Lecture 2 - First Aid & Incidence Management

First Aid: urgent need to treat life–threatening situations → everyone is responsible for giving proper care until
the victim is transported to a medical facility (first–aid does not replace the physician).

Assessing the Situation

1.​ Safety: Dangers, PPE, Safe to Approach.
2.​ Scene: factors involved, injury mechanism, casualties, injuries.
3.​ Situation: Event, People Involved, Ages

Assisting Emergency Services: STAY CALM, state you have first aid training and take charge if not other
medical personnel are available, identify safety risks and resources, and take action in avoiding key dangers
such as fire, hazards, sharp objects, chemicals, etc.

Traffic Accidents: can range from bicycle to major road vehicle crash.
1.​ Make the accident area safe for yourself and others before attending to any victims, and CALL 911.
a.​ E.g. park safely and set your hazard lights and warning triangles/flares, ensure the vehicle is off,
watch out for physical dangers (traffic), ensure no flames are present, alert emergency services
to damaged power lines, fuel spills, or any vehicles with HAZMAT signs.
2.​ Quickly assess casualties and prioritize treatment.
3.​ Give first aid to those with life–threatening injuries first.

Fires: spread very quickly, so the main priority is to warn any people at risk, activate the fire alarm, and call 911
for help (only after you are safely away from the fire).
-​ Leaving a Burning Building: activate the first fire alarm you see and try to help people escape but
without putting yourself at risk. Close doors behind you to prevent fire spreading
-​ DO NOT → re–enter a burning building, use elevators, move anything that is on fire, try to smother
flames with flammable materials, NEVER put water on an electrical or grease fire
-​ If you or something on you is on fire → STOP, DROP, and ROLL
-​ Smoke & Fumes: if you are stuck in a burning building, block gaps under doors with heavy fabric to
minimize smoke and go to a window to shout for help. Stay low to prevent smoke inhalation.

Electrical Incidents: electrocution way stun a person → stopped breathing/heartbeat, burns both where it
enters and exits the body, which can extend deep into tissues (depending on voltage and current type).
-​ DO → Turn off the source of electricity (circuit box) and move the source away
-​ DO NOT → touch the casualty if he is in contact with an electrical current, approach working
high–voltage wires, anything metallic to interrupt electrical contact.
-​ Lightning: seeks contact with the ground by the tallest feature (and anyone standing around) →
causes thermal injury and heart/breathing to stop → Needs CPR.

Water Incidence: at any age, they include drowning (common in under 16 y/o), hypothermia and shock (in
swimmers in cold water. Get the casualty onto dry land, such as by using a stick or rope, or swim to the
casualty and tow him ashore if your are a trained lifesaver and there is no danger → CALL 911.
-​ Once the casualty is out of water, shield them from the wind, and replace any wet clothing.

Mass Casualty (Major) Incidents: serious threat to a community which overwhelms emergency services (they
declare a situation → Mass Casualty), and the area around the incident will be sealed off.
-​ If you are the first person on the scene of a mass casualty, DO NOT APPROACH → CALL 911 and
communicate the type of event, location, access, hazards, and approximate number of casualties.
 Lecture 3 - First Aid Assessment

First Aid Approach → Check (1), Call (2), and Care (3)

Good Samaritan Laws: An individual, who is not a health care provider and who, in good faith and without
compensation, provides emergency care, will not be held legally responsible for acting or failing to act.
-​ They can be held legally responsible if acting with extreme carelessness or intent to cause harm.

Getting Permission to Help

-​ Consent: tell the person who you are, and that you here to help, and ask if that is okay.
-​ Baby or Child: as the parent, guardian, or caregiver for permission
-​ Alone Baby: assume you have permission to give first aid.
-​ Mentally Impaired Victim: assume you have permission to give first aid (implied consent).

