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Apply First Aid

Queensland Ambulance Service – Apply First Aid eLearning program 1

Queensland Ambulance Service: Apply First Aid eLearning program By Beyondedge

Apply First Aid


Table of Contents

Table of Contents ................................................................................................... 2

Lesson 1 ................................................................................................................. 5

Lesson 1 cont’d ...................................................................................................... 6 Lesson 1.1 – Introduction to First Aid ............................................................................. 7 Lesson 1.2 – Legal Considerations .................................................................................. 8 Lesson 1.3 – First Aid Equipment .................................................................................. 11 Lesson 1.3 – (Helpful Hints) – Call triple zero (000) for an ambulance ........................... 11 Lesson 1.4 – Communicable Diseases ........................................................................... 12 Lesson 1.4 – (Interactive Activity) – Communicable Diseases ....................................... 13

Chapter 2 ............................................................................................................. 15 Lesson 2.1 – Recognizing an Emergency ....................................................................... 15 Lesson 2.2 – Emergency Action Plan ............................................................................. 15 Lesson 2.3 – Priorities At The Scene of a Road Accident ............................................... 19 Lesson 2.3 – (Helpful Hints) – Priorities at the scene of a road accident ........................ 20 Lesson 2.3 – (Interactive Activity) – Priorities at the scene of a road accident .............. 21

Chapter 3 ............................................................................................................. 22 Lesson 3.1 – Danger ..................................................................................................... 22 Lesson 3.2 – Response ................................................................................................. 23 Lesson 3.3 – Send For Help ........................................................................................... 24 Lesson 3.4 – Airway ..................................................................................................... 25 Lesson 3.5 – Breathing ................................................................................................. 26 Lesson 3.7 – Defibrillation ............................................................................................ 28 Lesson 3.8 – Life Threatening Bleeding ......................................................................... 29 Lesson 3.8 – (Helpful Hints) – Severe Bleeding ............................................................. 30

Chapter 4 ............................................................................................................. 32 Lesson 4.1 – Questioning The Casualty & Witnesses .................................................... 32 Lesson 4.2 – Checking the Casualty’s Vital Signs ........................................................... 33 Lesson 4.3 – Head–To–Toe Examination ...................................................................... 35 Lesson 4.3 – (Interactive Activity) – Head–to–toe examination .................................... 37 Lesson 4.3 – (Helpful Hints) – The importance of the secondary survey ........................ 38

Chapter 5 ............................................................................................................. 39 Lesson 5.1 – Chain Of Survival ...................................................................................... 39 Lesson 5.1 – (Interactive Activity) – Chain of Survival ................................................... 40 Lesson 5.2 – What is CPR? ............................................................................................ 41 Lesson 5.2 – (Helpful Hints) – What is CPR? .................................................................. 41 Lesson 5.3 – How Do I Do CPR? .................................................................................... 42 Lesson 5.3 – (Interactive Activity) – How do you perform CPR? .................................... 45 Lesson 5.3 – (Helpful Hints) – Recovery position .......................................................... 46

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Lesson 5.4 – FAQ’s About CPR ...................................................................................... 47 Lesson 5.5 – Introduction to Defibrillation ................................................................... 49

Chapter 6 ............................................................................................................. 54 Lesson 6.1 – Respiratory System .................................................................................. 54 Lesson 6.2 – Asthma .................................................................................................... 54 Lesson 6.3 – Choking .................................................................................................... 57 Lesson 6.4 – Drowning ................................................................................................. 59 Lesson 6.5 – Anaphylaxis ............................................................................................. 59 Lesson 6.6 – Croup ....................................................................................................... 62 Lesson 6.7 – Hyperventilation ...................................................................................... 63

Chapter 7 ............................................................................................................. 65 Lesson 7.1 – Circulatory System ................................................................................... 65 Lesson 7.2 – Angina ..................................................................................................... 66 Lesson 7.3 – Heart Attack ............................................................................................. 67 Lesson 7.4 – Congestive Heart Failure .......................................................................... 68 Lesson 7.4 – (Helpful Hints) – Cardiac Arrest ................................................................ 69

Chapter 8 ............................................................................................................. 70 Lesson 8.1 – Blood and Blood Vessels .......................................................................... 70 Lesson 8.2 – Shock ....................................................................................................... 71 Lesson 8.3 – External Bleeding ..................................................................................... 73 Lesson 8.4 – Internal Bleeding ...................................................................................... 77

Chapter 9 ............................................................................................................. 80 Lesson 9.1 – Digestive System ...................................................................................... 80 Lesson 9.2 – Diabetes .................................................................................................. 80 Lesson 9.3 – Acute Abdomen ....................................................................................... 82 Lesson 9.4 – Nervous System ....................................................................................... 82 Lesson 9.5 – Fainting .................................................................................................... 83 Lesson 9.5 – (Interactive Activity) – Fainting ................................................................ 83 Lesson 9.6 – Stroke ...................................................................................................... 84 Lesson 9.6 – (Interactive Activity) – Stroke ................................................................... 85 Lesson 9.7 – Seizures ................................................................................................... 85

Chapter 10 ........................................................................................................... 89 Lesson 10.1 – Musculoskeletal System ......................................................................... 89 Lesson 10.2 – Fractures ................................................................................................ 90 Lesson 10.2 – Bandaging techniques ............................................................................ 92 Lesson 10.3 – Dislocations ........................................................................................... 92 Lesson 10.4 – Soft Tissue Injuries – Bruises, Strains and Sprains ................................... 93 Lesson 10.4 – (Interactive Activity) – Bruises, sprains and strains ................................. 93

Chapter 11 ........................................................................................................... 95 Lesson 11.1 – Concussion ............................................................................................. 95 Lesson 11.2 – Head injuries .......................................................................................... 95 Lesson 11.3 – Spinal Injuries ........................................................................................ 98 Lesson 11.4 – Tooth and Gum Injuries ........................................................................ 100 Lesson 11.4 – (Helpful Hints) – Tooth and gum injuries .............................................. 100 Lesson 11.5 – Eye Injuries .......................................................................................... 100

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Lesson 11.6 – Ear Injuries ........................................................................................... 102 Lesson 11.7 – Jaw Injuries .......................................................................................... 103

Chapter 12 ......................................................................................................... 104 Lesson 12.1 – Chest Injuries ....................................................................................... 104 Lesson 12.2 – Common Chest Injuries ........................................................................ 104 Lesson 12.2 – (Interactive Activity) – Common chest injuries ..................................... 107 In this activity you need to drag and drop the dressing into the correct position. When you have dressed the wound correctly the green tick will appear, confirming the placement of each item. .................................................................................................................. 107 Lesson 12.3 – Pelvic Injuries ....................................................................................... 108

Chapter 13 ......................................................................................................... 110 Lesson 13.1 – Poisons ................................................................................................ 110 Lesson 13.1 – (Helpful Hints) – Poisons ...................................................................... 113 Lesson 13.2 – Bites and Stings .................................................................................... 113 Lesson 13.2 – (Interactive Activity) – Bites and stings ................................................. 122

Chapter 14 ......................................................................................................... 124 Lesson 14.1 – Overexposure To Cold .......................................................................... 124 Lesson 14.2 – Overexposure to heat .......................................................................... 127 Lesson 14.3 – Burns ................................................................................................... 130

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Lesson 1 INTRODUCTION – APPLY FIRST AID Hello and welcome to the Queensland Ambulance Service, “Apply First Aid” program. This first aid program will give you crucial information on the theory and practice of first aid. The course consists of two parts: The first involves successful completion of this theory based, interactive and flexible learning program. The second will require you to attend a practical “Apply First Aid” training session conducted by Queensland Ambulance Service to be accredited to perform first aid. One of the benefits of you successfully completing your first aid training is that the statement of attainment provides liability insurance protection. This insurance protects you in the highly unlikely event of litigation following first aid intervention. We hope you enjoy it, and thank you for taking this important step in equipping yourself with the knowledge to save lives.

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Lesson 1 cont’d INTERACTIVE INSTRUCTIONS Let’s take a moment now to talk about how this program works: I’ll guide you through the various chapters, which contain lessons made up of theory, demonstration videos and interactive components. The grey panel below contains most of the navigation and setting buttons you need to control this eLearning program. After the lesson has completed downloading you can find navigational points by rolling your mouse over the timeline. Cue-‐tips will be revealed describing the content covered at these particular points. If you ever need to pause or to resume the lesson, use the pause/play button found below the timeline. To move forward in a chapter, click the ‘next’ button found to the right of the play/pause button. If you didn’t quite understand what was just covered you can always use the ‘back’ button found to the left of the play button. The next button labelled with the speaker icon allows you to adjust the volume. To quickly navigate to a specific lesson or chapter, use the menu button found on the bottom left. Here you make your selection from the pop up menu – this is great for when you need to revise a particular topic. If you ever need to exit or close the program down, make sure to only use the ‘ EXIT’ button found on the bottom right hand side. This will ensure that your progress is recorded so when you log-‐on again you can continue where you had left off. If this is the first time you’ve used this interactive course, it is recommended you progress in a sequential manner, that is, do one lesson at a time in the order that they appear. Along the way, I’ll give you some fun interactive activities to help you engage with & apply the information you’ve learnt. At the end of each chapter, there will be a quiz to help test your knowledge… so feel free to take notes or to review the chapter to make sure you understand each one before moving ahead.

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As you progress through the course, you’ll unlock a number of ‘helpful hints’ – these helpful hints will give you useful insights, advice and personal experiences from people who know their stuff. On successful completion of all chapters and assessment quizzes, you’ll need to print out a theory completion record for this part of your course. This record will allow you to progress to the practical training part of the course. If you missed something in these instructions remember you can click back to replay what was just covered. OK, now that you know how to use and navigate this course. Let’s get started.

Lesson 1.1 – Introduction to First Aid INTRODUCTION Hello and welcome to Chapter One. In this chapter you’ll learn about the general principals of First Aid, including legal considerations, first aid equipment and communicable diseases. Don’t forget: There will be a quiz at the end, so take your time and make sure you understand each lesson before progressing forward. In this course, we will refer to the ill or injured person as the casualty; or sometimes, we’ll ask Frank to assist – he’s our stand–in for the casualty. Say hello Frank. Frank has the unique ability to turn transparent to show you how first aid can have a direct positive medical impact to your casualty. Frank will also volunteer his services in some interactive activities, which we will talk about later. Thanks Frank. Also, throughout this course we will refer to ‘you’ as the ‘first aid provider’. Let’s start with understanding the basics. Firstly, what is First Aid? Well, as the name suggests, First Aid is the earliest care given to someone who is ill or injured. It can be administered by anyone with proper training, from an ordinary person to more advanced medical practitioners, like doctors, nurses and paramedics. For minor incidents, First Aid may be all that is required to assist a full recovery. In more serious situations, First Aid can greatly increase the chances of a positive outcome for casualties. Ok, so why do we need to know first aid?

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Well, the primary objective of First Aid is to:

Preserve life Protect the unconscious Prevent a casualty’s condition from becoming worse and Promoting the recovery of the casualty

You should aim to prevent:

Damage to yourself or bystanders Make sure the casualty’s condition does not worsen Avoid delays that could affect the casualty’s recovery and Protect the casualty from harmful intervention.

First Aid can take many forms, such as reassuring a casualty, treating the casualty and contacting the ambulance service. In critical situations, it may involve giving cardiopulmonary resuscitation (or CPR) – all of which may help to save a life. In emergency situations, it is often the quick but simple actions of someone applying First Aid that ensures a casualty has the best chance of making a full recovery. Although there is no way of anticipating an emergency situation, First Aid training is the best preparation you can have in the event that someone becomes ill or injured and requires assistance. RECAP Recaps will appear at the end of every lesson and will give you a list of the keynotes from that lesson. In this lesson: The primary objectives of First Aid are to:

Preserve life Protect the unconscious Prevent a casualty’s condition from becoming worse, and Promoting the recovery of a casualty

Lesson 1.2 – Legal Considerations Here you are at the scene of an emergency. Do you know what your legal obligations are? So let’s deal with this issue right now: A common concern that people have about administering First Aid is the risk of legal liability, which could arise from assisting an injured or ill person. It’s important to consider all the legal implications in some detail, so that you do not feel apprehensive about offering assistance.

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Once you know how the law works, you should feel confident in your approach to situations that require First Aid. It should be noted that in Australia to date, there has never been any successful legal action brought against someone who was trying to administer First Aid to a person in need. Therefore, when you work within the guidelines of your current first aid training and act carefully with full and proper consideration for the welfare of the casualty, you should feel confident in applying first aid. Remember, in life threatening situations, any form of assistance is likely to be of greater benefit than no assistance at all. One of the benefits of you successfully completing your first aid training with the Queensland Ambulance Service is the statement of attainment provides liability insurance protection. This insurance protects you in the highly unlikely event of litigation following first aid intervention. Here are some basic legal expectations you should know and comply with. Before administering first aid, you must obtain the consent of the casualty to begin first aid. This is to preserve their right to refuse any unwanted form of personal contact. A casualty’s consent is valid when:

Their decision is made voluntarily Their decision is informed Their decision covers the first aid treatment to be performed, and They have the capacity to provide consent.

It is not uncommon to come across a person who, due to injury or illness, is unable to consent to the first aid treatment being offered. Lets talk about ‘Capacity to consent’ in some detail: People who are considered to lack adequate capacity to provide consent include:

A person who has diminished ability to understand or communicate the nature and consequences of their decision, for example, a casualty who is unconscious or confused.

A minor, who in Australia or New Zealand is someone under 18 years of age

If you do not live in these countries, please check your local laws for information on the age limit of minors. If the casualty is a minor, then attempt to get permission

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from their parent or guardian to apply first aid. If they are not with the minor, or treatment will be delayed whilst seeking their consent, then consent can be inferred. However, it is important to remember, if a casualty cannot provide direct consent and First Aid could prevent death or serious injury, then the general principals governing consent may not apply, as it assumed the casualty would agree to being helped. For some employees with First Aid training, it is expected that they will offer assistance to their workmates should the need arise. This was known as “duty of care” but is now referred to as obligation. It is expected that you will always operate within the guidelines of their first aid training and with consideration for the welfare of the casualty. Under Australian law, a First Aid provider is not compelled to render assistance unless they are under obligation. In accordance with Queensland law, there is an obligation imposed on the driver of a motor vehicle involved in a road traffic crash. They are required to:

Stop at the scene Render any assistance to the best of their ability and Call for medical assistance

If you decide to provide assistance, you are then obligated to continue the treatment until: The casualty recovers, more advanced carers arrive, the accident scene becomes a danger to you or the casualty refuses treatment. A breach of obligation occurs when you as a First Aid provider fails to act in accordance to your first aid training. It can be determined that you have breached your obligation of care if you have provided first aid outside of the limits of your first aid training and you have not remained with the casualty until more experienced medical care arrives. These expectations may be affected, however, by the conditions and circumstances by which the first aid care is provided. Allowance maybe made for the particular stress of a situation. For example, the expectation of a single first aid provider at a multi casualty incident may be different to the provision of first aid to a single casualty. RECAP So, in summary, the legal expectations of you as a First Aid provider is:

To obtain consent of the ill or injured, where possible and To render assistance carefully, having regard for their level of skill and the

circumstances in which they have rendered assistance.

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Lesson 1.3 – First Aid Equipment Okay, so now that you understand what First Aid is and the legal aspects you need to consider, let’s take a look at some of the equipment you are likely to use. The most common accessory is a First Aid kit, and having one on hand means you will always be prepared to respond to accidents and emergency situations. First Aid can be performed with whatever equipment is available. Ideally a first aid kit, with sterile supplies and a variety of dressings and bandages however, in an emergency situation you may need to improvise. For example, you could use a clean towel or a jumper in the treatment of your casualty; which will be better than not using anything at all. In more serious incidents such as cardiac arrest, Automated External Defibrillators (or AED’s) may be required. They are intended to be used by everyday people in the home, workplace and community. An AED is a portable electronic device that assists the heart to regain its normal, healthy rhythm, which is necessary for a casualty to survive cardiac arrest. You may re–start the heart by using a defibrillator to give an electric shock. Defibrillation increases the casualty’s chances of survival when combined with immediate and effective CPR. RECAP Remember, being prepared with first aid equipment is important. So contact the Queensland Ambulance Service for more information on first aid kits, automatic external defibrillators and oxygen resuscitation equipment.

Lesson 1.3 – (Helpful Hints) – Call triple zero (000) for an ambulance I’d like to go through some of the questions that are asked when ringing for an Ambulance and to explain to you the importance of why we ask those questions the two first questions that we ask are the most important questions, they are; Where are you? What suburb are you at? Know where your at, where you are so we can send a Ambulance there if you don’t know where you are I can’t send you an Ambulance. The second most important thing is what is the phone number that you are calling from so if the line disconnects, or I need to call you back to get some more details then I’ve got a phone number that I’m able to contact you directly on. Those are the two most important questions without those we cannot get an Ambulance to you, the next question we will ask is what’s the problem tell me exactly what’s happened? We will also ask the age of the patient, will also ask whether they are male of female? Are the conscious? Are they breathing? People often stumble over are they conscious do you have an understanding of what that means that means are they awake are they alert are they able to respond to you in some way and then the next one is are they breathing.

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The reason why we will go through and ask these different questions is so that we can get the right Ambulance to you with the right skilled paramedic onboard we have paramedics that have different skills and depending on what condition you have will determine what style of paramedic you will get.

Lesson 1.4 – Communicable Diseases So, you arrive at the scene of accident and you are ready to administer first aid. But are you aware of the risks posed by communicable diseases? Communicable diseases are diseases that can be spread from one person to another. They may be in the form of bacteria, viruses, fungi, mites or lice. Some examples include:

Colds and flu Measles or mumps Various strains of Hepatitis HIV infection Herpes, and Some forms of Meningitis.

Communicable diseases are transmitted by the transfer of body fluids and other body micro–organisms, such as:

Blood Saliva Vomit Urine, and Faeces

So how are diseases transmitted? Let’s talk about how communicable diseases are spread; which is the means by which communicable diseases can spread between people. Firstly,

Droplet / airborne transmission: This occurs when droplets of fluid escape from the nose or mouth of an infected person during a sneeze or cough.

Other airborne transmission:

This can be a form of droplet transmission, but it can also occur when microorganisms are carried by air currents through ventilation or air conditioning systems.

Transmission by contact:

Viruses and germs can cause infection when contaminated blood or body fluids come into direct contact with skin, eyes or mucous membranes,

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such as the inside of the mouth or nose. Infection can also occur indirectly by contact with blood–soaked contaminants, such as bandages and clothing.

Vector–borne transmission: Contaminated objects, including hypodermic needles, fall within this category, as do living micro–organisms such as mosquitoes. These are referred to as vectors. Examples of vector–borne infections include Malaria, Dengue Fever and Ross River Fever.

You need to protect yourself and casualties from communicable diseases by minimizing contact with blood and other bodily fluids. There are standard precautions that can be followed to ensure safety, however a good rule of thumb is to treat all blood and bodily fluids as contaminated, and act accordingly. Therefore, wherever possible, you should:

Wear Personal Protective Equipment (PPE) such as gloves, boots and goggles Avoid contact with objects that may be contaminated Wash your hands thoroughly with soap and water before and after

administering First Aid Cover your own exposed cuts and grazes with waterproof dressings Avoid eating, drinking and other forms of hand–to–mouth contact whilst

administering first aid Change gloves before handling different casualties to minimize the possibility

of cross–infection between casualties And seek medical aid as soon as possible if contamination by infected blood

or body fluids occurs RECAP Communicable diseases can be spread in a number of ways:

Bodily fluids Through the air Through direct contact and By contaminated objects

You should always ensure you wear the right protective clothing and follow proper hygiene procedures.

Lesson 1.4 – (Interactive Activity) – Communicable Diseases Welcome to your first activity. Throughout this course, there will be a number of places where you will get a chance to apply your knowledge with an activity. These activities are not assessed – They are just a way for you to check your application of the concepts covered.

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Now that you’ve learnt about cross infection, let’s take a look at a couple of videos together. Watch the video and notice the First Aid Provider is performing a procedure that increases the risk for cross–contamination Write down any incorrect procedures you notice. Write down any incorrect procedures you notice. Then at the end of the clip, you’ll get a list of possible risks. Use the mouse to tick off all the risks you’ve detected during this scene. You can ‘Pause” the video to write down the risks or simply replay the clip as many times as you like. Depending on your result you may wish to try again. You will then be shown the video showing the correct procedure on how to avoid cross contamination. OK, ready to go? QUIZ That’s the end of chapter one, so it’s time to take a quiz. Remember, if you get a question wrong, you can repeat your answer until you get it correct. You will need to successfully complete all questions in this chapter. Ready to go?

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Chapter 2 Lesson 2.1 – Recognizing an Emergency Hello and welcome to Chapter two. In this chapter you will learn how to recognise an emergency situation, how to formulate an emergency action plan and what the priorities are at the scene of a road accident. The first step in responding to an emergency is to ‘recognise’ there is an emergency situation. An emergency situation is when someone requires immediate medical assistance. This is usually either a medical emergency from a sudden illness, such as someone suffering chest pain, or a traumatic emergency, like someone fracturing their arm after a motor vehicle incident. An emergency can happen anywhere and at anytime, so preparation is the key.

Lesson 2.2 – Emergency Action Plan Many variables exist in emergency situations and First Aid treatments could be critical in preventing a casualty’s condition from deteriorating before paramedics arrive at the scene. Knowing in advance just what to do and when to do is the key to helping you to stay calm and manage the initial apprehension you may feel in an emergency. After recognising an emergency situation, a systematic approach must be applied. It’s called an Emergency Action Plan. The steps are as follows:

Surveying the scene Determining whether the scene is safe Phoning for help Assess for life threatening injuries, and Conducting a secondary survey.

By following the steps in the emergency action plan, you are ensuring that the needs of the casualty and the situation are correctly prioritised. It is also less likely that important information about the casualty’s condition, or the emergency will be missed. Ok, so what’s a scene survey? Put simply, it is an overall evaluation of the situation that is made by you before any action is taken to help a casualty. It is mainly concerned with recognising hazards

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and determining the information that will be required when a call is made to activate ambulance services. So how do we go about surveying a scene? The process of surveying an emergency scene involves:

Determining if the scene is safe Taking reasonable steps to reduce the risk of existing hazards Determining what has happened Determining how many casualties are involved and the nature of their

injuries, and And using bystanders to call for help, if possible

Hazards at the scene of an accident or medical emergency are identified and gauged according to the risk they pose to each of the three categories of people likely to be present. In order of priority, these are:

The First Aid provider (that’s you) Any bystanders And the casualty

It may be the case that you are the only person capable of rendering assistance or calling for help and, as such, you must ensure not to endanger yourself and become an additional casualty. Bystanders should be warned about any dangers and kept at a safe distance to ensure they do not become casualties. Once the scene is considered safe, bystanders can be asked to assist if needed. Any hazards that may be present should be removed or controlled in such a way that will prevent further injuries, but only if it is safe to do so. It is also a good idea at this point to have a quick look around to ensure that there are no dangers developing. Situations involving hazards that are not easily controlled should be left for the attention and management of emergency service personnel who have the specialised training and equipment necessary to deal with them safely. The kinds of danger that need to be considered at an emergency scene can take many forms, such as traffic, used syringes, fallen power lines, fire, extreme weather, leaking fuel or gas, toxic fumes, unstable structures, bodies of water, poisonous substances, dangerous animals and the unpredictable actions of bystanders. Casualties also pose a danger to the first aid provider with the potential for the transmission of communicable diseases. To reduce the risk of transmission of communicable disease, use proper personal protection when available. You can refer to the previous chapter if you need a refresher.

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Things to consider if the casualty has to be moved: Avoid bending or twisting the casualty’s neck and back. Remember, spinal

injuries can be aggravated by rough handling. Try to have three or more bystanders to assist in the support of the head

and neck, the chest, the pelvis and limbs. If no bystanders are present, the first aid provider may need to drag the

casualty to safety (either with an ankle drag or arm-‐shoulder drag depending on the situation).

