1. Introduction to First Aid
 First Aid is an important skill and should
be taught to everyone who has the ability
to learn.
 If more people knew First Aid, more lives
would be saved.
 Myths and old fables are still being used
because of ignorance
 Proper training would result in a vast
difference between life and death or being
handicapped.

2. What is First Aid
First Aid is the immediate
and temporary
care/treatment given to
someone who is injured or
has suddenly taken ill,
using facilities and
materials available at the
time of the accident

3. Who is a First Aider?
A First Aider is someone who has
been trained and examined in the
skills of first Aid. When you are
trained, you feel apprehensive
when dealing with “the real thing”.
By facing up to these feeling, the
First Aider is better able to cope
with the unexpected.

4. Responsibilities of a First
Aider
 Observe if there is any danger to you,
the people around and the casualty
 Is the situation medical or a trauma
case?
 What is the nature of the illness of
injury?
 How many casualties are involved?
 What are the resources that you need
or is available to you?

5. The 3 P’s of First Aid
PRESERVE LIFE
PREVEENT
CONDITION FROM
BECOMING WORST
PROMOTE
RECOVERY

6. The ‘ABC’ of First Aid
AIRWAY
BREATING
CIRCULATION

7. 4 Steps to know before
treating casualty
What is it?
What causes it?
Signs and symptoms
How to treat

8. How does a First Aider work?
A first Aider work in
calm, skilful and
methodical way and
must always be
prepared

9. The Fight or Flight Response
 In an emergency your body responds by
releasing certain hormones called adrenalin.
Your heart beats faster and your breathing is
deeper and more rapid. You must stay calm!
Taking slow, deep breaths will help you to
calm down, leaving you better able to
remember your First Aid procedures.
 A First Aider must always protect
himself/herself first and try to prevent cross
infection by washing his/her hands with
soap and water, and wearing protective
gloves

10. Giving Care with Confidence
Every casualty needs to feel secure and safe in the
hands of the First Aider. You can create an air of
confidence and assurance by:
 Being in control – both of your own
reactions and of the problem.
 Working in a calm, skilful, methodical
way.
 Being gentle but firm; speaking to the
casualty kindly but in a clear and
purposeful way
 Build up Trust (Talk to the casualty,
explain what you are going to do, try to
answer questions honestly)

11. Taking Charge at the Scene
What you should do at the scene of an accident? Use the three Cs
(3Cs) of First Aid.
1. Fist Assess the Situation
Check the Scene for safety, is the scene
safe for you?
Before you approach the scene you must
do body, substance, isolation (BSI).
Protect yourself from all body fluids by
wearing protective gloves and try to
prevent cross infection. Wash your hands
with soap and water.

12. Taking Charge at the Scene
What you should do at the scene of an accident? Use the three Cs
(3Cs) of First Aid.
2. Delegate Responsibilities
Call for help, call the ambulance, tell
them where you are, how many persons are
injured and the nature of the incident.
You may need to call the police, fire
brigade or other mode of transportation
to take the casualties to the hospital

13. Taking Charge at the Scene
What you should do at the scene of an accident? Use the three Cs
(3Cs) of First Aid.
3. Delegate Responsibilities
Care. It is important to give proper
care to the casualty. You need to do a
more detailed assessment of the
casualty to see what need to be done
and to prioritize the care you will give.
The care you give will make a
difference between life or death.

14. Mass Casualties
Where there are mass casualties, your aim is
to try to save as many persons as possible
using triage to treat the most critical
persons/s. Using the BBC approach, that is
breathing, bleeding and consciousness –
your would it give priority treatment to
1. B – Breathing: Give mouth-to-mouth
breathing
2. B – Bleeding: Treat or arrest the bleeding
3. C – Conscious: Put in the recovery
position
casualties

15. Rapid Physical Assessment
When assessing a casualty you must
determine if it is a medical or trauma
Medical Cases Involve Natural
Illnesses such as:
a. Asthma
b. Fainting
c. Seizure
d. Stroke
e. Heart Attach
case

16. Rapid Physical Assessment
cont’d
When assessing a casualty you must
determine if it is a medical or trauma case
Trauma Cases Involve External Force,
forced upon the body
a. Laceration
b. Abrasion
c. Burns and scalds
d. Fractures
e. Amputation
f. Stab/puncture
g. Fall
h. Motor Vehicle Accident

17. Fainting & Unconsciousness
Fainting is a temporary loss of
consciousness caused by
temporary loss of oxygenated
blood to the brain. Other causes
by reaction to pain, exhaustion,
lack of food, emotional stress
physical inactivity, long standing
or sitting, heat stress
(dehydration), thirst and low blood
sugar.

18. Fainting & Unconsciousness
Signs & Symptoms
a. Extreme paleness
b. Perfuse sweating
c. Dizziness
d. Nausea
e. Cold and Clammy Skin
f. Numbness and tingling of hands
and feet

19. Fainting & Unconsciousness
Treatment
1. When treating the unconscious
fainting, the aim is to put back blood
to the brain:
• Check the ABC to find out if the casualty
is breathing.
• Loosen tight clothing.
• Elevate the person’s leg 8 to 12 inches
to allow the blood to flow to the brain.
• Give plenty of fresh air.
The casualty should regain consciousness
within 5 minutes

20. Fainting & Unconsciousness

21. Unconsciousness
Unconsciousness means that
the brain is not working
properly. An unconscious
person is completely
unresponsive or unaware of
what is happening in his/her
surrounding.

22. Causes of Impaired
Consciousness
The causes of impaired consciousness are:
lack of nutrients – (oxygen and glucose sugar
reaching the brain)
head injury
Brain tumor
Poisoning
Epilepsy
Diabetes
Shock
Fainting
Stroke
Heart attach
Electric shock

23. Levels of Consciousness
For responsiveness, user the
AVPU System:
1. Alert – is the casualty
responsive/aware
2. Verbally – Are they
responding verbally?
3. Pain – Are they responding to
pain?
4. Unconscious/Unresponsivene
ss – Are they unconscious?

