First Aid and Emergency Care

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First Aid and Emergency Care

• Prepared by
• Dr. Hanan Said Ali

2
Learning Objectives

• Give an overview about first aid of the following
  conditions
• Heart attack.
• Pulmonary embolus.
• Pulmonary oedema.
• Haemorrhage.
• Shock.
• Fractures.

3
Cardiac Emergency - Heart Attack

• Clinical Manifestations

• Clinical Manifestations

• Chest pain my have
• radiation of pain to
• back, jaw, or left arm.
• Palpitation.
• Dyspnea.
• Diaphoresis.
• Dizziness.

• Weakness.
• Elevated BP and HR. later, BP may drop.
• Nausea and vomiting
• cool and clammy skin
• (cold sweats).
• Fever.

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Cardiac Emergency - Heart Attack

• Rapid Assessment
• Is the patients airway patent?
• a. The airway is patent when speech is
  clear and no
• noise is associated with
  breathing.
• b. If the airway is not patent, consider
  cleaning the
• mouth and placing an airway.
• 2. Is the patient's breathing effective?
• a. Breathing effective.....the skin
  color normal,
• capillary refill is lt 2 second.
• b. If breathing is not effective,
  consider O2
• administration.

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Cardiac Emergency - Heart Attack

• Rapid Assessment Cont.
• Is the patients circulation effective?
• a. Circulation is effective when the
  radial pulse is
• present and the skin is warm and
  dry.
• b. If circulation is not effective,
  consider-
• Placing the patient in the recumbent position.
• Establish IV access.
• Giving a 2oo ml fluid bolus.

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Cardiac Emergency - Heart Attack

• Initial assessment and intervention
• Ask the patient to undress, remove all
  jewellery, put on gown.
• Get vital signs include pulse oximetry, or test
  capillary refill.
• a. Institute continuous heart monitoring,
  and non
• invasive blood pressure monitoring.
• b. Document the initial heart monitor
  strip and
• document changes of rhythm.

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Cardiac Emergency - Heart Attack

• Initial assessment and intervention Cont.
• 3. Place on oxygen at 4 litres by nasal cannula.
• 4. Assure the patient that he is safe.
• 5. Perform a focused physical examination
• a. Auscultate the lung.
• b. Listen to heart sound.
• c. Inspect for peripheral oedema.
• 6. Evaluate the level of consciousness to use as
  a baseline.

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Cardiac Emergency - Heart Attack

• Initial assessment and intervention Cont.
• 6. Establish intravenous access, hang normal
  saline and draw laboratory blood specimens.
• 7. Initiate any medications covered under nurse
  or paramedic initiated hospital protocol.
• 8. Initiate any diagnostic test e.g., ECG,
  laboratory studies,
• chest x- ray.
• 9. Instruct the patient not to eat or drink .

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Cardiac Emergency - Heart Attack

• Initial assessment and intervention Cont.
• 10. Elevate the side rails and place the
  stretcher in the
• lowest position.
• 11. Inform the patient, family, and caregivers of
  the usual
• plan of care .
• 12. Ask the patient to call for help before
  getting of the
• stretcher.

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Cardiac Emergency - Heart Attack

• Ongoing evaluation and intervention
• 10. Monitor vital signs an effective breathing.
• 11. Monitor therapy closely for the patient's
  therapeutic response ( effect within 20 30
  minutes).
• 12. Monitor closely for the development of
  adverse reaction to therapy.
• 13. Monitor the patient's laboratory and x-ray
  results and notify the physician.

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Respiratory Emergency Pulmonary Embolus

• Definition
• Is an embolus that causes obstruction of arterial
  pulmonary blood flow to the distal lung.
• Causes
• Trauma to the lower extremities or pelvis, long
  term fractures
• Immobility but is seen occasionally with obesity.
• Decreased peripheral circulation.
• Congestive heart failure MI.

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Respiratory Emergency Pulmonary Embolus

• How to assess pulmonary embolus
• It can be assessed through the signs and
  symptoms

signs and symptoms signs and symptoms
Shortness of breath Tachypnea Tachycardia Sudden- onset pleuritic chest pain increase with respirations. Cough, haemoptysis Diaphoresis, syncope, fever. If the embolus occludes a large vessel symptoms Anxiety, hypotension, and signs of right ventricular failure.
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Respiratory Emergency Pulmonary Embolus

• Diagnostic Test
• Arterial blood gas value and lung scan.
• Computed tomography angiography.
• Decreased O2 pressure and decreased pCO2.
• Chest radiography.
• ECG

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Respiratory Emergency Pulmonary Embolus

• Management
• O2 administration, from low- flow oxygen by
• nasal cannula to intubation.
• Analgesic IV if the pt. Extremely uncomfortable.
• IV fluids and vasopressors to maintain pressure.
• IV anticoagulants to prevent farther clot
• formation.
• Fibrinolytic therapy should be started
• immediately in the unstable pt.