Once it has been determined that the scene is safe, it is important to establish what has actually occurred. If you have not directly witnessed events leading to the emergency, any bystanders should be asked whether they saw what happened. If nobody has witnessed the incident, search for clues to work it out. It is important to have an understanding of how the emergency situation came about in order to know what kind of first aid is most likely to be needed. It will also form the basis of the information that will be provided to paramedics when they arrive. It is important to look thoroughly around the scene of an emergency incident to determine how many casualties are involved. This information will be required by the ambulance service, and will help you to establish priorities. When approaching a scene, look carefully for more than one casualty. At a road traffic accident, always look under the passenger side dash and in the back seat floor area, to ensure that no casualties, particularly small children and infants, have slipped forward off the seats. Also check the surrounding area to ensure that no casualties have been thrown from a vehicle. Use bystanders if possible to help you, or ask them to call triple zero (000) to activate the ambulance service. Bystanders can act as traffic control until the police service arrive, direct emergency services to the scene and assist with the treatment of a casualty. If there are no bystanders immediately present, you can shout out to try and attract the attention of someone who can help you. In any emergency situation involving sudden illness or injury, it is essential that the ambulance service be contacted as soon as possible. Remember, First Aid is interim assistance until more advanced medical care can be provided. Serious cases need qualified medical attention without unnecessary delay. In some circumstances, such as emergency situations at which bystanders are present, it is possible to call for an ambulance prior to determining whether the scene is safe. By getting a bystander to call triple zero for an ambulance, it enables you to remain with the casualty and provide ongoing care. If the person making the call to the ambulance service has to leave the scene, it is important that they know to report back once the call is made. They may be able to

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offer other forms of assistance to you once the call for ambulance assistance has been made. For example, conveying any treatment advice that may have been offered by the emergency medical dispatcher receiving their call. When a call is made to the Ambulance Service, a trained emergency medical dispatcher will ask the caller a number of questions. The questions are likely to include the following:

What is the exact location of the incident/accident? What is the phone number from which you are calling? What has happened? How many people are sick/injured? What is the nature of the casualty’s injuries? Are you with the casualty now? How old is the casualty? Is the casualty conscious? Is the casualty breathing?

Make sure you remain calm and your responses are clear and concise. The emergency medical dispatcher will dispatch the ambulance paramedics and provide you with First Aid advice. Remember not to end the call until you are told to do so by the emergency medical dispatcher. Now let’s look at assessing for life threatening injuries. This step involves the assessment of and response to the casualty’s vital signs and life threatening conditions that could lead to loss of life. The first thing you should check

Is a casualty’s response Then their airway And if they are breathing normally. After these vital signs have been assessed, it is important to then check for

any life threatening bleeding. So what is a secondary survey? A secondary survey allows a more thorough and systematic examination of the casualty conditions or injuries that were not initially apparent. Do not commence a secondary survey if any life–threatening conditions are present. You will learn more about how to conduct a secondary survey in Chapter 4. RECAP So, in summary, the Emergency Action Plan is: Survey The Scene

Is the scene safe?

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What happened? How many casualties are there? Are there any bystanders to help? Determine whether the scene is safe For yourself Bystanders, and The casualty.

Call triple zero and ask for the ambulance service

Listen carefully to the emergency medical dispatcher Give the exact location Give the call back phone number Provide incident details and the casualty’s condition. If possible, send a

bystander to make the call. And remember to hang up last.

Assess For Life Threatening Injuries

Response Airway Breathing normally Severe bleeding

Conduct A Secondary Survey

Question the casualty and bystanders Check vital signs Conduct a head–to–toe examination

Lesson 2.3 – Priorities At The Scene of a Road Accident Now that you have learned how to formulate an Emergency Action Plan, let’s have a look at how you can manage a road accident. It’s important to note that one of the biggest life threatening risks to casualties of road accidents is obstruction of their airway. Okay, here’s how you should approach a traffic accident:

Conduct a scene survey. Determine whether the scene is safe. Remove or control any hazards if safe to do so.

– This includes turning off the ignition of a crashed vehicle – Warning approaching vehicles

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– Not touching a vehicle, or attempting to rescue a person from within six metres of a fallen high voltage power line unless the electricity authority has declared the area safe – Warning the casualties and bystanders not to smoke.

Determine the number of casualties and the nature of their injuries. Call triple zero for help. Assess and assist the injured casualties

– Firstly, go to any unconscious casualties and assess for life threatening injuries. – If the person is unconscious and trapped in the vehicle, the casualty’s airway must be cleared of foreign material, and then head tilt and jaw support should be maintained. – Attending to any conscious casualties – Carefully assist any casualties from the vehicles – Stopping any bleeding – Immobilizing any obvious fractures – Rest and reassuring the casualty, and – Regularly monitoring and recording vital signs, including pulse, breathing, level of consciousness and pupil reaction.

RECAP For a road traffic accident you should:

Conduct a scene survey. Determine whether the scene is safe. Remove or control any hazards if safe Determine the number of casualties and the nature of their injuries. Phone for help. Assess and assist the injured casualties. You should always ensure you wear the right protective clothing and

follow proper hygienic procedures.

Lesson 2.3 – (Helpful Hints) – Priorities at the scene of a road accident Yeah, well if you do come across a motor vehicle accident my advice would be that you stay a safe distance away from the incident; preferable behind the incident two to three vehicle distances away, put your hazard lights on and then approach the scene if it is safe to do so to see if anyone needs assistance. If you’re on a highway or a motorway where there is a fair amount of traffic. If you can the assistance of a truck driver to use his truck as a barrier between the accident scene and oncoming traffic put his hazard lights on and maybe put out his hazard markers further back. That would be the safest way to approach a motor vehicle accident.

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The information the emergency services would require would be if there was any chemicals involved we need to look for things known as HAZCAM indicators or markers on the trucks in particular. There a diamond shape marker or sign on the truck and all you need to do is quote the numbers that are and the chemicals mentioned to the Ambulance service if you ring them first you also need to check to see how many people were involved in the accident is anybody trapped in particular because will notify the QLD Fire and Rescue Service to also attend and come out with there jaws of life to help extricate the patient from the vehicle.

Lesson 2.3 – (Interactive Activity) – Priorities at the scene of a road accident Now that we have learnt all about the hazards at the scene of a road accident it’s time to test your knowledge with another activity. Remember these activities do not count towards your final score, so you can relax. In this activity you required to analyse the accident scene and identify the possible hazards. Simply click on any areas that you think is a priority until you have found them all. Pop-‐up descriptions will appear when you roll over items. A running tally of how many priorities will need to be found is located below the timer. Don’t forget; you are also racing against the clock, just like you would in real life. If you do run out of time don’t worry you have the option to try again or have all the priorities areas automatically revealed. Ok, Ready to go? QUIZ That’s the end of chapter two, so it’s time to take a quiz. Remember, if you get a question wrong, you can repeat your answer until you get it correct. You will need to successfully complete all questions in this chapter. Ready to go?

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Chapter 3 INTRODUCTION Hello and welcome to chapter 3. In this chapter you will learn how to assess for life threatening injuries using the steps of the basic life support flowchart. A life-‐threatening injury is an injury that could possibly be fatal to the casualty if first aid is not applied as soon as possible. As you arrive at the scene of an incident you should remember the following steps by using the acronym D.R.S.A.B.C.D or Doctors A.B.C.D. That stands for: 1. Danger 2. Response 3. Send for Help 4. Airway 5. Breathing 6. CPR 7. Defibrillation These steps, as well as how to treat life-‐threatening bleeding, will be covered in more detail throughout the chapter.

Lesson 3.1 – Danger The first step after arriving at an emergency situation is to assess the incident for DANGER, as discussed earlier in Chapter Two. It is important to survey the scene and determine whether there are any dangers or hazards to you, the casualties or any bystanders. The kinds of danger that need to be considered at an emergency scene can take many forms, such as traffic, used syringes, fallen power lines, fire, extreme weather, leaking fuel or gas, toxic fumes, unstable structures, bodies of water, poisonous substances, dangerous animals and the unpredictable actions of bystanders. Any hazards that may be present should be removed or controlled in such a way that will prevent further injuries, but only if it is safe to do so. It is also a good idea at this point to have a quick look around to ensure that there are no dangers developing.

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Situations involving hazards that are not easily controlled should be left for the attention and management of emergency service personnel who have the specialised training and equipment necessary to deal with them safely. Once the incident has been deemed safe, you can begin to start assessing the casualty for life-‐threatening injuries using the RESPONSE method.

RECAP So remember: Check for DANGER

Your safety is the first priority so survey the scene for dangers and developing dangers before attending to casualties.

Only remove hazards if it is safe to do so, otherwise, leave it for emergency services personnel

Lesson 3.2 – Response The first step in assessing for life–threatening injuries is to determine the casualty’s level of consciousness, often indicated by their ability to respond. Initially, this should be done through the “talk and touch” method, ensuring that you do not aggravate any injuries. You should never shake casualties when checking for their response, especially infants or children. Checking for a response should only incorporate gentle touching and loud talking. A good way to remember the questions and directives that enable you to assess response is the acronym COWS:

– Can you hear me? – Open your eyes – What’s your name? – Squeeze my hands

There are three levels of consciousness: Conscious:

A state in which a person responds normally to questions and requests, such as those relating to the day, date, time and where they are

Altered level of conscious:

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A state in which a person responds to questions in a way that indicates they may be confused, disoriented, have altered thinking or a marked impairment of awareness

Unconscious: A state in which a person is not able to respond at all

A casualty who responds normally is conscious and breathing. At this point, you should identify yourself and obtain consent to apply first aid. It’s a good idea to ask the casualty their name, as using it will reassure them while you assess their injuries. A casualty who does not respond could be unconscious and, if so, is likely to be in a life–threatening situation. The two main concerns for an unconscious casualty are that they are unable to protect themselves from any danger and that they are unable to manage their own airway. When the respiratory system is not functioning effectively there is a disruption in the supply of oxygen to the brain. This can lead to unconsciousness in a few seconds and permanent brain damage in just minutes. If the casualty is unresponsive, call triple zero to request ambulance assistance, then assess for a clear airway and whether or not the casualty is breathing normally. RECAP So to recap: Check responsive; use the COWS method:

– Can you hear me? – Open your eyes – What’s your name? – Squeeze my hands

Three Levels of Consciousness:

Conscious – responds normally to questions and requests Altered level of conscious – responses to questions indicate they may be

confused and disoriented Unconscious – a state in which a person is not able to respond at all

Lesson 3.3 – Send For Help Once you have identified that the casualty is in a life-‐threatening situation, you must call triple zero (000) immediately for assistance.

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In any emergency situation involving sudden illness or injury, it is essential that the ambulance service be contacted as soon as possible. Remember, First Aid is interim assistance until more advanced medical care can be provided. In some circumstances, such as emergency situations at which bystanders are present, it is possible to call for an ambulance prior to determining whether the scene is safe. By getting a bystander to call triple zero for an ambulance, it enables you to remain with the casualty and provide ongoing care. If the person making the call to the ambulance service has to leave the scene, it is important that they know to report back once the call is made. They may be able to offer other forms of assistance to you once the call for ambulance assistance has been made. If there are no bystanders immediately present, you can shout out to try and attract the attention of someone who can help you. RECAP So to recap, remember:

Send for Help First Aid is only interim assistance so it is essential to call 000 for

assistance. If possible, get a bystander to call triple zero for an ambulance as it

enables you to remain with the casualty and provide ongoing care. And if there is no bystanders immediately present, you can shout out to

try and attract the attention of someone who can help you.

Lesson 3.4 – Airway Now that you’ve learned how to check for response, it is important to learn how to check a casualty’s airway. Start by looking in the mouth for foreign bodies such as food, loose dentures or fluid. DO NOT TILT THE HEAD BACK UNTIL THE MOUTH IS CLEARED OF ANY FOREIGN MATERIAL. Let me repeat that: DO NOT TILT THE HEAD BACK UNTIL THE MOUTH IS CLEARED OF ANY FOREIGN MATERIAL. Otherwise, you risk blocking the airway with this foreign material.

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Dentures should only be removed if loose or if they could possibly cause an airway obstruction. If secure, leave the dentures in place as it will help to ensure a good seal if rescue breathing is necessary. If water, vomit, blood or other fluid obstructs a casualty’s airway, place the casualty in the recovery (or side) position, sometimes referred to as the lateral position, which results in a sideways, slight downward tilting of their face. This position uses gravity to move the tongue away from the airway and assists with the draining of liquids from the mouth and also allows you to use the finger–sweep technique to clear the airway. The finger–sweep technique utilises the index and middle fingers to perform a sweeping action in the casualty’s mouth to remove the foreign body. And remember, do not probe during the process of clearing an airway, as it may push foreign material further into the airway and make it more difficult to clear. RECAP So let’s recap:

Check the airway First check for foreign bodies in the casualty’s mouth Do not tilt the head back until the mouth is clear of any foreign material Clear the mouth using finger sweep technique Do not probe during the process of clearing the airway

Lesson 3.5 – Breathing The next step in the basic life support process is breathing. Once it is established that the casualty’s airway is clear, you should then check if they are breathing normally. This is done through the look, listen and feel technique:

– Look for the rise and fall of the chest by placing your hand on the casualty’s stomach – Listen for the movement of air by placing your ear near their nose and mouth – Feel for the movement of air from the nose and mouth against your cheek.

If the casualty is breathing normally, and not already in the lateral or recovery position, then move them into this position, taking great care to avoid twisting the head, neck or spine. Remember, establishing and maintaining a clear airway always takes precedence over any injury, including a suspected spinal injury. To move someone into recovery position:

Move the casualty’s arm that is furthest away from you out to the side of the casualty

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Place the casualty’s arm that’s closest to you over the casualty’s chest Lift the casualty’s leg by bending the knee that’s closest to you. Grasp the casualty’s shoulder that’s closest to you and place the other

hand on the casualties hip Gently roll the casualty away from you, keeping the casualties head, neck

and spine straight Position the casualty so their hand and bent knee supports them in the

recovery position, and Gently tilt the casualty’s head slightly back and downwards to allow for

drainage

While the casualty is on their side in the recovery position, it is important to regularly check their airway and breathing. You should then immediately check for any life threatening bleeding. If any life threatening bleeding is found, then control it immediately. You should also commence a secondary survey while you wait for paramedics to arrive. RECAP So to recap, to check for breathing you:

– Look for the rise and fall of the chest by placing your hand on the casualty’s stomach – Listen for the movement of air by placing your ear near their nose and mouth – Feel for the movement of air from the nose and mouth against your cheek

To move someone into recovery position: • Move the casualty’s arm that is furthest away from you out to the side of the casualty • Place the casualty’s arm that’s closest to you over the casualty’s chest • Lift the casualty’s leg by bending the knee that’s closest to you. • Grasp the casualty’s shoulder that’s closest to you and place the other hand on the casualty’s hip • Gently roll the casualty away from you, keeping the casualties head, neck and spine straight • Position the casualty so their hand and bent knee supports them in the recovery position, and • Gently tilt the casualty’s head slightly back and downward to allow for drainage

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Lesson 3.6 -‐ CPR The next step in the D.R.S.A.B.C.D method is CPR or Cardiopulmonary resuscitation. If you have determined that the casualty is not breathing normally and is unresponsive it means they are in cardiac arrest and you will need to commence CPR as soon as possible. CPR requires the First Aid Provider to administer 30 chest compressions at a rate of 100 compressions per minute followed by 2 rescue breaths to the casualty. These are to be repeated until paramedics can take over, the casualty becomes responsive and starts breathing normally, it becomes impossible for you to continue or there is a danger to yourself. If the casualty starts breathing normally but remains unresponsive, roll them into the recovery position and monitor their breathing. It’s a good idea, if available, to have two people performing CPR on a casualty, as to prevent fatigue of the first aid provider. RECAP

If the casualty is not breathing normally and is unresponsive, commence CPR as soon as possible.

CPR requires 30 chest compressions followed by 2 rescue breaths to the casualty.

These are to be repeated until paramedics can take over, the casualty becomes responsive and starts breathing normally, it becomes impossible for you to continue or there is a danger to yourself.

If the casualty starts breathing normally but remains unresponsive, roll them into the recovery position and monitor their breathing.

Lesson 3.7 – Defibrillation Defibrillation is the best possible chance to resuscitate someone who is in cardiac arrest. The sooner defibrillation is attempted, the more likely a positive result will occur. For every minute a defibrillator is not used, the casualty’s chances of survival decreases by 10% An Automated External Defibrillator or AED as they are commonly known, have been developed for use by laypersons. The AED gives out easy to follow voice prompts and picture instructions for its use. If you have determined the casualty is in cardiac arrest and have access to an AED, use it in conjunction with CPR

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If you do not have an AED available, continue CPR until an emergency medical professional arrives or signs of life return, as the paramedics will be equipped with a defibrillator

How to use an AED will be discussed further in Chapter 5. RECAP So to recap, remember:

Defibrillation is the best possible chance to resuscitate someone who is in cardiac arrest

An Automated External Defibrillator or AED has been developed for use by laypersons.

If you have determined the casualty is in cardiac arrest and have access to an AED it is best to use it before commencing CPR.

If you do not have an AED available, continue CPR until an emergency medical professional arrives, as they will have a defibrillator with them

Lesson 3.8 – Life Threatening Bleeding The final lesson in this chapter is about life threatening bleeding. You should identify and immediately control any life threatening bleeding. This simply requires the casualty to be scanned from head–to–toe to detect signs of external bleeding. Bleeding is considered life threatening when it is spurting or cannot be controlled and must be treated as quickly as possible. This is the recommended treatment for life threatening bleeding:

Rest and reassure the casualty Call Triple Zero for an ambulance immediately Ensure you wear the correct personal protective equipment. Apply pressure to the wound using a pad and bandage. Elevate the wound if possible. Regularly monitor and record the casualty’s vital signs. Reassure and calm the casualty until paramedics arrive.

RECAP So to recap, the important points to remember when assessing and attending to casualties with life-‐threatening injuries are:

D for DANGER Check for hazards that could possibly harm yourself, bystanders or the casualty

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R for RESPONSE Once the area is safe, check the casualty for a response.

S for SEND FOR HELP If the casualty is unresponsive, send for help by either calling 000 yourself or by asking a bystander to call for you.

A for AIRWAY Check and clear the airway of the casualty of any foreign bodies.

B for BREATHING Check the casualty is breathing by using the Look, Listen and Feel method.

C -‐ CPR If the casualty is not breathing, commence CPR by administering 30 chest compressions followed by 2 rescue breaths. Continue until help arrives.

D for DEFIBRILLATION If available, use an AED and commence defibrillation on the casualty in cardiac arrest.

IF LIFE-‐THREATENING BLEEDING is identified then it should be controlled by:

Resting and reassuring the casualty Calling Triple Zero for an ambulance immediately Ensuring you wear the correct personal protective equipment. Applying pressure to the wound using a pad and bandage. Elevating the wound if possible. Regularly monitoring and recording the casualty’s vital signs. Reassuring and calming the casualty until paramedics arrive.

Lesson 3.8 – (Helpful Hints) – Severe Bleeding In severe bleeding from an Ambulance perspective we would like to ask the patient if/or the bystander if they could perhaps find a clean towel or a blanket or a nice clean shirt of some sort relatively we like to keep it dry we would ask that they apply firm but gentle pressure to the area without pushing to much on the open wound its very important that once we do apply that pressure we don’t take the if its a towel or whatever it is we don’t take that away from the wound and will keep that pressure on should bleeding go through the original towel we ask that you get a second object whether it be a still again a blanket or shirt and re–apply that on top of the original blanket or towel that you have. In relation to haemorrhage control I have recently proceeded to a case in the local area to a construction site where on arrival we found that a gentlemen had a circular saw injury which had penetrated his groin on arrival we found that his boss who was on scene who had a towel had applied really great haemorrhage control he put the towel on the sight of injury and didn’t move it until we arrived, there wasn’t a significant haemorrhage loss at this

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point of time but having that initial haemorrhage control allowed us to then focus on other part of the treatment he remained at that site while we continued re–assessing the patient he did really well he didn’t remove it the clot remained in place and we were able to give the gentlemen further treatment like fluids to get his blood pressure back up because the haemorrhage was controlled until/or by the time we had got on scene. QUIZ That’s the end of the chapter, so you know it’s time to take a quiz. Remember, if you get a question wrong, you can repeat your answer until you get it correct. You will need to successfully complete all questions in this chapter. Ready to go?

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Chapter 4 INTRODUCTION Hello and welcome to chapter four. In this chapter you will learn how to conduct a secondary survey. This involves questioning the casualty and witnesses, checking the casualty’s vital signs and conducting a head–to–toe examination. A secondary survey is a more comprehensive and systematic assessment of a casualty and is designed to identify any less obvious conditions. The process of a secondary survey involves three steps:

Questioning the casualty and witnesses Continuing to check vital signs, and Conducting a head-‐to-‐toe examination

Lesson 4.1 – Questioning The Casualty & Witnesses Here you are at the scene of an incident. How can you determine how a casualty became ill or injured? The best method is to observe what you see around the incident site and to question the casualty and witnesses. The term DOLOR is used to remind first aid providers of some simple questions that could be asked of a casualty: D – description: ask the casualty to describe the problem O – onset and duration: ask the casualty when the problem started and how it progressed L – location: ask the casualty where on the body the problem is O – other signs and symptoms: do you notice any other signs or is the casualty aware of other symptoms? R – relief: has anything provided relief. For example, rest, medication, positioning When speaking with the casualty, always offer reassurance, this will ease anxiety and stress that can have a negative affect on their condition. If it is difficult to communicate with the casualty, due to unconsciousness, injury, language barriers or age, question any witnesses or bystanders to establish the history of the incident. If there are no witnesses, your only option will be to make your own observations about the casualty and the incident site. RECAP The term DOLOR is used to remind first aid providers of some simple questions that could be asked of a casualty:

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D – description: ask the casualty to describe the problem O – onset and duration: ask the casualty when the problem arose and how it progressed L – location: ask the casualty where on the body the problem is O – other signs and symptoms: do you notice any other signs or is the casualty aware of other symptoms? R – relief: has anything provided relief. For example, rest, medication, positioning

Lesson 4.2 – Checking the Casualty’s Vital Signs So, having questioned the casualty and witnesses, you may have a clear picture of how the incident occurred. The next step in the process is to check the casualty’s vital signs. These are indicators of whether the body is acting normally or if it’s trying to make adjustments due to injury or illness. Vital signs are:

Conscious level Breathing Pulse, and Skin Colour

You need to pay close attention to vital signs, checking and recording them regularly until the paramedics arrive. Adults at rest breathe between 12 and 18 times per minute. Children at rest between 1 and 8 years old breathe slightly faster at 15 to 30 times per minute. Infants at rest under 1 year can breathe 25 to 50 times per minute. You need to regularly check for any change to a casualty’s breathing which could indicate their condition is improving or declining. Signs of abnormal breathing include:

Gasping Noisy breathing, such as wheezing or gurgling Breathing that is excessively fast or slow Pain when breathing.

Every time the heart contracts, it forces blood around the body through the circulatory system. This is referred to as a person’s pulse. If a pulse is present, it may be felt by placing two fingers over one of the radial arteries in the wrist, or over the carotid artery in the neck. A normal resting pulse rate for adults is generally between 60 to 100 beats per minute. A normal resting pulse rate for children is generally between 70 and 140

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beats per minute, while infants under 1 year of age are usually 90 to 160 beats per minute. A change in someone’s normal pulse rate could indicate an improvement or worsening in their condition and can be indicated by:

Irregularity Weakness A pulse that is too fast or too slow.

If the casualty is in shock due to blood loss, the radial pulse might be hard to find as the body redirects blood from the extremities to vital organs. In this instance, feel for a pulse in the neck and remember if they’re breathing then they must have pulse. To check for a casualty’s radial pulse:

Turn the casualty’s hand palm–side up, and then place your two fingers along the outer edge of the casualty’s wrist just above where their wrist and thumb meet.