First Aid Primary Survey → DR. ABC Hospital Primary Survey → ABCDE

1.​ Danger 1.​ Airway

2.​ Response 2.​ Breathing
3.​ Airway 3.​ Circulation
4.​ Breathing 4.​ Disability
5.​ Circulation 5.​ Exposure

Primary Survey → Rapid Assessment of the person for conditions that are life-threatening & managing them.
1.​ Danger: check for hazards and use PPE. If danger is suspected → DO NOT APPROACH, CALL 911.
2.​ Response: complete a mental status assessment.
-​ AVPU → ALERT and oriented, responds only to VERBAL,
only responds to PAIN, UNRESPONSIVE
3.​ Airway: if the airway is obstructed, try to clear it using the Head–Tilt
(moves the tongue away from the airway) & Chin–Lift (opens the
epiglottis) Maneuver. Never attempt to clear an obstruction blindly.
-​ If a person is speaking, crying, or moaning, their airway is
open and they are breathing.
4.​ Breathing (check in less than 10 seconds): look for chest
movement at a regular pattern, listen for breathing, and if the person is not breathing start CPR.
-​ Agonal Respiration: irregular and sporadic, considered a symptom of cardiac arrest → CPR.
5.​ Circulation: check for a pulse (via the carotid) and for external bleeding.
+​ Recovery Position: used to protect the airway in unresponsive people (unnecessary in fully responsive
people). The person is rolled on its side, and the head is positioned to keep the airway open.

Secondary Survey: a focused history and head to toe physical exam performed
after the initial assessment to check the person for other injuries and conditions
that may need care.
1.​ Detailed Patient History (SAMPLE): Signs/Symptoms, Allergies, Meds,
Past Medical History, Last Oral Intake, Events leading to the illness/injury.
2.​ Checking the Quality of the Person’s Vital Signs
3.​ Head–to–toe Exam: Head & Neck Clues (Bruising, Swelling, Deformity,
Bleeding) and check pockets.

Care: general guidelines include monitoring vital signs and responsiveness,

keeping the person in the most comfortable position (prevent hypo/hyperthermia), reassure the person, and
continue to watch for changes.
 Lecture 4 - Basic Life Support

Basic Life Support (BLS): Sequences of procedures performed to restore the circulation of oxygenated blood
after a sudden pulmonary or cardiac arrest until a patient can be given full medical care at a hospital.
-​ Basic Life Support: can be provided by trained medical personnel, such as trained paramedics, or by
anyone who knows how to do it, anywhere, immediately, without any other equipment.
-​ Purpose of CPR: Maintaining circulation and oxygenation to keep vital organs alive.
-​ Indications of CPR: Cardiac Arrest, Respiratory Arrest, or Both.

CAB–D Approach: guides the appropriate steps to assess and treat a patient in respiratory/cardiac distress.
-​ Circulation/Compression: measure the pulse, push hard and fast on the center of the victims chest.
-​ Airway: do the head–tilt, chin–lift maneuver to open the airway
-​ Breathing: Give mouth to mouth rescue breaths
-​ Defibrillation: electrical shock to restart the heart.

Adult Chain of Survival: Early Recognition of Cardiac Arrest (1), Activation of the Emergency Response
System (2), Early CPR to provide blood to vital organs (3), Early Defibrillation to restart the heart (4),
Comprehensive Post–Resuscitation Care to restore quality of life (5).

Steps of Adult CPR:

1.​ Assess Scene Safety
2.​ Determine Responsiveness: shake the shoulder and check for movement.
3.​ Check Carotid Pulse: check for a palpable carotid pulse for 5–10 seconds (not
more than 10 seconds). If there is no pulse/breathing, shout for help/start CPR.
4.​ Perform Chest Compressions: place the patient in a supine position on a flat
surface, kneel down and locate the lower ⅓ of the sternum between the nipples
in the midline of the body. Deliver 30 Initially.
-​ Positioning: lock your arms, place the heel of one hand over the proper
location, and the other hand on top of the first hand → push down between 5–6 centimeters.
-​ Good Quality Compressions: fast and hard, waiting for full chest recoil, with no interruptions to
the flow of compressions, at 100–120 compressions/min.
5.​ Open Airway: after the initial 30 compressions, open the airway using the head–tilt, chin–lift maneuver
or jaw thrust maneuver if there is a spinal cord injury.
6.​ Check Breathing and Deliver Rescue Breaths: can be mouth–to–mouth
(pinching the nose), mouth–to–nose, or with a ventilator (with a mask or
advanced airway), preferably with a barrier device.
-​ Give 2 rescue breaths, each lasting for 1 second, while looking for
chest rise and waiting for exhaling before administrating another.
7.​ Cycle: 30 chest compressions (100–120 comp./min, 5–6 cm deep) and 2
rescue breaths. Perform 5 cycles of CPR (~2 minutes) before switching off
to another provider if they are present. Continue Resuscitation until help arrives, the victim starts
breathing normally, or the rescuer becomes exhausted.

Automated External Defibrillator (AED): device that detects irregular heart rhythms and
automatically shocks to stop irregular beats and allow a normal rhythm (used by anyone).
-​ If the victim starts to breath normally → place in the recovery position.

Complications of CPR: Rib Fracture, Internal Injuries to Organs, Sternum–associated

Laceration, Vomiting and Aspiration, Gastric Distension.
 Lecture 5 - Medical Emergencies

Choking: when a foreign object becomes lodged in the throat or windpipe and obstructs the passage of air,
often from food in adults and ingestion of small objects in children.
-​ Signs & Symptoms: Holding the throat with the hands, Inability to speak, Difficulty breathing/wheezing,
whistling sound when trying to breathe, cough,
blue skin/lips, unconsciousness.
-​ First Aid For Chocking (Adults): encourage
the person to cough as hard as they can. If they
cannot cough, Give 5 Back Blows and 5
Abdominal Thrusts (repeat until the body is
expelled or the person loses consciousness).

Ischemic Heart Disease: when the heart isn’t getting enough blood, usually due to narrow vessels, thrombi, or
plaque build up. (Risk Factors → Smoking, Comorbidities, Obesity, Sedentary Lifestyle, Genetic)
-​ Angina: narrowing of a coronary artery from 40–70%, without causing permanent damage.
-​ Angina Treatment: rest, take GTN spray or tablet, another one if symptoms haven’t relieved in
5 minutes, and 5 minutes later call 911 and chew an aspirin if symptoms still haven't resolved.
-​ Heart Attack: severe blockage (90–100%) of a coronary artery, causing permanent damage.
-​ Heart Attack Treatment: if lasting more than 10 minutes treat it as a heart attack, taking
prescribed angina medication and aspirin 325 mg, monitor vitals.

Stroke: any disruption of the flow of blood to the brain, causing death disability.
-​ Types: Ischemic (85%), Hemorrhagic (15%), TIA → <24 hrs.
-​ BE FAST Diagnosis: symptoms of a stroke → Balance, Eyes (vision
loss), Face (uneven), Arms (can they raise them for 10 seconds),
Speech (slurred), Time is key.

Diabetes Mellitus: where the body fails to produce sufficient insulin

-​ Type 1: 20% of cases, Insulin–dependent DM, affecting children due to pancreas destruction.
-​ Type 2: 80% of cases, non–Insulin–dependent DM due to tissue resistance, with increased cases in the
old, obese, and those with a sedentary lifestyle.
-​ Symptoms: polyuria, polydipsia, frequent hunger, weight loss, delayed wound healing, fatigue.
-​ Monitoring: Fasting Blood Glucose → 80–126 mg/dL, Random BG after Meals → <180 mg/dL
-​ Hypoglycemia: if unconscious, complete a primary survey; if conscious, give sugary drink/food/water.
-​ Always seek medical advice following a hypoglycemic episode.
-​ Hyperglycemia: seek medical help immediately (call 911), monitor and record vital signs to prevent
acute complications such as Diabetic Ketoacidosis (Type I)) and Hyperosmolar Coma (Type II).

