First Aid and Cardiopulmonary Resuscitation

This outline of general first aid and cardiopulmonary resuscitation (CPR) is based on the American Red Cross standards. This chapter is designed to provide only basic outline and is not intended to train the reader. For more complete and detailed information or training, contact the American Red Cross or the American Heart Association.

Basic First Aid Principles

Definition

First aid is the immediate care given to injured or suddenly ill individuals until proper medical care can be administered. Proper first aid training can assist in saving a person's life, reduce complications if an injury or illness, and may promote quicker recovery.

Responsibilities

Typically, only a trained individual should administer first aid. When first aid is started, it is required that the first aid provider continues until another qualified provider or proper medical care arrives. If the injured individual is conscious, it is important to obtain consent from the individual or from the individuals parent or guardian before giving any care; it is the right of the individual to refuse treatment. If the injured individual is unconscious, first aid should be administered within the standards and limits of the first aid provider's training under the concept of implied consent. Good Samaritan laws can protect a first aid provider in liability cases if the care given has been in good faith and within the scope of the care-giver's training.

Universal Precautions

Universal precautions are procedures used in situations requiring contact with any body fluid, including blood, urine, sweat, tears, saliva, and semen. These procedures partially consist of proper gloving, masking, and eye protection to protect the caregiver and the patient from contractible diseases.

Assessment

Before administration of any first aid procedures, it is important to assess the victim's condition and obtain consent, if possible. If the situation appears to be a medical problem, obtain assistance as soon as possible.

Primary Assessment

Initial assessment of the immediate condition involves the ABC's of first aid. The ABC's (airway, breathing, circulation) are a memory device for the recommended actions in life-threatening conditions.

Airway

  • 1. Check whether the mouth and throat are clear of any object that would inhibit intake of air.
  • 2. If blocked, turn the head to the side and clear the oral cavity with your finger (finger sweep).

Breathing

  • 1. Check whether the victim is breathing by the feeling for breath and watching for thoracic expansion.
  • 2. If breath is absent, start artificial respiration.

 

Circulation

  • 1. Check the radial or carotid pulse.
  • 2. If a pulse is absent, start CPR.
  • 3. Check for signs of hemorrhaging.
  • 4. If bleeding is present, follow the procedure for wounds and bleeding.

 

Airway, breathing and circulation must be addressed and priorities set before moving to the next steps. It is important to take control of the situation; do not panic. It is also very important to take care of yourself in any situation that might be life threatening, because you cannot be of assistance if you become injured.

Secondary Assessment

A head-to-toe evaluation must be done to determine any specific conditions that might alter the type of first aid required. Following is a partial list of abnormal conditions that should be evaluated during the secondary assessment:

  • Swelling
  • Stains or burns around the mouth (possible poisoning)
  • Localized pain or tenderness
  • Structural abnormalities
  • Discoloration (e.g. tissue, nails, lips)
  • Full or partial paralysis
  • Evidence of convulsion (tongue is bitten)
  • Level of consciousness
  • Vital signs (pulse and respiration)
  • Temperature variance
  • Medical alert tag (provides medical information)

 

Environment

Assess the immediate area for signs of life-threatening conditions, such as fire or a dangerous location. Also look for signs of the cause of the injury or illness.

Conditions and Techniques

Airway Obstruction-Abdominal Thrust Maneuver

More than 3,000 deaths per year are a direct result of choking from an object lodged in the airway. The abdominal thrust maneuver (formally called the Heimlich maneuver) should be performed if the person is unable to speak, cough, or breathe. Continue to go through the steps of the maneuver until the victim coughs up the object, regains consciousness, or the emergency medical service (EMS) arrives.

 If the victim is conscious:

  • 1. Stand behind the victim
  • 2. Clasp your hands into a fist.
  • 3. Wrap your arms around the victim, placing your first below the rib cage on the midline.
  • 4. Perform up to five abdominal thrusts up and in.
  • 5. Check the victim.
  • 6. Repeat the sequence until the victim coughs up the object or loses consciousness or another trained individual relieves you.

In the case of an unconscious victim, the abdominal thrust maneuver is performed on the ground as follows:

  • 1. Place the victim in a supine position (face up).
  • 2. Straddle the victim's body.
  • 3. Clear the airway with a finger sweep, if necessary.
  • 4. Give two rescue breaths, if possible.
  • 5. Perform five abdominal thrusts with the palms of the hands.
  • 6. Check the victim.
  • 7. Repeat the sequence until the victim coughs up the object or regains consciousness, another trained individual relieves you, or the EMS arrives.

If the victim is a conscious infant:

  • 1. Perform five blows to the back.
  • 2. Perform five chest thrusts.

 

If the victim is an unconscious infant:

  • 1. Go through the steps required for a conscious infant.
  • 2. Follow each cycle with two gentle breaths.

Burns

Burns are tissue injuries that occur as a result of excessive heat, chemicals, or radiation. They are categorized according to severity, depth, and size of the damaged area. With approximately 8,000 lives lost annually in fires, burns are the leading cause of accident death in the United States. Half the casualties from burns are children younger than 14 and adults older than 64.

Extent of Burns

Depending on size and location of a burn, calculating its extent can be difficult, but that information is necessary to determine the correct course of action. In adults, burns over 15% of the body surface require hospitalization. In children, burns over 10% of the body surface require hospitalization. Burns of the extremities do not require hospitalization but do not require prompt medical attention. Victims with third-degree burns on 50% or more of the body surface an extremely high mortality rate.

First Aid for Burns

First Degree Burns

  • 1. Apply cold water.
  • 2. Apply a dry, sterile dressing.