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Respiratory Emergency Pulmonary Oedema

• Description
• Acute pulmonary oedema is a result of an acute
  event.
• Cardiogenic PE is caused by inadequate pumping of
  the left ventricle.
• Noncardiogenic PE or adult respiratory distress
  syndrome is a result of damage to the alveolar
  capillary membrane.

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Respiratory Emergency Pulmonary Oedema

• Assessment
• Assess signs and symptoms

Cardiovascular symptoms Respiratory symptoms
Lower extremity pitting oedema. Weight gain. Rapid, bounding pulse. Skin is cool, moist and may appear cyanotic. Blood pressure initially increases. Dyspnea, respiratory rate increases in an effort. Productive cough with frothy, white sputum. or a pink ting. Cyanosis Oxygen saturation decreases as hypoxia increased. Wheezing.
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Respiratory Emergency Pulmonary Oedema

• Diagnosis
• Chest x- ray.
• Management
• Administration of high- flow oxygen.
• Bronchodilators inhalation .
• Digoxin IV to increase contractility
• ( heart rate increased lead to decreased
  filling and contractility).
• Diuretic therapy

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Respiratory Emergency Pulmonary Oedema

• Management Cont.
• Nitroglycerin to increase venous distension and
  venous pooling, which decrease blood return to
  the heart.
• Urinary catheter to monitor urine output.
• IV morphine.

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Haemorrhage

• Definition
• It refers to a large amount of bleeding in a
  short time.
• Type of external bleeding
• A Arterial Bleeding
• B-Venous Bleeding
• C- Capillary Bleeding
• D- Melaena

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Haemorrhage

• Type of external bleeding Cont.
• E-Hematemesis F-Epistaxis G-Hemoptysis
  H-Rectal Bleeding
• I- Vaginal bleeding

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Haemorrhage

• Rapid ABC Assessment
• As Cardiac emergency .
• Initial Assessment and interventions
• Get vital signs and place on continuous heart and
  automatic blood pressure monitoring.
• Establish IV access with two large bore cannula.
• Draw a variety of tubes ( haematology, chemistry,
  coagulation study, PTT

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Haemorrhage

• Initial Assessment and interventions
• Assure the patient that he is safe.
• Perform a focused physical examination
• Auscultate the lungs.
• Assess for signs of anaemia by noting the color
  of the conjunctiva, nail beds and capillary
  refill in the palm of the hand.

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Haemorrhage

• Initial Assessment and interventions Cont.
• Evaluate the level of consciousness by AVPU-
• A. alert
• V. Responds to voice but not fully orient.
• P. Responds to pain.
• U. Unresponsive.
• For pt. With GIT bleeding
• Inspect the abdomen for injury and scars post
  surgery.
• Look for Cullens sign ( periumbilical bruising)
  and distention

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Haemorrhage

• Initial Assessment and interventions Cont.
• For pt. With GIT bleeding
• Auscultate abdominal bowel sounds, Percuss,
  palpate.
• For pt. With vaginal bleeding
• Inspect perineum for lacerations.
• Estimate vaginal blood flow.
• Consider placing drains e.g., nasogastric tube to
  reduce risk of vomiting., urinary catheter to
  monitor urinary output.
• Instruct the patient to be NPO.

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Haemorrhage

• Control of External bleeding
• For haemorrhage of the extremities.
• Elevate the extremities as high as possible above
  the heart level and compress the area.
• With elevation of the extremity maintained , a
  compression bandage will control the bleeding.

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Haemorrhage

• Control of Internal bleeding
• Venous access with two large bore ( 18 to 14)
  cannula or a central venous catheter.
• Continuous monitoring of the heart, blood
  pressure, pulse oximetry, and hourly urine
  output.
• Fluid resuscitation with isotonic IV solution
• ( normal saline), albumin, fresh plasma, in
  patients with coagulopathy, PRBC to maintain a
  hematocrit of 25 to 30.

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Haemorrhage

• Control of Internal bleeding Cont.
• Administer vitamin K 10 mg SC or IM for patient
  with coagulopathy.
• Administration of drug therapy specific to
  problem.
• Exploratory emergency surgery for uncontrolled or
  prolonged bleeding.
• For upper GIT bleeding gastric lavage with normal
  saline to remove blood clots beside endoscopy for
  diagnosis.

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Haemorrhage

• Penetrating wound of the abdomen
• Start with initial assessment and intervention.
• Testing of urine, stool, and gastric content for
  blood.
• CT for suspicion of solid organ lacerations.
• IVP for suspected disruption of the kidney,
  ureter, bladder, or urethra.
• Ultrasound visualizes the configuration of organs
  and hematoma.

