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BASIC FIRST AID PRACTICES

BY
MAJ EA ONUOSA FSS, MPH, BSC (EDU) RNM
Ag CI AN/NAT/OATT / CLS/COMBAT MEDIC

PRESENTED TO

YOUNG OFFICERS’ COURSE 35/20

NIGERIAN ARMY SCHOOL OF MEDICAL SCIENCES OJO-LAGOS

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INTRODUCTION

First aid is a science and an art. It is a science in that certain

knowledge is needed to perform different duties. First aid is an art
because acquiring this knowledge is not all that one needs, so
personal experience must be built up by practice. First aid is an
immediate or temporary treatment carried out in cases of emergency,
sudden illness or accident prior to the arrival of the doctor or
transportation of the victim to the hospital. It is generally performed
by anyone with basic first aid training. There are many situations
which require first aid, and many countries have legislations,
regulations, or guidelines which specifies a maximum level of first aid
provision in certain circumstances. This can include training or
equipment available in the workplace (such as an automated external
defibrillator), the provision of specialist first aid cover at public
gatherings or mandatory first aid training within schools. First aid
however, does not necessarily require any particular equipment or
prior knowledge, and can involve improvisation with materials
available at any time often by untrained people.
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INTRODUCTION CONT’D

The primary goal of first aid is to prevent death or serious injury from
worsening. The key aims can be summarized with the acronym
“PAPP” which means to preserve life, alleviate suffering, prevent
further harm and to promote recovery. In peace time when life is
going on a more or less planned path, it becomes a matter of interest
for both civilian and military personnel to achieve such knowledge;
however in time of war it becomes imperative. The speed at which
the patient is placed under medical care is of great importance to
recovery and may be the means of saving life. The purpose of this
presentation is to make sure the participants of YOC 35/20 (Med)
understand the objectives of first aid which are to save life and to
prevent illness and injury from deteriorating. Others include to
alleviate pains as fast as possible, to prevent and arrest bleeding and
to prevent mortality. And also this is to acquaint them with different
practices of first aid.

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AIM

The aim is of this paper to enhance the participants’ of

YOC (Med) 35/20 knowledge in administering first aid in
emergency situations.

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SCOPE
The scope of the lecture will cover the following:
a. General rules of first aid.
b. Qualities of a good first aider.
c. Wounds.
d. Burns
e. Scalds
f. Unconsciousness.
g. Haemorrhage.
h. Asphyxia
i. Fractures.
j. Splinting.
k. Syncope
l. Bites and Stings
m. Shocks.
n. Poisons

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GENERAL RULES OF FIRST AID
a. Safety first.
b. Remove the patient from danger or from further injury.
c. Treat the most urgent condition first and in order of precedence,
these conditions are:
(1) Apparent cessation of breathing.
(2) Severe haemorrhage.
(3) Shock.
(4) Unconscious patient should be placed in the prone
position or lying on the side, if this is difficult because of the condition,
lie the casualty in recumbent position with the head turned to the side.
(5) Unconscious patient must not be given anything to drink.
This also goes for patient who are Hemorrhaging or vomiting.
(6) Alcoholic stimulates should not be given as this have a
transient effect with a subsequent depressing event on the vital
centres.

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 GENERAL RULES OF FIRST AID CONT’D
(7) Reassure the patient by words of mouth. This gives
the patients confidence and is as important as efficiency in
treatment.
(8) Medical aids should be sought by a written message
rather than verbally. Verbal messages have a tendency to become
garbled.
(9) Organise unskilled onlookers or survivals to help in
any way possible, for example they can act as messengers, can be
used to telephone for a doctor or an ambulance or to bring any
required equipment.
(10) Control bystanders and on lookers and prevent them
from exciting the patients.
(11) Handle patient properly, if there is a suspected fracture,
support the affected limb most carefully. Do not lift patient
unless there are sufficient helpers around. Remove clothes if
necessary, to support the suspected fracture limb.

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 QUALITIES OF A GOOD FIRST AIDER
The followings are the qualities of a good first aider.
a. He/she should possess adequate skills (medical back ground) in order
to give correct, prompt, adequate and appropriate lifesaving assistance to
the victims of accident or sudden illness.
b. Common sense is very vital for a first aider.
c. A good first aider should have dutiful character and ability to learn.
d. He/she should have power of observation in accessing situation and
treat cases at hand in emergency.
e. He/she should have human feelings, truthful, kind and God fearing in
handling casualty.
f. He/she should be physically fit and have interest in first aid.
g. He/she should be able to keep to the basic principles of first aid in
handling cases on emergency.
h. He/she be should be courageous to approach and handle cases of
serious injuries.
i. He/she should be fast and accurate in carrying out first aid duties.
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WOUNDS
Wound is said to occur when the continuity of the skin or mucous membrane is
broken. There are different types of wounds which include;

a. Incised Wound: This type of wound occurs when the skin is

broken by deliberate sharp instrument such as knife, a piece of broken
glass/bottle, and blade, the wound usually bleeds freely but heals quickly,
definite and regular shaped.

b. Punctured wound: In this type of wound the depth is greater than

the length and there is danger internal organ being damaged. This type is
caused by a pointed instrument e.g bayonet, gunshot, nail etc.
c. Lacerated Wound: In this type of wound the skin and tissues are
torn rather than clean cut and the edge of the wound are irregular and there
is no definite shape. There is commonly crushing of the skin and muscle.
This type of wound occurs when a limb is caught up in machinery or after road
accidents.

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WOUNDS CONT’D

d. Contused Wound: In this type of wound there may be relatively

little damage to the skin but underlying issue may be severely damaged with
bleeding from blood vessels under the skin. This release of blood causes “Pus”.
This wound is caused by violent or force from a blunt instrument e.g. by
hitting the finger with hammer. Sometimes there may be very little or no
external bleeding but internal bleeding occurs.