24. Unconsciousness
Treatment
• Check the ABC and treat
accordingly
• Assess the level of response
using the AVPU
• Arrange urgent removal of the
casualty to the hospital

25. Seizures/Convulsions (Fits)
A Seizure also called a convulsion or
fits consists of involuntary contractions
of many of the muscles of the body.
The condition is due to a disturbance in
the electrical activity of the brain.
Seizures usually result in loss or
impairment of consciousness. The
most common cause is epilepsy

26. Seizures/Convulsions (Fits)
A Seizure is not a disease but a sign of an
underlying condition. Some causes of
seizures are:
a. Drugs, Alcohol or poison
b. Brain tumours
c. Infection, high fever
d. Diabetic problems
e. Trauma, Stroke
f. Heat stroke
g. Epilepsy
h. Unknown

27. Seizures/Convulsions (Fits)
Tonic-Clonic or Granmal Seizure
usually last only a few minutes and
consist of dramatic body movement.
Absence of Petit Mal Seizures
usually only last 10 - 30 seconds
and there are no dramatic body
movements.

28. Seizures/Convulsions (Fits)
Signs & Symptoms
a. Sudden loss of consciousness with casualty falling to the
ground, often making a loud cry.
b. An epileptic attach can be caused by bright light or colours,
sensation of strong odour or perfumes, exhaustion, hunger,
fright, fever, taste.
c. The body will stiffen, breathing may stop, convulsive
movements begin, the jaw may be clenched and breathing
my be noisy. Saliva at the mouth may b e blood-stained if
the tongue and lips have been bitten.
d. There may be a loss of bladder and bowel control.
e. Muscle and breathing become normal the casualty
recovers consciousness within a few minutes, but is very
tired and confused. May complain of headaches.

29. Seizures/Convulsions (Fits)
Treatment
1. Check the scene for safety for yourself and the
casualty.
2. Protect the casualty from injury, place something
soft under the person’s head, and loosen restrictive
clothing.
3. Remove potentially dangerous items such as hot
drinks and sharp objects, please note the time the
seizure started
4. Do not try to hold the casualty still during
convulsions, after the convulsion place the casualty
in the recovery position and stay with the person
until recovery, which is usually within 5 – 10 minutes
5. Do not put anything into or over the person’s
mouth.
6. Protect the casualty from embarrassment by asking

30. Types of Seizures
1. Generalised – this involves both sides of the brain
2. Tonic-Clonic (grand mal) seizures – The patient
becomes rigid, falls to the ground and the body
goes into violent jerky movements
3. Tonic – Sudden stiffening of the muscles, the
person becomes rigid and fall (no jerking) injuries
may occur from the fall
4. Absences – Interruption of consciousness, patient
stares blankly with fluttering eyelids and nodding of
the head, usually lasting few seconds (petit mal).
5. Partial seizures (simple) – Usually consciousness
and awareness is maintained. The persons may
have a strange feeling, taste, smell or sensation
(aura). There jerking of the body without changes
in consciousness.

31. Seizures/Convulsions (Fits)
Management
• Ensure an open airway.
• Protect the patient from injury during the seizure by
moving objects out of the way.
• Loosening any tight clothing, removing spectacles,
and supporting the head from injury with a blanket
or pillow.
• Do force anything into the mouth.
• Place the patient in the recovery position once
movements have stopped.
• Patients should be allowed to recover in their own
time.
• Treat any injuries that the patient may have
received.
• Do not physically restrain the patient.

32. Treatment for Unconscious
Fainting SKILL STEPS
Check the scene Is the scene safe? If the scene is safe BSI
and proceed.
Check for responsiveness Tap gently and shout “Are you OK?”
Call for help Shout for help to attract other people.
Position the casualty Roll casualty on their back in a single unit as
you roll, support the head.
Open the airway Use the head tilt/chin lift method.
Check for breathing Look, listen and feel for 3 0 5 seconds, keeps
airway open.
Loosen tight clothing and elevate
feet
It the casualty is breathing, loosen tight
clothing, elevate feet 8 – 12 inches, give lots
of fresh air, the casualty should revive within 5
minutes.
Put the casualty to sit When the casualty revives put the casualty to
sit & ask questions i.e. Are you on
medication? Are you hungry: Observe the
surroundings.
Give something sweet If the casualty is hungry give something sweet
i.e. glucose, sugar, chocolate, sweetie etc.

33. Recovery Position
Who should you place in the recovery position?
Casualties who are unconscious and breathing and
whose hearts are beating
This position ensures the following:
• An open airway
• Comfort
• Stability
• Draining
Insert Get pictures of each position

34. Recovery Position

35. ARTIFICIAL RESUSCITATION (AR)
RESPIRATORY ARREST
What is Respirator Arrest? Respiratory arrest is
when breathing stops.
So, whey does breathing stop? Breathing stops
when there is a blockage in the air passage
caused by:
1. Choking on objects: food, false teeth,
seeds, toys etc.
2. Drowning, suffocation, strangulation,
asthma, burns, stings, poisons, smoke,
fumes, rolling back of the tongue, vomitting,
drug or alcohol overdose

36. What should you do if breathing stops?
1. Remove the cause or remove the
casualty.
2. Check for breathing – if the casualty is
not breathing then
3. Start rescue breathing at once
4. If the air passage is blocked, check the
position of the hand then check mouth
and throat for objects/s.
5. When breathing starts, place casualty in
the recovery position.
6. Monitor the casualty as breathing may
stop.

37. When do you apply pressure?
AR is done when casualty is not
breathing and has a pulse
(heartbeat). If there is no
breathing and no heartbeat then
Cardio Pulmonary Resuscitation
or CPR should be applied.

38. Difference between Rescue Breathing and
Rescue Breath
Rescue Breathing –
• 1 breath every 5 seconds.
• If there is no pulse you administer Rescue
Breathing (breath 1 and 2 and 3 and 4 breath).
Rescue Breaths –
• First 2 breaths that are given after you open the
airway and check for breathing.
• If there is no breathing you must check the mouth
to see if it is clear and then give 2 rescue breaths at
a rate of 1 – 1½ seconds.
The purpose for Rescue breaths is to find out if there is a clear air passage and
to send oxygen to the lungs.