Slide your fingers toward the centre of the casualty’s wrist. You should feel the pulse between the wrist bone and the tendon.

Press down with your fingers until you feel the casualty’s pulse. Do not press too hard, or you will not be able to feel the pulsation.

Continue to feel the pulse for a full minute. Record this pulse rate and the time it was taken.

To check for a casualty’s neck pulse:

Gently tilt the casualty’s jaw upwards, and place your first two fingers of your hand at the casualty’s chin.

Move your fingertips gently downwards along the windpipe and throat. Press down with your fingers until you feel the casualty’s pulse. Do not

press too hard, or you will not be able to feel the pulsation. Continue to feel the pulse for a full minute. Record this pulse rate and the time it was taken.

The last vital sign to check is skin colour, as it can give critical early clues about their condition. A casualty who is suffering from shock from blood loss may be sweaty and will have pale skin that is cool to touch. This is because the body redirects blood away from the skin’s surface to support the functioning of the vital organs. Whereas flushed (very red) skin could indicate to high blood pressure or suffering an allergic reaction. RECAP Vital signs are indicators of whether the body is functioning normally or if it’s trying to make adjustments due to injury or illness. Vital signs are:

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Conscious level Breathing Pulse, and Skin Colour

You need to pay close attention to vital signs, checking and recording them regularly.

Lesson 4.3 – Head–To–Toe Examination The final lesson in this chapter is the head–to–toe examination. This is a step–by–step search for any injuries that are yet to be identified. It prioritises the more serious injury locations. These injuries should be treated in the order in which they are found. The sequence is:

Head Neck Chest or back Abdomen Pelvic area Legs Arms

Obviously, it will not always be necessary to carry out a head–to–toe examination. The types of injury it is useful to identify include minor bleeds, bruising over internal organs that could indicate internal bleeding and deformities that could indicate fractures. It may also locate a medic alert tag that will help you be aware of a casualty’s existing medical condition. You should avoid any unnecessary contact with obviously injured parts of the body. Watching a casualty’s facial expressions is a good gauge for any discomfort they might be in. For thoroughness, check both left and right, front and back of the body. HEAD When starting at the head you should look and gently feel for:

Moist areas on the scalp, which could be blood Blood or fluid from the nose or ears, which could indicate a skull fracture Foreign objects in the eye Pupils that are significantly different in size, which could indicate a brain

injury or stroke Evidence of a fracture or dislocation of the jaw Symmetry in the face. If one side of the face is drooping or is less

controlled than the other, it could be indicative of a stroke. Blood or loose teeth in the mouth, which could cause airway problems.

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NECK When checking the neck, if the casualty is complaining of neck pain, do not allow the casualty to move their head or neck. Gently feel along the top part of the spine for any irregularities or deformities and visually inspect the windpipe for bruising, swelling and other marks. CHEST or BACK When examining the chest, the most important thing to look out for is that both sides of the chest move equally when the casualty breathes. Have them take a few deep breaths and look for:

Any part of the chest that does not rise when the casualty breathes in, which could indicate a number of fractured ribs

Any wounds, particularly those that make a sucking sound Bruising, which could indicate internal injuries.

You should then check the casualty’s back for bleeding or any other abnormalities. If spinal injuries are not suspected, gently roll the casualty onto their side to assess the back. ABDOMEN You should look and/or gently feel for the following:

Unusual swelling or marks A hard or rigid abdomen, which could indicate severe internal bleeding Bruising.

If there is pain, ask the casualty to show you where it is situated and note the location. Also ask the casualty to rate the intensity of the pain on a scale of 1 to 10, with 1 being the slightest of pain and 10 being the severest. PELVIC AREA You should look for visible signs of any life threatening bleeding in or around the pelvic area. If life-‐threatening bleeding is apparent, there may be a need to remove parts of clothing to identify and treat the injury. LEGS You should look and/or gently feel for any bleeding, deformity or bruising on either leg. If no deformity is evident, place your hand under the soles of the casualty’s feet and ask them to push against your hand. Then reverse this process by putting your hand on top of the casualty’s feet and asking them to pull against it. This will help determine whether there are any obvious weaknesses on one side of the body or the other, which could indicate that the casualty has suffered a stroke.

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ARMS You should look and/or gently feel for any bleeding, deformity or bruising on either arm. If no deformity is evident, ask the casualty to squeeze both your hands. As with the leg examination, this will help to determine if there are any obvious weaknesses on one side of the body or the other, which could indicate that the casualty has suffered a stroke. Continue to monitor the casualty’s level of consciousness, breathing, pulse and skin colour throughout the examination process. If any problems relating to these vital signs become apparent, stop the secondary survey and address them immediately. If the casualty does not have a life threatening condition and the head to toe examination reveals no other significant injury, this would be a good opportunity to record their full name and date of birth, documenting their injuries, condition and the treatment steps that have been instigated. When the Paramedics, they may ask a first aid provider for information about the casualty’s medical and incident history to assist their understanding of the situation. RECAP A head–to–toe examination is step–by–step search for any injuries that are yet to be identified. The sequence is:

Head Neck Chest or back Abdomen Pelvic area Legs Arms

Lesson 4.3 – (Interactive Activity) – Head–to–toe examination As you have just learnt, it is important to treat a casualty’s injuries in the right order of priority in a head-‐to-‐toe examination. Click on the number one pin, drag and drop it onto the first part of the body you would check in a head-‐to-‐toe examination. Here’s a tip for you, drag the number one pin onto the casualty’s head to start with, then decide which area should be examined next by dragging the number two pin to that area of the body and so on. The numbers indicate the correct order the casualty should be examined. If you place a pin in the wrong order, it will simply not stick, so you will need to try a different area.

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Don’t forget, you are racing against the clock on this one too, so do it as quickly as you can. Ready to start?

Lesson 4.3 – (Helpful Hints) – The importance of the secondary survey Our secondary survey is important as it does allow you to identify any further injuries or complications that might of happened when the patient has been injured but we can’t take the focus of the initial survey from a paramedics point of view it allows you to identify life threatening conditions or things that are going to cause this patient to be in harms way so your airway your breathing and your circulation are most important because they are 3 areas that are going to cause the greatest problems if they aren’t addressed so in your airway we appreciate that you roll them on there side keep the airway clear with there breathing, with there breathing keep monitoring their airway, tilt there head back and then go onto there circulation they do have a pulse just keep re–assessing them, if they don’t have a pulse commence CPR and just in that initial ABC look for your any uncontrolled haemorrhage that may be in place. In the past I have attended a case in Queen St mall where a gentleman has collapsed in a very public area. They made a triple “0” call (000) to our call centre here and the patient on questioning was realised that they were in cardiac arrest the bystanders did a very good job of following their initial primary survey which was the ABC’s they cleared the airway started CPR and commenced CPR until we arrived. It is important to realise that yes there might be additional injuries but we would like you to focus more on their airway, breathing and circulation because we can address those other injuries when we get there but it is good to point out that if you do notice any thing in a secondary survey that let us know when we do get on scene because we can treat that as well once we address the primary initial survey. QUIZ Well that’s the end of this chapter; you’re doing really well, but it’s time to take a quiz. Now remember, if you get a question wrong, you can repeat your answer until you get it correct. As you know by now, you will need to successfully complete all questions in this chapter. Are ready to go?

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Chapter 5 INTRODUCTION Hello and welcome to this crucial chapter on CPR. In this chapter you will learn about cardiopulmonary resuscitation or CPR. Don’t forget to take the quiz and remember to check out the demonstration videos that show you how to administer CPR correctly to an adult, child and infant. CPR is a vital, life saving skill that every person should know. Learning how to effectively perform CPR can prepare you to respond in the event you observe a cardiac arrest. Cardiac arrest occurs when the heart stops beating. A person who suffers a cardiac arrest will be unconscious and show no signs of life. Cardiac arrest may occur at any age from various causes, but the most common is heart disease. To be prepared to respond to a cardiac arrest appropriately and effectively, you need to know how to call triple zero for the ambulance service and how to provide CPR.

Lesson 5.1 – Chain Of Survival CHAIN OF SURVIVAL The chain of survival is critical to achieving the successful resuscitation of a casualty in cardiac arrest. Successful resuscitation depends on all links in this chain being activated in a timely way. A delay in the actions specified in any link will significantly decrease a casualty’s chances of survival. Follow the links in the chain and you are well placed to give a casualty, who is in cardiac arrest, vital early treatment. So, what are the links? Link 1 – early recognition Early recognition that a person is suffering from a cardiac condition or is in cardiac arrest is essential. This allows you to commence the vital treatment a casualty requires and to call for an ambulance as soon as possible. Link 2 – early access Early activation of the ambulance service is an essential link in the chain. It will provide the casualty early access to the care that can be provided by paramedics with advanced skills and equipment for a casualty in cardiac arrest. Link 3 – early CPR The timely and effective provision of cardiopulmonary resuscitation (CPR) significantly increases a casualty’s chances of surviving a cardiac arrest. The purpose of CPR is to maintain blood flow and thereby the supply of oxygen to the body’s vital organs until ambulance paramedics can provide more advanced forms of care.

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Link 4 – early defibrillation Defibrillation is designed to stop certain dangerous heart rhythms and assist the heart to regain a normal rhythm. This will result in effective circulation recommencing to oxygenate the vital organs. The greater the lapse of time before defibrillation is attempted, the less successful it is likely to be. Some public venues, such as service clubs, shopping centres and major sporting grounds, have their own defibrillators and staff trained to use them. Link 5 – early advanced life support or ALS. Queensland Ambulance Service paramedics are trained in the use of, and carry, advanced cardiac drugs to increase the casualty’s chances of survival during resuscitation attempts. If a casualty has been successfully resuscitated by first aid providers, paramedics are able to stabilise them prior to departing for hospital. Link 6 – definitive care Definitive care is available at hospital where higher level of medical care can be provided. Prompt CPR and early defibrillation will increase the chances of survival for a casualty in cardiac arrest. RECAP OK, so let’s recap those links: Link 1 – early recognition Link 2 – early access Link 3 – early CPR Link 4 – early defibrillation Link 5 – early advanced life support or ALS Link 6 – definitive care

Lesson 5.1 – (Interactive Activity) – Chain of Survival Welcome to the chain of survival activity. This activity is designed to help you remember the correct order in the chain of survival. Simply drag and drop the links in the chain to arrange them in the correct order. You need to complete the activity within the allocated time, so keep an eye on that timer. Don’t worry if you don’t get them all on the first go, you can try again. So are you ready to start the activity?

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Lesson 5.2 – What is CPR? If this happened to a loved one, would you know what to do? Could you use CPR to assist them? Firstly, what is CPR? CPR stands for cardiopulmonary resuscitation. “Cardio” refers to the heart and “pulmonary” refers to the lungs. Therefore CPR is about getting oxygenated blood to the brain, heart and other vital organs, of a person who is unable to do it themselves. Without it, they will die. CPR involves pushing on their chest to pump the heart and blowing air into a person’s lungs by mouth–to–mouth resuscitation. CPR should only be performed on someone who’s had a cardiac arrest. If they have, they will appear to be unresponsive and not breathing normally.

In this instance, CPR should commence immediately, beginning with chest compressions. There is no specific timeframe for how long you should administer CPR. Keep going until:

The person recovers A paramedic or health care professional takes over or tells you to stop It becomes impossible for you to continue, or There is danger to you.

RECAP So to recap CPR stands for cardiopulmonary resuscitation and should only be performed on someone who’s had a cardiac arrest. If they have, they will appear to be:

– Unresponsive, and – Not breathing normally

Lesson 5.2 – (Helpful Hints) – What is CPR? Some people fear calling triple zero (000) because they don’t want to get involved because they don’t have an understanding of what first aid is. Please don’t ever do that always know that you can render first aid and help all you need to do is ring through to the Queensland Ambulance service on triple zero (000) speak to an emergency medical dispatcher will ask some questions will get a ambulance out while the Ambulance is proceeding to your location they have qualified instruction,

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they are qualified to give you instructions so you can render first aid for example if you come across a person that is not breathing then we will teach you how to breath for them if you come across someone who is bleeding we will instruct you on how to stop that bleeding over the phone

Lesson 5.3 – How Do I Do CPR? HOW DO I DO CPR? Now that you’ve learnt what CPR is, you can now learn how to use it. Administering CPR slightly varies depending on the age of the casualty. ADULT CPR There are ten steps for administering CPR to an adult. The first step is to check for danger. Ensure safety for yourself, any bystanders and the casualty. The second step is to check for response. Remember COWS from chapter 3? -‐ Can you hear me? -‐ Open your eyes -‐ What’s your name? -‐ Squeeze my hands The third step is to call triple zero and ask for an ambulance. Remain calm while answering questions and stay on the phone until you are told to hang up. After that, the fourth step is to check the airway. If fluid or vomit is present in the mouth, roll the casualty onto their side, tilt the face downwards and clear the mouth with your fingers. The fifth step is to check for normal breathing. Look and feel for the rise and fall of the chest. Listen and feel for breaths. If the casualty is not breathing normally, prepare for resuscitation. The sixth step is to start compressions. Partially remove any clothing that may inhibit your ability to perform compressions. Place one hand on the lower half of the sternum with the heel of your hand in the centre and the other hand on top. Push down on their chest to compress their heart. Push one third of their chest depth thirty times at a rate of 100 compressions per minute. The seventh step, tilt the head backwards by placing one hand on the forehead and the other hand on the chin and lift. The eighth step is to start rescue breaths. Seal the nose and give two rescue breaths into the mouth, watching for the chest to rise. The ninth step is to repeat compressions and breaths. Repeat 30 chest compressions and 2 rescue breaths. Continue until paramedics take over, the casualty begins breathing normally and becomes responsive, it becomes impossible for you to continue or there is danger to yourself.

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The tenth and final step is recovery. If the casualty shows signs of recovery, roll them onto their side and check they are breathing. Offer reassurance to the casualty and any bystanders. Now, let’s see that demonstration again and make sure you are watching closely to ensure that you understand the correct procedure: 1. Look for danger 2. Check for a response 3. Send for help 4. Clear the airway 5. Check for normal breathing 6. Prepare to resuscitate (CPR) 7. Start compressions 8. Start 2 rescue breaths 9. Repeat compressions and breaths until paramedics arrive, the casualty begins breathing normally and becomes responsive or it becomes impossible for you to continue 10. If the casualty begins breathing normally but remains unresponsive, roll them into the recovery position. CPR FOR CHILDREN AGED 1 TO 8 YEARS OLD Now we’ve covered CPR for an adult, let’s look at CPR for children aged 1 to 8 years old. There are also ten steps for administering CPR for a child: The first step is to check for danger. Ensure safety for yourself, any bystanders and the casualty. The second step is to check for response. Remember COWS? -‐ Can you hear me? -‐ Open your eyes -‐ What’s your name? -‐ Squeeze my hands The third step is to call triple zero and ask for an ambulance. Remain calm while answering questions and stay on the phone until you are told to hang up. After that, the fourth step is to check the airway. If fluid or vomit is present in the mouth, roll the casualty onto their side, tilt the face downwards and clear the mouth with your fingers. The fifth step is to check for normal breathing. Look and feel for the rise and fall of the chest. Listen and feel for breaths. If the casualty is not breathing normally, prepare for resuscitation. The sixth step is to start compressions. The critical point for compressions on a child is that you must be able to push one third of their chest depth. Therefore you may need one hand or two hands to do this, dependent on the size of the child.

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Partially remove any clothing that may inhibit your ability to perform compressions. Place one hand on the lower half of the sternum with the heel of your hand in the centre and the other hand on top. Push down on their chest to compress their heart. Push one third of their chest depth thirty times at a rate of 100 compressions per minute. The seventh step, tilt the head backwards by placing one hand on the forehead and the other hand on the chin and lift. The eighth step is to start rescue breaths. Seal the nose and give two rescue breaths into the mouth, watching for the chest to rise. The ninth step is to repeat compressions and breaths. Repeat 30 chest compressions and 2 rescue breaths. Continue until paramedics take over, the casualty begins breathing normally and becomes responsive, it becomes impossible for you to continue or there is danger to yourself. The tenth and final step is recovery. If the casualty shows signs of recovery, roll them onto their side and check they are breathing. Offer reassurance to the casualty and any bystanders. INFANT CPR (LESS THAN ONE YEAR OLD) We just covered CPR for a child, now let’s look at CPR for an infant. There are also ten steps for administering CPR to an infant less than one year old. The first step is to check for danger. Ensure safety for yourself, any bystanders and the casualty. The second step is to check for response. DO NOT SHAKE but gently touch and talk to the infant. For example, firmly stroke the infant’s feet. The third step is to call triple zero and ask for an ambulance. Remain calm while answering questions and stay on the phone until you are told to hang up. The fourth step is to check the airway. If fluid or vomit is present in the mouth roll the casualty onto their side, tilt the face downwards and clear the mouth with your fingers. The fifth step is to check for normal breathing. Look and feel for the rise and fall of the chest. Listen and feel for breaths. If the casualty is not breathing normally, prepare for resuscitation. The sixth step is to start compressions. Place two fingers on the centre of the chest and compress one third of the chest depth. Compress thirty times, at a rate of 100 compressions per minute. Partially remove any clothing that may inhibit your ability to perform compressions. The seventh step, place one hand on the forehead and use the other hand to support the chin. DO NOT TILT THE HEAD BACKWARDS. The eighth step is to start rescue breaths. Seal the nose and give two rescue breaths into the mouth, watching for the chest to rise. In an infant a rescue breath more resembles a puff of breath. The ninth step is to repeat compressions and breaths. Repeat 30 chest compressions and 2 rescue breaths. Continue until paramedics take over, the

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casualty begins breathing normally and becomes responsive, it becomes impossible for you to continue or there is danger to yourself. The tenth and final step is recovery. If the casualty shows signs of recovery, roll them onto side and check they are breathing. Offer reassurances to the infant and any bystanders. RECAP There are ten steps involved with CPR. They are: 1. Check for danger 2. Check response 3. Call triple zero (000) 4. Check airway 5. Check breathing 6. Give 30 chest compressions at a rate of 100 compressions per minute 7. Tilt the head backwards 8. Give two initial rescue breaths or puffs for infants 9. Repeat this sequence until paramedics arrive 10. Recovery, which means rolling the casualty on to their side if they are breathing and offering the casualty reassurance.

Lesson 5.3 – (Interactive Activity) – How do you perform CPR? Great you have just learnt about CPR, so it’s time to put yourself to the test in a CPR Activity The purpose of this activity is to practise the ‘delivery’ of the cycles along with the number of compression versus number of breaths and the correct timing to deliver these. You will be simulating the process on Frank our virtual casualty who has kindly volunteered himself for this virtual exercise. Please note: To obtain competency in CPR, you are still required to successfully demonstrate, correct CPR procedures on a real manikin during the practical part of this course. Sorry virtual Frank. Ok click on I agree when you are ready to proceed. How do we use this CPR activity? This virtual CPR activity has two components – Frank will be our casualty The first part is the compression simulation, as you can see displaying Frank’s ribcage. The second part is the breaths simulation, displaying Frank’s cross-‐section view of his airway.

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1. Compressions, step 1. Place your virtual hands over the correct position on Frank’s chest. A green tick will appear when you have done this correctly.

2. To simulate compression again use the space bar or click on the compress button in the interface at the required rate. You will notice the pulsing red heart icon. This is the correct rate you should be applying the compressions to.

3. Clear the casualty’s airway. In this virtual exercise you must perform the following steps to achieve this action. Use the arrows to tilt Frank’s head back then use the other arrow to hold Frank’s jaw out.

4. To simulate breath resuscitation, press the spacebar or click on the breaths button on the interface to simulate the deliver of the two breaths to the casualty. The 30 compressions and 2 rescue breaths cycle is repeated five times in this virtual CPR activity.

The number of cycles preformed are monitored on the cycle counter displayed here. The casualty’s vital signs are monitored by the two status health bars, that simulate the response to your CPR delivery. Naturally, you want to keep the casualty’s health bars in the green zone and you do this by applying CPR correctly.

Ok, did you get all that? If you think you ready to begin then click the ‘Start Activity’ button.

Lesson 5.3 – (Helpful Hints) – Recovery position As a paramedic there is nothing more frustrating then arriving on a scene seeing a large group of bystanders standing around somebody who is unconscious and lying on there back for whatever reason cardiac arrest or any other reason. As a paramedic over 20 years of service I’ve seen a number of unnecessary deaths where people have been left on there backs they have vomited and there airways have become obstructed and they have died all people have to do is put them in there recovery position or on there side clear there airway until the ambulance arrived and they would have given them an increased chance of surviving. If a patient is in cardiac arrest the important thing to remember is that ultimately you should be doing compressions and ventilations to give the patient or the casualty the best chance of surviving a cardiac arrest. However if you are uncomfortable with doing ventilation or you don’t have a protective barrier because you don’t know that person then compressions are better then nothing at all the Australian resuscitation council highlights clearly that any attempt of CPR is better then none at all.

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Lesson 5.4 – FAQ’s About CPR Welcome to the Frequently Asked Questions on CPR. Choose the question from this list you’d like to ask, and I’ll answer it for you. So what is the difference between a heart attack and a cardiac arrest? Well, a heart attack (the medical term is a ‘myocardial infarction’) is defined as damage that occurs to the heart muscle when the blood supply in the coronary arteries is blocked and heart tissue does not receive enough oxygen–rich blood. A heart attack may lead to a cardiac arrest when so much of the heart is damaged that it is unable to contract regularly and subsequently stops beating or an abnormal rhythm develops. As there is no way to predict when a heart attack might lead to a cardiac arrest, it is very important to recognise and acknowledge signs and symptoms of a heart attack and seek professional help immediately. When tilting the head backwards, is there any risk of neck injury? Ok, provided common sense and a calm, gentle but firm approach to the head tilt is followed, the chances of making a neck injury worse are outweighed by the benefits of opening the airway. For the majority of casualty’s this will not cause any problems. However, if a neck injury is suspected, as may occur in a road accident or a fall from a height, then neck movements should be kept to a minimum. Is it possible for someone who has no pulse to still be breathing? No, it is not possible. If a pulse is not present, this means the heart has stopped beating and the lungs will not be able to function. Immediately after a cardiac arrest there may appear to be some shallow gasping breaths. This is not normal breathing, and CPR should be commenced immediately. Is it likely that a rib will be injured or broken during chest compressions? It is possible. However, provided common sense and a calm, gentle but firm approach to the compressions are followed, the potential benefits of chest compressions far outweigh any potential for injury. If ribs break during compressions, stop and check your hand positioning and then continue with compressions. Is CPR different if there are multiple first aid providers? No. Frequent rotation of the first aid provider’s, approximately every 2 minutes, is useful to reduce fatigue.

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When I do rescue breaths is there enough oxygen in my breath to assist the casualty? Yes, the air we breathe in contains about 21% oxygen and the rest is mostly nitrogen. We use only around one quarter of the oxygen in each breath so we are actually breathing out air with about 16% oxygen content. That is still enough to oxygenate the casualty during CPR if carried out effectively. If a person suffering a cardiac arrest does not get CPR, how long does it take before they may sustain brain damage? This will vary according to the age and the general state of health of the casualty prior to the cardiac arrest. The brain is very sensitive to oxygen starvation. After 4 minutes, brain damage is possible. After 6–10 minutes brain damage is likely. Over 10 minutes without oxygen will almost certainly lead to brain damage. To minimize the risk of brain damage, CPR should be commenced immediately. Is it necessary to use any special equipment when doing CPR? You may prefer to use a face shield or resuscitation mask as a barrier between you and the casualty’s mouth during mouth–to–mouth resuscitation. The absence of a face shield should not prevent you from administering rescue breaths. If you are unwilling to do rescue breathing you should do continuous chest compressions only at a rate of 100 per minute. What is the chance of survival for a person suffering a cardiac arrest who gets CPR? CPR alone will not save a life. However, it will increase the casualty’s chance of survival. It is important to recognise that, in some situations, a cardiac arrest will be irreversible, regardless of treatment or intervention. Survival is greatly improved if casualties in receive early bystander CPR and early defibrillation. If I do CPR correctly can I expect the person to spontaneously start breathing or recover before the ambulance arrives? No. CPR assists the casualty by oxygenated blood to the brain and other vital organs. It is rare a person will recover spontaneously before receiving advanced care from the ambulance paramedics. The earlier CPR is administered (even if it isn’t perfect), the greater the chance of survival. Why do I call for an ambulance before starting CPR? CPR on its own will not restart a heart in cardiac arrest. The key treatment for a cardiac arrest is defibrillation, that’s why it is important to ring for an ambulance before starting CPR. This will ensure that a defibrillator will arrive as soon as possible. Remember, a trained emergency medical dispatcher will guide you through CPR, in case you don’t completely remember what to do.