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Haemorrhage

• Penetrating wound of the abdomen
• Start venous access with two large bore cannula
  IV fluids of normal saline and blood products.
• Give oxygen via mask.
• Insert an indwelling urinary catheter ( do not
  insert if injury is suspected to the urethra.
• Insert a nasogastric tube to reduce the risk of
  aspiration.
• .

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Haemorrhage

• Penetrating wound of the abdomen
• Perform dressing of wounds, and stabilization of
  impaled objects.
• Keep the patient NPO.
• Give prophylactic antibiotics.
• Prepare the patient for possible surgery and
  hospital admission or transfer.

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Shock

• Shock
• is a fatal condition that occurs when cells
  become hypoxic as a result of decreased
  perfusion.
• Causes of shock
• Hypovolaemic shock
• Massive external bleeding.
• Hemothorax, fractures, GIT bleeding, burn.
• Massive vomiting diarrhea.
• Excessive diuretic use.

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Shock

• Causes of shock Cont.
• 2. Cardiogenic shock
• MI, cardiomyopathy, dysrhythmias, heart valve d.
• 3. Distributive shock
• Sepsis, anaphylaxis, spinal cord injury,
  overdose.
• 4. Obstructive shock
• Pneumothorax, pericardial tamponade, aortic
  aneurysm, pulmonary embolus, valvular diseases

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Shock

• Clinical manifestations
• 1. Respiratory
• Elevation of respiratory rate, rhythm, and depth.
• Tachypnea, wheezes.
• breath sounds may be absent, unequal, or
  diminished.
• 2. Circulatory
• Weak thready pulses, drop in systolic pressure.
• Flattened jugular vein when the patient is
  supine.
• Cardiac dysrhythmias presence of S3 or S4
• Restlessness, anxiety, or confusion, unresponsive
  patient.

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Shock

• Clinical manifestations
• 3. Nonessential Organs
• Skin Cool skin, pallor, cyanosis and
  diaphoresis.
• Capillary refill take more
  than two second.
• Kidney Urine output is decreased.
• BUN and creatinine
  increased.
• GIT Hypoactive or absent bowel sounds.

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Shock

• Initial Stabilization and Management
• Goal
• Manage inadequate tissue perfusion.
• Supplemental oxygen at 100 should be provided.
• Endotracheal intubation and mechanical
  ventilation anticipated.
• Peripheral and central venous assess should
  maintained.

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Shock

• Administration of IV fluids and blood as
  appropriate .
• Warmed IV fluids are preferable to avoid
  hypothermia.
• Acid Base Balance
• Administration of sodium bicarbonate to correct
  metabolic acidosis documented by measurement of
  ABG.

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Shock

• Hemodynamic Monitoring
• Pulse oximetry and non-invasive blood pressure
  monitor.
• Central venous pressure (CVP) to measure
  circulating volume ( 4 to 10 cm H2O).
• Arterial pressure may be measured invasively
  using an arterial line . Normal
  between 70 and 90.
• (A pressure less than 70 indicates inadequate
  circulating volume)

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Fractures

• Definition
• A fracture consists of a break or crack in the
  bone.
• Signs and Symptoms
• Deformity.
• Pain.
• Tenderness.
• Swelling.
• Crepitus.
• Bony fragment protrusion
• Impaired neurovascular status and may be shock.

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Fractures

• Management
• 1. Expose the area
• Remove all clothing and jewellery near the
  suspected fracture.
• 2. Perform a physical assessment
• Inspect for color, position and obvious
  differences as compared to the uninjured side.
• Look for break in the skin.
• Assess for bleeding and deformity.
• Assess the extremity for pain, pallor, pulses,
  paresthesia,
• and paralysis

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Fractures

• Management Cont.
• 3. Immobilize
• Splint with the appropriate splint to immobilize
  the joints below and above the injury.
• 4. PRICE
• P....... Protect
• R....... Rest
• I......... Ice
• C........ Compress
• E......... Elevate

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Fractures

• Management Cont.
• Use heated blankets on the rest of the body to
  maintain normal body temperature.
• 5. Medications
• Administer analgesics.
• Open fractures are often treated with
  prophylactic intravenous antibiotics.
• 6. Diagnostic Testing
• X- ray

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Fractures

• Management Cont.
• 6. On- going monitors
• Frequently reassess the five Ps
• Pain.
• Pallor.
• Pulses.
• Paresthesia.
• Paralysis

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Fractures

• Management Cont.
• 7. Anticipate
• Anticipate definitive stabilization, cast,
  traction, internal or external, fixation, and
  hospitalization for closed or open reduction.

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• Thank You