Presentation on theme: "Cycle First Aid by Steve Evans SRPara MCPara Liverpool Century RC Member Opening Slide, The benefits of cycling far outweigh the dangers or risk of accident,"— Presentation transcript:
1Cycle First Aid by Steve Evans SRPara MCPara Liverpool Century RC Member Opening Slide, The benefits of cycling far outweigh the dangers or risk of accident, but a fact of life accidents do happen, and quite often not the cyclists fault, so it is sensible to teach all cyclists, Road, Race, Off Road Mountain Bikers, First Aid.
2Cycle First AidWhether out cycling alone or in a group the cyclist may be the First Person on scene, so a working knowledge of First Aid would be of use, there is a need to understand the mechanics of Trauma,common injuries, underlying problems and how to treat them and the course tries to do this.
3Cycle First Aid Aims of First Aid Preserve Life Prevent Condition WorseningPromote RecoverySend for Help Early 999 or 112State the aims of First Aid, these are the same whether you are a First Aider, Fire fighter or Police officer,Preserve life even if the patient ends up in a wheel chair, prevent getting worse by keeping the blood within the patient, promote recovery by good spinal control, phone early for help.
4Systematic ApproachC - Care – Be aware of danger to yourself “A dead rescuer is no good to anybody” and to the casualty and othersMoving trafficBlind BendsSpilt fuelCreate a NO smoking areaHaving a systematic approach will help you, as in an emergency situation it is good to have a plan AAs stated a dead rescuer is no use to anybody.Create a safe scene, make use of bystanders or other cyclists.
5Systematic Approach C - Care R - Reconnaissance – You need to know how many Casualties there are, for each unconscious / seriously injured casualty you need an Ambulance ( 3 on the floor = 3 Ambulances )Each Ambulance only has 1 stretcher so when phoning 999 it is very helpful to tell the Ambulance control how many Patients cannot get up off the floor no matter what reason, unconscious, broken leg etc.
6Systematic Approach C – R – Inform – Dial 999 or 112 for the Ambulance Service or other Emergency Services if there is spilt fuel, threat of fire, trapped casualties, dangers to othersEarly phoning for the Emergency services means help will arrive sooner.
7Systematic Approach C – R – I – Treat the casualties according to their needs remember your Priorities Catastrophic bleed, Airway, BreathingDo NOT Move the Casualty unless their life is threatenedHaving sent for help, sort out Catastrophic Bleeding, Airway being Neck (Cervical) Aware and Breathing.these will be covered in greater depth later on in this course.
8Common InjuriesHead on - Head and Face, Potential Neck – check the damage to the cars windscreen, Chest or Abdominal, fractures to thigh bone, (handle bars) hand / thumbSide impact - Traumatic amputation of lower leg or fractures / dislocated ankleFOOSH - Fractured Clavicle/Shoulder, broken wrist/forearmOver Half of Cyclist who end up in hospital have Head injuries,50% Arm, 40% Leg, 5% Chest/abdomen.Road RashThis slide explains the most common injuries a Cyclist will encounter.FOOSH is Fallen On Out Stretched Hand, a common injury.
9Common InjuriesUpper Limbs are the most common injuries these include Collar Bones and Shoulder.
10Consider the DamageLook at the potential for injuries,internal and externalIn this slide we can see the Cyclist has substantially damaged the rear of the car so must have been travelling at speed. We would be drawn to the poor cyclist lying on the floor but we must also look to the damage that has occurred helping us to suspect certain injuries.
11Priorities Catastrophic (life Threatening ) Bleed Airway – clear if blocked or open if not breathing, being aware of potential Neck Injury, Cover open chest woundsCervical Awareness – DO NOT Remove Helmet unless life is threatenedBreathing – if No then start resuscitationA patient will bleed out quicker I.e. die from a massive bleed rather than die from a blocked airway, within 3 minutes from a Femoral bleed versus 3 to 4 minutes from a block airway were the Tongue blocks it.The UK Resuscitation Council states if breathing is less than 6 per minute the patient is officially not breathing as this will not sustain life, so chest compressions should be started.
12The No 1 Cause of DeathThe No 1 Cause of Death in Trauma is a blocked AirwayWhen Unconscious the tongue drops to the back of the Casualty’s throat blocking their airwayThis is preventable by performing a Jaw Thrust or Chin LiftMost people have a tongue and when they become unconscious they and their tongue become floppy it then blocks the airway.the Jaw thrust holds the patients head and allows the rescuer to open the patients airway so is the preferred manoeuvre were Trauma is involved.