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What happens when the ambulance arrives? The ambulance service regards a call to a cardiac arrest as the highest priority. The ambulance paramedics will bring a defibrillator with them. The defibrillator is connected to the casualty’s chest and reads electrical activity in the heart. Defibrillation involves giving the heart an electric shock to assist it to return it to a normal rhythm. Can I catch a disease providing CPR? The possibility of disease transmission through CPR is low. However, to overcome any concerns you might have about disease transmission, face shields can be purchased for use in CPR. As most cardiac arrests occur in the home it is very likely that the person requiring CPR will be a spouse, relative or someone known to you. Can I catch a disease from a training manikin? Catching a disease from a manikin is extremely unlikely, providing a few simple precautions are taken. Your first aid instructor will provide you with your own clean manikin facemask at the start of the training session. How do I do rescue breathing on a person with a stoma? A stoma is an artificial airway usually found at the base of the neck... You should place your mouth over the casualty’s stoma and perform rescue breathing as per standard rescue breathing instructions. Do I position a pregnant casualty differently when doing CPR? Yes. Place the pregnant casualty on their back with their right buttock raised.

Lesson 5.5 – Introduction to Defibrillation Defibrillation is the fourth link in the chain of survival. The sooner defibrillation is attempted, the more likely a positive result will occur. For every minute a defibrillator is not used, the casualty’s chance of survival decreases by 10%. In an emergency, the first aid provider needs to know how to recognise an emergency, call triple zero (000) and start resuscitation. The next step in the chain of survival is ensuring the casualty is defibrillated as soon as possible. Defibrillation is designed to stop certain dangerous heart rhythms and assist the heart to regain a normal rhythm. If successful, this will result in effective circulation, which will allow oxygen to reach vital organs such as the brain, heart and lungs. The greater the lapse of time before defibrillation is attempted, the less successful it's outcome is likely to be.

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Until the last few years, paramedics and medical professionals have been the only people to use defibrillators to treat casualties in cardiac arrest. With advanced technology, automated external defibrillators or AED’s as they are commonly known have been developed for use by everyday people like you and me. So how does an AED work? The defibrillation process uses electricity to depolarise (or contract) the entire heart muscle at one time, after which, repolarisation (or resting) of the whole heart muscle occurs. The process effectively stops the heart. Once repolarisation has occurred, it is hoped that the heart’s normal electrical activity will resume. To better understand how an AED works, a basic understanding of the actions of the heart is useful. The pumping action of the heart is called a contraction and it is controlled by the electrical system within the heart. The heart is a double pump. It comprises of four hollow chambers, with the right side separated from the left side by a thin wall. The heart muscle is called the myocardium and it receives its blood supply from the coronary arteries. The term used to describe the death of the myocardium due to the lack of oxygen is myocardial infarction, which is commonly referred to as a heart attack. The heart has two key actions:

Mechanical Action, and Electrical Action

An Electrocardiogram or ECG is a graphic display of the heart’s electrical impulses as they travel through the conduction system. Applying the AED pads to the skin of the chest picks up this electrical activity. A majority of AED’s do not allow the first aid provider to see the ECG display. A normal healthy person will have what’s called a normal sinus rhythm. The two rhythms that can be reversed by defibrillation are:

Ventricular fibrillation (VF) And pulse less ventricular tachycardia (VT)

An AED is used to reverse the effect of cardiac arrest. Remember, if the casualty is not breathing normally or is unresponsive, the casualty is in cardiac arrest. Safety Precautions Before an AED is used on a casualty, a safe working environment must be created. Broadly, there are three areas of danger that must be considered: CONTACT -‐ No person is to be in either direct or indirect contact with the casualty as time of defibrillation.

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CONDUCTION – There should be no conductive items in the vicinity of the casualty such as:

Water or rain Metal or grates Vomit or blood or perspiration on the chest.

EXPLOSION – Do not defibrillate if there is a chance of explosion due to the presence of:

High level of oxygen Petroleum liquid such as petrol, diesel or Liquid Petroleum Gas (or LPG) Flammable substances on clothes.

AED’s may have their own safety warnings that can show visibly on the display screen, and may emit an audible sound when the AED is turned on. Operating an AED Using an AED is easy. The most important thing to remember is to listen to and obey the voice prompts given by the AED. To operate an AED, follow these steps:

Turn the machine on Expose the casualty’s chest Prepare the chest by wiping it dry. If chest hair is present, this should be

shaved in the areas where the pads will be placed to ensure proper contact. Apply the pads in a roll-‐on fashion to expel air and ensure a good adhesion Direct those performing CPR to stop Direct all persons nearby to stand clear Allow the AED to analyse the heart rhythm Follow the voice prompts of the AED

Should the AED advise that no shock is indicated, the first aid provider should:

Check if the casualty is breathing If the casualty is not breathing, recommence CPR for two minutes Stand clear to allow the machine to analyse the casualty’s heart rhythm

again. If the casualty is breathing, move them into the recovery position and

continue to monitor their vital signs. Should the AED state that a shock is indicated:

The operator will call ‘stand clear’ and check to ensure there is no contact with the casualty.

The AED voice prompt indicates a shock is to be given.

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The shock button will illuminate Press this button to deliver the shock The machine will indicate that a shock has been delivered Follow the machine’s prompts to commence CPR. The machine will

reanalyse in two minutes. If the prompts of the machine are obeyed, a successful outcome may be expected without injury to others. In the event of unsuccessful reversion, and when standard protocol is exhausted:

Leave the pads on the casualty Continue CPR until relieved or exhausted Care for relatives and loved ones.

In the event of successful reversion, when the casualty begins to breathe normally or regains consciousness:

Leave the pads on the casualty Check casualty’s breathing If they are not breathing, continue CPR If they are breathing, check for a response If they are not responding, place them in the recovery position If they are responding, place them in a position in which they are more

comfortable. If you want to find out more information about AED’s or purchase an AED, please contact us. RECAP So let’s recap: To operate an AED, follow these steps:

Turn the machine on Expose the causality’s chest Prepare the chest Apply the pads in a roll-‐on fashion to expel air and ensure a good adhesion Direct those performing CPR to stop Direct all persons nearby to stand clear Allow the AED to analyse the heart rhythm Follow the voice prompts of the AED

And when the casualty once again shows signs of life or has a successful reversion:

Leave the pads on the casualty Check casualty’s breathing

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If they are not breathing, continue CPR If they are breathing, check for a response If they are not responding, place them in the recovery position If they are responding, place them in a position in which they are more

comfortable. QUIZ That’s the end of the chapter, so you know it’s time to take a quiz. Remember, if you get a question wrong, you can repeat your answer until you get it correct. You will need to successfully complete all questions in this chapter. Ready to go?

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Chapter 6 INTRODUCTION Hello and welcome the next chapter. In this chapter you will learn about the respiratory system, respiratory emergencies and how to treat them. The body needs a constant and adequate supply of oxygen in order to sustain life and function effectively. The respiratory system, which regulates our breathing, is the body’s mechanism for providing this necessary oxygen. When we inhale, air enters our lungs via our airways. Oxygen from the air is then exchanged into the bloodstream and the used air is exhaled into the atmosphere.

Lesson 6.1 – Respiratory System RESPIRATORY SYSTEM The bodies need a constant and adequate supply of oxygen in order to sustain life and function effectively. The respiratory system, which regulates our breathing, is the body’s mechanism for providing this necessary oxygen. When we inhale, air enters our lungs via our airways. Oxygen from the air is then exchanged into the bloodstream and the used air is exhaled into the atmosphere.

Lesson 6.2 – Asthma Asthma Asthma is a disorder of the airways in the lungs. People with asthma have sensitive airways that narrow when they are exposed to a range of triggers, leading to difficulty in breathing. Asthma can be a life–threatening emergency. Many things can trigger an asthma attack and each person will react differently to various triggers. Some known triggers are:

Upper respiratory tract infection Dust mites Pollens Changes in air temperature and weather conditions Exercise Stress Animal hair Some foods and preservatives.

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Three processes occur during an asthma attack, all of which contribute to a narrowing of the airways:

The smooth muscle surrounding the airways contract. Excessive mucus is secreted. The airway walls swell due to inflammation.

There are several types of asthma medication. Reliever medications provide relief from asthma symptoms within minutes of use by relaxing the tight muscles of the airways. These medications usually come in blue / grey devices. Preventative medications are used for longer–term prevention and are not useful in a sudden attack. These medications usually come in brown, orange or red devices. Combination medications are a combination of preventer and reliever medications. These combination types of medications are also not very effective in a sudden asthma attack. These medications usually come in purple, red and white devices. There are many different asthma medication delivery devices, which are commonly known as:

Puffers Puffers and spacers Accuhaler Autohaler Turbohaler

Chronic asthmatics should have an emergency management plan that has been developed with their doctor. Such a plan shows you the best course of action to assist an asthmatic. Asthma attack can be broken into three categories of severity.

Mild asthma Severe asthma Life threatening asthma attack

Symptoms and signs of a mild asthma attack include:

Coughing Wheezing Rapid breathing A rapid pulse.

Symptoms and signs of a severe asthma attack include:

Pale skin Anxiety

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Struggling to breathe Wheezing during exhalation Inability to speak in complete sentences.

Symptoms and signs of a life–threatening asthma attack include:

Exhaustion, characterized by an inability to breathe effectively Speaking only in single words Cyanosis, which is a blue discoloration around the lips Complete absence of wheezing or a silent chest Semi–consciousness or unconsciousness.

A spacer should be used if possible as it will ensure that the medication is breathed into the airways and does not settle at the back of the casualty’s throat. If a spacer is not available, you can improvise by using a plastic water bottle. To administer the 4 x 4 x 4 technique:

Sit the casualty in a comfortable, upright position. Remain calm and reassure the casualty. Try not to leave the casualty alone. Have the casualty take four puffs of their medication. Wait four minutes if there is no improvement, repeat the action and call

triple zero immediately. If using a spacer with the puffer, place one puff of medication in the spacer, and ask the person to take 4 breaths from the spacer. Then wait 4 minutes. If there is no improvement, repeat the action and call triple zero. If the casualty has collapsed or is unable to use an inhaler then you should:

Call triple zero for an ambulance immediately. If oxygen is available, it should be administered immediately. If breathing stops, follow the steps to resuscitation that you have learnt in

the previous chapter. Remember, if you suspect the attack is severe or the casualty cannot speak in complete sentences, then call triple zero for an ambulance immediately. RECAP To administer the 4 x 4 x 4 technique: • Sit the casualty in a comfortable, upright position. • Remain calm and reassure the casualty. • Try not to leave the casualty alone. • Have the casualty take 4 puffs of their medication.

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• Wait four minutes if there is no improvement, repeat the action and call triple zero immediately for an ambulance.

Lesson 6.3 – Choking Now that you’ve learned about asthma, let’s turn our attention to another respiratory hazard – choking. This occurs when foreign material, such as food, fluid or a small toy, obstructs the airway in or above the windpipe. Obstructions can partially or completely block an airway and are a life–threatening emergency. The signs and symptoms of an airway obstruction will depend on the cause and severity of the condition. Airway obstructions can be gradual or sudden in onset and lead to a complete obstruction within a few seconds, so close monitoring of the casualty’s condition is essential. If the choking casualty is conscious, there maybe extreme anxiety, agitation, coughing, gasping sounds or loss of voice. These signs and symptoms may progress to the casualty exhibiting the universal choking sign. A partial obstruction of the airways can be recognised by:

Breathing that may be noisy Labored breathing Some escape of air felt from the mouth

Infants, children and young adults may also display some specific additional signs of breathing distress such as:

In–drawing of the soft tissues above the breast bone and between the ribs

Flaring of the nostrils. A complete obstruction of the airway can be recognized by:

Some breathing effort No sounds of breathing No escape of air from the mouth and/or nose.

Whether the casualty can cough effectively or not determines how severe the airway obstruction is. If the casualty has an effective cough than they are likely to have a mild airway obstruction. When treating a mild airway obstruction, encourage the casualty to

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keep coughing in an attempt to expel the foreign material. If the obstruction is not relieved, then call triple zero for an ambulance immediately. If the casualty does not have an effective cough they have a severe airway obstruction. Call triple zero for an ambulance immediately. If the casualty with a severe airway obstruction is conscious, give up to five sharp back blows with the heel of your hand in the middle of their back between the shoulder blades. Remember to check after each back blow to see if the foreign body has been removed. If the back blows are unsuccessful at removing the airway obstruction and the casualty is still conscious, then perform five chest thrusts. To give chest thrusts, identify the same compression point on the sternum as you would when doing CPR, and give five chest thrusts. Chest thrusts are similar to chest compressions, and are given sharper and at a slower rate. If the obstruction is not removed after five chest thrusts and the casualty is still conscious, keep alternating between giving five back blows and five chest thrusts. If the casualty is unconscious and foreign material is visible, attempt to clear their airway with finger sweeps, then commence CPR. The treatment for an infant or small child with an airway obstruction is the same as an adult with the following exceptions:

When administering back blows, lay the infant or small child across your lap with their head below their chest in a downwards-‐facing position, prior to delivering the back blows.

When administering chest thrusts, lay the infant across your lap with their head pointing downwards.

Remember to stop after each back blow and chest thrust to check if the foreign body has been relieved.

RECAP If the casualty is an adult and suffering from a complete airway obstruction:

• Call triple zero for an ambulance immediately. • If conscious, give up to five sharp back blows between their shoulder blades. • Recheck the airway after each back blow for signs of breathing. • If back blows are ineffective, apply chest thrusts. • Recheck the casualty after each chest thrust. • If unconscious, commence CPR.

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Lesson 6.4 – Drowning Let’s say you walk into your neighbour’s yard and find one of their children floating motionless in the pool. Would you know what to do? Drowning occurs when a casualty is immersed in water or other fluid. The primary effect on a casualty from drowning is the interruption of the oxygen supply to the brain. Early rescue and resuscitation of a drowning casualty are significant factors in increasing their chances of survival. Signs and symptoms of drowning include:

Coughing Chest pain Frothy sputum Clenched teeth Shortness of breath Blue lips and tongue Unconsciousness Irregular or no breathing.

If a casualty is drowning, follow these steps.

Ensure the scene is safe. Remove the casualty from the water immediately if it is safe to do so. Assume spinal injury to a casualty recovered from immersion in water. Call triple zero (000) for an ambulance immediately. Follow the steps to resuscitation that you learnt in chapter 5.

Lesson 6.5 – Anaphylaxis Anaphylaxis is the most severe form of allergic reaction and is potentially life threatening. It must be treated as a medical emergency, requiring urgent medical attention. Anaphylaxis is a generalised allergic reaction, which often involves more than one body system, especially the respiratory and cardiovascular systems.

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A severe allergic reaction usually occurs within 20 minutes of exposure to the trigger. It is characterised by rapid changes to the airway, breathing or circulation problems usually associated with skin and mucosal changes. The key features of anaphylaxis are:

It is a generalised allergic reaction with respiratory and/or cardiovascular involvement.

It can affect many parts of the body and It can have rapid onset and progress quickly, so time is of the essence.

Some of the most common triggers are:

Foods, especially peanuts or other nuts, eggs, cow milk and shellfish. Certain drugs, such as penicillin. The venom of stinging insects, such as bees, wasps or ants. Substances or material containing latex.

Many people affected by allergies often carry prescribed medication with them in the form of injectable adrenaline. An injection of adrenaline is critical in the management of life-‐threatening anaphylaxis. Adrenaline counteracts the signs and symptoms, which are caused by the release of histamine and other chemicals during anaphylaxis. Adrenaline works by

Reducing constriction and swelling in the airways and Constricts blood vessels, which in turn reduces the swelling and increases

blood pressure bringing it back to normal parameters. Possible side effects of adrenaline include:

Fast heart beat Pale skin, and Tremors

However, the benefits outweigh the side effects. If the casualty is carrying an adrenaline auto-‐injector for the allergy it should be used immediately where state and territory legislation permits. For more information about anaphylaxis go to www.allergy.org.au There are 2 different auto injectors:

Junior for a child between 10 and 20 kilograms, which is green Adult for casualty’s over 20 kilograms, which is yellow

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The junior adrenaline auto-‐injector delivers half the dose of Adrenaline the adult adrenaline auto-‐injector delivers. Administering an adrenaline auto injector is simple: When administering an adrenaline auto-‐injector, check the manufacturer’s guidelines, which accompany the particular brand that has been prescribed to the casualty for instructions on how to use the auto-‐injector. Once the injection has been administered, gently massage the injection site for approximately 10 seconds. And remember to record the time the adrenaline auto injector was administered. Anaphylaxis has a range of signs and symptoms. Onset can range from minutes to hours of exposure to a trigger. Signs and symptoms are highly variable and may include:

Difficult / noisy breathing Wheeze or persistent cough Swelling of face and tongue Swelling or tightness in throat Difficulty talking or hoarse voice Loss of consciousness or collapse Pale skin and limp body (young children) Abdominal pain and vomiting Hives, welts and body redness.

If you are treating a casualty for anaphylaxis, follow these steps:

Prevent further exposure to the triggering agent if possible Administer the casualty’s prescribed adrenaline auto injector Call Triple Zero for an ambulance Allow the casualty to assume a position of comfort. Administer a second adrenaline auto injector after 5 minutes if there has

been no response If breathing stops commence CPR.

RECAP So, to recap: If you are treating a casualty for anaphylaxis, follow these steps:

Prevent further exposure to the triggering agent if possible Administer the casualty’s prescribed adrenaline auto injector Call Triple Zero for an ambulance Allow the casualty to assume a position of comfort. Administer oxygen or asthma medication for respiratory symptoms.

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Administer a second adrenaline auto injector after 5 minutes if there has been no response

If breathing stops commence CPR.

Lesson 6.6 – Croup Some respiratory conditions only affect children. One such condition is croup, which affects infants and children between the ages of six (6) months and five years. On average, one in 75 children will be affected by croup in their first year of life. It is usually caused by a virus, and involves inflammation and swelling of the larynx (voice box), trachea (windpipe) and bronchi (the large airways in the lungs). The condition becomes worse at night and as air temperature drops and the humidity changes. Croup is caused by a viral infection and is usually not serious. However, it can be serious if the child cannot inhale enough air. The child can develop cyanosis, a blue colouring around the lips and mouth and become extremely drowsy and irritable. When a child is experiencing severe signs of croup, urgent medical treatment is required. Signs and symptoms of croup include:

Mild fevers and a runny nose (common cold) A hoarse voice Barking couch which often sounds like a ‘seal bark’ A noisy, high pitched sound on inhalation which is called stridor Rapid and laboured breathing Cyanosis or blue discolouration around the lips The child is distressed and anxious.

To treat a child with croup, follow these steps:

Reassure the child and keep them calm Remain calm yourself Sit the child up to make it easier for them to breathe

Call triple zero for an ambulance immediately if:

- The child is struggling to breathe, - Has the bluish colour around the lips/mouth, - Looks sick or is unusually drowsy and irritable.

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Modern life-‐saving treatment can be commenced by paramedics and will be continued at the hospital. Medical treatment is very effective and can assist the child to improve within a few hours. Please note: Taking a child into a steamy bathroom with warm moist air or using a vaporiser has not been clinically proven to help croup. Also, there is the risk that unsupervised children left in a bathroom may burn themselves with the hot water.

Lesson 6.7 – Hyperventilation Hyperventilation is the term used to describe the signs and symptoms resulting from over-‐breathing. The increased depth and rate of breathing disrupts the normal balance of oxygen and carbon dioxide levels in the blood. Not every person who is breathing deeply or rapidly is suffering from hyperventilation. Other more serious conditions that could be present include: • An asthma attack • Heart failure • Heart attack • Collapsed lung • Some forms of poisoning • Diabetes. The casualty may have any or all of the following signs and symptoms: • Rapid breathing • Occasional, deep sighing breaths • Rapid pulse • Altered conscious level (they may faint or lightheaded) • Hand and finger spasms in a prolonged attack. • Shortness of breath • Inability to get enough breath • Discomfort or stabbing pain in the chest • Pressure across the chest • A feeling of panic or sense of impending doom • Blurred vision • Tingling of the fingers, toes and lips. To treat a casualty for hyperventilation: • Calm and reassure the casualty. • Encourage them to slow their breathing down. • Follow the steps for resuscitation if required

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• The casualty should be taken to hospital, preferably by ambulance. • Remember; do not use a bag for re-‐breathing. QUIZ That’s the end of the chapter, so it’s time to take a quiz. Remember, if you get a question wrong, you can repeat your answer until you get it correct. You will need to successfully complete all questions in this chapter. Ready to go?

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Chapter 7 INTRODUCTION Hello and welcome to Chapter 7. In this chapter you will learn about the circulatory system, cardiac emergencies and how to treat them.

Lesson 7.1 – Circulatory System Okay, let’s take a closer look at the circulatory system, shall we? It consists of three components: the heart, blood vessels and blood. THE HEART The heart is a four–chambered pump that moves blood around the body through the blood vessels in a smooth and continuous cycle. It is approximately the size of your fist and it sits behind and to the left of the breastbone. The top two smaller chambers are known as the atria. The right atrium receives deoxygenated blood returning from general circulation. The left atrium receives oxygenated blood from the lungs. From the atria, blood flows into the two larger, lower chambers known as the ventricles. When the ventricles contract, deoxygenated blood from the right ventricle is pumped to the lungs and, simultaneously, oxygenated blood from the left ventricle is pumped into the aorta for distribution to the whole body, including the heart itself. Because it is a muscle, the heart requires its own supply of oxygenated blood in order to function. The heart’s blood supply is delivered between heart contractions through the coronary arteries, which surround the surface of the heart and feed the muscle. Narrowing or blockage of the coronary arteries can lead to angina or a heart attack. A heart rate that is too fast (more than 180 beats per minute) will reduce the amount of blood the heart receives, as there is insufficient time between contractions to adequately fill the coronary arteries. The heart also has its own electrical conduction system. This provides the electrical stimulation that causes the muscle cells to contract, enabling blood to be pumped from the heart. In conjunction with one another, the respiratory and circulatory systems combine to supply oxygen to all cells throughout our body. A problem with any component of these systems can lead to serious complications and even death.

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There are a number of conditions that will compromise the ability of the circulatory system to provide adequate oxygen and nutrients to the body’s cells. The three most common conditions that have the potential to result in serious consequences are:

Angina Heart attack Congestive heart failure

Let’s explore these conditions in more detail now.

Lesson 7.2 – Angina The first condition we’ll look at is angina. This is a heart condition caused by restricted blood flow through coronary arteries that are narrowed as a result of the build–up of plaque, or fatty deposits, along the arterial walls. The chest pain that is associated with angina occurs because inadequate levels of oxygenated blood are reaching the heart muscle. This is why an increase in heart rate brought about by exertion; exercise or anxiety often precipitates an attack of angina. As the heart rate increases, the heart muscle requires more oxygen to be able to function effectively. When the required oxygen is not available due to the restricted blood flow, chest pain occurs. The pain is described in many ways, but most commonly it is referred to as:

Crushing Heaviness in the chest Tightening around the chest Or, simply, a discomfort

It is rarely described as a sharp pain. Generally, casualties who suffer from angina are aware of their condition and have medication to assist with alleviating the symptoms. Angina medication comes in either a measured–dose spray or a dissolving tablet, and both are administered under the tongue where it is absorbed through membranes into the blood stream for rapid distribution. It is also important to understand that angina can lead to a heart attack, and that the signs and symptoms are the same. All instances of angina should therefore be suspected, and treated as, a heart attack.