39. Rescue Breath
We breath in 21% of Oxygen –
• Our bodies use only 5%
• That leaves 16% which is usually
exhaled – This is enough to resuscitate
someone.
• Deprivation of oxygen from the brain for
4 – 6 minutes will cause the brain cells
and tissues to die therefore quick
response is necessary.

40. Rescue Breath
After Opening the Airway -
A. By using the head-tilt/chin left method,
check for breathing
B. By looking, listening and feeling for 3
– 5 seconds
If the victim is not breathing gently pinch
the nose shut and give 2 full breaths

41. Rescue Breath
Use the thumb and index finger of the
hand that is on the victim’s forehead,
pinch the victim’s nose shut while
keeping the heel of the hand in place to
maintain head-tilt.
Your other hand should remain under
the victim’s chin, lifting up immediately,
give 2 full breaths while maintaining an
airtight seal with your mouth over the
victim’s mouth

42. Rescue Breath
After giving 2 rescue breaths, if breaths
go in you check for circulation -
C. By feeling the carotid pulse at the
neck.
If there is a pulse but not breathing,
administer rescue breathing i.e. 1
breath every 5 seconds.
After the first 5 sets of breaths check
if breathing starts.

43. Rescue Breath
1. The victim begins to breathe.
2. Medical help arrives.
3. Another trained first Aider come to
take over, or
4. You are too exhausted to contine.

44. Rescue Breathing for Adults
1. Kneel next to the casualty’s head.
2. Open the airway using the head tilt, chin lift
method.
3. Check for breathing: Look listen, and fell for 5
seconds. Check mouth for food or objects/s that
could block air passage.
4. Give 2 rescue breaths – seal lips over casualty’s
mouth, pinch the nose and breathe.
5. Check pulse for 10 seconds using the carotid at
the neck.
6. Give 1 rescue breath every 5 seconds. After the
1st 4 of breathing, check if breathing starts.

45. Rescue Breathing for Adults

46. Rescue Breathing for Child
Give 1 breath every 4 seconds
Rescue Breathing for Infant
1. Be careful and gentle with infants
2. Tilt the head back gently – not as far as an adult
or an older child.
3. Put you mouth over the baby’s mouth and nose
to form a seal.
4. Give 1 puff every 3 seconds

47. When to Stop Breathing for the Casualty
1. When the casualty starts breathing
again.
2. When qualified aid arrives.
3. A next First Aider comes to assist.
4. When you are tired and exhausted
Note: In all cases you must take the
casualty to the hospital whenever
Rescue Breathing is applied. When
the casualty starts breathing, place
the casualty in the recovery position.

48. When to Stop Breathing for the
Casualty
Mouth-to-Mouth
breathing

49. Skills for Rescue Breathing
SKILL STEPS
Check for
responsiveness
Tap the patient gently, pinch on ear lobe, “Are
you OK?”
Call for help Shout for help to attract another person and
to call an ambulance
Position the Patient Roll the casualty on back in a single unit. As
you roll, support head.
Open the airway Use the head-tilt/chin-tilt method.
Check for breathing Look, Listen and feel for 3-5 seconds. Keep
airway open.
Give 2 Rescue Breaths At a rate of 1 – 1½ seconds. Maintain open
airway.
Check for Pulse Feel the CAROTID PULSE for 5- 10
seconds.
Rescue Breathing Give 1 breath every 5 seconds. Do 5 sets.
Then check for breathing
Recheck Pulse Feel the CAROTID PULSE for 5 – 10
seconds.

50. Pulse Rate
AGE RATE
Infants 120 – 160 beats per minute
Toddler 90 – 140 beats per minute
Pre-Schooler 75 – 100 beats per minute
Adults 60 – 80 beats per minute
Respiratory Rate
AGE RATE
Infants 30 – 60 breaths per minute
Toddler 24 – 40 breaths per minute
Pre-Schooler 22 – 34 breaths per minute
School Age 18 - 30 breaths per minute
Adults 12 - 20 breaths per minute

51. The Heart
The Heart is a muscular organ which acts
like a double pump. It is situated in the chest
behind the breastbone and rib cartilages,
between the lungs and immediately above
the diaphragm.
The Heart is divided into a right and left
side and there is no direct communication.
Each side is further divided into an upper or
collecting chamber (auricle or atrium) and
a lower or pumping chamber (ventricle).
Between each auricle and ventricle there is a
non-return valve.

52. Heartbeat
The heartbeat may be felt just below
and to the inner side of the left
nipple.
The heart contracts in adults at an
average rate of 72 times per minute
when sitting or at rest but the rate
can vary with excitement, exertion,
fear or change of position; hence the
importance or considering the
patient’s position in cases of
bleeding or shock.

53. Mechanism of the Circulation
The right side of the heart pumps the
blood through the lungs – Pulmonary
Circulation.
The left side is concerned with the
SYSTEMIC (or general) circulation of the
blood through the body.
With each contraction of the heart, blood is forced
through both of these circulatory systems from the
ventricles and with each relaxation of the heart
blood pours into collecting auricles from which the
ventricles are refilled.

54. Pulmonary Circulation
Venuous blood is collecting from 2 large veins
draining the upper and lower parts of the body
into the right auricle and from this chamber
passes through a valve to the right ventricle,
whence it is forced by compression through the
pulmonary artery to the lungs.
In the lungs it gives off carbon dioxide gas and
water vapour and picks up oxygen gas from the
inspired air. This process is known as the
interchange of gases.
After being recharged with oxygen the blood
returns to the left auricle through the pulmonary
veins.