Complications of wounds. Complications can occur if wounds are not managed

properly. The followings are the complications associated with wound;
a. Infection
b. Haemorrhage.
c. Shock.
d. Injury to the deeper organs.
e. Fracture.

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WOUNDS CONT’D

Treatment of Wounds.
a. To prevent infection the wound must be covered immediately with clean
dressing as quick as possible. A clean ironed piece of house hold linen is probably
as close to a sterile dressing can be used in an emergency, however, a sterile
dressing is preferable if available. The dressing should be applied firmly in
position.

b. If haemorrhage occurs this must be stopped as quickly as possible.

c. If the wound is severe shock may likely occur and should be treated,

d. Each wound has to be judged on its own merit and the first aid worker
should use common sense in deciding how serious it is and if deeper organs has
been affected, if greater how serious it is and if deeper organs has been affected.
If greater damage is suspected medical aid should be sought out and
arrangement made to transport the patient to hospital as soon as possible.

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WOUNDS CONT’D

Treatment of wounds cont’d

e. If glasses or foreign bodies are present in a wound, the first aid

worker should not try to remove them but should apply a ring pad
e.g a head tie, large handkerchief or small towel rolled up and
applied round the wound rather than in it and this should be
bandaged lightly in position if a fracture is suspected. The wound
should be dressed and limb immobilized as for a fracture.

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BURNS

Burns is an injury to the skin and other organic tissues primarily caused
by dry heat, electricity, extreme cold or by contact with chemicals.
Causes of Burns include:
a. Thermal agent.
b. Electricity.
c. Gas fire.
d. Coming in contact with electric wire.
e. Lightening.
f. Friction e.g from a revolving wheel.
g. Ionizing radiation i.e. X-ray nuclear exploration.
h. Strong acids such as carbonic acid and sulphuric acid,
hydrochloric acid and Lysol.
i. Strong acids such as caustic soda, caustic potash and
strong ammonia.

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BURNS CONT’D

Signs and Symptoms. These are the signs and symptoms of burns.
a. Severe pain.
b. Redness of skin and blisters.
c. Destruction of issue and muscles.
d. Subnormal temperature.
e. Pulse is quick and weak.
f. Shallow respiration.
g. Cold and clammy skin
h. Low blood pressure.
i. Thirst.
k. Haemorrhage e.g blood serum.

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BURNS

The Gravity of burns. The Gravity of burns depends on the

extent of the burns and the situation of the burns. In
deciding the extent and severity of burns the body can be
divided into several areas, each area constituting a
percentage of Total Body Surface Area (TBSA). In TBSA the
following are to be consider, superficial burns are not
involved in this calculation and rule of nine divides the
body-adequate for initial assessment for burns. Lund and
Browder Chart is the most accurate because it adjusts for
age. Palm method or Rule of nines is used for quick
assessment though difficult.

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BURNS CONT’D

Wallace Rule of Nines. Wallace rule of nines chart is used to

determine the percentage of surface area that has been burnt. The chart
divides the body sections that represent 9 percent of the body area.
a. Head and neck = 9%
b. Each upper extremity (Arms) = 9% each
c. Each lower extremity (Legs) = 18% each
d. The trunk (Anterior and Posterior) = 36%
e. Genitalia (Perineum) = 1%

In children the head represents a large proportion of the body and the
limb a smaller proportion. If 15% of an adult’s body or 10% of the body of
a child is burnt, the condition should be considered serious and requires
immediate hospital treatment. The most serious dangers to patients in
the short term are shock and infection and in the long term is scaring and
possibly deformity

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BURNS CONT’D

Palm Method. Palm method as a general rule is that the skin on the
palm of hand comprises 0.5% of your total surface area (For children, it’s
1% ) You can check the size of a patient’s hand and compare it with the
size of a burn to make a quick guess about the percentage. It can be hard
to estimate the size of a burn in an extensive one.

(The rule of nine is not always the rule. The Rule of Nines provides
reasonable estimates of body surface area for patients ranging from 10 to
80 kg. For obsessed patients weighing more than 80 kg, a rule of fives is
proposed. 5% body surface area for each arm 5 x 4 or 20% for each leg, 10
x 5 or 50% for the trunk and 2% for the head)

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23/11/2018
Lund Browder Chart used for determining BSA

23/11/2018
 50%

Livingston EH. Percentage of burned body surface area

determination in obese and non-obese patients J Surg Res. 2000
Jun 15;91(2):106-10.
23/11/2018
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BURNS CONT’D
Treatment for Burns. In the treatment of burns, note that the victim is
not encouraged to drink at large quantity of fluid and do not remove
clothing as this may worsen the situation. The followings are the steps to
be taken;
a. Remove the patient from the source of burns if possible e.g. if
the person is in a burning room it is necessary to remove the person
from the room before any treatment can take place.
b. Treat for shock immediately.
c. Reassure the patient, if thought necessary send for medical aid or
arrange immediate transport to hospital.
d. Cover the burns with a dry dressing if possible, the dressing should
be sterilized but it is likely that sterile dressings are not immediately
available, depending on the size of the burns, the inside of a freshly
washed ironed handkerchief. Pillow case or sheet can be used. Gentle
handling and carrying is needed.
e. If patient complained of thirsty, give a sip small quantity and
frequently. (Only if the burn is not severe)

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BURNS CONT’D
Treatment for Chemical Burns. The treatment for Chemical Burns
should be carried out immediately. For acid burns, wash the affected
parts for 10-15 minutes with alkaline solution. Cover the affected part
with clean dressing. If severe transport to nearby hospital or send for
doctor. Reassure the casualty.
Treatment for Alkali Burns. Wash the affected part for 5-10 minutes
with alkaline solution. Cover the affected part with clean dressing. If
severe transport to nearby hospital or send for doctor. Reassure the
casualty.
Rescue of Casualty on Flame. One or two persons may be on flames
following a fire outbreak in a building or an explosion resulting in flames.
The emergency treatment for this case include:

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BURNS CONT’D
a. Extinguish the flame by throwing thick materials e.g blanket,
bed cover, or wrapper over the casualty.
b. Roll the casualty up in a rug or carpet to keep off air and thereby
putting off the flames.
c. Lie the patient down and cover the burns with clean
materials.
d. Treat the patient for shock immediately.
e. Do not give anything by mouth if burns are severe.
f. Transport the casualty to the hospital.
g. Reassure casualty.

