1. 1 FIRST AID REFRESHER November 2010 Susan Baines

2. 2 Contents Changes to guidelines Ringing for help Assessing patients Unconscious and breathing – fainting/seizures Unconscious and not breathing Choking Assessing the walking wounded Soft tissue injuries Fractures Everyday First Aid – bumped head, nosebleed, burns, bleeding

3. 3 Changes to guidelines The Resuscitation Council UK are updating their guidelines but these won’t come into force until April 2011 For untrained bystanders the recommendation is to call for help, ask for an AED (automated external defibrillator) and trainer if possible and commence chest compressions. For trained first aiders the recommendations are the same i.e. compressions and rescue breaths until advised/taught otherwise. New First Aid app available that can be downloaded on iPhone

4. 4 Ringing for help Before anyone rings for an ambulance you need to assess the patient for breathing/consciousness etc so that when you do ring, the ambulance service can grade the incident appropriately and determine which vehicle to send and in what response time When ringing for ambulance if possible give the postcode of where you are

5. 5 Assessing patients Check for danger Check the patient for any response Maintain airway – head tilt, chin lift Look, listen and feel for normal breathing for no more than 10 seconds

6. 6 Unconscious and breathing Assess (breathing normally) – call for help – place in the recovery position Fainting If unconscious, recovery position Raise the legs if possible If conscious, lay flat and raise the legs Do not confuse fainting with loss of consciousness from other underlying conditions Seizures Protect from harm Place something soft under the head DO NOT restrain or put anything in the mouth If possible time the seizure Only call for an ambulance if the seizure is prolonged or multiple seizures occur Stay with the person until fully recovered

7. 7 Unconscious and not breathing Assess (not breathing normally) – call for help – commence CPR Start chest compressions, 30 compressions at a rate of a 100-120/min at a depth of 5-6cm After 30 compressions open the airway again using head tilt and chin lift Give 2 rescue breaths Return to chest compressions immediately Continue with chest compressions and rescue breaths in a ratio of 30:2 DO NOT INTERUPT RESUSCITATION unless the patient starts to regain consciousness AND starts to breath normally

8. 8 Choking It is important not to confuse this emergency with fainting, seizure or other conditions that may cause sudden breathing difficulties and loss of consciousness – you need to ask the question “are you choking” General signs of choking Attack occurs whilst eating Victim may clutch their neck Signs of mild airway obstruction Response to question “are you choking?” Victim speaks and answers yes Other signs Victim is able to speak, cough and breathe Signs of severe airway obstruction Response to question “are you choking?” Victim unable to speak Victim may nod in response Other signs Victim is unable to breathe Breathing sound wheezy Attempts at coughing are silent Victim may be unconscious

9. 9 Adult Choking Treatment (also used in children over the age of 1 year) Assess severity Mild airway obstruction (effective cough) Encourage cough. Continue to check for deterioration to ineffective cough or until obstruction relieved Severe airway obstruction (ineffective cough) Conscious - 5 back blows, 5 abdominal thrusts Unconscious - Start CPR Should you encounter a person with an apparent obstruction who is coughing effectively, DO NOT slap them on the back. Reactions to the slaps may cause the person to inhale the object and cause complete obstruction.

10. 10 Assessing the walking wounded Look  Are they pale/flushed/sweaty  Are they showing signs of pain/discomfort  Are they bleeding from anywhere  Are there any signs of swelling/bruising/deformity  Can they move normally Listen  Can they talk normally  Can they tell you what happened/ what is happening  Are they confused/disorientated

11. 11 Soft Tissue Injuries Sprains – involve over extension of a joint. Can include ligament, blood vessel, nerve or tendon damage. Signs and symptoms Sudden pain in the joint Unable to weight bear Bruising/swelling Tender or painful to touch

12. 12 Strains – involve overstretching of the major muscles of the limb. Tendons attached to the muscle will tear if the muscle is forced to stretch excessively Signs and symptoms Pain increasing with movement A “crack” may be heard as the tendon parts from the bone Swelling if near a joint