55. Systemic Circulation
From the left auricle the blood now rich in
oxygen passes through a valve to the left
ventricle and from there is forced out
through the main artery of the body (Aorta)
which through numerous branches,
distributes it to all parts of the body

56. Heartbeat
 On an average the heart beats
60 to 80 times per minute.
 Pumps approximately 5 liters
(1.3 gallons) per minute at rest
 With activity the heart pumps a
much as 25 liters (6.5 gallons)
per minute

57. Heartbeat
 In heart failure, the heart is unable
to increase the amount of blood it
pumps as you exercise
 This may make you feel short of
breath when you try to walk a long
distance or climb a flight of stairs.
 Most persons with heart failure
also feel tired.

58. Angina Pectoris
Angina Pectoris is a common symptom of
chronic heart disease (C.H.D). It is a transient
pain or discomfort due to temporary lack of
adequate blood supply to the heart muscle.
The pain may be located in the centre of the
chest.
The pain is usually described as being
crushing, pressing, constricting, oppressive or
heavy.
May spread (more often the left) or both
shoulders and/or arms to the neck, jaw, back or
upper mid-portion of the abdomen
(epigastrium).

59. Angina Pectoris
Angina Pectoris that is either new,
worsening in severity (e.g. more
frequently, lasting longer, responding
less to nitro-glycerine or rest), or
coming on at rest is called unstable
angina. Patients with this form of
angina are at high risk for acute
myocardial infarction and should be
hospitalized immediately.

60. Characteristics of Angina
Pectoris
Rapid onset usually triggered by exertion or stress.
Short duration 3 – 5 minutes
Chest pain radiating down the arms and into the jaw.
Dyspnoea (difficulty breathing)
Mild to moderate nausea
Diaphoresis (profuse sweating)
Anxiety
Relieved by rest and nitro-glycerine tablets within 10
minutes
The Most frequent cause of angina is coronary
atherosclerosis.

61. ATHEROSCLEROSIS
Atherosclerosis is the condition in which an
artery wall thickens, as the result of a building
up of fatty materials such as cholesterol. It is
commonly referred to as hardening of the
arteries.
It is caused by the formation of multiple
plaques within the arteries.
It can cause strokes, heart attacks, congestive
heart failure and most cardiovascular diseases
because it interferes with the coronary
circulation supplying the heart or cerebral
circulation supplying the brain

62. Clinical Manifestation of Coronary
Heart Disease
Persons with coronary artery disease
may show no signs or signals of heart
disease (asymptomatic) or have signs
that do suggest coronary heart disease
(symptomatic).
In a person with symptomatic CAD,
coronary artery narrowing progresses
over time.

63. Heart Attack (Acute Myocardial
Infraction)
A Heart attack occurs when an area of
the heart muscle is deprived of blood
(oxygen) for a prolonged period (usually
more than 20 to 30 minutes)
Usually results from severe narrowing or
complete blockage of a diseased
coronary artery and result in death of the
heart muscle cells supplied by the artery.

64. Embolism
Embolism occurs when an object or
plaque moves from one part of the body
through circulation and causes a
blockage of blood vessel in another part
of the body
Coronary Embolism
Pulmonary Embolism
Cranial Embolism

65. Signs of Heart Attack
The most common signal of a heart
attach is an uncomfortable pressure,
fullness, squeezing or pain in the
centre of the chest. It usually lasts fro 2
or more minutes and may come and go.
Other signals may include:
Nausea
Sweating
Shortness of breath
A feeling of weakness

66. Sudden Cardiac Death (Cardiac Arrest)
Sudden death occurs when heartbeat
and breathing stop abruptly or
unexpectedly.
May occur as the initial an only
manifestation of C.H.D.
May occur before any symptom.
Occurs within 1 to 2 hrs after the
beginning of a heart attack.

67. Actions for Survival
Know the warning signs. Have the
person stop whatever he or she is
doing.
Have the person sit or lie down
comfortably
 If prescribed by a physician, nitro-glycerine
tablets can be administered to
relieve the pain or Angina Pectoris. No
more that 3 tables within 10 minutes
 Call your doctor or take the victim to the
nearest hospital

68. Risk Factors
Risk factors are conditions or
behaviours that may increase
the changes of someone
developing a disease. Heart
disease develops over a long
period of time. You should begin
reducing risks at an early age.

69. Risk Factors that cannot be
changed
Some risk factors cannot be modified or eliminated
Heredity - A history of premature C.H.D. in siblings
or parents suggest an increased
susceptibility that my be generic.
Gender - A woman has a lower incidence or
coronary arteriosclerosis before
menopause. The incidence increase
significantly, however, in postmenopausal
women, who also have worse clinical case
when compared to men. Men are at a
greater risk than women
Age - The death rate from C.H.D. increases with
age. However, nearly 1 in 4 deaths
occurs in persons under age 65.

70. Risk Factors that can be changed
Exercise - Exercising on a regular basis will
strengthen the heart and blood vessels.
Stress - Because of stress, blood vessels may
constrict, blood pressure may rise and the
liver may be stimulated to produce more
cholesterol.
Diet - Reduce cholesterol intake and maintain
and ideal body weight to reduce you risk of
heart disease.
Cigarette - Every time you smoke, your arteries and
Smoking heart react. Nicotine constricts blood
vessels, increases the heart rate, raises
cholesterol levels, lower the ability of blood
to carry oxygen and increase blood
pressure

71. Keeping a Healthy Heart
Keep your weight at an ideal level by
eating nutritious diet meals and
exercising regularly
Eat Fruits, vegetables, cereals,
pasta, low-fat diary products, fish,
poultry and lean meats.
Ignore the saltshaker and limit the
amount of highly-salted, processed
foods you can eat.

72. Keeping a Healthy Heart
Keep your weight at an ideal level by
eating nutritious diet meals and
exercising regularly
Eat Fruits, vegetables, cereals,
pasta, low-fat diary products, fish,
poultry and lean meats.
Ignore the saltshaker and limit the
amount of highly-salted, processed
foods you can eat.