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Lesson 7.3 – Heart Attack You’ve probably heard the term heart attack before, but what is it really? Also known as an acute myocardial infarction is caused by a complete blockage of a coronary artery. A heart attack is usually sudden in onset may occur at rest or under exertion or stress. A heart attack presents in the same way as angina, but the symptoms will not be relieved by rest or medication. A lack of oxygen causes damage to the heart muscle, which disrupts the heart’s electrical system. This disruption can cause an irregular heartbeat and poor circulation. You will need to act quickly as a heart attack is a life–threatening emergency and every minute is vital. The sooner a casualty can be treated by professional medical personnel, the less likely it is that there will be permanent damage to their heart muscle. Signs and symptoms that indicate angina or a heart attack include:

A central, crushing type of chest pain lasting more than ten minutes Pain radiating up the neck or down an arm Shortness of breath Increased breathing rate Increased pulse rate Irregular pulse Pale, cold and sweaty skin Nausea and/or vomiting Sudden collapse.

Not all heart attacks involve chest pain. Some casualties just look and feel unwell, although they may have the other listed symptoms. When treating a casualty for angina or a heart attack, follow these steps:

Have the casualty stop all physical activity. Remain calm and provide reassurance. Encourage casualty to rest. If the casualty is conscious, place them in a position of comfort, usually

sitting up to assist with breathing. Assist the casualty to take any prescribed medication they have to treat

episodes of chest pain or discomfort from angina. Call triple zero for an ambulance. Keep the casualty calm. Monitor and record the casualty’s vital signs.

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If the casualty is or becomes unconscious, follow the steps to resuscitation that you learned in the chapter on CPR.

RECAP When treating a casualty for angina or heart attack, follow these steps:

Have the casualty stop all physical activity. Remain calm and provide reassurance. Encourage casualty to rest. If the casualty is conscious, place them in a position of comfort, usually

sitting up, to assist with breathing. Assist the casualty to take any prescribed medication they have to treat

episodes of chest pain or discomfort from angina. Call triple zero for an ambulance immediately. Keep the casualty calm. Monitor and record the casualty’s vital signs. If the casualty is or becomes unconscious, follow the steps to

resuscitation that you learned in the chapter on CPR.

Lesson 7.4 – Congestive Heart Failure The next condition to look at is congestive heart failure, which may be an acute (short–term) or a chronic (long–term) condition in which the heart cannot pump blood normally. It results from permanent damage to the heart muscle from a variety of causes, such as a previous heart attack or old age. Because the heart cannot pump effectively it compromises the casualty’s ability to breathe effectively. Casualties who suffer from this condition are usually on medication to assist them. Occasionally, their condition can be worsened by things such as severe viral infections, upper respiratory tract infections and heart attacks. Signs and symptoms of congestive heart failure include:

Severe breathlessness Coughing or wheezing Noisy, gurgling breathing Swelling of the feet, ankles or abdomen Tiredness and severe fatigue.

To treat a casualty with congestive heart failure:

Help the casualty to rest in a sitting position. Reassure and calm the casualty. Call triple zero for an ambulance immediately. Observe the casualty’s vital signs.

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Be prepared for a sudden collapse. If the casualty becomes unconscious, follow the steps to resuscitation

that you learned in the chapter on CPR. RECAP To manage a casualty with congestive heart failure:

Help the casualty to rest in a sitting position. Reassure and calm the casualty. Call triple zero for an ambulance immediately. Observe the casualty’s vital signs. Be prepared for a sudden collapse. If the casualty becomes unconscious, follow the steps to resuscitation

that you learned in the chapter on CPR.

Lesson 7.4 – (Helpful Hints) – Cardiac Arrest I went to a case recently where a healthy fit 50 year old male had been suffering “Indigestion” for a period of approximately 8 hours overnight, he thought he could deal with it. It progressively got worse he went to his doctor at approximately 8 or 9 o’clock in the morning and his doctor actually diagnosed that he was actually having a heart attack we arrived on scene and his heart attack was so serious that he went into cardiac arrest half way to hospital. We managed to revive the patient and his now alive and well however what he thought was Indigestion turned out to be a heart attack. So two points there one irrespective of how fit and healthy you are chest pain is chest pain and should be treated as such if you believe you are suffering Indigestion my advice to you would be that you try some ant acids or a glass of milk and if that pain has not gone away in 15 minutes you should be calling an ambulance. The other issue that we need to be aware of is normal chest pain comes with pain and that’s particularly important for patients who are suffering from diabetes because the diabetes damages the nerve ending and they rarely experience chest pain in fact we call it a silent heart attack they do display the other signs and symptoms like there pale, there cold, there sweaty and there having difficulty breathing but they don’t have chest pain. So if someone has diabetes and has unexplained difficulty breathing we need to treat that as a heart attack. QUIZ That’s the end of the chapter. You know what that’s means, it’s time to take a quiz. Remember, if you get a question wrong, you can repeat your answer until you get it correct. You will need to successfully complete all questions in this chapter. Ready to go?

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Chapter 8 INTRODUCTION Hello and welcome to the chapter eight. In this chapter you will learn about blood, bleeding, shock and how to treat them.

Lesson 8.1 – Blood and Blood Vessels The thing we’re going to look at is bleeding, which in simple terms is a loss of blood from the vessels of the circulatory system. Also known as haemorrhaging, it can occur internally or within the body, or externally at the skin’s surface. Bleeding is not always severe and can often be managed by the body’s own clotting processes or simple first aid interventions. However bleeding that cannot be controlled, whether internal or external, is always life–threatening. For our bodies to function effectively, an adequate volume of oxygenated blood needs to be circulated at a pressure that is sufficient to supply oxygen and nutrients to vital organs. Severe bleeding results in a reduction of the amount of blood circulating throughout the body, causing a decrease in the supply of oxygenated blood. This is one of the primary causes of shock, a condition we will talk about in a moment. As you learnt in previous chapters, the search for severe external bleeding is carried out during the emergency action plan. The search for signs and symptoms of internal bleeding, takes place during the head–to–toe examination during the secondary survey. BLOOD AND BLOOD VESSELS Blood represents about 8% of a person’s body weight. The four main functions of blood are to:

Transport oxygen, nutrients, carbon dioxide and waste products Protect against disease Clot to assist wound healing Maintain a constant body temperature.

There are three types of blood vessels:

Arteries Veins and Capillaries.

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These three types of blood vessels will all bleed in a different way. Arterial bleeding will be profuse and rapid because they are under pressure. It will be spurting, which will make it difficult to control and difficult for clots to form. This bleeding will be bright red, as arterial blood is comprised of highly oxygenated red blood cells. Venous bleeding is easier to control because the blood in the veins is under less pressure, which assists with clotting. Because it carries less oxygen, venous blood is a much darker red. Capillary bleeding is the most common and easiest to control, as capillaries are closest to the surface of the skin. Blood tends to ooze rather than flow or spurt, as the pressure in the capillaries is very low. The body will attempt to compensate for blood loss by increasing the heart and breathing rates. Simultaneously, the clotting process commences. Severe bleeding that markedly reduces circulating blood levels is a life–threatening situation. RECAP The four main functions of blood are to:

Transport oxygen, nutrients, carbon dioxide and waste products Protect against disease Clot to assist wound healing, and Maintain a constant body temperature.

Lesson 8.2 – Shock Now you know how vital blood is to the human body, let’s look at what can happen when the circulatory system is disrupted. The first condition we’ll examine is shock. This is the term used to describe the condition resulting from the body’s inability to maintain effective circulation. Shock can easily lead to death if the cause is not treated. Shock will initially affect non–vital organs as blood is redirected to maintain blood flow to vital organs. The non–vital organs, which are initially affected by shock, include:

The skin; which will become pale, cold to touch and sweaty The digestive system, which will make the casualty feel nauseous. The

body uses a lot of blood to digest food, so if a casualty in shock has eaten recently they may vomit.

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When shock is occurring the body re–directs critical oxygenated blood supply to the following vital organs:

The brain The heart The lungs The kidneys.

Circumstances that may cause shock include: Loss of circulating blood volume, which can result from:

severe bleeding major or multiple fractures major trauma severe burns or scalds severe diarrhea and vomiting severe sweating and dehydration (heat stroke). Heart disorders Abnormal dilatation of blood vessels, which can result from: severe infection allergic reaction severe brain or spinal cord injury.

Signs of shock may include:

collapse cool, sweaty skin that may appear pale rapid breathing Deteriorating of the level of consciousness rapid, weak pulse And vomiting.

Symptoms of shock may include:

dizziness muscle weakness thirst anxiety restlessness nausea shortness of breath and feeling cold.

To treat a casualty suffering from shock, follow these steps:

Control any external bleeding as soon as possible with direct pressure. Call triple zero for an ambulance immediately. Administer oxygen if available.

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Maintain the casualty’s body temperature. Reassure the casualty. Do not give the casualty anything to eat or drink. Regularly monitor and record the casualty’s vital signs.

RECAP To treat a casualty suffering from shock, remember to follow these basic steps:

Control any external bleeding as soon as possible with direct pressure. Call triple zero for an ambulance immediately. Administer oxygen if available. Maintain the casualty’s body temperature. Reassure the casualty. Do not give the casualty anything to eat or drink. Monitor and record the casualty’s vital signs

Lesson 8.3 – External Bleeding Now that you understand shock, let’s discuss external bleeding. A wound is a soft tissue injury to the skin that may or may not involve the tissues and muscles beneath. There are a number of different types of wounds:

An abrasion occurs when the outer protective layers of the skin are damaged, usually over bony parts as a result of falling or sliding on hard surfaces, like gravel rash.

A laceration is a wound made by tearing of the skin and tissue. For

example, a wound from a barbwire fence.

An incision is a wound made by slicing or cutting, such as with a knife or piece of metal. If the wound is deep, blood vessels, tendons and other structures may be cut.

Puncture wound – is a penetration of the skin by anything from a metal

stake to a bullet. External bleeding may not be as severe as the internal bleeding resulting from this wound.

An imbedded or impaled object occurs when foreign matter remains

embedded in a puncture wound. External bleeding may not be as severe as the internal bleeding resulting from this wound.

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Amputation occurs when a body–part is torn or cut from the body by a force or object (for example, an arm caught in farm machinery or a limb severed by a chainsaw). Surgical reattachment is sometimes possible, although success depends upon proper preservation of the amputated part.

Contusion is a closed wound caused by falls, blows against hard objects or

crushing resulting in bleeding into tissue. This causes bruising that appears as a discolouration under the skin.

Avulsion – occurs when a piece of skin, and at times other soft tissue, is

either partially or completely torn away. This often involves significant bleeding.

A minor wound is a small external wound on the surface of skin. Most

times, a casualty suffering from a minor wound requires basic first aid only, and do not need to seek further medical attention.

To treat a casualty with a minor wound, such as an abrasion, laceration, incision or contusion, follow these steps:

Ensure that there are no embedded objects in the wound that may result in further damage if direct pressure is applied. Apply indirect pressure if such an object is identified in a wound.

At the source of the bleed, apply firm, direct pressure to this point using a sterile pad, clean

cloth or hands. Instruct the casualty to apply the pressure if they are able. Draw the edges of the wound together. Apply the dressing directly over the wound and firmly secure it with a

bandage, ensuring that the site of the wound remains covered. Elevate the bleeding part and restrict movement. Monitor and record the casualty’s vital signs, observing closely for signs of

shock. Check occasionally to ensure that circulation beyond bandaging is not

compromised. Embedded objects should not be removed as they may be plugging the wound and restricting bleeding. Padding, such as a ring–bandage, should be placed around embedded objects and held firmly in place by a bandage. An object that remains in a puncture wound is called an embedded or impaled object. As with other puncture wounds, external bleeding is not usually severe. However, internal bleeding can be severe if the object damages a major blood vessel or internal organs.

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To treat a casualty with an embedded or impaled object, follow these steps:

Call triple zero for an ambulance. Do not remove the object. Rest and reassure the casualty. Expose the wound by cutting clothing around the object then:

– control the bleeding (apply pressure around, not to, the embedded object). – stabilise the object – pad around the object

Now, treat the casualty for shock. Regularly monitor and record the casualty’s vital signs.

And remember: it’s important not to remove impaled objects as they may be controlling the bleeding and further injury could be caused by removal. A life–threatening bleed is indicated by blood that gushes or spurts from a wound, or blood that does not clot after all efforts to control the bleed have been exhausted. To treat a casualty with a life–threatening bleed, you need to identify the bleeding point and then:

Apply firm direct pressure sufficient to stop the bleeding. If bleeding continues, apply another pad and a tighter dressing over the

wound. Call triple zero for an ambulance. Elevate the bleeding part. Restrict movement Advise the casualty to remain at total rest.

If major bleeding continues it maybe necessary to remove the pad or pads to ensure that a specific bleeding point has not been missed. As a last resort, and only when other methods of controlling bleeding has failed, a tourniquet maybe applied to a limb to control a life threatening bleed. For example, a traumatic amputation of a limb or major injuries with massive blood loss. A tourniquet consists of a wide bandage of at least 5 centimetres wide applied to the limb high above the bleeding point. The tourniquet should be tight enough to stop all circulation to the injured limb and control the bleeding. The time of application must be noted and passed onto paramedics. Once applied, a tourniquet should not be removed until the casualty receives specialist medical care. A tourniquet should

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not be applied over a joint or wound, and must not be covered up by any bandaging or clothing. An amputation is usually caused by a shearing force from a sharp object. It is important to treat the casualty before attending to the preservation of the amputated part. To treat a casualty with an amputation:

Call triple zero for an ambulance immediately. Control bleeding by:

– applying direct pressure and elevation – if the bleeding is not controlled, apply a tourniquet.

Rest and reassure the casualty. Keep the casualty warm. Treat the casualty for shock. Regularly monitor and record the casualty’s vital signs. Once the casualty has been treated, if possible preserve the severed body

part: Do not wash the amputated part. This can cause damage to the part and

reduce the likelihood of it being successfully reattached to the casualty. Place the part in a clean plastic bag and seal the bag. Place the bag in a container of water and crushed ice. Take care to ensure

that the part does not come into direct contact with the ice. This will cause damage to nerve endings that may still be alive.

Send the part with the casualty to hospital. A crush injury results from the application of a heavy weight or crushing force to a part of the body. Crush injuries are often serious because of the large extent of damage that maybe done to soft tissue and bones, but they are particularly serious when the casualty’s head, neck, chest or abdomen are involved. A crush injury can occur in a wide range of situations such as a person crushed by a car or by an industrial accident or by prolonged pressure due to body weight in an unconscious person. Crush syndrome occurs when there is a prolonged delay in removing the crushing force from the casualty. When the force is removed after the prolonged period, harmful toxins can swiftly inundate other areas of the body and cause severe shock and renal failure in the casualty. To treat a casualty who has been crushed by an object, follow these steps:

Call triple zero for an ambulance immediately.

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If it is safe and physically possible, all crushing forces should be removed immediately.

Remain with the casualty and wait for the assistance of emergency services.

Rest and reassure the casualty, and keep them as comfortable as possible.

Monitor and record the casualty’s vital signs.

Nosebleeds can result from trauma or spontaneously for other medical reasons, such as a casualty suffering from high blood pressure. Not all bleeds are life–threatening and are usually easily managed, though even minor bleeds can be indicative of a more serious condition. To manage a casualty with a nosebleed, follow these steps:

If it seems that the nosebleed is a result of a head injury, call triple zero for an ambulance immediately.

Sit the casualty up with their head tilted slightly forward. Do not tilt the head back.

Apply direct pressure to the soft part of the nostrils below the bridge of the nose for at least 10 minutes.

On a hot day, or if the casualty has been exercising, direct pressure may need to be applied for up to 20 minutes.

Apply a cold compress, if available, to the back of the neck and forehead. Encourage the casualty to breathe through their mouth. When the bleeding stops, advise the casualty to avoid blowing their nose. If the bleeding continues for more than 20 minutes, seek medical

assistance. RECAP Usually external bleeding can be controlled by the application of appropriate pressure on or near the wound. The main aim is to reduce blood loss from the casualty. This is achieved by the use of direct pressure, which is usually the fastest, easiest and most effective way of stopping bleeding. However, in some circumstances if there is an obvious imbedded object, indirect pressure may be used.

Lesson 8.4 – Internal Bleeding Not all bleeding is easy to identify. Would you know what to do in this situation? Internal bleeding is often difficult to recognize but should always be suspected where there are signs and symptoms of shock.

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Internal bleeding comes from an internal organ or structure within the body and not from its surface. It could be difficult to recognize because it may not involve an obvious wound. Internal bleeding can be mild, such as bruising, which results from broken capillaries under the surface of the skin, or more severe. It can present a life–threatening emergency since blood is still lost from the circulatory system even though it is not lost from the body. Internal bleeding can be recognized by these signs and symptoms:

Signs and symptoms of shock, including: – pale, cold and sweaty skin – anxiety and restlessness – rapid, weak pulse – rapid, shallow breathing – fainting.

Pain, tenderness or swelling over or around the affected area The appearance of blood from a body opening, for example:

– bright red and/or frothy blood coughed up from the lungs – vomiting of blood, which may be bright red or dark brown – blood–stained urine – rectal bleeding, which may be bright red or black and tarry.

Internal bleeding cannot be effectively managed by you, but the following general measures may be very effective in saving a life:

Call triple zero 000 for an ambulance immediately. Reassure the casualty. Assist the casualty to lie down. Raise the legs if the injuries permit. Administer oxygen if it is available. Do not give any medication or alcohol. Do not permit the casualty to have anything to eat or drink. Monitor and record the casualty’s vital signs at regularly.

RECAP To manage internal bleeding

Call triple zero 000 for an ambulance immediately. Reassure the casualty. Assist the casualty to lie down. Raise the legs if the injuries permit. Administer oxygen if it is available. Do not give any medication or alcohol.

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Do not permit the casualty to have anything to eat or drink. Regularly monitor and record the casualty’s vital signs at frequent

intervals. QUIZ That’s the end of the chapter, so it’s time to take a quiz. Remember, if you get a question wrong, you can repeat your answer until you get it correct. You will need to successfully complete all questions in this chapter. Ready to go?

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Chapter 9 INTRODUCTION Hello and welcome to the next chapter. You’ve learned a lot about the human body so far. In this chapter we’ll examine acute medical emergencies, starting with the digestive system and then moving on to the nervous system. As well as learning why these conditions occur, you’ll also learn methods for treating them.

Lesson 9.1 – Digestive System Let’s start with an overview of the entire digestive system. It comprises the oesophagus, stomach, gall bladder, pancreas, liver, small and large intestines, appendix and rectum. It serves three major functions:

Ingestion Digestion Waste elimination

The digestive process starts in the mouth, where chewing and saliva begin breaking down the food we eat before it travels down the oesophagus and into the stomach. In the stomach, gastric juices break the food down further into nutrients before it is passed into the intestines for absorption into the bloodstream. The gall bladder is the storage place for bile, which is added as the food passes into the intestine to break down fats. The liver stores, processes and regulates absorbed nutrients. When all of the nutrients have been absorbed, the waste is then eliminated via the small and large intestines.

Lesson 9.2 – Diabetes One of the most high profile diseases related to the digestive system is diabetes. It is a metabolic disease characterized by an imbalance between levels of glucose and insulin in the body. Glucose, a type of sugar resulting from the breakdown of food by the digestive system, is the body’s main source of energy. Insulin is a hormone secreted by the pancreas that is needed to facilitate the transfer of glucose from the bloodstream into the body’s cells. There are two types of diabetes:

Type I – This usually develops in childhood. Sufferers require daily insulin injections because their bodies produce little or no insulin.

Type II – This usually develops in adulthood and sufferers typically still secrete some insulin. This type is controlled by diet, exercise and/or oral

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medication, although some severe sufferers may require insulin injections.

Diabetics of both types can experience an imbalance in the concentrations of sugar and insulin in their blood, resulting in either:

• Hypoglycemia – too little sugar in the blood. Or

• Hyperglycemia – too much sugar in the blood Both conditions can cause altered states of consciousness and represent potentially serious medical emergencies. The signs and symptoms of hypoglycaemia occur and progress rapidly. They include:

Rapid, weak or bounding pulse Increased breathing rate Cold and clammy skin Profuse sweating Muscular weakness Confusion and disorientation Trembling Hunger Seizures Bizarre or combative behaviour Anxiousness and restlessness Unconsciousness.

The signs and symptoms of hyperglycaemia progress slowly. They include:

Deep, rapid breathing Nausea and vomiting Excessive thirst and frequent need to urinate Warm, dry skin Abdominal pain Sickly sweet breath like acetone, or nail polish remover. Unconsciousness.

The management of hypoglycaemia and hyperglycaemia is the same:

Call triple zero for an ambulance. If the casualty is conscious, give them fluid or food containing sugar, such

as lollies, non–diet soft drinks, fruit juice or water containing several teaspoons of sugar.

If the casualty is unconscious, do not give any fluid or food. Regularly monitor and record the casualty’s vital signs.

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Whilst the management plan is the same for both conditions, only hypoglycemic casualties will respond to sugar. No undue harm will occur to hyperglycemic casualties when sugar is given.

Lesson 9.3 – Acute Abdomen Acute abdomen is a general term for a multitude of abdominal conditions. Some signs and symptoms include:

Abdominal pain Nausea and vomiting Raised temperature Abdominal rigidity Diarrhea Shock Blood in the urine and Protrusion of intestines through an abdominal wound.

To manage a casualty with acute abdomen, follow these steps:

Place the casualty on their back with knees slightly raised and supported. Rest and reassure the casualty. Manage the casualty for shock. Do not give food or water. Regularly monitor and record vital signs. Call triple zero for an ambulance.

RECAP For treatment to a casualty with an acute abdomen, follow these steps:

Place the casualty on their back with knees slightly raised and supported. Rest and reassure the casualty. Treat the casualty for shock. Do not give food or water. Regularly monitor and record vital signs. Call triple zero for an ambulance.

Lesson 9.4 – Nervous System Let’s move on from the digestive system and take a closer look at the nervous system. This is the master control and communication system of the body. It is the system by which the brain communicates with the body via a network of nerves, the main bundle of which forms the spinal cord. The spinal cord begins at the base of the brain, extends through the spinal column and into branches that reach throughout our bodies.

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Lesson 9.5 – Fainting We’ve all seen people faint on TV and in the movies, but what exactly goes on in the body when it happens? Well, fainting occurs when there is sudden dilation of the blood vessels or a change in heart rhythm, reducing the flow of blood to the brain. This causes the casualty to momentarily lose consciousness. Fainting usually occurs when a person is standing, when they stand up suddenly from a seated position or when they are exposed to high temperatures for prolonged periods of time. The collapse that follows puts the casualty in a horizontal position, allowing blood to circulate to the brain more readily so that the casualty recovers consciousness rapidly. Most casualties will feel the episode approaching and will say that they suddenly feel faint or lightheaded. First aid providers should assist someone who feels this way to lie on the ground on their backs prior to collapsing. If possible, their legs should be elevated slightly to assist the flow of blood to the brain. Signs and symptoms that a person may be about to faint include:

Pale, cold and clammy skin Slow, weak pulse Yawning Light–headedness

To treat a casualty for fainting, follow these steps:

If the casualty is conscious, lay them flat and elevate their legs. Recovery is usually rapid.

If the casualty is unconscious, place them in the recovery position. Regularly monitor and record the casualty’s vital signs. Rest and reassure the casualty. If symptoms of faintness persist, the casualty should see a doctor to

ensure that they are not suffering from a more serious condition.