Complications. When burns are not well managed complications will

occur. The complications include the followings:
a. Infections.
b. Anemia.
c. Scaring.
d. Contracture.
e. Deformity.

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SCALDS

Scald is destruction of tissue by moist heat. It can be caused by boiling water or

any hot liquid such as tea and soup and steam or hot air. The signs and
symptoms are similar to burns. The treatment of scald is:
a. Remove clothing quickly on the affected area.
b. Keep the affected are dry, apply dry clean dressing bandage
lightly in position.
c. If blisters appear do not burst, protect with dressing and keep
dry.
d. Give warm drink and calm the patient down.
e. Treat for shock depending on the degree of the tissue
damage.
f. Reassure the casualty.
g. Send for doctor or transport to a nearby hospital.

Scald and Burns of the Mouth. Scald and burns of the mouth can be caused
by chemical substances or hot fluids. It causes severe pains and swelling which
may result in dental caries and halitosis. The treatment involves giving of plenty
of demulcent e.g milk to drink. The milk cools down the effect of the chemical
substance and will give smoothing effect on the mouth.

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UNCONSCIOUSNESS

Unconsciousness is a state which occurs when the ability to maintain an

awareness of self and environment is lost. It involves a complete or near-
complete lack of responsiveness to people and other environment stimuli. The
causes are the followings:

a. Faintness.
b. Asphyxia and its various causes.
c. Injury to the brain e.g fracture of the skull. Concussion or
compression, Seizure, tumors to the brain, electric shock, insulin coma as a
result of diabetic etc.

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UNCONSCIOUSNESS CONT’D

Levels of Unconsciousness. Unconsciousness is in different levels. They

altered levels of consciousness is any measure of arousal other than
normal which differ from somnolent, obtunded, stuporous, and
comatose.

a. First Stage of somnolent (sleepy) is describable as a state of partial

consciousness. The casualty may be able to answer simple question about
his name and address but not aware of the time and place. It is a mild
depressed level of unconsciousness or alertness may be classed as
lethargic. Someone in this stage can be aroused with little difficulty.

b. Second Stage of obtunded. People in this stage have more depressed

level of consciousness and cannot be fully aroused. Sometimes he may be
able to obey simple commands like “sit up” “lie down” and “Take’.

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UNCONSCIOUSNESS CONT’D

Levels of Unconsciousness Cont’d

c. Third Stage of stupor. Those that are not able to be aroused

from a sleep-like state are said to be stuporous. He may not be able
to answer any question than responding to painful stimuli.

d. The fourth stage of comatose. It is a state of

unconsciousness when the patient cannot respond to anything
whether questions, command or painful stimuli. It is a complete stage
of unconsciousness. Inability for the casualty to make any purposeful
response.

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UNCONSCIOUSNESS CONT’D

Management of Unconsciousness. When a first aider is able to identify an

unconscious casualty, try to determine what caused the unconsciousness. Check
to see if he/she is wearing any medical alert tag. If you can identify the cause,
call emergency medical services and give first aid treatment until their arrival.
The first aid treatment includes the followings:
a. Check the person’s airways, breathing and circulation.
b. Undo tight clothing round the neck, chest and waist.
c. If there is no particular injury and the patient’s face is pale with cold
and clamming skin, place the patient in a prone position with head turned to
one side.
d. Clear saliva or secretion from the mouth and ensure the tongue is
well forward.
e. If the face is flushed, place the patient on his back with his head
and shoulder slightly raised.
f. Ensure adequate ventilation round the patient.
g. Keep the patient warm by covering with blanket.
h. Send for medical aid or arrange for immediate transportation to
the hospital.

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TREATMENT OF UNCONSCIOUSNESS CONT’D

i. Treat any obvious causes e.g haemorrhage, fracture or head injury.

j. Do not give anything by oral.
k. On Arrival to the Hospital. Report immediately to the doctor, all
findings before commencing first aid such as:
(1) The position of the patient before commencement of first aid.
(2) The colour of the face, pale or flushed.
(3) The presence or absence of wound on the head.
(4) Either there was any severe haemorrhage.
(5) Any odour from the patient’s breathing e.g alcohol or sticky
sweet smell.
(6) Whether there was any sign of seizure.
(7) Pulse rate rapid, weak slow or bounding.
(8) Respiration deep, slow, or rapid, shallow or hunger type.
(9) Either patient was absolutely still.