73. Fats and your Heart
Certain fatty foods tend to increase the amount
of cholesterol in the blood while other types of
fats help to decrease cholesterol
Saturated Fats tend to raise the level of
cholesterol in the blood. They are fats that
harden at room tempeture.
Polyunsaturated Fats tend to lower the level
of cholesterol in the blood. They are found in
liquid oils of vegetable origin. They include oils
made from corn, cottonseed, sunflower, sesame
seed, soybean and sunflower seed.

74. Animal Origin Saturated Fats
Fatty cuts of beef, pork and
lamb
Butter, cream and whole milk
Cheese made from cream
and whole milk

75. Vegetable Origin Saturated Fats
 Hydrogenated shortenings
 Coconut Oil
 Cocoa butter and palm oil used in
most commercially prepared
cookies
 Pie fillings and non-dairy cream
substitute.

76. High-fat foods, which are
concentrated sources of calories,
include:
 Fats of all kinds(shortening, oil, butter,
margarine)
 Cheese
 Salad dressing
 Fried foods
 Sauces and gravies, bacon fat
 Scrapple
 Sausage
 Ribs
 Potato chips and other snack chips

77. Cardio Pulmonary Resuscitation (CPR)
 C.P.R. is administered when someone’s
pulse and breathing stops.
 When both breathing & pulse have
stopped, the victim has suffered sudden
death. C.PR. Is never used to restart the
heart.
 There a many causes of sudden death:
drowning, smoke, inhalation, suffocation,
poisoning, electrocution and choking.
 The most common cause is heart attach

78. Definition of Death
Clinical Death: The heartbeat and breathing
have stopped. This is best
thought of as near or apparent
death, and it may be reversed.
Biological Death: This is permanent brain
death due to lack of oxygen.
This death is final.
During the 1st few minutes of clinical death,
promptly initiate C.P.R. which may turn the
victim back to productive life. Without C.P.R.
biological death will occur.

79. Decision Making
Make a decision about what to do next, based on what
the instructor says. Continue to give appropriate care.
The ABCs of C.P.R.
Begin the ABCs of C.P.R. by:
a. Opening the airway using the head-tilt, chin
left method. Once the airway is open, place
you ear close to the victim’s mouth.
b. Check for breathing
 Look at the chest for movement
 Listen for sounds of breathing
 Feel for breath on your cheek
After 3 – 5 seconds, if none of these signs are present, the victim is
not breathing

80. External Chest Compressions
Artificial circulation is
provided by external chest
compressions. In effect,
when you apply rhythmic
pressure on the centre of
the casualty’s breastbone,
you are forcing heart to
pump blood.

81. Performing Chest Compressions
 Kneel at victim’s side near the chest.
 Place the heel or your hand in the middle of the
breastbone and the middle of the nipple line
 Place your other hand on top of the hand in
position. Be sure to keep you fingers up off the
chest wall.
 Bring you shoulders directly over the victim’s
sternum as you compress downwards, keeping
your arm straight.
 Depress the sternum about 1½ inches to 2
inches for an adult victim then relax pressure
on the sternum completely

82. Performing Chest Compressions
cont’d
 Do not remove your hands from the victim’s
sternum but allow the chest to return to its
normal position between compressions.
 Relaxation and compressions should be of
equal duration.
 If there is no breathing do external chest
compressions (C.P.R.) The proper ratio is 30
compressions to 2 breaths.

83. Emergency Actions Steps
Remember the 3 steps: Check, Call, Care upon
finding a collapsed person.
1. CHECK the scene and victim
2. CALL for help and send for emergency
medical services
3. CARE – give appropriate care. If the victim
is not lying flat on his or her back, roll the
victim over, moving the entire body at once.
Your instructor will demonstrate this

84. Emergency Actions Steps

85. Skills for CPR
SKILL STEPS
Check for responsiveness Tap gently on patient. Shout “Are you OK?”
Call for help Shout for help to attract another person and to call an
ambulance
Position The Patient Roll the casualty on back in a single unit. As you
rools, support the head.
Open the airway Use the heat-tilt/chin-lift method
Check for breathing Look, listen, and feel for 3 – 5 seconds. Keep airway
open
Give 2 rescue breaths At a rate of 1 – 1½ seconds. Keep airway open.
Check for pulse Feel the CAROTID PULSE for 5 – 10 seconds. If
there is no pulse…
Locate Compression Position Place the heel of your hand in the middle of the
breastbone an the middle of the nipple line. Place
your hand on the top of the hand in position.
Give 30 compressions Position shoulders over hands with elbows locked
and arms straight. Compress breastbone 1½ - 2
inches. 100 compressions per minute.
Give 2 rescue breaths Pinch nose shut. Maintain an open airway. Give 2
rescue breaths at a rate of 1 - 1½ seconds.
Do Cycles Do 5 cycles of 30 compressions and 2 breaths.

86. Skills for CPR cont’d
SKILL STEPS
Recheck pulse Feels the CAROTID PULSE for 5 – 10 seconds.
Give 2 rescue breaths If no pulse, maintain open airway, pinch nose
shut and give 2 full breaths.
Continue compression/breathing cycle Continue cycles of 30 compressions and 2
breaths. Recheck pulse every few minutes.

87. Stroke
Stroke (cerebovascular accident, CVA) is
damage to part of the brain due to
obstruction or rupture of a blood vessel.
Extensive damages lead to death.
Stroke occur when a blood vessel is blocked
by a blood clot preventing that area of the
brain from receiving oxygenated blood, or a
blood vessel ruptures and blood pours into or
over the brain.

88. Causes of Stroke
1. Thrombus/Tumor - A Blood Clot
2. Aneurysm – A weakening of an arterial wall
which may lead to a rupture due to bulging
of the artery.
3. Embolism – Movement of a blood clot or
foreign body (fat or air) inside a blood
vessel. The clot is called bolus.
4. Compression – Blood leaks into the
surrounding space causing pressure against
the artery preventing blood flow.