Lesson 9.5 – (Interactive Activity) – Fainting Now it’s time to do the fainting activity. In this activity, we need to redirect blood flow back to the brain by elevating the legs. This will be a timed activity Frank our casualty has fainted and you need to elevate his legs. Click drag the arrow up to elevate the legs. When you have the right elevation a tick will confirm the correct position when you release the mouse. Now you can drag the chair to prop and hold his legs up. Once his legs are elevated the blood will flow back to his brain and he’ll regain consciousness.

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Are you ready to help Frank?

Lesson 9.6 – Stroke Let’s turn our attention now to another condition that can be quite common – a stroke. This is an immediate life–threatening condition requiring urgent medical attention. It occurs in two main forms: cerebral vascular accident (CVA) and trans–ischaemic attack (TIA). A CVA is caused by a blockage or rupturing of a blood vessel in the brain. Tissues beyond the blockage or rupture receive no blood supply and permanent damage to the brain can occur, resulting in physical and/or sensory impairment such as paralysis or loss of speech. A TIA also known as a mini–stroke, is a temporary condition caused by a minor blockage of a blood vessel in the brain. Recovery is fairly rapid because a TIA is a short–term event that does not cause permanent damage, but it does present some of the signs and symptoms of a stroke. All symptoms of stroke should be considered indicative of a CVA and managed accordingly. A stroke may occur suddenly, the signs and symptoms of a stroke may include:

Sudden, severe headache Flushed, warm or sometimes ashen grey face Pupils of unequal size Weakness or paralysis, usually on one side of the body Brief loss of consciousness Blurred vision Absent or slurred speech, or inability to structure sentences properly Loss of bowel and bladder control Facial droop and salivary drool.

To treat a casualty for stroke, follow these steps:

Call triple zero for an ambulance. If the casualty is conscious:

– rest and reassure them – position them with their head and shoulders raised by at least 30 degrees. This minimizes the amount of blood being pumped from the heart to the brain and will help to reduce further damage. Support the affected side if possible. – regularly monitor and record vital signs – you may be able to determine which side of the body is affected by

asking a conscious casualty to smile. The affected side of the mouth will not move up into a smile.

If the casualty is unconscious, and you suspect a stroke:

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Call triple zero for an ambulance – place them in the recovery position to help drain any fluids or vomit from the mouth – regularly monitor and record vital signs.

FAST is a simple way for remembering the signs of stroke: F for facial weakness – can the person smile, has their mouth or eye drooped? A for arm weakness – can the person raise both arms? S for speech difficulty – can the person speak clearly and understand what you say? T for time to act fast – seek medical attention immediately, call triple zero (000) for the ambulance.

Lesson 9.6 – (Interactive Activity) – Stroke We are almost finished with this lesson. To strengthen your knowledge on how to treat a casualty suffering from a stroke we will now do an activity. In this activity you must correctly treat Frank who has had a stroke. There are two parts to the activity. One is the treatment of a conscious casualty, the other is the treatment unconscious. Choose which one do you wish to do first?

Lesson 9.7 – Seizures Let’s turn our attention from strokes to seizures. These are caused by a sudden inappropriate discharge of electrical activity in the brain that can lead to a range of physical manifestations. These include staring spells and facial twitching to uncontrollable muscular activity appearing as stiffness and jerking of the limbs and loss of consciousness. A condition in which seizures commonly occur is epilepsy. The most common type of epileptic seizure is the generalized tonic–clonic seizure, often called a grand mal seizure. These rarely last more than a few minutes. When they are complete, the casualty goes into what is known as a postictal state, which is the recovery period for the casualty. During this period, the casualty may be unresponsive, sleepy, weak or disorientated. Due to the large number of muscles that were contracting during the seizure, the casualty will feel extremely tired. Epilepsy is not the only cause of seizures and it is important to remember that other injuries or medical conditions can result in seizures. A seizure may occur:

In a person with epilepsy

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As a result of almost any condition affecting the brain, such as head injury, stroke, meningitis, brain tumor.

In association with some poisons and drugs During withdrawal from alcohol or other drugs of dependence In children under 5 years, in association with a high temperature, called

febrile convulsion. Some signs and symptoms of seizures are:

Aura, which is an unusual sensation preceding a seizure – the casualty may go quiet and stare

Collapse and momentary rigidity, called the tonic phase Uncontrolled, spasmodic, jerky movement of the limbs and body, called

the clonic phase. This usually subsides after a few minutes Possibility of loss of bladder and/or bowel control Cyanosis around the face and lips Dilated pupils that are slow to react Unconsciousness Confusion, incoherence, drowsiness and lethargy for a period after the

seizure, called the postictal phase To treat a casualty who is suffering from a seizure, follow these steps:

Protect the casualty from injury by moving furniture or sharp objects that may inflict harm and put padding under their head.

Do not restrain the casualty or try to stop the seizure. Allow the seizure to run its course. – Cover the casualty if there has been loss of bladder or bowel control.

Do not put your fingers or any other objects in the casualty’s mouth.

Once the seizure has stopped: Check the unconscious casualty’s airway and breathing. Place the casualty in the recovery position Check the airway. If fluid or vomit is present in the mouth, tilt the face

downwards and clear the mouth with your fingers. Check for and treat any injuries the casualty may have suffered during

the seizure. And allow recovery in a quiet place. Remember, they will be extremely embarrassed. Stay with the casualty until they are fully conscious and aware of their

surroundings. Call triple zero for an ambulance if any of the following occur:

– The casualty has a seizure of any duration? – The casualty has repeated seizures.

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– The casualty has not had a seizure previously. – The casualty does not regain consciousness following the seizure. – You are unsure as to the cause of the seizure. – The seizure takes place in water.

Febrile convulsions occur in approximately 3% of children at some stage in the first five years of life. They are brought on by a high body temperature, usually greater than 38°C, that is usually caused by a viral infection. It is the sudden rise in temperature, rather than the high temperature itself, that causes the febrile convulsion. A child experiencing or about to experience febrile convulsions may:

Have a history of infection Appear sick Start crying Have flushed, hot skin Begin convulsing Have eyes rolled back in their head Become stiff or floppy Stop breathing and turn blue, but will usually begin to breathe again after

one to three minutes.

To treat a child for febrile convulsions, follow these steps: Reduce clothing on the child to a minimum, like a nappy or underwear. Cool the child by fanning them gently but be careful not to overcool them

or cool them too quickly. Do not allow the child to start shivering. Call triple zero for an ambulance.

Remember: do not cool a child too quickly as their body could attempt to compensate and cause their temperature to rise even higher, which is counterproductive. Never let a child shiver as this is one of the body’s mechanisms for raising body temperature, but it applies only to children with fevers. It does not apply to older children or adults who are suffering from heat exhaustion or heat stroke. These illnesses require the body’s temperature to be reduced quickly. RECAP To treat a casualty who is suffering from a seizure, follow these steps:

Protect the casualty from injury by moving furniture or sharp objects that may inflict harm and putting padding under the head.

Do not restrain the casualty or try to stop the seizure. Allow the seizure to run its course.

Do not put your fingers or any other objects in the casualty’s mouth.

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Once the seizure has stopped: – Check the unconscious casualty’s airway and breathing. – Check for and treat any injuries the casualty may have sustained during the seizure. – Place the casualty in the lateral position and allow recovery in a quiet place. – Cover the casualty if there has been loss of bladder or bowel control. Remember, they will be embarrassed. – Stay with the casualty until they are fully conscious and aware of their surroundings.

QUIZ That’s the end of the chapter, so it’s time to take a quiz. Remember, if you get a question wrong, you can repeat your answer until you get it correct. You will need to successfully complete all questions in this chapter. Ready to go?

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Chapter 10 INTRODUCTION Hello and welcome to this next chapter. You’ve learned a lot about the different systems in the human body and now we come to the musculoskeletal system. Throughout this chapter you’ll learn how it works, as well as how to handle fractures, dislocations and soft tissue injuries such as bruises and sprains. Don’t forget to take the quiz and remember to check out the demonstration videos, activities and helpful hints.

Lesson 10.1 – Musculoskeletal System The musculoskeletal system of the human body consists of a bony framework called a skeleton that is held together by ligaments, layers of muscle, tendons and other connective tissues. The two main components of the musculoskeletal system are the skeleton and the muscles. The functions of the musculoskeletal system include:

Giving the body shape Protecting the internal organs Providing the mechanisms for movement.

The human body consists of more than 200 bones of varying shapes and sizes. Bones have a rich supply of blood and nerves and therefore can bleed and be painful when they are damaged. The bleeding can become life–threatening if it is not properly treated. Tendons are cords of fibrous tissues that attach muscles to bone. Ligaments are fibrous connective tissues that join bone to bone and stabilize the joints. Joints are structures formed by the ends of two or more bones coming together. They are held together by ligaments, which restrict their movement. When a joint is forced beyond its normal range of motion, ligaments stretch and tear. When this happens, the joint becomes unstable because too much irregular movement of its bones is permitted. There are four types of injury that occur to the musculoskeletal system:

Fracture – this is a break in the bone. Fractures can occur in several ways, but the most common cause is some form of traumatic injury.

Dislocation – this occurs when there is a displacement of bone–ends in a joint, such as a knee or a finger

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Sprain – this occurs when there is a partial tear of the ligaments Strain – this occurs when over–exertion of a muscle damages its tissues.

Lesson 10.2 – Fractures FRACTURES Fractures, sometimes referred to as breaks, are most common injury to bones in the musculoskeletal system. There are three types of fractures:

Closed (or simple) – where the skin’s surface is not broken at the fracture site.

Open (or compound) – where the skin surface has been broken at the fracture site.

Complicated – where other organs are involved, for example, a fractured rib causing a punctured lung.

Fractures can be caused by:

direct force indirect force and in rare cases, abnormal muscle contraction.

Signs and symptoms of fractures include:

Pain Tenderness Swelling or irregularity Loss of power or function Bleeding Shock like signs and symptoms Crepitus (a grating sensation felt when the ends of a broken bone rub

together) Open wounds with or without exposed bone ends Discolouration Shortening of the limb Deformity.

As a general rule, when treating a casualty with a fracture, where paramedics are less than 30 minutes away, you do not need to splint the fracture. In these circumstances, you should support the injury in the position found and not move the casualty unnecessarily. If you do have to move a casualty for example, if there is approaching danger or if paramedics are more than 30 minutes away, then you immobilise the fracture.

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If splints are not readily available, you can use what are known as body splints. This is when a part of the body is used as the splint, such as splinting the casualty’s uninjured leg to the injured leg. This is a good method of splinting that ensures the casualty’s injured leg will not be moved unnecessarily. The principles behind splinting are to:

Minimize pain Prevent further damage to soft tissues by restricting movement of the

broken end of the bones Minimize any bleeding Prevent a closed fracture from becoming an open fracture and Reduce the risk of shock.

Triangular bandages are large three–sided pieces of cloth that can be folded in various ways to be utilized in different situations. Triangular bandages are commonly used in fracture management; however if triangular bandages are not available, you may have to improvise with other material. When managing any fracture you should always follow these simple steps:

Reassure the casualty Position the casualty comfortably to ensure they remain as still as

possible. Control any associated severe bleeding Immobilize the fracture above and below the site to prevent movement

of the bone ends Check the circulation below the fracture site. Call triple zero for an ambulance. Regularly monitoring the casualty’s vital signs.

Prior to showing you how to treat specific fractures, here are some helpful hints for you to remember:

Listen to the casualty. They are the ones that feel the pain and are in the best position to determine what is comfortable.

Plan your treatment. Do not move the fractured limb anymore than is necessary. Tie the bandage off on the uninjured side. Make sure the ties are firm, but not too tight.

When you complete the practical training of this first aid course, you will have a chance to practice how to treat a fracture.

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RECAP When managing any fracture you should always follow these simple steps:

Reassure the casualty Position the casualty comfortably so they remain as still as possible. Control any associated severe bleeding Immobilize the fracture above and below the site to prevent movement

of the bone ends Check the circulation below the fracture site. Call triple zero for an ambulance. Monitor the casualty’s vital signs.

Lesson 10.2 – Bandaging techniques Here we have a selection of the most common types of bandaging techniques that are required to treat broken limbs. To view the clip, click on the video you wish to watch. You are free to watch these videos at your own pace and in any order, but remember you must watch all videos before you can continue on to the next lesson. Ready to start?

Lesson 10.3 – Dislocations Looks painful, doesn’t it? But this climber horse rider hasn’t broken anything; rather she’s dislocated her shoulder. So how do you treat it? Dislocations often look like a fracture, so if you’re in doubt, treat and splint as a fracture. Some signs and symptoms of dislocation are:

Pain Inability to move Deformity Tenderness Swelling and discolouration.

There are a few important things to remember when treating a dislocation:

Never replace the joint back into the socket. Rest and support the limb in the most comfortable position for the

casualty. Apply a cold pack. Immobilize the dislocation. Monitor and record vital signs.

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Call triple zero for an ambulance.

Lesson 10.4 – Soft Tissue Injuries – Bruises, Strains and Sprains Let’s move on from fractures and dislocations and examine the different types of soft tissue injuries that can occur. Signs and symptoms of soft tissue injuries include:

Pain Swelling Bleeding into the tissue (bruising)

To manage a soft tissue injury, you should follow the RICER technique:

Rest Ice Compression Elevation Referral

• Rest – rest the casualty and the injured part to reduce further damage. Avoid movement and don’t put any weight on the injured part of the body. • Ice – apply an ice or cold pack for 20 minutes wrapped in a towel every four hours to the injured part. Continue this treatment for 48 hours. Do not apply cold pack directly to the skin. • Compression – apply a roller bandage to the injured part, preferably crepe or elastic, for two hours. Compression reduces the bleeding and swelling. Check occasionally to ensure that circulation beyond the bandaging is not reduced. • Elevation – elevate the injured part to stop bleeding and swelling. If possible place the injured area on a pillow for comfort and support. • Referral – refer the injured person to a qualified medical professional for accurate diagnosis, ongoing care and treatment. RECAP To manage a soft tissue injury, you should follow the RICER technique:

Rest Ice Compression Elevation Referral

Lesson 10.4 – (Interactive Activity) – Bruises, sprains and strains Alright, now we have learnt how to treat a sprain lets test you knowledge with a quick activity.

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To complete this activity, simply drag and drop the steps into the correct order. Release each step over the correct numbered space. Please note, that you must complete this activity within the allocated time. Click start to begin the activity. QUIZ That’s the end of the chapter, so it’s time to take a quiz. Remember, if you get a question wrong, you can repeat your answer until you get it correct. You will need to successfully complete all questions in this chapter. Ready to go?

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Chapter 11 INTRODUCTION Hello and welcome to this next chapter. In this chapter you will learn how to identify and treat head and spinal injuries. Before we get into that, let’s take a look at the nervous system. It is a complex body system, made up primarily of the brain, nerves and spinal cord. The brain is the master organ of the body and is responsible for the regulation of all systems. The brain sends and receives messages via a network of nerves that transmit information as electrical impulses around the body. When the head sustains damage, it can severely impair the nervous system. Head injuries can include concussion, a fractured skull, cerebral compression and other brain damage.

Lesson 11.1 – Concussion The first head injury we’re going to look at is concussion. This is a temporary loss or altered state of consciousness occurring after a head injury. Casualty’s who subsequently show a decline in conscious level is suffering from a more serious brain injury, which requires urgent medical attention. The signs and symptoms of concussion are:

Temporary confusion Confusion that lasts several minutes Inability to recall the incident Repeatedly asking what happened Irritability and refusal of assistance Combativeness Inability to answer questions or obey commands.

Lesson 11.2 – Head injuries Head injuries may cause loss of consciousness, damage to the brain, eyes, ears, teeth, airways and mouth. Severe head injuries may lead to death or permanent brain damage. The establishment and maintenance of a clear airway is the first priority in the care of a head injury casualty. This takes precedence over the management of associated injuries. Head injuries may be caused by trauma of varying degrees. Always consider the actual mechanism of injury that is how the injury has occurred, such as a heavy object falling from a height and landing on the casualty’s head.

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Signs and symptoms of head injuries are:

Skull deformity Obvious signs of a head wound Unconsciousness, drowsiness or vagueness Loss or memory Agitation or irritability Lack of coordination and loss of limb power Slurred speech Bleeding into the eyes Bruising around the edges of the eyes and behind the ears Have bleeding or straw colored fluid discharge from ears, nose or mouth. Develop changes in size or shape of pupils Having or have had a seizure.

From a first aid perspective, all casualties with a head injury should be considered to have a spinal injury. The treatment for head injuries is:

Implement the emergency action plan. Call triple zero for an ambulance. Move the casualty only if it is absolutely necessary to do so. If you are required to move the casualty, (for example they are

unconscious or bleeding from the ear) fully immobilize the casualty prior to moving them.

Support the head and neck with both hands, minimizing head and neck movement.

Control any external bleeding. Lightly cover open wounds. If the casualty is bleeding from the ear, carefully position them with the

bleeding ear down. However, if you find the casualty is bleeding from both ears, cover the ear or ears with a sterile pad.

Rest and reassure the casualty. Regular monitor and record vital signs.

Motorcycle helmets should only be removed if absolutely necessary, either when the casualty is unconscious, the airway is blocked or potentially blocked. Removal of the helmet is essential if resuscitation is required. If the first aid provider needs to treat a casualty who is wearing a helmet the following treatment process should occur: For a casualty that is conscious, orientated and is able to describe his/her injuries then:

the helmet can stay in place until the paramedics arrive.

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The casualty should be rested and reassured. A full examination of the casualty should occur as normal to detect any

injuries. If the casualty does not want the helmet removed, then they have not given consent to do so. For an unconscious casualty the treatment is as follows: -‐ Roll them into the recovery position, then begin helmet removal (I’ll talk about this in a moment). This will allow for airway management and the removal of blood or vomit. Please note, if the helmet is left on whilst the casualty is in the recovery position, then the neck would be flexed laterally, which could worsen neck and spinal injuries. Motorcycle helmets are to be removed with the following steps: 1. Wherever possible, two people should undertake helmet removal – one

person to steady the head and neck of the casualty, the other person to gently remove the helmet. A single person should only carry out the procedure if no one is available to assist.

2. Carefully position the casualty on their back, where practicable. Use the log roll method to position the patient.

3. Stabilise the head by placing hands on each side of the helmet. 4. Cut the helmet chinstrap or unbuckle if easy to do so. 5. Support the neck and head with one hand and carefully insert fingers under

the helmet rim to hold the jaw firmly between thumb and fingers. 6. Pull sides of the helmet outwards to loosen the internal grip over the ears

and side of the head. 7. Keep the helmet sides apart and tilt it upwards at the front, to clear the chin

and nose. Support the head from falling back as the helmet is removed, avoiding any head or neck movement,

8. Tilt the helmet forward to clear the back of the head and carefully lift it off, avoiding any head or neck movement.

9. After removal of the helmet, stabilises the head to minimize head and neck movement.

10. The helmet should accompany the victim to the hospital for later inspection. RECAP So to recap what we’ve learnt on head injuries:

A head injury may cause loss of consciousness and could include damage to the brain, eyes, ears, teeth, airways and mouth.

All casualties with a head injury should be considered to have a spinal injury.

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If you are required to move the casualty, fully immobilize the casualty prior to moving them.

Always support the head and neck with both hands, minimizing head and neck movement.

And for head injuries involving the casualty wearing a motorcycle helmet, only remove the helmet if absolutely necessary; either if the casualty is unconscious, the airway is blocked or potentially blocked

Removal of the helmet is essential if resuscitation is required.

Lesson 11.3 – Spinal Injuries Let’s move our down the body and discuss spinal injuries. The spinal column is the principal support system of the body. The spinal column surrounds and protects the spinal cord. Spinal injuries can occur in the following regions of the spine:

The neck – the cervical spine The back – the thoracic spine. The lower back – the lumbar spine.

The possibility of a spinal injury must be considered in the overall management of all trauma casualties. Some common causes of spinal injuries include:

Motor vehicle crashes Diving accidents Assaults Industrial accidents, such as falls or something falling from a height Head injuries Landing heavily on your feet or buttocks from a height

Without the proper diagnostic tools, you will not be able to determine if a spinal fracture or damage to the spinal cord has occurred. The spine can be broken even if there is no evidence of paralysis. When in doubt, always treat the casualty for a spinal injury. Signs and symptoms of a spinal injury may include:

Pain and tenderness at the site of the injury Weakness of the extremities Numbness and tingling Loss of feeling or sensation Swelling or bruising over the injured area Altered level of consciousness

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Evidence of a wound Loss of bladder and or bowel control Altered breathing effort Altered body temperature.

When treating a conscious spinal injury casualty:

Dial triple zero for an ambulance Only move the casualty if it is absolutely necessary to do so. If you are required to move the casualty, fully immobilize the casualty by

supporting the head and neck with both hands. This will minimize head, neck and spinal movement

Control and external bleeding. Never rush the treatment. Take your time handling the casualty carefully. Re–assure the casualty. Maintain normal body temperature. Regularly monitor and record vital signs.

When treating an unconscious spinal injury casualty:

Dial triple zero for an ambulance If the casualty is breathing, place the casualty on their side. If you are required to move the casualty, fully immobilize the casualty by

supporting the head and neck with both hands. This will minimize head, neck and spinal movement.

Control and external bleeding. Never rush the treatment. Take your time handling the casualty carefully. Maintain normal body temperature. Regularly monitor and record vital signs.

RECAP Signs and symptoms of a spinal injury may include:

Pain and tenderness at the site of the injury Weakness of the extremities Numbness and tingling Loss of feeling or sensation Swelling or bruising over the injured area Altered level of consciousness Evidence of a wound Loss of bladder and or bowel control Altered breathing effort Altered body temperature.

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Lesson 11.4 – Tooth and Gum Injuries Tooth and gum injuries are also classified as head injuries. If one or more teeth have been knocked out, you need to control any bleeding to the gum area as well as protect the dislodged tooth or teeth. Some signs and symptoms of tooth or gum injuries are:

Bleeding from the damaged area Pain A broken tooth or teeth Missing teeth. To treat someone with a tooth or gum injury, follow these steps: If the casualty has associated head or facial injuries, call triple zero for an

ambulance. Sit the casualty down with their head tilted forward to allow for fluid to

drain. Place a gauze swab into the tooth socket and ask the casualty to bite

down on it for up to 20 minutes. If the tooth cannot be placed back into the socket, it is best to preserve

the tooth by placing it into the casualty’s mouth, between the lips and gum.

If there is any possibility of the casualty swallowing the tooth then it is better to place the tooth in a container with a small amount of milk. Never use water as this can damage the tooth.

Seek dental aid as soon as possible as the tooth has a better chance of surviving if replaced within 60 minutes.

Lesson 11.4 – (Helpful Hints) – Tooth and gum injuries If you ever have to treat a patient with a dislodged tooth, which normally happens at sporting events or school playgrounds the best thing to do is sterile dressing and get the patient to bite down on that to stop any bleeding and then if you have got the tooth then place that in a glass bottle with milk, milk is the best option to reserve the tooth as opposed to water it’s less abrasive and it’s got less chemicals than water so that’s the best option.

Lesson 11.5 – Eye Injuries Now that you’ve learned about tooth and gum injuries, we can move on to eye injuries. The eye is essentially a globe that is held in shape by the pressure of fluids within it. It contains a retina, optic nerve and iris.

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All eye injuries are potentially serious because of the danger of infection and damage to sight. The eye may be injured in a number of ways:

Foreign bodies, such as particles of dust or dirt, eyelashes, insects, metal or wood fragments

Burns, including chemicals, household sprays, welding flash, ultraviolet light from the sun, smoke from fires

Trauma from a direct blow to the eye causing a laceration or bruising Penetration caused by a foreign object piercing the eye.