13Tongue Blocking Airway As seen in the picture the tongue of the unconscious patient drops to the back of the patients throat blocking their airway.
14Jaw ThrustPreferred way of opening a traumatically injured patients airway is by performing the jaw thrust, this must be the first action of choice as it keeps the neck still as we do not want to make neck injuries any worse.
15Criteria for Helmet Removal A Blocked Airway that cannot be cleared in any other wayThe Casualty's Chest or Abdomen is not rising and falling (Not Breathing)The need for ResuscitationRemember that it takes 2 Persons to remove a Helmet safelyWe need only to remove full face helmets and only if the above criteria is met, most cycling helmets do not need to be removed in the early stages of an accident.
16Control Of Haemorrhage Catastrophic bleed needs sorting out First, remember a patient may bleed out faster than they will die from a blocked airway.
17Wound Types Contusion (bruise) Laceration – tearing of the tissue Incision – clean cut with sharp knifePuncture – penetrating woundGraze / abrasion – Road RashThe Different types of wounds bruising of Lungs and Brain are life threatening,Laceration is easier to control, straight cuts are harder to control, think of a cut garden hose, blood pours of a vein and pumps out of an artery, leave penetrating objects in place, we will cover road rash now.
19Road Rash These injuries look and feel painful Look beyond the gore Are there underlying injuriesFracturesInternal Injuries/bleedingHead InjuriesThis slide explains what to look for.
20Road Rash Treatment Check for Underlying Injuries Wash out Dirt and GritCover with Clean dressingNeeds scrubbing within a medical centre to prevent scaring and promote healingMoist dressings help the healing processCheck for Infection later on,i.e. redness, hot to touch, swelling in Armpit or GroinThe treatment of road rash.
21Body’s Reaction to Bleeding The body reacts three ways to control bleedingBlood clotsEnds of vessels contractBlood pressure fallsA chemical reaction takes place when red blood cells are damage they clump together to form a clot,if you stretch an elastic band when it snaps the ends curl over and so do human blood vessels, but over time they uncurl and start to bleed, as blood leaves the body there is a drop in pressure, we help the body by raising wounds above the heart providing the limb is not broken.
22Blood Loss P - Posture / Position E - Expose / Examine Remembering we might consider raising the limb and the patient might feel faint it is good practice to either sit or lie the patient down, we then need to see what we are dealing with I.e. penetrating trauma.
23Foreign ObjectsWe cannot see what the end of this object looks like so leave it in place as we do not want to do more damage, increase bleeding or let infection in.
25Blood Loss P - Posture / Position E - Expose / Examine E - Elevate P - PressureContinuing with PEEP we need to raise the un fracture limb or head above the heart and apply direct .or indirect pressure to the wound
26Pressure PointsBrachial – Upper arm, underneath the bicep muscle pressing against the upper arm boneGet students to find this pressure point.
27Pressure PointsAlong side major bones are major blood vessels by pushing the bicep muscle up and away you can normally find the brachial artery.
28Pressure PointsBrachial – Upper arm, underneath the bicep muscle pressing against the upper arm boneFemoral – upper 3rd of the groin pressing the femoral artery against the rim of the pelvis this will take 2 thumbsThe femoral artery is very hard to find and takes a massive amount of pressure to stop the bleed.
29The femoral artery runs over the rim of the pelvis.
30Pressure PointsBrachial – Upper arm, underneath the bicep muscle pressing against the upper arm boneFemoral – upper 3rd of the groin pressing the femoral artery against the rim of the pelvis this will take 2 thumbsApply for Max 10 mins then release for 1 minute to flush the build up of toxins then re-apply if requiredAs the slide says only apply pressure for 10 minutes before considering reapplying it.
31Shock Signs & Symptoms Pale, cool, clammy skin Ashen, cyanosed skin Fast weak pulseRapid shallow breathingNauseaFeeling faint – lower level of consciousnessThese are the signs and symptoms of shock, when the body is under attack it shuts down the outer edge thus keeping the blood in the core feeding the brain, heart and lungs.
32Shock-The Falling Lift Early – Disorientated / ConfusedCompensates by – Fast Pulse- Rapid Breathing- Pale cool Clammy SkinFeels FaintLate Sign – CyanosedLate Sign - UnconsciousnessAs the patient starts to go further into shock the body starts to compensate, the brain starts to lack oxygen and so speeds up the heart rate and breathing and shuts down the skin, once it can no longer cope the patient starts to pass out and goes blue (cyan), the passes out before dying.