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HAEMORRHAGE/BLEEDING

Haemorrhage may be defined as an escape of blood from the blood

vessels. Any type of vessels may be involved; it could be internal or
external. Haemorrhage can be caused by:
a. Direct injury to the blood as a result of wound or surgical
intervention.
b. Disease of the blood vessel wall, this may be caused by infection
or malignancy.
c. Disease of the blood e.g haemophila, it is a condition
characterized by a delay in the coagulation time of blood which due
to lack of a factor in the blood necessary for satisfactory clothing
known as antihaemophilic factor.
d. Ruptured ectopic gestation.
e. Haemoptysis.
f. Ante and post-partum haemorrhage
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HAEMORRHAGE CONT’D
Types of Haemorrhage.
External haemorrhage; Escape of blood from the blood vessels into
the surface of the body and can be seen and internal
Concealed haemorrhage; blood escapes from the blood vessels into a
cavity or organ of the body or into the tissue as a result of injury e.g
lungs, heart, liver fracture rib, kidney etc.
Sources of Haemorrhage. The sources of haemorrhage can be
classified according to the type of blood vessel affected. This is as
follows:
a. Arterial Bleeding. If an artery is severed the blood will be bright
red in colour, this is due to the presence of oxygen in the blood. Sporting
from the wound, each spurt coincides with the heart- beat. Escaping
from that part of the heart close to the heart. Escaping from the wound
under great pressure.
b. Venous bleeding. If a vein is severed the blood will be dark red in
colour, this is due to the small amount of oxygen present in the blood.
Flowing from the wound in steady and will not be under great pressure.
Escaping from the part of the wound farthest from the heart.
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HAEMORRHAGE CONT’D
c. Capillary bleeding. This occurs in superficial wound e.g in a graze
and the blood will be oozing from the wound. Neither bright nor dark
ted in colour. Welling up from all over the wound.
Time of Haemorrhage. Time of Haemorrhage. Bleeding may
actually occur at the time of injury. It could be primary, reactionary and
secondary.
a. Primary Haemorrhage: This occurs at the time of the injury or
operation or when the blood vessel has been damaged by disease.
b. Reactionary Haemorrhage: Occurs after 24 hours of the injury or
operation because after the treatment , the blood pressure returns to
normal the clot use by nature to stop bleeding is then push out and
further bleeding will occur.
c. Secondary Haemorrhage: Rarely occurs but if it does, it takes
place in anything from 7 to 10 days after the injury or operation and is
due to infection. If micro-organism has infected the wound they break
down the clot. This usually takes several days to occur; this secondary
haemorrhage is slow to develop. It is extremely dangerous and shows the
importance of keeping wound absolutely clean.

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HAEMORRHAGE CONT’D
Signs and Symptoms of haemorrhage. It casualty may have internal
or external bleeding. The followings are the signs and symptoms that
indicate a casualty is bleeding.
a. Increased pulse rate.
b. Pallor of the face and the body.
c. Low body temperature.
d. Deep sighing expiration.
e. Restlessness.
f. Anxiety.
g. Fainting.
h. Blurred vision, dizziness.
i. General weakness of the body.
j. Excessive sweating.
k. Cold clammy skin.
l. Thirst.

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HAEMORRHAGE CONT’D
Management of Haemorrhage. In case a casualty is identified to be
bleeding, the first aider should do the followings:
a. Send for medical aid immediately: Inform relevant authority, police
and hospital.
b. Remove all tight clothing around the neck, chest and waist.
Remove shoes, cap etc.
c. Encourage fresh air around the patient and avoid crowding.
d. Having the patient lying flat with the head lower than the rest part
of the body.
e. Apply direct pressure to the site of bleeding by means of a padded
gauze and bandage.
f. If bleeding is from the limb, hand or legs elevate the part and apply
tourniquet to the upper part.
g. Reassure the patient, as he will be anxious and possibly afraid.
f. Monitor vital signs: Temperature, Pulse and Respiration (TPR) to
know the state of condition.
g. If bleeding still continues, remove patient to hospital for expert
management

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SPECIAL HAEMORRHAGES
Epistaxis. This term epistaxis is bleeding from the nose; the bleeding may
be slight or severe. It is caused by:
a. Disease and Hypertension.
b. Catarrhal infection – This is due to constant blowing of nose and
having injuries of tiny blood vessels of the nostril.
Management of Epistaxis. Epistaxis can be managed in emergency
situation as follows:
a. Place the patient in a chair, in a sitting position with the head held
forward. In severe bleeding this will prevent the blood flowing to the back of
the nose and throat, this may prevent it from being swallowed or inhaled.
b. Loosen tight clothing round the neck, chest and waist; place the patient
near an open window.
c. Ask the patient to breathe through his or her mouth.
d. Pinch the nose firmly between the thumb and forefinger.
e. A cold compress in the form of a handkerchief wrung out in iced water
can be applying over the bridge of the nose and at the back of the neck.
f. Keep the patients sitting very stable.
g. If the bleeding is very severe and does not stop within several minutes
the patient may require to be seen by a doctor who will carry out any further
treatment which may be necessary.
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SPECIAL HAEMORRHAGES CONT’D

Haemoptysis. This is the term used to describe coughing out of blood.
The blood may be coming from any part of the respiratory tract; quite
commonly from the lungs.
Causes:
a. Pulmonary tuberculosis, due to germ called tubercle bacilli.
b. Growth or tumors.
c. Injury to the chest and the blood is mixed with sputum.
Treatment of Haemoptysis.
a. The patient should be placed in a comfortable position, sitting
up in a chair or if at home propped up in bed.
b. Tight clothing round the neck, chest and waist should be
loosened.
c. The patient must be reassured and kept very still and quiet, any
moment or excitement might cause further bleeding.
d. Ice may be given to suck.
e. Medical aid should be obtained it is important to have the
extent of the damage investigated as soon as possible.

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SPECIAL HAEMORRHAGES CONT’D

f. Keep all specimen of sputum for the doctor’s inspection. By
examining them he may be able to assess the amount of damage
Melaenia. This is the term used to describe the presence of blood in
the stools. If the blood is escaping from vessels high up in the intestinal
tract e.g from a bleeding duodenal ulcer, it will make the appearance
black and tarry. The change in colour is due to the fact that intestinal
juices have been in contact with the blood. Maleana is caused by:
a. Hemorrhoids
b. Dysentery
c. Cancer of the lower bowel, colitis, inflammation of
intestines.
Treatment. The patient should be put to bed, quiet and still. Any
specimen of stools or blood should be kept for inspection. Medical aid
should be obtained as hospital treatment may be necessary. Note – If a
patient has black stools it is important to find out if he has been taking
an iron tonic. Since the iron which is not absorbed is passed in the
stools giving them a black appearance