Some signs and symptoms of eye injury include:

Pain in the eye Discomfort Bleeding or watering eyes Spasm of the eyelid Redness of the eye Gritty feeling in the eye Burning sensation Inability to open the eye.

Suspect significant injury if the casualty:

Has loss of vision Loses part of the field of vision Has severe pain in the eye Or has double vision.

How you treat a casualty with an eye injury will depend on the nature of the injury. When treating a casualty for foreign bodies in the eye:

Check under the eyelid for foreign bodies. If the object is not embedded, gently flush it out with eyewash. If the foreign object has not been removed, cover both eyes with a pad

and seek medical aid. To treat a casualty with a penetrating eye injury, follow these steps:

Dial triple zero for an ambulance. Do not remove the object. If the eyeball is hanging out of the eye socket do not try to put back in

place. Stabilize the penetrating object. Place a drink cup or something similar over the eye and secure. You need to cover the uninjured eye with a pad. The aim is to reduce eye

movement. Lay the casualty on their back, raising and stabilizing the head and

shoulders.

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Rest and reassure the casualty. Monitor and record vital signs.

A chemical burn to the eye is a serious emergency. Permanent damage can occur within seconds and the first 10 minutes following the injury will determine the final outcome. Burning and tissue damage will continue to occur as long as any substance is left in the eye, even if that substance is diluted. Management MUST begin immediately. Signs and symptoms of a chemical burn to the eye include:

Irritated, swollen eyelids Redness of the eye or red streaks across the surface of the eye Blurred or diminished vision Excruciating pain in the eyes Irritated, burned skin around the eyes.

To treat a casualty with chemical burns to the eye:

Dial triple zero for an ambulance. Flush the eyes with running water for at least 20 minutes. Monitor and record vital signs.

It’s important to remember to never try and remove contact lenses.

Lesson 11.6 – Ear Injuries Injuries can occur to the internal or external part of the ear. Foreign substances can block or injure the ear canal. The eardrum is located at the end of the ear canal and can be easily damaged by pressure. Cleaning someone’s ear must be left to trained medical professionals. Common ear injuries include lacerations and foreign bodies obstructing in the ear canal. If a casualty is bleeding from the ear, follow these steps:

Lightly place a sterile pad over the ear and position the casualty with the injured side down to allow for drainage. Be aware that bleeding from the ear may indicate a head wound.

Call triple zero for an ambulance. If the casualty is suffering from a foreign body in the ear:

Rest and reassure the casualty. Seek medical aid.

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Lesson 11.7 – Jaw Injuries Any injury to the jaw can cause airway problems, so you must monitor the casualty’s breathing. Signs and symptoms of jaw injuries include:

Pain Bleeding Deformity of the jaw and face Dribbling Unable to open mouth Swelling.

If the casualty is conscious and suffering from a jaw injury:

Maintain an open airway. Ask the casualty to support the jaw in a position of comfort. Sit the casualty up, leaning them forward to allow for drainage of saliva

and blood. Never bandage the jaw. Monitor and record vital signs. Wipe away saliva and blood. Call triple zero for an ambulance.

If the casualty is unconscious, follow these steps:

Dial triple zero for an ambulance. Place them in the lateral (side) recovery position. Maintain the airway. Monitor and record vital signs.

QUIZ Ok, that’s the end of this chapter, so it’s time to take a quiz. Remember, if you get a question wrong, you can repeat your answer until you get it correct. You will need to successfully complete all questions in this chapter Ready to go?

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Chapter 12 INTRODUCTION Hello and welcome to this next chapter. In this chapter you will learn how to identify and treat chest, abdomen and pelvic traumatic injuries.

Lesson 12.1 – Chest Injuries The chest cavity houses some of the major organs that our bodies need to function, including the lower airway, heart and major blood vessels. This is why injuries to the chest can be life threatening.

Lesson 12.2 – Common Chest Injuries Now that you know what the chest cavity houses, let’s look at the type of injuries that can occur. There are two types of chest injuries: closed and open. Closed chest injuries are a result of blunt trauma applied to the chest cavity, which can cause extensive damage to the ribs and internal organs. Blunt trauma is associated with falls, motor vehicle accidents and blows to the chest. Open chest wounds are a result of a penetrating injury. Penetrating trauma is associated with stabbings; gunshot wounds and falls onto objects sharp enough to penetrate the skin. The three most common sorts of chest injuries are:

Fractured ribs Flail chest (A flail chest occurs when multiple ribs are broken and are

floating free) And sucking chest wound.

Fractured ribs are the most common chest injury. Complications can occur if the rib has punctured the lung. Signs and symptoms of fractured ribs include:

Pain Bruising Difficulty breathing Tenderness Deformity Shock. Distress

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The treatment for a casualty with broken ribs is:

Place the casualty in a comfortable position normally half sitting, and encourage them to lean to the injured side.

Ask the casualty to breathe slowly and provide reassurance. Monitor and record vital signs. Call triple zero for an ambulance.

It is important to never strap the casualty’s arm against their chest as this may impair their breathing. A flail chest is life–threatening and occurs when a segment of the chest wall breaks under severe trauma and becomes detached from the rest of the chest wall. It occurs when multiple adjacent ribs are broken in multiple places, separating a segment, so a part of the chest wall moves independently. For example, when a casualty who is not wearing a seat belt comes into contact with the steering wheel in a car crash. Signs and symptoms of a flail chest may include:

Obvious deformity Pain Breathing difficulties Bruising Tenderness Shock.

When treating a casualty with a flail chest

Place the casualty in a comfortable sitting position leaning towards the injured side.

Stabilize the floating segment by using your hand or a pad, then support the casualty’s arm against the chest and apply a sling.

Ask the casualty to breathe slowly and carefully. Monitor and record vital signs. Call triple zero for an ambulance.

A sucking chest wound occurs when the chest wall is punctured. Air is then sucked into the chest cavity, which will cause the lung to collapse. If air continues to enter the chest space faster than it can escape, then the rising pressure can force the collapsed lung to press on the heart and other lung. This is a life–threatening condition that can lead to death if not managed appropriately. Signs and symptoms of a sucking chest wound

Breathing difficulties

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An obvious chest wound, which may be bubbling and bleeding Air being sucked in and out of the chest cavity Possibility of bright red or pink, frothy blood being coughed up Pain Cyanosis or blueness around the lips, ears and fingernails Shock.

To treat a casualty with a sucking chest wound

Place the casualty in a comfortable position leaning towards the injured side.

Cover the wound with a dressing or your hand until you can place a three–sided dressing to the wound.

Place an airtight dressing (use plastic, cling wrap, etc.) and seal it with tape along the sides and on top of the dressing, leaving the bottom of the dressing unsealed.

This creates a one–way valve and allows for air trapped within the chest cavity to escape and prevents air being sucked into the wound.

Keep the casualty warm and treat for shock. Monitor and record vital signs. Rest and reassure the casualty. Call triple zero for an ambulance.

Like the chest cavity, the abdomen contains major blood vessels and organs. Penetrating or blunt trauma can cause serious injury to the abdominal region. The effect of this injury may include extensive external and internal bleeding due to internal organs being punctured or cut. There may also be evidence of exposed bowel protruding from the wound. Some signs and symptoms of abdominal injury include:

Abdominal (stomach) pain Guarding (the casualty protecting their abdominal area with their hands,

and bent over) Bleeding and associated wounds Bruising of the abdomen Abdominal rigidity, if the stomach feels hard, indicating probable internal

bleeding Nausea and/or vomiting Part of the bowel may be exposed Shock.

To treat a casualty suffering from an abdominal injury, follow these steps:

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Control any bleeding. Remember, there may be internal bleeding if the abdomen has sustained major trauma.

Call triple zero for an ambulance. If conscious, place the casualty on their back and elevate their upper

torso by placing a pillow or folded blanket under their head and shoulders and place a rolled up blanket under their knees.

If unconscious, place the casualty in the recovery position. If the bowel is exposed, cover it with a moist (normal tap water is fine),

non–stick dressing and bandage the dressing in place. Rest and reassure the casualty. Keep the casualty warm. Monitor and record vital signs.

Remember:

Do not attempt to replace the exposed bowel back into the abdominal cavity.

Never touch the exposed bowel with your fingers as this may cause a spasm of the bowel and a bowel obstruction.

Do not give food or drink RECAP Signs and symptoms of abdominal injury:

Abdominal (stomach) pain Guarding Bleeding and associated wounds Bruising of the abdomen Abdominal rigidity Nausea and/or vomiting Part of the bowel may be exposed Shock.

Lesson 12.2 – (Interactive Activity) – Common chest injuries

In this activity you need to drag and drop the dressing into the correct position. When you have dressed the wound correctly the green tick will appear, confirming the placement of each item. Please note: you must complete this activity within the allocated time. Here’s a tip all fluid drains out by gravity. Shall we get started then?

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Lesson 12.3 – Pelvic Injuries It may come as a surprise, but pelvic injuries can be life threatening. The pelvic area contains and protects the urinary and reproductive systems and parts of the major blood vessels. Major blood vessels may be injured by pieces of broken bone from a fractured pelvis. This is a serious condition because blood loss from the pelvis is usually high (between one and two litres). There is also the risk of major infection due to waste products being released from a ruptured bladder. Some signs and symptoms of pelvic injury include:

Pain and tenderness Casualty may wish to urinate Guarding (the casualty protecting their abdominal area with their hands,

and bent over) Shock.

To treat a casualty suffering from a pelvic injury, follow these steps:

Place the casualty in a comfortable position. Control any bleeding. Remove objects from the casualty’s pockets that may be causing

discomfort. You must gain consent to do this and ensure the casualty retains the property in a plastic bag or similar.

Support and protect the fractured area. Encourage the casualty not to pass urine. Keep the casualty warm. Rest and reassure the casualty. Monitor and record vital signs. Call triple zero for an ambulance.

RECAP To treat a casualty suffering from a pelvic injury, follow these steps:

Place the casualty in a comfortable position. Control any bleeding. Remove objects from the casualty’s pockets that may be causing

discomfort. You must gain consent to do this and ensure the casualty retains the property in a plastic bag or similar.

Support and protect the fractured area. Encourage the casualty not to pass urine. Keep the casualty warm. Rest and reassure the casualty.

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Monitor and record vital signs. Call triple zero for an ambulance.

QUIZ That’s the end of the chapter, so it’s time to take a quiz. Remember, if you get a question wrong, you can repeat your answer until you get it correct. You will need to successfully complete all questions to achieve certification for this part of the course. Ready to go?

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Chapter 13 INTRODUCTION Hello and welcome to the chapter thirteen. You’re almost at the end, so keep up the good work. In this chapter you will learn how to identify and treat poisoning, bites and stings.

Lesson 13.1 – Poisons Poisoning maybe accidental or deliberate. The term poison refers to a wide variety of substances that have the potential to cause illness or injury when they come into direct contact with or enter the body. Poisons can have effects that range in severity depending upon the type and amount of poison involved, AND the age, size and general well being of the affected person. Around the home and in other everyday situations, there are many poisonous substances that can result in serious and potentially life-‐threatening emergencies. Some common poisons include household cleaners, pesticides, weed killer, paints, poisonous plants, motor vehicle fumes, pool chemicals and prescribed medication. When any form of poisoning occurs, you can obtain advice about how to manage the situation and treat the casualty by calling the Poisons Information Centre on 13 1126. This is a 24-‐ hour, Australia-‐wide number that connects to a network of Poisons Information Centres across the country. Recognition of poisoning may be obvious from the circumstances of the incident, but this is not always true. A person may complain of physical symptoms without realising these are due to a poison. Poisonous effects include:

Hyperactivity, followed by drowsiness and unconsciousness Irregular heartbeat, followed by cardiac arrest Difficulty breathing Damage to bone marrow.

Alternatively, they may exhibit abnormal behaviour, which may be misinterpreted as alcoholic confusion or psychiatric disturbance. In industrial environments or emergency situations involving chemical transport vehicles or the storage of chemicals, you should look for an Emergency Information Panel or EIP on the vehicle. An EIP is a sign of specified format used to identify dangerous goods when transported in tanks.

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If safe to do so, then you should attempt to identify the HAZCHEM alphanumeric code of 2 or 3 digits on the Emergency Information Panel. The HAZCHEM code provides initial emergency response information about dangerous goods to the emergency services when responding to an incident involving those goods. Poisons can enter the body by: • Inhalation • Absorption • Ingestion • Injection. Poisoning by inhalation occurs when poisonous substances are breathed into the lungs, so it is often associated with breathing difficulty and respiratory arrest, particularly when exposure has occurred in a confined space that is not well ventilated. Some inhaled poisons are not easy to detect. For example, carbon monoxide poisoning results from a casualty inhaling car exhaust fumes, which can be odourless. Organic substances such as glues, hair spray, lighter fluid, dry cleaning fluid, nail polish remover and petrol may be deliberately inhaled to produce altered sensation. Non-‐poisonous gases (for example, in fire suppressant systems) can also be harmful if they replace oxygen-‐containing air. These dangers are increased by exercise, placing a bag over the face, or inhalation in a confined space. At times a casualty may recover rapidly from inhalation poisoning after they have been moved into an area with fresh air, though it is important to remember that some inhaled toxins can cause serious medical problems. A casualty who has suffered from inhalation poisoning should seek urgent medical assessment and treatment. You should take special care to avoid inhaling the air exhaled by the casualty affected by inhalation poisoning. Stay uphill and upwind if possible. Poisoning by absorption occurs when toxins come into contact with the external surfaces of the body and are absorbed through the skin. The natural toxins of poisonous plants that cause irritation when you brush against them fall into this category, as do liquid chemicals used in agricultural dips and other animal treatments, and industrial chemicals. It is possible with this type of poisoning for clothes to become contaminated by the poison involved, which prolongs a casualty’s exposure. It is important that such clothing is removed and the affected area beneath thoroughly flushed with water.

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You should avoid coming into direct contact with contaminated clothing and the affected area of the casualty. Use disposable gloves if possible. Poisoning by ingestion occurs when a person swallows a poisonous substance or object, such as drugs, household chemicals or dangerous plants. Overdosing on a substance such as a drug also leads to poisoning. A narcotic drug overdose sustained by a casualty using a syringe to inject drugs into their body. Animals such as snakes, spiders, ticks and bees inject their poison into a casualty. You should attempt to safely retain any relevant items of the poisoning to assist with later identification of the substance taken. For example, presence of containers for chemicals or medication. The effects of different poisons can result in: • Irritation and burning, such as when dishwasher powder is swallowed or inhaled. • Stimulation or depression, such as caused by drugs and the sniffing of solvents. • Death by asphyxiation, such as when carbon monoxide exhaust fumes are inhaled. • Damage to the nervous system, such as caused by exposure to cyanide. To treat a casualty who is suffering from poisoning, follow these steps. • Be careful not to come into direct contact with the poisonous substance. • Ring the Poisons Information Centre on 13 11 26. • Call triple zero (000) for an ambulance. • Try to find out what has been taken, how much and when. • Regularly monitor and record vital signs. • Keep any containers of chemicals or medication found, to show to the ambulance paramedics. To treat an unconscious casualty who is suffering from poisoning:

Apply, D.R.S.A.B.C.D Before commencing resuscitation, quickly wipe down any obvious poison

contamination from around the mouth and nose, or use a resuscitation barrier device.

RECAP To treat a casualty who is suffering from poisoning, follow these steps: • Be careful not to come into direct contact with the poisonous substance. • Ring the Poisons Information Centre on 13 11 26. • Call triple zero for an ambulance. • Try to find out what has been taken, how much and when. • Regularly monitor and record vital signs. • Keep any containers of chemicals or medication found to show to the ambulance paramedics.

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Lesson 13.1 – (Helpful Hints) – Poisons Unfortunately some people tend to store poisons in a alternative container other then the one that it was purchased in old milk cartons, or a soft drink bottle this presents a real danger to everyone in the house or in the workplace and they won’t know what’s in the container and this can lead to a serious accident of someone ingesting the poison and there is a range of conditions that will present from that. Poisons should be stored in the appropriate container clearly labelled with what’s in the bottle and it should be stored in a safe lockable place out of reach of children. In the event that someone does ingest a poison call triple “0” immediately and call the poisons information line and if you know what the poison is that they have ingested ensure that the triple “0” (000) operator knows what that substance is and the poisons information line also.

Lesson 13.2 – Bites and Stings A bite or sting from dangerous species of animal, such as snakes, spiders, jellyfish, the blue–ringed octopus and cone shells causes what’s known as envenomation. While there are instances where venom may enter the circulatory system directly, for example, from a bite through the wall of a blood vessel, venom generally enters via the lymphatic system. If the bite or sting occurs on a limb, we can slow the travel of venom carried by the lymphatic system by using a pressure immobilization bandage. The casualty should be rested and the limb splinted to stop it from moving, otherwise the venom will continue to travel throughout the body. To apply the pressure immobilization bandage:

Rest and reassure the casualty. If on a limb, apply a pressure immobilization bandage over the bite as

soon as possible. Never wash away evidence of the venom as this is used to determine what anti-‐venom is required to treat the casualty.

Elasticised bandages (10-‐15cm wide) are preferred, however if unavailable, crepe bandages, clothing or other materials should be used.

The bandage should be firm and tight, you should be unable to slide a finger between the bandage and the skin.

If the bandage does not cover the entire limb, apply a second bandage starting at the fingers/toes and extending up the entire limb. This will restrict the lymphatic flow and assist in immobilization of the limb.

Mark the bite site on the bandage so it can be cut out at the hospital without removing the whole bandage and maintaining pressure.

Use a splint to immobilize the limb and keep the casualty relaxed until an ambulance arrives.

Remember; DO NOT remove the bandage once it has been applied correctly.

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If the bite is not on the limb, firm direct pressure on the bite site may be useful. The pressure immobilization technique is recommended for application to bites and stings by the following creatures:

All Australian venomous snakes, including sea snakes. If the snake cannot be identified, treat as venomous.

Funnel web spiders The Mouse spider Blue–ringed octopus Cone shell.

The pressure immobilization technique is NOT recommended for the first aid management of:

Other spider bites (including redbacks) Bee, wasp and ant stings Jellyfish stings Fish stings (including stonefish) Bites or stings by scorpions, centipedes or beetles

Snakes are common all over Australia with many of the common ones being highly venomous. Here are a few you should go out of your way to avoid, in fact, avoid all animals that you suspect of being venomous; Tiger snakes, sea snakes, brown snakes, taipans, the death adder, the copperhead snake, the black snake and the rough scaled snake. You are most likely to see one on hot days when they are active and during floods when they gather on high ground. Remember, 70 percent of snakebites occur on the legs. The effects of a snakebite can include:

Muscle paralysis and, eventually, breathing failure Bleeding due to the inability of the blood to clot Breakdown of red blood cells Muscle damage caused by release of kidney toxins.

Signs and symptoms of snakebite include:

Paired fang marks, although could be a single mark or scratch mark Headache, nausea and vomiting Abdominal pain, bright blood in urine, faeces or vomit Blurred or double vision Difficulty speaking, swallowing or breathing Limb weakness or paralysis Swollen glands in the area of the bitten limb

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Respiratory arrest Sweating

To treat a casualty for a snake bite:

Rest and reassure the casualty. Apply a pressure immobilization bandage. Regularly monitor and record vital signs. Begin resuscitation if necessary. Call triple zero for an ambulance immediately.

You must NEVER:

Cut or incise the bite Do not use an arterial tourniquet, use the pressure immobilisation

bandage over the full limb And never wash or suck the bite.

Funnel webs are common along the east coast of Australia. They can be quite large (7cm long) and are aggressive. The smaller males are five times more venomous than the fatter females, and you can find them inside houses as they look for a mate. Common homes for funnel webs are under rocks and logs in the garden, where they build a funnel–shaped web. The venom in a funnel web spider bite is highly toxic and acts on the central nervous system. Signs and symptoms of funnel web spider bites

Tingling around the mouth Muscular spasm or weakness Severe pain at the bite site Profuse sweating and copious secretion of saliva Confusion leading to coma Breathing difficulty.

To treat a casualty for a funnel web spider bite, follow these steps:

Rest and reassure the casualty. Apply a pressure immobilization bandage. Regularly monitor and record vital signs. Begin resuscitation if necessary. Call triple zero (000) for an ambulance immediately.

Mouse Spiders are widely distributed across mainland Australia. They can grow up to three centimetres long and are sometimes mistaken for funnel web spiders. They can be found in both coastal and drier habitats, whereas the funnel web lives in moist coastal areas. Mouse spiders live in burrows or holes in the soil.

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The venom in a mouse spider can be extremely toxic and is similar to that of a funnel web spider. Signs and symptoms of a mouse spider bite are:

Severe pain at the bite site Tingling around the mouth Muscular spasm or weaknesses Profuse sweating and copious secretion of saliva Confusion leading to unconsciousness Breathing difficultly

To treat a casualty for a mouse spider bite, follow these steps:

Call triple zero for an ambulance immediately Rest an reassure the casualty Apply a pressure immobilisation bandage to the affected limb (arm or leg) Regularly monitor and record vital signs (heart rate and respiration rate) Begin resuscitation is necessary.

The blue ringed octopus is found in rock pools around Australia. It displays blue rings on its tan body when it is alarmed. It can bite and has paralysing venom. Without basic life support, death can occur from respiratory paralysis within 30 minutes. There are 70 species of cone–shaped shells in the warmer waters of Australia, at least seven of which are dangerous. They have a harpoon like tooth at their mouth and can deliver paralysing venom. Without basic life support, death can occur from respiratory paralysis within 30 minutes. The effects of blue–ringed octopus bites and cone shell stings are:

Severe respiratory distress Severe stinging and reddening of the skin at the sting site.

Signs and symptoms of blue–ringed octopus bites and cone shell stings:

Numbness of the lips and tongue Blood visible at the injury site Progressive weakness of the breathing muscles, which will lead to

breathing difficulties or respiratory arrest. To treat a casualty for blue–ringed octopus bites and cone shell stings

Rest and reassure the casualty. Apply a pressure immobilization bandage. Regularly monitor and record vital signs. Commence resuscitation if necessary. Call triple zero (000) for an ambulance immediately.

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Prompt application of the pressure immobilization bandage will trap most of the venom at the bite site. Because of muscle paralysis leading to breathing failure, resuscitation must be continued because the paralysis will eventually go away after some hours. Bites and stings from many creatures create intense pain for a casualty, but are not immediately life-‐threatening. Except in the case of a severe allergic reaction, any serious effects other than pain are slow to occur and, generally, pressure immobilization is not necessary. In some cases it can actually make the casualty’s condition worse. Redback spiders are extremely common. They live outside, such as in piles of old corrugated iron or under outside chairs. They can also live inside, behind furniture and in corners of the garage. They build a web and weave a silken cocoon containing their young. They are not very aggressive. Signs and symptoms of redback spider bites include:

Intense pain at the bite site, which becomes hot, red and swollen Hallucinations Fevers Profuse sweating, especially at the bite site Swollen glands Nausea, vomiting and abdominal pain Rapid pulse Muscular weakness.

To treat a casualty for a redback spider bite, follow these steps:

Rest and reassure the casualty. Regularly monitor and record vital signs. Apply an ice compress to lessen the pain. Call triple zero (000) for an ambulance immediately. Anti–venom is available at hospitals.

Most Australian spiders aren’t dangerous, with the exception of mouse spider and funnel web, so to treat all other spider bites, follow these steps:

Apply an ice compress. Rest and reassure the casualty. Seek medical aid for pain relief. Call triple zero (000) for an ambulance. Begin resuscitation as necessary. Do NOT apply a pressure immobilization bandage.

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Australian scorpions and centipedes are not dangerous, unlike overseas varieties, which regularly kill people. Scorpion and centipede injuries are usually indicated by local pain and swelling. To treat a casualty suffering form this, follow these steps:

Apply an ice compress. Give reassurance. Seek medical aid for pain relief. Call triple zero for an ambulance. Apply a pressure immobilization bandage immediately if anaphylaxis

occurs. People commonly receive stings from these insects. Some people suffer allergies to the venom. These allergic reactions can be severe and occur quickly. Respiratory or cardiac arrest may occur in some instances. Some signs and symptoms of bee or wasp stings and ant bites include:

A visible sting Painful red swelling Allergic symptoms An itchy rash Facial swelling Swelling in the airway Difficulty breathing Collapse, but only in rare cases.

