breathing (respirations 30 per minute or Fast breathing (respirations 30 per minute or

greater)greater) Anxiety, confusion, or unconsciousness Anxiety, confusion, or unconsciousness

(diminished mental state) (diminished mental state)

Shock ManagementShock Management Elevate legsElevate legs Keep warmKeep warm!!!!!!

Eye InjuriesEye Injuries

Substance in eyeSubstance in eye Irrigate with sterile saline solution or sterile waterIrrigate with sterile saline solution or sterile water

Blunt injuriesBlunt injuries Cover both eyesCover both eyes

Impaled ObjectsImpaled Objects Do not remove Do not remove

object unless it object unless it interferes with CPR interferes with CPR or airwayor airway

Stabilize in place Stabilize in place with large bulky with large bulky dressingsdressings

Bleeding ControlBleeding Control Types of bleedingTypes of bleeding

Arterial bleedingArterial bleeding Bright red in colorBright red in color Difficult to controlDifficult to control Profuse and spurting due to high pressure from the heart Profuse and spurting due to high pressure from the heart

as it contractsas it contracts Venous bleedingVenous bleeding

dark red/maroon in color dark red/maroon in color Usually easy to control because the veins are under low Usually easy to control because the veins are under low

pressurepressure Venous bleeding in the neck can suck in air an air Venous bleeding in the neck can suck in air an air

embolismembolism

Bleeding ControlBleeding Control

Types of bleedingTypes of bleeding Capillary bleedingCapillary bleeding

Slow and oozing due to their small size and low Slow and oozing due to their small size and low pressurepressure

Easy to control in most cases. Easy to control in most cases.

Bleeding ControlBleeding Control Elevate extremityElevate extremity Add gauze and apply Add gauze and apply

pressure dressingpressure dressing Use tourniquet as last Use tourniquet as last

resortresort Once applied do not Once applied do not

removeremove Extremity will most likely Extremity will most likely

need to be amputated due need to be amputated due to complete stoppage of to complete stoppage of blood flowblood flow

Burn ManagementBurn Management

Thermal BurnsThermal Burns - Burns are the third leading - Burns are the third leading cause of accidental deathcause of accidental death in the United States in the United States Superficial burns (first degree)Superficial burns (first degree)

Involve only the epidermal layer of skinInvolve only the epidermal layer of skin They are painful, dry, red, and blanch with pressureThey are painful, dry, red, and blanch with pressure Such Such injuries generally heal in three to six days without injuries generally heal in three to six days without

scarringscarring


Thermal BurnsThermal Burns Partial-thickness Partial-thickness

(second degree)(second degree) Involve the epidermis Involve the epidermis

and portions of the and portions of the dermisdermis

Painful, red, weeping, Painful, red, weeping, usually form blisters, usually form blisters, and blanch with and blanch with pressurepressure

Scarring is possibleScarring is possible

Burn ManagementBurn Management Thermal BurnsThermal Burns

Full-thickness burns (third Full-thickness burns (third degree) degree)

Extend through and destroy the Extend through and destroy the dermisdermis

Usually painlessUsually painless Skin appearance varies from Skin appearance varies from

waxy white to leathery gray, to waxy white to leathery gray, to charred and blackcharred and black

The skin is dry and inelastic, and The skin is dry and inelastic, and does not blanch with pressuredoes not blanch with pressure

Scarring is severe with Scarring is severe with contractures; spontaneous contractures; spontaneous healing is not possible. healing is not possible.


Thermal BurnsThermal Burns Fourth degree burns Fourth degree burns

Life-threatening injuries that extend through the skin Life-threatening injuries that extend through the skin into underlying tissues, such as fascia, muscle, or boneinto underlying tissues, such as fascia, muscle, or bone


Thermal BurnsThermal Burns ManagementManagement

Remove from danger and stop the burning process Remove from danger and stop the burning process Apply sterile burn sheet, or dry sterile gauze if no burn Apply sterile burn sheet, or dry sterile gauze if no burn

sheet available sheet available Consider inhalation and airway burnsConsider inhalation and airway burns