89. Signs & Symptoms of Stroke
 Headache (may be only the symptom at
first)
 Collapse or fainting (syncope)
 Weakness or paralysis in one or more limbs
(usually the hand.)
 Difficulty speaking and facial weakness
 Intense dizziness and visual disturbance
 Seizures
 Unequal pupils
 Loss of strength, typically on one side of the
body
 Loss of bowel and bladder control

90. Treatment
 Emergency care depends on signs shown
 Perform an incident size up (BSI)
 Call the emergency medical service
immediately
 Maintain an open airway and be prepared to
provide CPR
 Keep the patient at rest
 Protect all paralyzed parts
 Provide emotional support
 Place the patient in the recovery position to
allow for drainage

91. Risk Factors for Cardiac Illnesses
 Hypertension
 Cigarette smoking
 Diabetes
 High cholesterol
 Lack of exercise
 Family history of heart
disease/stroke
 History of angina or previous chest
pain

92. Aneurysm
An Aneurysm is a localized, blood-filled
dilation (a blood-like bulge) of a blood
vessel caused by disease or weakening
of the vessel wall. Aneurysm most
commonly occur in the arteries in the
brain in the aorta, as the size increases
there is a risk of rupture which can result
in severe hemorrhage, stroke and other
complications including sudden death.

93. Signs & Symptoms of Aneurysm
No Response
Abnormal breathing
No signs of circulation

94. Treatment
Keep the victim – stop them from doing what they
are doing and put them to sit or lie down
Activate the emergency medical service
immediately
Stay with the patient and monitor his condition. If
an Automated External Defibrillator (A.E.D.) is
available, keep it close by
Place the patient in a comfortable position
If the patient has medication you may assist with
the prescribed dose
If the pain persists after 5 minutes activate the
emergency medical service and be prepared to
start C.P.R.

95. Causes of Aneurysm
Atherosclerosis – A condition of the arteries in
which the blood flow is blocked by fatty
deposits.
Arteriosclerosis – Any condition in which the
walls of the arteries are thickened and made
rigid, making them unable to process an
adequate supply of blood.

96. Airway Obstruction (Choking)
Choking is the result of an object in the air
passage. A foreign object that is stuck at the
back of the throat my block the throat or cause
muscular spasm. A casualty with a completely
blocked passage will show the following signs:
Clutching the throat with the hands. Unable to
speak
Unable to breath, unable to cough
Will lose consciousness

97. The Unconscious Chocking
Victim
If the victim becomes unconscious:
Turn over on back
Perform finger sweep and try to remove the
object
Open the airway and attempt to ventilate
Re-tilt head and give 2 full breaths
Perform up to 5 abdominal trusts
Do finger sweep. Give 2 full breaths
Repeat abdominal trust, finger sweep and 2
full breaths

98. Conscious Chocking
Determine if patient is choking
Stand behind patient and deliver abdominal
trusts
Repeat until object is expelled or patient loses
consciousness

99. Skills for Treating Unconscious
Choking
SKILL STEPS
Check of scene safety If the scene is safe, BSI and proceed
Check for responsiveness Tap gently on patient. Shout “Are you OK?”
Call for help Shout for help to attract another person and to call an
ambulance - 110
Position The Casualty Roll the casualty on back in a single unit. Support the head as
you roll.
Open the airway Use the heat-tilt/chin-lift method to open airway and check for
breathing
Check for breathing Look, listen, and feel for breath 3 – 5 seconds. Use the head
tilt/chin left method.
If not breathing
Check the Mouth Look into the mouth for food, loose dentures and other foreign
objects. Turn head to you, use index finger to hook sweep to
clear the mouth
Give 2 rescue breaths Give 2 quick rescue breaths At a rate of 1 – 1½ seconds.
Maintain an open airway.
Re-tilt Head If air does not go in you should re-tilt the head to make sure
that the airway is fully open and give 2 breaths again

100. Skills for Treating Unconscious
Choking
SKILL STEPS
Straddle the Casualty If air does not go in for the second time you are now sure that
the throat is blocked, straddle the casualty
Give 5 Abdominal thrusts Place the heal of one hand on the abdomen above the navel
and below he tip of the sternum. Place your hand on top of the
hand in position and give 5 abdominal thrust pressing down
while pushing up.
Roll the casualty on side When the object is dislodged, place the near hand across the
chest, roll the casualty on their side for drainage and hook
sweep with index finger to clear the mouth.
Position casualty Place casualty on their back
Open the airway Use head tilt/chin lift method
Check for breathing Look, listen and feel for breath 3 – 5 seconds. Use head tilt/chin
lift method.
If no breathing
Give 2 breaths Give 2 rescue breaths at a rate of 1 – 1½ seconds, air goes into
the chest, rise and fall, maintain an open airway
Check for pulse If there is no pulse and no breathing give rescue breathing, i.e. 1
breath every 5 seconds. If there is no pulse, no breathing give
30 chest compressions, 2 breaths

101. Skills for Treating Unconscious
Choking

102. Asthma
In an asthma attack, the muscles of
the air passage in the lungs go into
spasm and the lining of the airway
become swollen. This causes the
narrowing of the air passage,
making breathing difficult.
Sometimes there is a recognized
trigger for an attack such as an
allergy, a cold, dust, drugs, carpet,
animals, flowers etc..

103. Signs & Symptoms of Asthma
Difficulty in breathing
Wheezing as the casualty breathes out
Difficulty speaking and whispering
Distress and anxiety
Coughing
Casualty my lose consciousness and stop
breathing

104. Treatment
Keep calm and reassure the casualty, ask the
person to sit and lean forward. if lying down
prop the person with 3 to 4 pillows to have
them in the sitting position.
Ask the person to breathe slowly and deeply
to get more oxygen.
Ask casualty for medication. Allow or Assist
with the taking of medication. If casualty does
not respond to the medication, prepare to take
to the hospital
Get history from casualty or relatives and
friends using acronym S.A.M.P.L.E.