Second-Degree Burns

  • 1. Immerse the burn in cold water.
  • 2. Apply a dry, sterile dressing.
  • 3. Treat the victim for shock and seek medical attention.
  • 4. Do not break blisters or apply ointments or antiseptics.

Third-Degree Burns

  • 1. Cover the burn with a dry, sterile dressing.
  • 2. Do not remove adhered clothing.
  • 3. Elevate affected extremities.
  • 4. Treat the victim for shock and seek immediate medical attention.

Chemical Burns

Irrigate the burn with water for 5 minutes or follow the instructions on the label of the chemical's container, if available.

Heat-Related Injuries

Heat injuries occur with prolonged exposure to abnormally high temperatures. The effects can be dramatically accelerated by humidity, wind, length of exposure, and degree of temperature variance. The effects can also be aggravated by the victim's current condition of fatigue, emotional stress, and presence of the other injuries, alcohol in the system, smoking, or types of clothing.

Heat Cramps

Heat cramps are muscular pains and spasms caused by salt being lost through sweating and not replaced. Cramps become more severe when the victim drinks large amounts of fluids while in the state of salt deficiency. Heat cramps can develop into mental confusion and convulsions.

First Aid for Heat Cramps

  • 1. Give the victim sips of salt water, half a glass every 15 minutes for 1 hour.
  • 2. Massage the cramps to relieve spasm.

Heat Exhaustion

Heat exhaustion is caused by extreme sweating from heat without proper fluid replacement. It is characterized by fatigue, weakness, cramps, and collapse.

First Aid for Heat Exhaustion

  • 1. Give the victim sips of salt water, half a glass every 15 minutes for 1 hour.
  • 2. Have the victim lie down and elevate the legs.
  • 3. Loosen clothing.
  • 4. Cool the victim with cold compresses, fans, or air conditioning.
  • 5. If the victim vomits, discontinue the fluids and seek medical assistance as soon as possible.
  • 6. Advise the victim to rest and stay out of warm environments for the next five days.

Heat Stroke

Heat stroke is a response to heat characterized by an extremely high body temperature (106 degrees or higher) and lack of sweating. The victim is hot, red, and dry. The pulse is rapid and strong, and the victim may be unconscious. Heat stroke is the most life-threatening heat-related condition.

First Aid for Heat Stroke

  • 1. Undress the victim, but maintain modesty.
  • 2. Bathe or sponge bathe the victim with cold water or rubbing alcohol until the victim's temperature reaches 102 degrees, and then dry the victim.
  • 3. Use a fan or air conditioner to promote cooling.
  • 4. Monitor the victim's temperature.
  • 5. Do not give stimulants.
  • 6. Obtain medical assistance as soon as possible.

Cold-Related Injuries

Cold injuries are the direct result of prolonged exposure to abnormally low temperatures. The effects can be dramatically accelerated by humidity, wind, length of exposure, and degree of temperature variance. Injuries can also be aggravated by the victim's current condition of fatigue, emotional stress, presence of other injuries, and alcohol in the system, smoking, or wet clothing. Overall symptoms include shivering, numbness, low body temperature, drowsiness, muscular weakness, confusion, impaired judgment, unconsciousness, staggering, loss of vision, or euphoria.

Hypothermia

Hypothermia is a condition related to prolonged exposure to low temperatures. It is categorized according to current body temperature. Mild hypothermia is a body temperature above 90 degrees, and profound hypothermia is a body temperature below 90 degrees.

First Aid for Hypothermia

  • 1. Perform artificial respiration, if necessary.
  • 2. Move the victim to a warm room or environment,
  • 3. Remove any wet, frozen, or constrictive clothing.
  • 4. Rewarm the victim rapidly with warm blankets or by placing the victim in a warm bath.
  • 5. If conscious, give the victim warm liquids (no alcohol).
  • 6. Dry the victim thoroughly.
  • 7. Follow the recommended first aid for frostbite.

Frostbite

Frostbite is a condition in which crystals form in the fluids and soft tissues of the body. It generally affects the fingers, toes, nose, cheeks, and ears, Symptoms include pale, glossy skin that appears white or gray. Blistering is also common as tissue damage increases. Eventually, gangrene may set in as circulation decreases.

First Aid for Frostbite

  • 1. Cover the frozen part.
  • 2. Provide extra blankets and clothing.
  • 3. Move the victim indoors or to a warm environment.
  • 4. Give the victim a warm drink (no alcohol).
  • 5. Rewarm the frozen part quickly by immersing it in warm water or gently wrapping it in a warm blanket.
  • 6. Handle the area gently; no massage. Swelling will be rapid when thawed out.
  • 7. If the feet are involved, do not let the victim walk.
  • 8. Once the part is rewarmed, have the victim exercise it.
  • 9. Gently wash the area with soap and water and then pat it dry.
  • 10. Do not break any blisters.
  • 11. Place gauze between the digits, if affected.
  • 12. Do not apply any other dressings unless absolutely necessary.
  • 13. Elevate affected area.
  • 14. Do not apply heat.
  • 15. Obtain medical assistance as soon as possible.
  • 16. Give fluids as needed if conscious and not vomiting.

Fractures

Fractures are the result of a break or crack in a bone. They are usually classified as simple (closed) or compound (open), based on whether or not the skin is broken. Symptoms and signs include deformity, swelling, pain and tenderness, loss of limb function, discoloration, and possible bleeding.

First Aid for Fractures

  • 1. Give immediate first aid for breathing, bleeding, shock, or other emergencies as needed.
  • 2. Protect the victim from further injury.
  • 3. Obtain medical assistance based on severity of condition.
  • 4. Immobilize the break and its proximal and distal joints.
  • 5. Elevate the injury only if it is possible to do so without disturbing the injury.
  • 6. Apply splints, if possible.