When treating a casualty for bee or wasp stings and ant bites, follow these steps:

Scrape the sting off sideways. Do not attempt to pull the sting out, as this may inject more venom into the sting site.

Apply an ice compress to relieve the pain. Rest and reassure the casualty. Call triple zero (000) for an ambulance. Begin resuscitation as necessary.

Remember, some people may be allergic to bee stings. Ask the casualty if they have an emergency action plan for the administration of an adrenaline auto–injector. Ticks are found in warm and moist regions of Australia. They often attach where they may not be easily found, such as in nooks and folds around the genitals and anus, behind ears and in the hair of a casualty. Paralysis ticks are small and if signs and symptoms appear, a detailed search may be necessary. The tick burrows its head into the skin and feeds off blood.

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Signs and symptoms of tick bites include: Local irritation Lethargy Weakness of muscles, particularly in children Double vision Difficulty swallowing or breathing Unsteady gait or staggering walk.

To treat a casualty for a tick bite, never squeeze the tick’s abdomen because a further release of venom will occur. Instead follow these steps.

Use fine curved forceps. Press the points down onto the skin on either side of the front part of the tick then close the points of the forceps and lift or lever the tick out intact. The tick should be removed slowly, allowing it to withdraw its mouthparts.

Do not grasp the tick’s body with fingers or forceps as this may result in incomplete removal as well as more toxins being released.

After removing the tick, antiseptic cream should be applied and the casualty advised to consult their doctor to check that no further treatment is required.

If there are signs of allergic reaction, such as a rash, headaches, fever or aching joints, the casualty should seek medical advice immediately.

Anti–venom is available at hospitals for Australian paralysis tick envenomation.

Stonefish, bullrout, platypus and stingray are found in waters all around Australia. They are well camouflaged and easily stepped on. Wounds are generally to the feet, so wear shoes when wading. Signs and symptoms that may occur include:

Intense pain and swelling Grey/blue discolouration on skin Sometimes an open wound is present, with possible associated bleeding Irrational behaviour and panic may occur.

To treat a casualty suffering from an injury caused by a stonefish, bullrout, platypus or stingray, follow these steps:

Rest and reassure the casualty. Place the affected part in water as hot as the casualty can tolerate as this

may relieve the pain. In the uncommon event that heat does not relieve the pain, apply an ice

pack, as this may be effective. Call triple zero (000) for an ambulance. Regularly monitor and record vital signs.

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Box jellyfish, commonly called stingers in northern Australia, are found from October to May in the coastal waters of tropical Australia, from Bundaberg in Queensland around to Geraldton in Western Australia. If you visit this area during these months, never swim in coastal waters. The sting of a box jellyfish cause severe respiratory distress and severe stinging and reddening of skin. Signs and symptoms of box jellyfish stings include:

Immediate burning pain to the skin Savage, multiple whip welts with a frosted ladder pattern in the sting

marks Adherent tentacles on the skin are usually present Irrational behaviour due to the extreme pain caused by the sting In major stings, there can be:

– Cessation of breathing – Cardiac arrest.

To treat casualty suffering a box jellyfish sting, follow these steps:

• Carefully remove the casualty from the water. • Avoid rubbing the sting area. • Immediately douse the sting area with vinegar for at least 30 seconds; do not wash with fresh water. • If vinegar is not available, carefully remove tentacles off skin and rinse well with seawater.

Call triple zero (000) for an ambulance.

• Commence resuscitation as necessary. • DO NOT USE a pressure immobilization technique. • Regularly monitor and record vital signs. • Anti–venom is available.

The Irukandji jellyfish is a small jellyfish approximately 2cm diameter, making it difficult for swimmers to notice in the water. Irukandji are most likely found in tropical Australian waters from November to May, though incidents of Irukandji Syndrome in Far North Queensland have been recorded for all months of the year. A casualty may not initially complain of severe pain after coming into contact with an Irukandji. Approximately 5 to 45 minutes after being stung, the casualty may present with the following signs and symptoms:

• Severe backache or headache • Shooting pains in their muscles, chest and abdomen • Nausea • Anxiety

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• Restlessness • Vomiting • Breathing difficulties.

To treat a casualty for an Irukandji sting, follow these steps:

• Carefully remove the casualty from the water. • Avoid rubbing the affected area. • Immediately douse the affected area with vinegar for at least 30 seconds; do not wash with fresh water. • If vinegar is not available, carefully remove tentacles off skin and rinse well with seawater. • Commence resuscitation as necessary. • DO NOT USE a pressure immobilisation technique. • Call triple zero for an ambulance.

Bluebottles are commonly found along the coast, and are more common on exposed ocean beaches after strong onshore wind. The colour of a blue bottle is not always blue, and can range from a blue to a pink colour with a translucent body. The body of a bluebottle measures 3 to 15cms. The tentacles can range in length from 15cms up to 10 metres. Signs and symptoms of bluebottle stings include:

• Reddening of the skin • Sharp, painful sting (aggravated by rubbing the affected area) • Red line with small white lesions • In severe cases blisters and welts looking like a string of beads may appear • Signs of shock • Children, asthmatics and people with allergies may experience respiratory distress.

To treat a casualty for a bluebottle sting, follow these steps:

• Carefully remove the casualty from the water. • Avoid rubbing the affected area. • Rinse the affected area well with seawater. • Place the affected part in water as hot as the casualty can tolerate as this may relieve the pain. • In the uncommon event that heat does not relieve the pain, apply an ice pack, as this may be effective. • Call triple zero (000) for an ambulance. • Monitor and record vital signs.

Vinegar is used to de–activate the discharge of nematocysts, or stinging capsules, of all known box jellyfish, and prevents further injection of venom. However vinegar may cause nematocyst discharge in some other jellyfish stings and therefore should

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be used only for known box jellyfish stings, including Irukandji stings. Vinegar cannot relieve the pain already present. Recent studies have shown that water applied to a jellyfish sting once the skin has dried will cause the undischarged nematocysts to fire. In most cases, first aid providers are unlikely to be able to identify the jellyfish. In the tropics, because of the risk (even if small) that the casualty has been stung by a potentially lethal jellyfish, the priority must be to preserve life. If the species causing the sting cannot be clearly identified as harmless, or due to a “Bluebottle”, it is safer to treat the casualty with vinegar. Outside the tropics, where huge numbers of non-‐life threatening stings occur, the primary objective is pain relief with heat or cold. The most common injury resulting from a domestic animal bite is laceration of the casualty’s skin. The treatment of a laceration resulting from a domestic animal is the same as the treatment of a laceration found in the chapter on bleeding and shock. RECAP The pressure immobilization technique is recommended for application to bites and stings by the following creatures:

All Australian venomous snakes, including sea snakes. Funnel web spiders Mouse spiders Blue–ringed octopus. Cone shell. Bee, wasp and ant stings.

The pressure immobilization technique is NOT recommended for the first aid management of:

Other spider bites (including redback) Jellyfish stings Fish stings (including stonefish) Bites or stings by scorpions, centipedes or beetles

Lesson 13.2 – (Interactive Activity) – Bites and stings Great, now it’s time for a quick activity. This activity will test your knowledge. You have to drag the right treatment to the matching bite or sting You will achieve this by click dragging the correct treatment and dropping it over the bite/sting that matches do this till all bites are matched to the right treatment.

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You have to place complete this activity before the allocated time. Ok, are you ready to begin? QUIZ That’s the end of the chapter, so you know it’s time to take a quiz. Remember, if you get a question wrong, you can repeat your answer until you get it correct. You will need to successfully complete all questions in this chapter. Ready to go?

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Chapter 14 INTRODUCTION Hello and welcome to the next chapter of the First Aid Flexible Learning Course. Congratulations for making it this far! In this chapter you will learn how to identify and treat the effects that extreme temperate has on the body. Overheating or overcooling can both be first aid emergencies. In normal circumstances, the human body self regulates at an average temperature between 36.5°C and 37.5°C using the skin. The skin assists in regulating body temperature by reacting to hot and cold conditions so the inner body temperature remains consistent. The skin is the outer covering of the body, also known as the epidermis. Interestingly, the skin is the body’s largest organ. The skin serves as the body’s protective cover and plays a very important role in the defense against infection and in regulating temperature. The skin also has the ability to send messages to the brain via its receptors, to alert of changes in the environment. Overexposure to either hot or cold environments can result in the body being unable to maintain its normal temperature. The responses generated by the body to compensate for significant temperature changes can lead to the impairment of vital bodily functions and even result in death if overexposure continues for an extended period of time. You may be required to manage conditions occurring as a result of overexposure to cold environments, such as hypothermia and frostbite, or conditions occurring as a result of overexposure to hot and humid environments, such as heat cramps, heat exhaustion and heat stroke.

Lesson 14.1 – Overexposure To Cold Let’s take a look at what happens to the body when it is overexposed to the cold. Hypothermia occurs when the heat being generated by the body is insufficient and the body’s temperature drops below 35 degrees Celsius.

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Situations that present a particular risk of hypothermia are typically those involving wet and windy, cold weather conditions, but also those involving bodies of water, such as when someone falls into or is stranded in cold water. Hypothermia can come on in stages, becoming progressively more serious if first aid treatment is not provided. The signs and symptoms the casualty experiences will generally be indicative of how severe the hypothermia is. This occurs according to a sequence:

1. Shivering – an automatic response by the body to generate heat that does not occur when the body temperature falls below approximately 35°C.

2. Lethargy 3. Decreased motor and sensory function (lack of coordination, loss of

sensation) 4. Decreased level of consciousness 5. Decreased effectiveness of the body’s vital functions (for example, a slow

pulse and slow respiration rate) 6. Unconsciousness and death.

Signs and symptoms of severe hypothermia can include:

Absence of shivering Incoherence Irrational behaviour Inability to walk Unconsciousness, with a death–like appearance Slow or irregular, weak pulse Slow, shallow breathing.

The overriding principle for managing a mild or severe hypothermic casualty is to reduce heat loss. For example:

Protect the casualty from wind, rain or snow. Remove any wet clothing. Have the casualty put on dry, warm clothing, If the casualty cannot be protected from the weather, remove and

replace wet clothing with dry clothing. Alternatively wrap something warm and dry over their wet clothing to minimize the effects of wind chill.

If the casualty is not shivering and medical assistance is delayed, you will need to improve the casualty’s ability to generate heat and re–warm them gently. This can be done by: – increasing muscular activity – increasing heat – wrapping the casualty in blankets

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– applying heat packs to areas where major blood vessels pass close to the skin, like the neck, armpits, groin and behind the knees. – sharing body heat.

If the casualty is conscious, give them warm food and drinks. Do not give alcohol.

Call triple zero 000 for an ambulance. Be cautious not to re–warm a hypothermic casualty too quickly. The sudden introduction of too much heat can cause dangerous heart rhythms. Frostbite is an extreme condition most commonly caused by exposure to sub–zero temperatures. It occurs most commonly in the extremities, particularly if they are directly exposed to the elements. For example the fingers, toes, ears and nose. The depth of the frozen tissue determines the degree of severity. Frostbite is classified as:

Incipient (also called frost nip) – affecting the tips of the ears, nose, cheeks, fingers, toes and chin. However the skin will be blanched white, but this early stage is painless.

Superficial – affecting the skin and the tissues just beneath the skin. The skin will be firm and waxy, and the tissue beneath is soft, numb and will turn purple during thawing.

Deep – affecting the entire tissue depth. The tissue beneath the skin is solid and waxy white in colour with a purplish tinge.

The signs and symptoms of frostbite include:

Numbness in the affected part Wax–like appearance to the skin Lack of movement Lack of circulation to the affected part Pain. Casualties with frostbite are likely to be hypothermic also. Always

manage hypothermia before treating frostbite. To treat a casualty who is suffering from frostbite, follow these steps:

Remove any clothing that restricts circulation as well as any other items, such as jewellery, that may be affected by later swelling.

Call triple zero for an ambulance. If the ambulance service or medical assistance is not readily available,

place the affected part in warm water for between 15 and 60 minutes. Do not use dry heat or water that is too hot (test with an elbow), as this will burn the frozen tissue.

Monitor the casualty closely for shock during the warming process.

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Cover the affected part with a dry, sterile, bulky, protective dressing. Tissue that has thawed on its own should not be actively re–warmed. Do not give alcohol or tobacco to a casualty with frostbite, as these will reduce circulation to the frozen tissues. RECAP The signs and symptoms the casualty experiences will be generally indicative of how severe the hypothermia is, according to this sequence:

1. Shivering – an automatic response by the body to generate heat that does not occur when the body temperature falls below approximately 35°C.

2. Lethargy 3. Decreased motor and sensory function (lack of coordination, loss of

sensation) 4. Decreased level of consciousness 5. Decreased effectiveness of the body’s vital functions (for example, a slow

pulse and slow respiration rate) 6. Unconsciousness and appearance of death.

Lesson 14.2 – Overexposure to heat So, now that we know what happens when the body suffers overexposure to the cold, what happens when it is over exposed to heat? Hyperthermia occurs when the heat being generated by the body is too much and the body’s temperature rises above 38 degrees Celsius. Factors that disturb the body’s heat balance and causes over heating include:

Excessive physical exertion Hot climatic conditions with high humidity Inadequate fluid intake Infections (particularly viral illnesses) Excessively warm environments (for example, an unventilated factory

with a tin roof) Wearing inappropriately heavy or dark clothing on hot days Use of medications that impair heat loss (for example, those for

depression, anxiety and Parkinson’s disease) Extremes of age.

Heat cramps are muscle spasms resulting from the loss of complex salts. This occurs when the body loses more fluid through sweating than it can replace. This imbalance in body fluid levels is usually associated with exertion for example in sporting

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activities and occupations involving physical labour in warm, often outdoor environments. Some signs and symptoms of heat cramps include:

Pale, clammy skin Cramping pains in the affected area Nausea.

To treat a casualty suffering from heat cramps, follow these steps:

Rest the casualty in the shade. Gently stretch the affected muscle. Apply a cold pack to the affected muscle. Give sips of cool water when nausea passes. Rest and reassure the casualty.

Heat exhaustion is a serious condition that can develop into heat stroke. It occurs when excessive sweating in a hot environment reduces the blood volume. Some signs and symptoms of heat exhaustion include:

Pale, cold or clammy skin Rapid or weak pulse Rapid breathing Profuse, prolonged sweating Thirst Nausea Vomiting Headache (constant) Cramps Dilated pupils Normal or below normal temperature.

To treat a casualty suffering from heat exhaustion, follow these steps:

Lay the casualty down in a cool place if possible. Loosen or remove any excess clothing. Cool the casualty by fanning or by sponging with water. If conscious, give small amounts of cool water to drink. Rest and reassure the casualty. Regularly monitor and record the casualty’s vital signs. Call triple zero (000) for an ambulance.

Heat stroke is a medical emergency and occurs when the core body temperature rises above 40.5C and the body’s internal systems start to shut down.

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If heat stroke is not addressed quickly, damage to the body’s organs, such as the brain, heart and kidneys, will affect the functioning of other vital body systems and the casualty’s condition will deteriorate rapidly. Heat stroke is most often associated with heat waves, which the elderly, young and debilitated are most at risk from physical exertion in high temperature environments. Some signs and symptoms of heat stroke include:

Dry, hot skin (usually red) Rapid pulse (weakening over time) Constricted pupils Sweating has stopped Irrational or aggressive behaviour Staggering and fatigue Visual disturbances Headache Vomiting Collapse and seizures Unconsciousness

To treat a casualty with heat stroke, follow these steps:

Call triple zero for an ambulance. Remove the casualty from the source of exposure if possible. Remove any excess clothing. Cool the casualty by: Dampen the skin with a wet cloth or atomizer spray.

– fanning the wet cloth with a magazine or fan. Treat the casualty for shock. Monitor and record the casualty’s vital signs. Apply cold packs to areas where major blood vessels pass close to the

skin. Such as, the neck, armpits, groin and behind the knees. RECAP Some of the signs and symptoms of heat stroke include:

Dry, hot skin (usually red) Rapid pulse (weakening over time) Constricted pupils Sweating has stopped Irrational or aggressive behaviour Staggering and fatigue Visual disturbances Headache

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Vomiting Collapse and seizures Unconsciousness

Lesson 14.3 – Burns BURNS Now that you’ve learned about overexpose to cold and heat, let’s shift our attention to burns. A burn is an injury to the skin and sometimes the soft tissues beneath that result from the application of a burning agent, force or substance, such as:

Flames or hot objects, which cause dry burns. Hot liquids or steam, which cause wet burns and scalds. Electricity/lightning Chemicals, such as acidic or alkaline substances. Friction – from grass or carpet, or from rope running through

unprotected hands. Radiation from the sun, welding or a specific industrial or medical agent. Extreme cold causing cryogenic burns. This occurs when the body comes

into contact with freezing materials like liquid nitrogen, liquid petroleum gas or dry ice.

A burn is likely to be moist due to the secretion of a straw–coloured fluid from the blisters. This fluid, called plasma, comes from the blood. The greater the extent of a burn, the greater the amount of associated fluid loss. This loss of plasma plus the pain of the burns increase the likelihood of shock. Burns are also associated with a loss of temperature control. This is why burn casualties often feel cold. It is important that burnt areas are cooled as quickly as possible, since affected tissue continues to burn for some minutes following the removal of the burning source. However you should be careful not to overcool a burns casualty. Like any wound that breaks the surface of the skin, burns are a potential source of infection. You should be aware of the risk this presents to the casualty and you, and endeavour not to come into direct contact with a burn. Burns can also expose or damage nerve endings and affect the sensation of pain, or it can affect the layers of skin and underlying tissues deeply enough that nerve endings are deadened, so the sensitivity of a burn can vary. Burns can range in severity from those that do not require medical attention to those that are disfiguring and life–threatening. This severity depends upon:

The depth the tissues are affected The size of the burnt area

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The part of the body affected The age of the casualty. It is important to remember that all infants and

small children experiencing any burns should be medically assessed by a medical practitioner.

Burns are classified into three levels of severity:

Superficial – commonly referred to as first–degree burns. These burns show a reddening, sunburn look, on the outer layer of the skin. They are painful, but usually heal within three to seven days. Some minor swelling may occur.

Partial thickness – commonly referred to as second–degree burn. These burns involve blistering and damage to the superficial and deep layers of the skin. The skin will look moist and mottled pink or red with associated white patches. Plasma may ooze from the blisters and healing can take several weeks.

Full thickness – commonly referred to as third–degree burns. These burns involve whitish or blackened areas, with damage to all layers of the skin down including underlying structures such as muscles, blood vessels, nerves and bones. There may be less pain as nerves in the deep layer of the skin are destroyed. However, all deep burns will have associated superficial burns, so the casualty will still experience pain.

The rule of nines is a system used by the medical professional for estimating how much of a person has been burned. The casualty's body is divided into areas that are accorded a percentage value of the body’s total surface area. The sum of the assigned percentages given to areas that have been burned indicates the overall proportion of a casualty’s body that is burned. Some signs and symptoms of burns include:

Red, blistered, white or blackened skin Straw–coloured liquid (plasma) oozing from blisters Pain – particularly associated with superficial and partial thickness burns. Severe shock due to loss of fluid from the circulatory system Altered level of consciousness. Burns secrete plasma, but they do not bleed. If bleeding is present it

signifies that the casualty has another injury. To treat a casualty for burns, follow these steps:

Direct the casualty to stop, drop and roll if their clothing is alight. Active flames can also be smothered with a non–synthetic coat/blanket or sand if this does not endanger the first aid provider.

Call triple zero for an ambulance.

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Cool the area as soon as possible by flushing with clean water using any available resources, such as the tap in a sink, a shower, a garden hose or a bucket of water.

The affected areas should be cooled for: – At least 20 minutes for thermal, radiation or chemical burns – At least 30 minutes for bitumen burns, but do not attempt to remove bitumen from the skin or eyes. Moist dressings should not be applied to areas involving large burns.

Never let the casualty shiver. If possible remove, any jewellery, such as a watch, bracelets or rings, as

these are likely to be affected by swelling. Remove any loose clothing from the affected area, but do not attempt to

remove clothing that is sticking to the burn. Cover the area with a burns dressing. If one is not available, cover the

burn with a damp dressing such as a wet cloth or sheet, depending upon the size of the burn.

A damp dressing is important, as it will assist in a number of ways:

– By protecting the wound from contaminants and minimizing the risk of infection – By continuing to draw heat from the burn – By reducing pain, as any exposed nerve endings are protected from the movement of air – By keeping anything from sticking to the burn – If medical care is not available within 30 minutes, remove the moist dressing and apply a dry dressing. This will avoid the casualty from being overcooled.

You will then: Rest and reassure the casualty. Regularly monitor and record the casualty’s vital signs. Begin resuscitation if required. Examine the casualty for other injuries.

NEVER:

Apply lotions, ointments, creams, or powders to deep burns Break blisters Attempt to remove clothing or any other substance that is stuck to a burn Apply pressure to a burn Attempt to clean a deep burn Apply ice or iced water directly to burns.

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Inhalation burns affect the respiratory tract and can seriously compromise a casualty’s ability to breath. Burns to the face, particularly around the mouth and nose, are a good indication that inhalation burns may be present. Therefore the casualty’s breathing needs to be monitored closely. Internal burns can also result from swallowing corrosive chemicals or drinking very hot fluids. Chemical burns resulting from contact with caustic substances that have a corrosive effect on living tissue. The kinds of substances that can cause the skin to burn are usually strongly acidic or alkaline. This can include many common household products, such as cleaning agents (including bleach, oven and drain cleaners, bathroom and toilet cleaners), pool and garden chemicals, paint strippers, car batteries, fireworks and flares. This is why it is so important to read and follow the manufacturer’s guidelines. In industrial environments there will be material safety data sheets, know as a MSDS, displayed near stored chemicals. These sheets give detailed information about specific chemicals that are present on site and importantly, what should be done to manage emergency situations. In order to minimize the severity of a chemical burn, it is important to flush the burned area with cool, running water as soon as possible. However, if the burning agent is a dry substance, it is recommended that the substance be brushed away before flushing the affected area with water. To treat a casualty with a chemical burn, you should follow these steps:

Avoid contact with any chemical or contaminated material by always wearing personal protective equipment, including heavy–duty, chemical–resistant gloves.

Flush the affected area immediately with cool, running water and remove any contaminated Clothing. This will limit further exposure to the burning substance.

Continue to flush the affected area with cool, running water for at least 20 minutes.

If the eyes are affected, ensure that the water washes under the eyelid(s). Read the material safety data sheet if it is available and Call the Poisons Information Centre on 13 11 26. Call triple zero for an ambulance.

Electrical burns, including lightening strike, are caused when an electrical current passes through the body. An electric shock can actually produce devastating internal injury with little external evidence.

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Electrical burns or lightning strikes can also cause other serious underlying injuries. These may involve the cardiac and respiratory systems, could result in a loss of consciousness or trauma. To treat a casualty for an electrical injury, follow these steps:

Call triple zero for an ambulance. Ensure the power source has been switched off before handling the

casualty. Call the electrical authority. Commence resuscitation if required. Give oxygen if available. Monitor and record the casualty’s vital signs.

DO NOT try to cut electrical leads or powerlines. If there are casualties in a motor vehicle that is in contact with or close to powerlines, advise them to remain in the vehicle until the power supply can be switched off, and not to touch the metal components of the vehicle. Vehicle occupants will be safely insulated from an electrical current even if the vehicle is affected. QUIZ That’s the end of the chapter, so you know it’s time to take a quiz. Remember, if you get a question wrong, you can repeat your answer until you get it correct. You will need to successfully complete all questions in this chapter. Ready to go?

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