13. 13 Treatment RICER Rest Ice Compression Elevation Referral if increase in pain and/or swelling or reduction in movement What to avoid Heat – increases bleeding into affected area Alcohol – increases swelling Running – increases blood flow and can make injury worse Massage – increases bleeding, avoid for first 72 hours

14. 14 Ice Therapy Dangers to be aware of: Never apply ice directly to the skin as it can cause an ice burn Ice should not be applied to the following vulnerable areas as it can cause damage to peripheral nerve tissue:  The neck  The upper part of the collar bone  The bony aspects of the elbow  The front of the hip region  The outer side of the knee Ice should not be applied to the kidney region under the back of the ribs.

15. 15 Fractures Signs and symptoms Pale Cool, clammy skin Rapid weak pulse Pain/ tenderness at injured site Guarding of injured site Loss of power to the limb May be bleeding if there is an open fracture Nausea Deformity Treatment Immobilise limb to reduce movement and pain Will need to go to the hospital

16. 16 Managing everyday incidents Nosebleed Sit the person down with head tilted slightly forward Ask them to pinch the soft part of their nose After 10 minutes check for further bleeding If still bleeding apply pressure for a further 10 minutes If still bleeding severely and not stopped after 30 minutes will need medical attention If bleeding stops advise person not to blow or pick the nose for at least an hour to ensure clot is not dislodged. Burns As soon as possible cool the burn with cold running water for a minimum of 10 minutes Cover the burn with a sterile dressing if necessary For deep burns or minor burns covering a large area, medical attention is necessary

17. 17 Major bleeds Main aim is to stop the flow of blood. Gloves Look at wound to see if anything is embedded in it Ask person to apply pressure to the wound (or around the wound if there is anything embedded) If the wound is on a limb and there is no evidence of fracture, elevate the limb Cover the wound with clean dressing Depending on the wound, steristripping may be helpful Medical help Bleeding (minor) Gloves Observations as above Clean the wound Apply dressing Bleeding

18. 18 Your aim is to prevent injury to the eye. Sit the casualty down facing the light. Ensure you examine every part of the eye, ask the casualty to look up, down, left and right. If you can see an object on the white of the eye: Wash it out using the sterile saline pods – only drop the water on to the white part of the eye. Tip the head back and drop into the corner of the eye Objects under the upper eyelid: Ask the casualty to pull the upper lid down over the lower lid. The lower lashes may brush the object clear. Caution: Do not touch anything that is sticking to or embedded in the eyeball or the iris, the coloured part of the eye. Place an eye pad over the eye. Take or send the casualty to hospital. Foreign body in the eye

19. 19 Minor head injury and knocks to the head are fairly common. Following the injury, if the person is conscious and there is no deep cut or severe head damage, it is unusual for there to be any damage to the brain. If there is any loss of consciousness, medical assistance will be required. Treatment of minor head injuries Ice to any swollen areas If bleeding – treat bleed Observation – vomiting, confusion, dizziness, blurred vision Head injury advice letter/ inform parent as necessary/ refer to hospital as necessary Head Injuries

20. 20 WRITTEN ADVICE FOLLOWING A HEAD INJURY Name …………………………………………… Date ……………….. Dear Parent Your son/ daughter sustained a head injury today at ………. Whilst there are no obvious signs of concussion, it is possible that complications may occur up to 24hrs following injury. If any of the following symptoms occur, take them to the nearest hospital A&E department immediately: Persistent vomiting Increased drowsiness/ dizziness Lack of consciousness or becoming unconscious Confusion Loss of balance or weakness Disturbance of vision Severe persistent headache Any form of fit Any discharge/ bleeding from nose or ears Please ensure that a responsible person is available to observe your son/ daughter for the next 24 hours and is alert for the above symptoms. If you are concerned in any way go straight to hospital S. Baines (School Nurse) This leaflet has been produced for information only and does not cover all possibilities.

21. 21 REMEMBER If you are a qualified First Aider deal with the situation as it arises, ask for assistance from other first aiders as necessary. Please remember to record all incidents that happen in school as accurately as possible on the medical room record sheet.