Apply high flow O2 if indicatedApply high flow O2 if indicated

Burn ManagementBurn Management Chemical BurnsChemical Burns

Brush off excess chemicalBrush off excess chemical Irrigate with sterile water (if chemical does not react with water) until Irrigate with sterile water (if chemical does not react with water) until

burning process is stoppedburning process is stopped Cover with sterile burn sheetCover with sterile burn sheet If chemical reacts with water call HAZ-MAT team, obtain MSDS, orIf chemical reacts with water call HAZ-MAT team, obtain MSDS, or call call

poison controlpoison control PotassiumPotassium SodiumSodium

Burn ManagementBurn Management Electrical Burns Electrical Burns

(mostly internal (mostly internal injuries)injuries) Stop the burning processStop the burning process Neutralize the heat sourceNeutralize the heat source Remove smoldering Remove smoldering

clothingclothing Prepare AED and Prepare AED and

anticipate cardiac arrestanticipate cardiac arrest Apply sterile burn sheet to Apply sterile burn sheet to

burnsburns

Heat Related Heat Related EmergenciesEmergencies

Heat CrampsHeat Cramps Painful, brief muscle cramps that occur during Painful, brief muscle cramps that occur during

exercise or work in a hot environmentexercise or work in a hot environment Remove from environment and hydrateRemove from environment and hydrate


Heat ExhaustionHeat Exhaustion Often pale with cool, moist skin, sweating profusely, Often pale with cool, moist skin, sweating profusely,

muscle cramps or pains, feels faint or dizzy may muscle cramps or pains, feels faint or dizzy may complain of headache, weakness, thirst, and nausea. complain of headache, weakness, thirst, and nausea.

Core (rectal) temperature elevated (usually more than Core (rectal) temperature elevated (usually more than 100F) and the pulse rate is increased100F) and the pulse rate is increased

Rest in a cool, shaded areaRest in a cool, shaded area Give cool fluids such as water or sports drinks Give cool fluids such as water or sports drinks Loosen or remove clothingLoosen or remove clothing Apply cool water to skinApply cool water to skin Do not use an alcohol rubDo not use an alcohol rub


Heat StrokeHeat Stroke Unconscious or markedly abnormal mental Unconscious or markedly abnormal mental

status (dizziness, confusion, hallucinations, or status (dizziness, confusion, hallucinations, or coma) coma)

Flushed, hot, and dry skin Flushed, hot, and dry skin Rectal (core) temperature of 105F or moreRectal (core) temperature of 105F or more Call EMS immediatelyCall EMS immediately Move the person to a cooler environment, or Move the person to a cooler environment, or

place him or her in a cool bath of water, or place him or her in a cool bath of water, or moisten the skin with lukewarm water and use a moisten the skin with lukewarm water and use a fan to blow cool air across the skinfan to blow cool air across the skin

Give cool beverages by mouth only if the person Give cool beverages by mouth only if the person has a normal mental state has a normal mental state and can tolerate itand can tolerate it

Cold Related Cold Related EmergenciesEmergencies

Frostbite – occurs when tissues freezeFrostbite – occurs when tissues freeze Superficial frostbiteSuperficial frostbite

May experience burning, numbness, tingling, itching, or cold May experience burning, numbness, tingling, itching, or cold sensations in the affected areassensations in the affected areas

Deep frostbiteDeep frostbite Swelling and blood-filled blisters are noted over white or Swelling and blood-filled blisters are noted over white or

yellowish skin that looks waxy and turns a purplish blue as it yellowish skin that looks waxy and turns a purplish blue as it re-warms and may even appear blackened and deadre-warms and may even appear blackened and dead

Keep the affected part elevated in order to reduce swellingKeep the affected part elevated in order to reduce swelling Move to a warm area to prevent further heat lossMove to a warm area to prevent further heat loss Remove all constrictive jewelry and clothes because they may further Remove all constrictive jewelry and clothes because they may further

block blood flowblock blood flow Give the person warm fluids to drinkGive the person warm fluids to drink


Deep frostbiteDeep frostbite Apply a dry, sterile bandage, placing Apply a dry, sterile bandage, placing

cotton between any involved fingers cotton between any involved fingers or toes (to prevent rubbing), and or toes (to prevent rubbing), and take the person to a medical facility take the person to a medical facility as soon as possibleas soon as possible

Never re-warm an affected area if Never re-warm an affected area if there is any chance it may freeze there is any chance it may freeze againagain

Do not rub the frozen area, friction Do not rub the frozen area, friction created by this technique will only created by this technique will only cause further tissue damagecause further tissue damage


Hypothermia – Core body temperature of less than 95FHypothermia – Core body temperature of less than 95F Below 95FBelow 95F

Shivering is seen, pulse, breathing rate, and blood pressure all Shivering is seen, pulse, breathing rate, and blood pressure all decrease, may experience some clumsiness, apathy, confusion, and decrease, may experience some clumsiness, apathy, confusion, and slurred speechslurred speech

Below 89.9F Below 89.9F Shivering stops, victim may be in a stupor, heart rhythm may become Shivering stops, victim may be in a stupor, heart rhythm may become

irregularirregular Below 82.4F Below 82.4F

Reflexes are lost and cardiac output continues to fall, risk of Reflexes are lost and cardiac output continues to fall, risk of dangerously irregular heart rhythms increases, and brain activity is dangerously irregular heart rhythms increases, and brain activity is seriously slowed, pupils are dilated, and the victimseriously slowed, pupils are dilated, and the victim appears comatose appears comatose or deador dead