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SPECIAL HAEMORRHAGES CONT’D

Haematemesis. This is the term of vomiting blood. The blood
may be coming from any part of the upper alimentary tract. Probably
the commonest site of bleeding is from gastric ulcer. The blood is
dark- red and not frothy, the blood mixed with food particles. Causes
of haematemesis include:
a. Certain blood disease e.g Leukemia.
b. If aspirin or any drug containing acid is taking on an
empty stomach.
Treatment. The patient should be immediately made to lie
down. Tight clothing round the neck, chest and waist should be
loosened. Reassurance is essential as the patient will be afraid,
especially if the vomiting is severe. The patient should be kept
absolutely still and quiet. Any movement at all may increase the
bleeding. The patient should not be given anything by mouth. Water
may be given to rinse the mouth; it should not be allowed to be
swallowed. A doctor must be sent for to assess the extent of the
bleeding.
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SPECIAL HAEMORRHAGES CONT’D

Haematuria. This is defined as passing out of blood with urine. It may be

from vessel in the kidneys, the Ureters, the urethra and the bladder. It can
be caused by:
a. Trauma.
b. Calculus or stone formation.
c. Inflammation.
d. In addition to these causes, it may occur during
menstruation in case of women.

Treatment. The patient should be advised to go to bed and keep quiet. A

doctor should be sent for to assess the situation or transport the patient to
the hospital immediately. Any specimen of urine should be kept for
inspection by the doctor.

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SPECIAL HAEMORRHAGES CONT’D

Uterine Bleeding. Normally blood escape from the uterus through
vagina at the menstrual period. Any bleeding occurring not associated
with the menstrual period must be considered as a serious and urgent
matter. Uterine bleeding may be signs of threatened abortion/miscarriage.
The treatment of uterine bleeding is as follows:
a. The patient must be put to bed immediately.
b. The foot of the bed be elevated, this can be done by
placing a chair underneath the bottom of the bed.
c. Reassure the patient and try to keep her absolutely still
and quiet.
d. Loosen tight clothing round the neck and waist.
e. Apply a sanitary towel (pads) to the vulva and keep all
pads for the doctor’s inspection. By examining the pads, the doctor may be
able to judge how much blood has been lost.
f. Always send for medical aid and if the haemorrhage is
severe, arrange for transportation to hospital. A note should be sent with
the patient giving am assessment of the amount of the blood loss.

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ASPHYXIA

Asphyxia is a suspected interference with respiration due to the fact

that the body is not receiving sufficient oxygen and there is an
accumulation of carbondioxide in the blood. This can be caused by:
a. Occlusion and obstruction of the upper respiratory tract. This
may be due to:
(1) Strangulation with rope or chocking
(2) Smothering with a pillow.
(3) Impaction of a foreign body such as bone in the throat or
a piece food inhale into the larynx or trachea.
(4) Pressure on the chest by failing masonry beams or when
a person is buried under debris
(5) Drowning.
(6) A compilation another condition such as swelling due to
the burning of mouth and throat.
(7) Inhalation of blood or vomiting.

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CAUSES OFASPHYXIA CONT’D

b. Paralysis of the muscles of respiration, this can occur due to:

(1) Electric shock.
(2) Being struck by lightning.
(3) Certain poisons such as strychnine and morphine.
(4) Diseases such as poliomyelitis.
c. The effect of certain gases: These include carbon -monoxide,
ammonia and chloride.

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ASPHYXIA CONT’D

Signs and Symptoms. A casualty with asphyxia can present with

the followings:
a. Difficulty in breathing, restlessness and agitation.
b. The casualty begins to struggle, trying to remove
obstruction from throat and tearing his clothe.
c. Coughing and sputtering.
d. Cyanosis occurs. This is noted by bluish colouration of the
tips of the fingers, the lips and ears.
f. In the course of the struggling to overcome asphyxiation the
face becomes congested with blood, the neck vein becomes
distended and the pupils dilated.
e. Whereby there is no struggling the victim appears to go to
sleep. This happens in asphyxiation by some gases, such as carbon
-monoxide.
g. The above signs symptoms may last for about five minutes
and if not relieved the casualty becomes unconscious and
breathing stops.
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ASPHYXIA CONT’D
Treatment.
a. Remove the patient from source of danger e.g gas or smoke
filled room and take out of water in case of drowning.
b. Remove the source of danger e.g pillow from the face, bone
from the throat or debris from the chest.
c. Undo all tight clothing round neck, chest and waist.
d. As far as possible clean the mouth of any obstruction such as
vomit, blood or saliva.
e. If breathing has ceased start artificial respiration.
f. In cold weather keep the person reasonably warm by placing
a blanket underneath the body and one over the body, but do not
over heat the patient.
g. Bending head downwards and giving a good slap on and in
between the shoulder blade, if possible, make dislodge of foreign
body.
i. If due to obstructed tongue pull out with a tongue forceps.
j. If penetrating chest wound cover up with air tight dressing.
k. If necessary ambulation to hospital as fast as possible.
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FRACTURE
A fracture is a break in the continuity of a bone, fracture usually occurs in
one of these three ways.
a. Direct Violence: In this type of fracture the bone breaks at the site
where the force or violence has been applied. For example fracture of the skull
can occur if the person is hit directly on the head or fracture of the leg if the
person is run over by a car and the car wheel passes directly over the leg.
b. Indirect Violence: In this instance the fracture occurs some distance
away from the area where the violence has been applied. For example, a
fracture of the humerus or clavicle maybe caused by the patient falling on his
outstretched hand. There will be no fracture of the bone of the hand but a
fracture may occur some distance away at a vulnerable point such as the shaft of
the humerus or mid clavicle. Also the spine may be fracture by jumping from a
height and landing on the feet with the legs held rigid. The violence in this case is
transmitted through the lower limbs to the vertebral column resulting in a
fracture of one more vertebrates.
c. Muscular Violence: This fracture occurs as a result of sudden forceful
contraction of the muscles, by this sudden contraction of the bone to which the
muscle is attached may smog. For example a sudden strong contraction of the
quadriceps extension group of muscles can pull sharply on the patella causing it
to fracture.