33Shock - Treatment Treat the possible cause Loosen tight clothing Rest – comfortable positionReassurance – Nil by MouthConsider raising the legs – Not in Cardiac casesThe role of the first aider is to help the body to help itself.
34Head Injuries Laceration to scalp Concussion – shaking of the brain Compression – Bleeding in skullSkull fracture – cranium / baseHead injury is high in cycling injuries and so the different types are laceration a cut head which bleeds lots and is difficult to dress.concussion of the brain can mask bleeding within the brain, compression means the brain is being squashed and can lead to death, fractures of the skull can lead to bleeding within the brain.
35Levels of Consciousness Alert and responsiveVerbal - Responding to speechPain - Responding to painUnresponsive -No responseThese are most important when dealing with severe head injuriesIt is important to note the initial level of consciousness as this will help to tell the paramedics if the patient is getting better or worse.
36Compression Head Injury Left picture good health no blood in skull and pupils equal, left picture shows bleeding within the skull causing compression of the brain with associated signs.
37Compression Head Injury Bleeding within the Skull compressing the brainLoss of ConsciousnessUnequal PupilsFlushed faceSlow full bounding pulseVomitingTREATMENT = 999 AmbulanceBe Neck Injury AwareCompression can lead to death if not spotted or treated quickly.
38Concussion Shaking of the brain Loss of Consciousness – amnesia VomitingHeadache/dizziness = HospitalBroken helmet = more seriousTreatment, Monitor the Patient for changes, take to hospital if concernedConcussion can mask a brain bleed so should be treated as serious.
39Head Injury Treatment Gain history Monitor AVPU, Breathing, pulse Dress any woundsIf Unconscious A.B.C.Treatment remember the patients level of consciousness is really important.
40Functions of the Skeleton Gives shape and supportProtects internal organsAlong side major bones are major blood vessels / nerves for protectionThis slide is explains some of the functions of the skeleton.
41Classifications of Fractures Closed – the bone is fractured but there is no external woundOpen – there is an external wound leading to the site of the fracture. The bone may be protrudingComplicated – the ends of the bones have damaged underlying organsToday fractures/ broken bones now only come in 3 categories and can be a mixtures of the above.
42Hand InjuriesPicture of different hand injuries at a cyclist might suffer.
43FOOSH-Arm InjuriesFallen on to out stretched hand FOOSH.
44Broken Collar BoneA typical cycling injury can you see the step or drop of the arm.
45Broken Collar BoneAs you can see within the body why we see the step.
46Complications of Collar Bone injury Damage to Underlying Organs- Punctured Lung causing difficulty in breathingDamage to blood vessels- Arteries and veins leading to blood lossDamage to nerves- loss of movement or sensationAlong side major bones are major blood vessels and nerves.
47Signs and Symptoms of Collar Bone Injury Pain over the area of the breakA bump may be felt or a step seenA reddish-purple bruise starts to appearThe shoulder appears to sag or dropInability to raise the arm due to painPeople report a popping or snapping soundSigns and Symptoms of a fractured clavicle.
48Treatment of Collar Bone Injury Look for Underlying problems, breathing or massive swellingApply a sling or at least support the injured sideTreat for shockGive pain relief if availableSend to hospital for an X-RayDo not allow to ride any furtherTreatment for fractured clavicle.
49Leg InjuriesPictures of different types of breaks.
50Signs & Symptoms of a fracture SwellingLoss of movementIrregularityPainDeformityUnnatural movementCrepitusTendernessShockIf along side of bones are blood vessels then they might be damaged causing swelling, damaged nerves means loss of movement, misshapen bones are deformed and irregular, pain comes from misplacement of the ends of the bone, crepitus is felt as the ends of the break grate against each of other, obviously it would be tender and each bone when broken has a shock value, so a fractured upper arm is like loosing 2 pints of blood a fractured fermur is like loosing 4 pints of blood and a fractured pelvis is the same as loosing 10 pints of blood.
51Fractures - Treatment Upper limbs – support in a comfortable position Lower limbs – do NOT move unless life is threatenedLower limbs – do NOT attempt to straighten limbsTreat for ShockDo no harm is the way forward, you can cut off the circulation to a hand or foot by straining a limb.