Cold Related Cold Related EmergenciesEmergencies Hypothermia treatmentHypothermia treatment

Check ABC’sCheck ABC’s Because the victim’s heartbeat may be very weak and Because the victim’s heartbeat may be very weak and

slow, the pulse check should ideally be slow, the pulse check should ideally be continued for at least 1 minute before beginning CPRcontinued for at least 1 minute before beginning CPR

Rough handling of these victims may cause deadly Rough handling of these victims may cause deadly heart rhythms heart rhythms

Remove all wet clothes and move the person insideRemove all wet clothes and move the person inside The victim should be given warm fluids if he or she is able to The victim should be given warm fluids if he or she is able to

drinkdrink Cover the person’s body with blankets and aluminum-coated Cover the person’s body with blankets and aluminum-coated

foils, and place the victim in a sleeping bagfoils, and place the victim in a sleeping bag Avoid actively heating the victim with outside sources of Avoid actively heating the victim with outside sources of

heat such as radiators or hot water bathsheat such as radiators or hot water baths Strenuous muscle exertion should be avoidedStrenuous muscle exertion should be avoided

CO PoisoningCO Poisoning

Carbon monoxide (sometimes referred to as Carbon monoxide (sometimes referred to as CO) is a colorless, odorless gas produced by CO) is a colorless, odorless gas produced by burning material containing carbonburning material containing carbon Carbon monoxide binds to hemoglobin several Carbon monoxide binds to hemoglobin several

hundred times more strongly than oxygenhundred times more strongly than oxygen Carbon monoxide is the leading cause of Carbon monoxide is the leading cause of

accidental poisoning deaths in America accidental poisoning deaths in America Concentrations as little as 0.04% (400 parts per Concentrations as little as 0.04% (400 parts per

million) carbon monoxide in the air can be fatal million) carbon monoxide in the air can be fatal

CO PoisoningCO Poisoning Signs and symptoms of CO poisoningSigns and symptoms of CO poisoning

HeadacheHeadache HallucinationsHallucinations DizzinessDizziness Nausea or vomitingNausea or vomiting Flu-like symptomsFlu-like symptoms Chest painChest pain Shortness of breath on exertionShortness of breath on exertion SeizureSeizure Flushed skinFlushed skin Altered mentationAltered mentation

CO PoisoningCO Poisoning

TreatmentTreatment Move all family members and pets to fresh air Move all family members and pets to fresh air

away from the source of carbon monoxide (CO)away from the source of carbon monoxide (CO) Apply high flow O2Apply high flow O2 Treatment in hyperbaric chamber may be Treatment in hyperbaric chamber may be

necessarynecessary Monitor for cardiac arrestMonitor for cardiac arrest

CO PoisoningCO Poisoning Effects of CO related to PPMEffects of CO related to PPM

35 ppm (0.0035%) Headache and dizziness within six to eight 35 ppm (0.0035%) Headache and dizziness within six to eight hours of constant exposurehours of constant exposure

100 ppm (0.01%) Slight headache in two to three hours100 ppm (0.01%) Slight headache in two to three hours 200 ppm (0.02%) Slight headache within two to three hours200 ppm (0.02%) Slight headache within two to three hours 400 ppm (0.04%) Frontal headache within one to two hours400 ppm (0.04%) Frontal headache within one to two hours 800 ppm (0.08%) Dizziness, nausea, and convulsions within 45 800 ppm (0.08%) Dizziness, nausea, and convulsions within 45

minutes, Insensible within two hoursminutes, Insensible within two hours 1,600 ppm (0.16%) Headache, dizziness, and nausea within 20 1,600 ppm (0.16%) Headache, dizziness, and nausea within 20

minutes, death in less than two hoursminutes, death in less than two hours 3,200 ppm (0.32%) Headache, dizziness and nausea in five to ten 3,200 ppm (0.32%) Headache, dizziness and nausea in five to ten

minutes, death within 30 minutesminutes, death within 30 minutes 6,400 ppm (0.64%) Headache and dizziness in one to two 6,400 ppm (0.64%) Headache and dizziness in one to two

minutes, death in less than 20 minutes.1minutes, death in less than 20 minutes.1 12,800 ppm (1.28%) Unconsciousness after 2-3 breaths, death in 12,800 ppm (1.28%) Unconsciousness after 2-3 breaths, death in

less than three minutes.less than three minutes.

Questions??????Questions??????

basic first aid

Documents

basic airway management

airway adjunct oral

cpror airway

obstructed airway

minutes of cpr

chest pain management

absent cpr

chest pain management