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FRACTURE CONT’D

Predisposing Factors. Under certain circumstances bones are more likely to fracture:
a. Old Age Group: In old age people the bones are brittle and break easily.
b. Disease of Bone: If bones are not healthy, they are liable to break with a minimum
amount of violence. Examples of diseases which predispose to fracture are:
(1) Osteomylitis.
(2) Rickets.
(3) Tuberculosis.
(4) Inflammation of the bone marrow.
(5) Cancer of bone.
(6) Some congenital disorders.

Classification of Fractures. Fracture is classified according to the condition of the tissue

adjacent to the fracture bone.
a. Simple or Closed Fracture: In a simple or close fracture the bone is broken but there
is no communication directly or indirectly between ends of the bone and the exterior. In
other words, the skin is not broken.
b. Compound or Open Fracture: In a compound fracture as well as the broken bone
there is also broken skin. The soft tissues under the skin are also damaged. It is important
to note that in a compound fracture the broken ends of the bone need to penetrate
through the skin. The fact that skin is broken at all makes it a compound fracture. The
danger of this type of fracture is infection.

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FRACTURE CONT’D

c. Greenstick Fracture: This danger of this type of fracture occurs in children

usually under the age 10 years. Instead of breaking the bone bends like a
greenstick. This occurs because the bones in children are still fairly soft.
d. Comminuted Fracture: In this type of fracture the bone is crushed or
broken in several places. There are usually several splintered fragments of bone.
e. Impacted Fracture: In this type of fracture the ends of the broken bone are
pushed into one another and tightly wedged together. This happens in a fracture
of the shaft of the femur is pushed end into the acetabulum. This type of
fracture causes shortening of the limb, if it’s not properly treated.
f. Complicated Fracture: In this type of fracture not only the bone is damaged
but injury to internal organ also takes place e.g. fracture ribs.
g. Transverse Fracture: In this instance, the bone is broken straight across.
h. Oblique Fracture: Here the bone is broken instantly. There is more danger
here of the fracture becoming compound due to the danger of a splinted of bone
piercing the skin.
i. Spiral Fracture: In this type of fracture the broken bone twisted round the
bone.

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FRACTURE CONT’D

j. Depressed Fracture:- This type of fracture usually occurs in the skull or

cranium in which part of the bone is driven inwards, Any injury to the head
should be treated as a serious matter. Maybe a simple, compound or depressed
fracture. The dangers involved in a fracture of the skull are:
k. Concussion of the Brain: This is the term used to describe the shaking up
of the brain.
l. Compression of the Brain: In this condition a piece or pieces of bone may
have been driven into the brain. There may also be bleeding into the brain.
There pressure caused by blood or pieces of bone or pieces of bone in the
brain are extremely serious.

Signs and Symptoms

a. Severe pain at the site of fracture.
b. The area is tender and swollen
c. Shock with all its signs and symptoms.
d. There will be loss of function.
e. Deformity.
f. Crepitus

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FRACTURE CONT’D

Treatment of fracture
a. Immediately support with hands and below the fractured bone.
b. By body splitting e.g. injured femur bandage satisfactory to the injured one.
c. By the use of slings.
d. By the use splints pad and bandages.
e. Open fracture-wound dressing with aseptic technique.
f. If condition warrants always lay patient flat to counter-acts of shock.
g. The foot should be raised with a pillow or folded blanket.
h. Comfort and reassure if conscious.
i. Use tourniquet to stop a profuse bleeding.
j. Stimulants like hot tea, with glucose, coffee maybe given if conscious.
k. Early ambulation to the hospital.
 
 

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SPLINTING
Splint is an appliance made of woods, metal, plastic or Plaster of Paris
(POP) used for immobilization of fracture or dislocated limb or joint.
Uses of Splint
a. To immobilize fracture and dislocated joints.
b. To prevent or correct deformity.
c. For easy transportation of injured person.
d. To maintain fraction example pulling of shrunk tissue caused by breaking of
bone.
Types of Splint
a. Wood padded with any soft tissue caused by breaking of bone.
b. Wire ladder padded with cotton wool.
c. Improvised Splint such as:
(1) Thickly rolled newspapers.
(2) Thickly rolled blanket.
(3) Thickly pulled.
(4) Padded Rifle.
(5) Tight the sound leg with the injured leg, e.g. fracture of the femur,
tibia and fibula.

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SPLINT CONT’D
Rules of Splinting
a. Prepare your splint by padding it all rounds with soft materials.
b. Splint patient where he lies before evacuation.
c. Do not attempt to set the fracture or dislocated joints.
d. Apply splint firm enough to support fracture, but not tight enough impair
circulation.
e. Support your splint, ties above and below fracture to avoid Crepitus.
f. Secure knots on lateral and anterior aspects of the limb.
g. Apply pads where skin surfaces meet over a boning prominence.

Thomas Splint. Consists of a padded ring which encircles the thigh at the
groin and a small narrow stretcher to support the injured leg. The stretcher part
usually larger than the limbs and provides an anchor for a prescribed lotion
before an injured leg is placed on Thomas Splint, a skin traction is first of all
applied on that leg to provide a pulling mechanism.
Note: If you applied splint on injured limb or placed an injured limb in a
Thomas Splint, make sure you examine the limb as from time to time as follows:
To ensure blood circulation is not impaired.
That the splint is still effective.

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SYNCOPE
Syncope or fainting is a state of temporary unconsciousness due to diminish
blood supply to the brain.
Causes
a. Exhaustion, lack of food and exertion while in the state of fatigue.
b. Emotional feeling or frightened.
c. Accident involving minor injury especially those involving loss of blood.
d. Lack of fresh air in close atmosphere and heat.
e. Posture standing upright after resting.