Seizures: involuntary contractions of many of the muscles in the body. The condition is due to a disturbance in
the electrical activity of the brain associated with aura (warning sign) and confusion.
-​ Types: can be generalized (colonic, myoclonic, atonic, tonic) or Partial (simple or complex).
-​ Causes: Epilepsy, Head Injury, Brain Tumor or Infection, Decreased O2 or Hypoglycemia, Toxicity.
-​ Urgent Hospitalization needed if it continues for >5 minutes, memory loss
occurs, recurrent, etc.
-​ First Aid: Stay Calm and reassure the patient (1), Check the Time (2), Protect
the Head and Remove anything tight/from the mouth (3), Place the patient in
the recovery position (4), observe the patient for recovery or recurrence (5),
Call 911 if the seizure continues for more than 5 minutes or recurres (6).
Fainting: loss of consciousness due to temporary loss of blood to the brain, from stress, pain, or malnutrition.
-​ The patient is placed in trendelenburg, and 911 called if the patient does not recover after 20 minutes.

Allergy: abnormal reaction of the immune system to harmless triggers, such as pollen, dust, nuts, etc.
-​ Mild Allergy: assess signs and symptoms, remove the trigger, take anti–allergy medications
-​ Anaphylaxis: includes inflamed airways, difficult breathing, or impaired consciousness as a severe
allergic reaction → Call 911, Give Emergency Epinephrine, & Monitor Vitals (another Epi after 5 mins).

Asthma: chronic illness where certain triggers cause inflammation

of the bronchioles → difficulty breathing.
-​ Triggers: air pollution, allergies, strong odors, cold/flu, RTIs.
-​ Signs and Symptoms: wheezing/coughing when exhaling,
gasping, shortness of breath, rapid/shallow breathing, chest
tightness, tingling in the hand/feets.
-​ First Aid for Asthma: Eliminate Triggers, Get the patient
into a comfortable position, give any prescribed asthma
medication (inhaler).

Types of Wounds

Simple Laceration​​: when a clean Complex Laceration: due to

surface is cut from a sharp–edged tearing or ripping forces, causing
object, causing profuse bleeding deep tissue damage and
and damage to structures like contamination with bacteria,
tendons or nerves due to increasing the risk of infection,
straight–across cut. but without as much bleeding.

Abrasion: superficial wound, Contusion: bruising due to

where the superficial skin is ruptured capillaries beneath the
removed due to fall or friction skin from a blunt blow, causing
burn, with foreign particles that blood to leak into tissues. Extensive
could cause infection. Contusion → deeper damage, such
as a fracture or internal injury.

Stab Wound: Deep Incision Puncture Wound: caused by

made by a blade, typically a nails or needles with a small entry
knife, that causes serious injury site, they can cause deep internal
to internal organs and damage and increase infection
life–threatening internal risk due to germ and dirt
bleeding. contamination of the nail/needle.

Gunshot Wound: from a Avulsion: forcible tearing off of

bullet or missile, resulting in skin or another part of the body,
infection from clothing or air such as an ear or a finger,
contaminants. It is very including amputation and the
important to note both the exposure of muscles, tendons,
entry and exit wound (if or other tissues.
present).
 Lecture 7 - Effects of Head and Cold

Skin: protects the body from injury and infection, and

maintains a constant body temperature.

Assessing a Burn: Extent, Location, Depth, and Airway

Involvement

Depth of Burns
-​ First Degree: only the epidermis is affected.
-​ Second Degree: deeper injury, causing blistering.
-​ Third Degree: involving all layers of the skin.
-​ Fourth Degree: extends into the muscle and bone

Burn Treatment: cool the burn, remove accessories,

cover the injured area with plastic wrap or sterile
nonstick dressing, call 911 for emergency help, and
reassure the patient.
-​ DO NOT → apply ice directly, remove anything
sticking to the burn, apply any lotion or ointment
to the area, apply adhesive dressings, cover any
face burns, allow the patient to eat/drink.

Electrical Burns: occur when electricity passes through

the body. Do not approach the patient until electrical
course is turned off, and if the patient is unconscious and not breathing → begin CPR.