52Strains & Sprains Strain – history of over stretching - sudden sharp pain- swelling possible crampsSprain – history of twisting a joint- pain at joint- swelling possible discolourationNot all limb injuries involve breaks but without the aid of X-ray sometimes you can’t tell the difference.
53Strains & Sprains Treatment Treatment for bothR.I.C.E.RestIce – bag of frozen peas in a clothCompress – not to tightElevate – to the height of a stoolTreatment of strains and sprains
57Spinal Injuries - Causes Sports accidentsRoad Traffic CollisionsFallsVertical Deceleration InjuryDiving AccidentsHead injuriesDirect force injuriesDifferent causes of spinal injuries
58Spinal Injuries – Signs & Symptoms History is VitalMay be no obvious signs of injuryLack of sensationPins & NeedlesInability to move limbsBack or Neck painNo symptoms present – damage yet to be doneRescuers put more people in wheel chairs than accidents, within the spinal column is the spinal cord which cannot be repaired when damaged.
59Spinal Injuries - Treatment If you suspect a spinal injuryThe Casualty must Not be moved unless their life is threatenedKeep the head still – Trauma Head holdDo not allow others to interfereRemember – there is no second chanceAlways rule out spinal injury when dealing with a traumatic cycling injury.
60Trauma Head HoldThe preferred hold of the suspected spinal injury.
61Spinal InjuriesIf there is Vomit or blood in the Casualty’s airway and it cannot be cleared. Then there is need for a Log Roll to be performedLog Rolls can only be performed safely with 4 persons, one to hold the head and control the rest of the group, there is a need to work as a team and roll the Casualty on to their side as one unit (Log)This is only used when the alternative is death.
63Priorities for CPR D - Danger R - Response S - Stop Life Threatening BleedingA - Airway - be Neck Injury AwareB - Breathing NO dial 999C - Compressions / Rescue Breaths(1 person to hold the head)The new approach to the unconscious patient.The Action button only works if you are also using the BHF Buying Time DVD.as of October 2010 the rate of Chest Compressions is 100 to 120 at a depth of 5 to 6 cm, bystander chest compressions are better than not doing anything.
64Trauma Head HoldWhen performing CPR on the suspected spinal injury, one person to perform the trauma head hold and the second rescuer to perform chest compressions.
66Adult Basic Life Support NotesThe determinant for starting CPR is now a patient who is “Not breathing normally”. This indicates agonal or cheyne-stokes breathing where the heart has alreadyStopped. Agonal breathing is characterised byrespiratory effort in short gasps, with absences in breathing up to seconds in-between gasps.There is no longer an initial 2 ventilations. Once a decision to commence has been made, the rescuer starts with 30 compressions.There are no longer any pulse or circulation checks once CPR has started. The determinant for stopping resuscitation is a patient who is “Breathing normally”.The rescuer has the option to perform compression-only CPR, at a rate of 100 compressions per minute. This is where the need for mouth-to-mouth would previously have prevented people from doing anything.The UK Resuscitation Council recommendation for Life Support, note there is a reluctance for rescuers to start chest compressions as the patient may be gasping in their dying breaths, below 6 breaths per minute the patient IS dying, start Chest Compressions.as of October 2010 the rate of Chest Compressions is 100 to 120 at a depth of 5 to 6 cm, bystander chest compressions are better than not doing anything.
67Effectiveness of Rescuer CPR Number ofCompressionsApproved1 min81.592.9%2 min80.267.2%3 min80.639.2%4 min84.331.3%5 min77.418.0%There is a need to if possible change the person doing the chest compressions every 2 minutes as you quickly lose efficiency.Hightower D: Annals of Emergency. Medic. (1995) Sept 26:3
68ICE in your MobileIt is recommended that you place In Case of Emergency (ICE) in your contacts within your Mobile phoneIt is good practice as Emergency workers like Doctors , Nurses and Paramedic will be able to contact your family if you are Unconscious or Badly injuredPlace Name, Number and relationshipAfter the London Bombing the Emergency Services had difficulty contacting relatives of the Unconscious and Badly Injured and a Paramedic suggested that ICE in your mobile would be a good way of carrying this information as most cyclists will take their mobile out with them in case of breakdown or trouble.
69Really Bad Cycling Injury Helmet Hair Now to add some humour after all this doom and gloom.
71Cycle First Aid by Steve Evans SRPara MCPara Liverpool Century RC Member Steve Evans NHS Paramedic with over 39 years in the Ambulance Service and author of this presentation, Steve is also a member of Liverpool Century Road Cycling Club.