105. Treatment cont’d
S - Signs and Symptoms (How long has the casualty
been wheezing or breathing short?
A - Allergies (any known allergies to drugs, food,
pollens, pet, carpet, smoke, dust)
M- Medications (does the casualty have his/her
medication (inhaler)?
P- Pertinent past history (did the casualty have a
recent cold or respiratory infection?)
L - Last meal (Has he/she had any fluids since this
attack started?)
E- Events leading to the attack (What was he doing
or exposed to that may have caused the attack?)

106. Wounds
A wound is an abnormal break in the skin or
tissues of the body that allow bleeding and
enables germs to enter. A wound is either
open or closed.
As a first Aider, your priorities are as follows:-
A. Assess the casualty’s condition (ABC)
B. Protect yourself (BSI) – put on gloves
C. Control bleeding by applying direct
pressure and elevation. To prevent shock
apply pressure pad.
D. Comfort, reassure and prepare to take
casualty to hospital.

107. Types of Wounds (GLACIAS CAP)
G - Gunshot – the entry may be small and neat. Any exit
wound may be large and jagged.
L - Laceration – jagged or ripping forces resulting in tear
or lacerations, rough edges caused by barb wire,
band saw.
A - Abrasion (graze) – superficial wound, damage to
skin surface.
C - Contusion (bruise) – closed would, the skin is not
broken, the blood flows between the tissue and is
caused by a blunt blow. Otherwise called “coco” or
black and blue.
I - Incisions - this is a clean cut caused by a sharp
edged object such as a razor, knife, thread.
A - Avulsion – the tearing loose or tearing off of large
flaps of skin or flesh e.g. earring torn from ears.

108. Types of Wounds cont’d
S - Stab wound – caused by knife or long instrument
driven forcefully into the body.
C - Crush – occurs on hard/soft tissues of the body,
for example an iron dropping on the toes.
A - Amputation – the cutting or tearing off the hands,
fingers, arms, legs, feet, toes.
P - Puncture – caused by knives, nails, ice picks
puncturing the body in a straight line. When there
is an entry and exit it is called a perforated would
Evisceration- protrusion of the intestines
Penetrating Chest Wound
The heart, lungs, and major blood vessels are protected by 12 pairs
of ribs which make up the ribcage. If a sharp object penetrates the
chest wall, there will be internal bleeding.

109. Treatment for Wounds
Rest
Elevate
Direct Pressure
Clean
Use material available to make bandage
Tie bandage

110. Bleeding
Bleeding is the emission of blood from the
circulatory system. The heart pumps blood
around the body. The blood is the vehicle in
which oxygen travels throughout the body.
The blood carries oxygen to the cells and
takes away carbon dioxide.
Types of Bleeding:
Arterial
Venous
Capillaries

111. Types of Blood Vessels
Arteries
Veins
Capillaries

112. Arteries
Arteries carry blood away
from the heart and they have
a strong outer thick muscular
layer and run next to the
bones. The blood in the artery
is bright red in color. When
an artery is cut, the blood
spurts to the rhythm of the
heart beat.

113. Veins
Veins carry blood to the heart. This is
made possible by the surrounding
muscles and the heart suction. The walls
are thinner and are provided with valves
to prevent blood going in the wrong
direction. The smaller arterioles and
venues control the blood flow into and
out of the capillary bed. They are next to
the surface. The blood in the vein is dark
red in colour. When a vein is cut, there is
a heavy steady stream.

114. Capillaries
Capillaries connect the arteries to the
veins. This is where exchange takes
place between the bloodstream and
the body tissues. They allow for the
exchange of gasses and transfer of
nutrients and waste products.
Remember:
The typical Adult has 6 litres (About 12 pints)
of blood. The volume must be maintained for
proper circulatory functions.

115. Pressure Points
Arterial bleeding can be controlled by
digital pressure applied at pressure
points. Pressure points are placed over
a bone where arteries are close to the
skin. Pressing the artery against the
underlying bone can control the flow of
blood to the injury. The most commonly
used pressure points to control profuse
bleeding in emergencies are:
Brachial Artery for bleeding from the arm
Femoral Artery for bleeding from the leg
Temporal Artery for bleeding from the scalp

116. Pressure Points

117. Functions of the Blood
 Carry oxygen and Carbon dioxide
 Carry nutrients and water
 Carry waste products from the tissues to the
excretory organs
 Distributes enzymes and hormones
 Distributes heat generated by muscular activity
and transported to the skin for cooling.
 Protects the body from infection by means of the
white blood cells.
 Coagulation of wounds by platelets when they
come into contact with damaged tissue.

118. Lymphatic System
The lymphatic System is a
network of vessels called lymph
vessels. These vessels contain
fluid similar to plasma, called
lymph. Lymph in filtered through
bodies known as lymph nodes.
The lymphatic system assists in
the removal of waste from body
tissues, transportation of nutrients
and fighting infection.

119. How to control bleeding
There are 2 methods used to control bleeding:
A. Direct pressure
B. Elevation
Direct Pressure
Most cases of external bleeding can be
controlled by applying direct pressure to the
site of the wound, by using a sterile dressing.
You can also apply pressure at the pressure
points. Pressure points are sites where an
artery that is close to the skin surface lies
directly over a bone, for example on the inside
of the upper arm, femoral in the thigh.

120. How to control bleeding cont’d
Elevation
Elevation is to elevate the would or the affected
part above the heart, if there are no suspected
fractures.
Nose Bleeding
The best way to control bleeding is by using
direct pressure, or even elevation.
Put the casualty to sit, tilt the head forward,
pinch the nose shut and breathe through the
mouth for 10 – 15 minutes. Repeat the
procedure if bleeding continues
Remember to protect yourself at all times from body
fluids

121. Shock
Circulatory Shock – occurs when there is not enough
blood to fill the circulatory system needed to supply the
vital organs of the body.
Hypovolemic Shock – means bleeding profusely,
vomiting and diarrhoea, severe dehydration and burns
caused by the loss of plasma component of the blood.
Metabolic Shock – is fluid shock caused by loss of
blood fluid by way of diarrhoea and or vomiting
(hypovolemic shock).
Cardiogenic Shock – is heart shocks caused by the
heart failing to pump enough blood to all parts of the
body. This is caused by damage to the heart itself.