Signs and Symptoms

f. Giddiness swoons and falls down.
g. The face is pale in colour.
h. Sweating profusely.
i. Cold and clammy skin.
j. Quick, feebly and thread pulse.

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SYNCOPE CONT’D
Treatment
a. Examine the patient to know the cause of fainting attack e.g profuse
bleeding, arrest bleeding if necessary.
b. Lie patient down with head low and the feet raised and supported in an
elevated position.
c. Always loosen tight clothing around the neck, chest and waist including
shoes.
d. Warmth is required by the use of blanket if the patient feels cold.
e. Send away onlookers and bystanders to avoid overcrowding.
f. Use trencher to remove him from crowded room if necessary.
g. Fanning the patient face may be necessary if the room is hot.
h. On return to consciousness give him a stimulant e.g hot tea, coffee, hot
glucose small quantity at intervals.
i. Transport to nearby hospital for further treatment.

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BITES AND STINGS
Snake bites, insect bites or sting can cause intense pain and/or swelling. The
severity of snakebite depends upon the type of the snake, location of bite and
the amount/virulence of the venom injected. Snake commonly found in Nigeria
includes vipers, cobras, mambas, puff adders and sea snake. All these snakes are
poisonous and may cause death in less than 24hours. Bites from humans,
animals such as dogs can cause severe bruises, lacerations and infection. Insects’
stings (eg bee, scorpion) can cause allergic reactions which lead to anaphylactic
shock. Thus, snakebites, dog bites or bites or bee stings, if not treated properly
and promptly can cause serious illness or even death. Knowledge and prompt
application of first aid measures in such situations can lessons the severity of
injuries and prevent worsening of the condition. The following guidelines are
specific to particular situation.

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BITES AND STINGS CONT’D

a. Snake Bite. The first aid management of snake bite is as follows:
(1) Try and identify the snake. If possible kill it for identification.
(2) Reassure the casualty and allay anxiety and fear.
(3) Arrange for evacuation ASAP.
(4) Do not move the limb that has been bitten (this reduces risk of
poisonous spread)
(5) Bandage the bitten part firmly but not so tightly that it stops
blood reaching or leaving the affected part.
(6) Do not cut, suck or scrub the wound.
(7) Gently wash the wound and pat dry with clean swabs
(8) Immobilize the affected area and transport the casualty to the
hospital.
NOTE: Poisonous snake bites are indicated by one or two fang marks on
the skin, whereas multiple teeth make suggests that the snake is not
poisonous.

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BITES AND STINGS CONT’D

b. Dog bite. Dangers in animal bites are infections and rabies. The
first treatment is as follows:
(1) Put on the disposable gloves.
(2) Wash the wound thoroughly with soap and water in order to
reduce risk of infection. The most serious infectious risk is rabies
which can only be prevented but not cured.
(3) If the possible, confirm if the dog has been vaccinated or
not.
(4) Leave the wound open.
(5) Reassure victims while arranging for evacuation.

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BITES AND STINGS CONT’D

c. Bee sting. Although a sting by a bee is bearable, multiple bee

stings can lead to anaphylactic shock which can be fatal. The bee usually
leaves its stings within the wound and this act as a ‘’foreign by’’ and it
must be removed immediately. This sting can be removed by pressing a
hollow ring, such as the tube of watch key on to the wound. lf this is not
available, sterilize a needle by passing it through a flame. Open the
wound, expose the sting and remove it with a pair of tweezers. Bath the
area thorough with weak ammonia or with a solution of bicarbonate of
soda (two tea spoons to a pint of water). An antihistamine may be
applied to reduce the antigenic effect of the sting. If general symptom
develops such as headache, severe swelling of the affected part, pain and
shock, send for the medical aid or transport the patient to the nearest
hospital. Reassure the victim.

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BITES AND STINGS CONT’D

d. Scorpion Sting. Scorpion sting can be treated by cleaning area with

Methylated spirit. Remove the poison with a tweezers e.g part of the
handkerchief damped in the water, if possible. Apply anti-histamine
cream e.g. part Anthisan cream. Early transfer to hospital where an
injection of plain xylocaine or xylocaine 5cc or 10cc will be injected
intradermally or subcutaneously around the side of sting may be  

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SHOCK

Shock may be defined as a depression of the vital centre of the medulla

oblongata due to its being depleted of sufficient blood supply. The
essential factor in shock is a lower blood pressure. Shock may be primary
or secondary.
a. Primary Shock: This occurs immediately after the accident or sudden
illness
b. Secondary shock: This may not develop until several hours after the
accident or sudden illness and is usually very serious

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SHOCK CONT’D
Classification of Shock. There are several items to classify shocks.
Probably two most common used are:
a. Oligemic (Hypovolaeic) Shock. This occurs when the tissues
have been damaged and there is loss of blood or fluids from the
circulation. It is very commonly present in the following circumstances.
(1) Fracture.
(2) Haemorrhage
(3) Burns and Scald.
(4) After surgical operation
(5) In any sudden illness with extreme pains, such
as a perforated gastric ulcer or in coronary thrombosis.
(6) In several vomiting and diarrhea. In Oligemic
shock the main factor involved in loss of fluid from the body or a
reduction in the circulatory blood.

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SHOCK CONT’D
b. Neurogenic Shock. This may happen when no specific injury has
taken place but when an Emotional upset has occurred. It can occur in
the following circumstances.
(1) In state of fear.
(2) In state of high emotion due to bad news.
(3) Being involved in an accident, although not physically
injured.
(4) Due to exposure to cold.
Signs and Symptoms. Shock presents with the followings.
a. Cold and clammy skin.
b. Slow pulse, and then gradually it becomes rapid and weak.
c. Breathing is fast and shallow respiration.
d. The blood pressure if taken, it will be lowered than the normal.
e. Pallor of face.
f. Sweating.
g. Cold clammy skin.
h. Rapid, shallow breathing.