Chemical Burns to the Eye: do not allow the patient to touch the eye, remove a contact lens (if easy).

Dehydration: occurs when the fluids lost from the body are not adequately replaces → no medications are
given; replace lost water and salts through rehydration.
-​ Causes: excessive sweating, prolonged sun exposure, fever, severe diarrhea and vomiting.

Heat Exhaustion: caused by loss of salt and water from the body through excessive sweating.
-​ Risk Factors: Vomiting and Diarrhea, Age, Drugs
-​ Signs and Symptoms: Sweating with pale, clammy skin, Leg cramps, Rapid and weakening pulse.
-​ Management: lay the patient down in a cool and shady place (in trendelenburg), provide plenty of
water, monitor vitals, call 911 if temperature rises above 40ºC or the consciousness decreases.
-​ Heatstroke: same as heat exhaustion, but the patient has decreased consciousness and a
temperature above 40ºC, needing emergency care. If unconscious or abnormal breathing → CPR.

Frostbite: injury to body tissues caused by exposure to extreme cold,

typically affecting the nose, fingers, or toes and often resulting in
gangrene → soft tissues are permanently damaged in severe cases.
-​ Color Changes: white, then mottled and blue. On recovery,
skin may be red, hot, painful, and blistered. If gangrene
occurs, tissue could become black due to ischemia.
 Lecture 8 - Pediatric First Aid

Important Considerations when making a Plan:

1.​ Access to a telephone and a backup phone if it is out of order.
2.​ Do you have someone to take care of the child if you have to leave?
3.​ Do you have a fully equipped first aid box that is easy for you and the others to find?
4.​ Make an important phone list that you and others can find easily.
5.​ Have you been on a first aid course to learn what to do in an emergency?

Priorities of Treatment (Primary Survey):

-​ Airway: carefully open the airway with the head–tilt/chin–lift maneuver.
-​ Breathing: while keeping the airway open, look, listen, and feel to see if the child is breathing normally.
If the child is unconscious and not breathing normally → perform CPR.
-​ CPR: Give 5 rescue breaths before chest compressions, then continue CPR (30:2).
-​ If you are alone, perform resuscitation for 1 full minute before going for help.
-​ Circulation: includes abnormal rhythm, cardiac arrest, and bleeding problems

Chest Compression for Children: keeping the airway protected, place two
fingers (for a baby < 1 y/o) or one/two hands (for a child over 1 y/o) on the
chest and compress the the chest to ⅓ of its depth (30 compressions).

Secondary Survey (SAMPLE): Symptoms, Allergies, Medications, Past

Medical History, Last Meal, Event leading up to the incident and perform a
head to toe pediatric examination.

Treating Choking in Children:

-​ Over 1 Year Old: encourage the child to cough, which should clear mild obstructions. If the obstruction
does not clear, give 5 firm back blows with the palm of your hand between the shoulder blades.
-​ Abdominal Thrusts: stand behind the child, make a fist with both hands and place just above
the belly button with your thumb inwards. Thrust Sharply Inwards and Upwards 5 times.
-​ Repeat Back Blows and Abdominal Thrusts, not interrupting the treatment.
-​ Under 1 Year Old: If the obstruction does not clear, shout for help, lay the
baby stomach down across your forearm, and give up to 5 back blows
between the shoulder blades. Then…
-​ Chest Thrusts: turn the baby over, chest upper most and head
tilted down below the chest, and give up to 5 chest thrusts using 2
fingers. These are similar to chest compressions, but sharper.

Treating Anaphylaxis in Children: lay the child on the floor, and sit them upright
if they feel it makes breathing easier. If the child feels they are about to faint, place
them in Trendelenburg.
-​ Administer Epi–Pen if available. If the child becomes unconscious, check ABCs and start CPR.

Treating Asthma in Children: help the child to sit upright, and use a blue ventolin
inhaler with the Aerochamber. If the attack is severe and not responding to the
medication, call for help.