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SHOCK CONT’D
i. Thirst.
j. Yawning and gasping for air.
k. Restlessness and aggressiveness.
l. Weakness and dizziness.
m. Temperature is subnormal i.e. 970 F

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SHOCK CONT’D
Management of Shock.
a. Loose and untie clothing round neck, chest and waist and waist and make sure
the patient is not been crowded by spectators or bystanders.
b. Lie patient down and turn his head one side so that the tongue does not fall
back.
c. Raise the foot side higher than the head to allow rapid flow of blood to the
patient’s brain.
d. Keep the patient warm by applying blanket.
e. Give hot tea or coffee if the patient is conscious.
f. If the patient is bleeding profusely do not give any stimulant
g. If the patient is conscious reassure him by appearing calm and self confidence
h. Pain should be relieved as far as possible, for example supporting an injured limb
or placing the patient in the most comfortable position.
i. Carryout artificial respiration and cardiac massage, observed the whole body if
there is bleeding.
j. Medical aids should be sent for if the condition is serious, if there is going to delay
in getting the patient to the hospital and if the patient is in pain. A doctor is the only
person who can administer drugs which relieve pains.

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POISIONS
A poison also called toxins is a substance which if taken is capable of
causing illness or death of a living organism. When introduced in
sufficient quantity into the body or ingested could also cause temporary
or permanent damage. A person discovered to have taken poison must be
treated with greatest urgency. There are usually three causes of poison
which are:
 a. Accident: This is the commonest cause of poisoning. It may occur in
several ways:
(1) By eating contaminated food, poisonous berries
or fungi
(2) By drinking contaminated water or drinking
poisonous drink from a wrongly label bottles.
(3) By accidental taken an overdose of medicine e.g
sleeping tablets. This frequently happens with children.

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POISIONS CONT’D
b. Suicide: Attempted suicide should be suspected if an apparently
healthy person is found obviously conscious, however, making no effort
to help. Usually there may be a history of mental depression and threat
to committee suicide.
c. Murder: Murder or attempted murder may be carried out by
ingestion of poison. The poison may be applied in a large dose or
repeated small doses.
Classifications of Poisons.
a. Irritant poisons: They act on the alimentary tracts causing
irritation and inflammation. Common sources of irritant poison are:
(1) Contaminated food, e.g contaminated canned food, meat
pie, sausage etc.
(2) Poisonous berries or fungi e.g toad’s stools which may be
mistakenly ingested for mushrooms.
(3) Chemical substances e.g Mercury, Phosphorus, Iodine and
lead. Some of these chemicals are present in paints and weed
killers.
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POISONS CONT’D

b. Narcotic poison: They act on nervous system, there effects can be

varied. They can act as hypnotics. Hypnotics induce sleep,
unconsciousness e.g Opium, Morphine, Heroine Cocaine and various
barbiturates such as phenobarbitone.
The antidotes for Poisons. The good thing about poison is that if
detected early, measure can be taken to counter the effects. The
following substances can be used to counter effects of poison:
a. Emetics: An emetics is a substance which capable of producing
vomiting, this removes the poison from the stomach. The emetics
should be given as soon as possible after the poison has been ingested
hoping that he will vomit the poison before absorbing into the blood
stream.

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POISONS CONT’D

Examples of antidotes are:

(1) If the poison is an acid, an alkaline drink can be given. The
can be prepared by adding one level teaspoonful of bi carbonate
to a cup of water.
(2) If the poison is an alkaline, an acid can be given. This can
be prepared by adding approximately three table spoonful of vinegars
to a cup of water.
b. Aperients: When the stomach is completely emptied by vomiting, it
may be desirable to give aperients to remove only poison which may
have passed into the intestine. Castor oil or Epsom salts are convenient
aperients to use. If castor oil is used a suitable dose is two spoon
tablespoon for an adult or two teaspoon for a child. If Epsom salts used a
suitable dose is one desert spoon in a glass of water.

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POISONS CONT’D
c. Demulcents: A demulcent is a substance which soothes irritated
mucous membrane. It can be administer after vomiting freely without
been induced. Examples are:
(1) Milk which is the most palatable.
(2) Salad dressing cream, mayonnaise.
(3) Olive oil.
(4) Liquid paraffin.
(5) Thick barley water.
(6) Pap.
Irritants poison:
The signs and symptoms of poison is the same in respective of the type
ingested.
a. Nausea
b. Vomiting
c. Acute abdominal pain
d. Diarrhea
e. Syncope, Shock and prostration.
f. Eventually unconsciousness.
.
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POISON CONT’D
Treatment for irritant poison
a. If the victim is still conscious though may be drowsy, try and keep
awake and give emetics.
b. After vomiting give a stimulant inform of strong black coffee.
c. An aperients should also be given.
d. If found unconscious transport to the hospital immediately, if
breathing ceases artificial respiration may be necessary during
transportation.
 
Deliriants poison. Deliriant poisons alter mental status, causing
agitated confusion e.g. atropine or other anticholinergic drugs. It
presents with:
a. Dryness of the mouth and throat.
b. Thirst.
c. Unsteadiness.
d. Dilated pupils
e. Delirium.
f. Comma.
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POISONS CONT’D

Treatment of Deliriant Poisons. In the treatment of deliriant

poisoning , the first aider does the followings:
a. Give an emetic.
b. After vomiting give a stimulant inform of strong tea or
black coffee.
c. Send for medical or transport to the hospital
immediately, if becomes unconscious and breathing ceases artificial
respiration may be necessary during transportation.
d. Treat for shock.

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CONCLUSION

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REFERENCES
1. A Handbook on First Aid; Umar Faruk
Adamu
2. Nigerian Defence Academy; Cadet Precis,
First Aid Revised Edition, 2000
3. Precis for Young Officers Course
Participants. Nigerian Army School of
Medical Sciences Ojo-Lagos

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