122. Shock cont’d
Neurogenic Shock – is nerve shock, when something
goes wrong with the nervous system such as injury in a
accident, when there is not enough blood in the body to
fill the new space.
Anaphylacatic Shock – is allergy shock caused by
something to which the casualty is extremely allergic.
Pshycogenic Shock – is fainting caused by fear, grief,
exhaustion, hunger, emotional stress, heat, low blood
sugar, anaemia. This causes the nervous system to
react and dilate the blood vessels. The flow of blood to
the brain is interrupted.
Septic Shock – is bloodstream shock caused by
infections. Poisons are released that causes the blood
vessels to dilate.

123. Symptoms
Signs & Symptoms Causes
• Altered mental status • Internal and external bleeding
• Anxiety, restlessness • Crush injuries
• Pale, cool clammy skin • Burns – plasma
• Nausea, vomiting • Illness-peritonitis, cardiac conditions
• Rapid breathing,
Tachycardia
• Severe allergic reaction
• Unresponsiveness • Severe bleeding
• Strong thirst • Poisoning
• Cyanosis • Heart attack
• Hypertension • Electrical Shock
• Profuse bleeding
• Diarrhoea
• Shaking and trembling
• Nausea
• Thirst
• Weakness
• Restlessness
• Fear
• Dizziness

124. Casualty Appearance
Cold and Clammy Skin
Breathing rapid and Shallow
Pulse rapid and weak
Pupils dilated

125. Treatment for Shock
Check for breathing and maintain an open
airway
Control bleeding, splint major fractures and
treat any other cause.
Elevate the legs 8 – 12 inches, if there are no
fractures.
Loosen tight clothing, monitor, and record vital
signs. This must be done every 5 minutes.
Do not give the casualty anything by mouth,
prepare for vomiting.
Prepare to take the casualty to the hospital.

126. Other conditions which may
cause Shock
Diarrhoea & Vomiting
Dehydration
Vomiting

127. How to prepare Oral
Rehydration Fluid
i. Boil and cool one (1) litre water.
ii. Add 4 tablespoons of dark sugar.
iii. Add 1 teaspoon salt
iv. Pour into clean covered bottle.

128. Burns & Scalds
Burns - injuries resulting from
exposure to dry heat, extreme
cold, radiation, corrosive
substances and friction.
Scalds – injuries caused by
(moist) wet heat from hot liquids,
vapours, teas or hot fat.

129. Burns & Scalds
Burns are usually classified according
to depth, size or degree of skin damage
as first, second or third degree burns.
First Degree – Superficial burns: Involve
the top layer of the skin known as the
epidermis. There is redness, swelling,
pain and tenderness. Sun burn is a
superficial burn.
Second Degree – Partial thickness:
involves both the epidermis and the
dermis(the 2 top layers of the skin).
Second degree burns involve intense pain,
redden skin that is moist and has blistes

130. Burns & Scalds
Third Degree – Full Thickness Burns:
involves all dermal layers, nerves, fat
tissue, muscle, bone or organs. This can
be dry and leathery and may appear white,
dark brown or charred. Since there is
often nerve damage present, there may be
no sensation or pain present.

131. Treatment - Burns & Scalds
If a burn involves the mouth, nose,
throat or airway, this is considered
critical and requires medical attention.
1. Flush the burned area under
cool running water for 15 – 20
minutes or until cool.
2. Do not break blisters.
3. Remove all jewellery.
4. Monitor ABC and treat or
shock.

132. Classification of Burns
Heat (Thermal): This includes fire, steam and
hot object
Chemicals: This includes caustics, such as
acids and alkalis.
Electricity: This includes electric outlets,
frayed wires and faulty circuits.
Lightning: This includes electrical burns
and injuries during thunder
storms.
Sunlight: This includes burns to the skin
or eyes due to the ultraviolet
rays from the sun.

133. Classification of Burns

134. Caring for Burns
Chemical Burns - To care for chemical burns
wash the chemical from the body with water,
flush the area for 15 – 30 minutes, remove
contaminated clothing, shoes, socks and
jewellery during the wash. Apply dry an sterile
dressing.
Electrical Burns – On the scene of an
electrical burn, the most serious problem
sustained is cardiac arrest. Nervous system
damage and injury to internal organs may also
occur. Make sure that the source of electricity
has been turned off, use dry stick or board and
wear rubber sole shoes.

135. Caring for Burns
Electrical burns cont’d:
Treatment
1. Prepare for complications involving the
airway and heart.
2. Evaluate the burn. Look for entrance and
exit wound (enter the hand and exit the
foot).
3. Apply dry sterile dressing to the burn sites.
4. Monitor ABS and treat for shock.
5. Prepare for removal to the hospital.

136. Caring for Burns
Lightning Burns – Lightning burns occur
when someone is electrocuted during a
thunder storm. Treat as electrical shock.
Sunlight (Radiation) – This is a superficial
burn. Treat – have bath and pat dry.
Friction (Brush Burns) – Spinning wheel or
fast moving rope – cool with plenty of water.

137. Poisoning, Bites and Stings
A poison is a toxic substance – solid,
liquid or gas, if it enters the body may
cause harm or death.
4 main ways by which poison may
enter the body:
1. Swallowed (ingested) by Mouth
2. Inhalation (Breathing)
3. Absorption (Contract)
4. Injection (under the skin)

138. Signs & Symptoms
Ingested poison
May include any of the following:
1. Burns or stains around the casualty’s mouth.
2. Breath odours, body odours.
3. Abnormal breather and pulse rate
4. Dilated or constricted pupils
5. Sweating
6. Excessive saliva or foaming at the mouth
7. Pains in the mouth or throat, stomach,
abdomen
8. Convulsion
9. Altered mental status including

139. Treatment
Swallowed Poison
1. Do not give anything by mouth, take
the casualty to the hospital at once,
take the poison or container with you.
2. Prepare to treat for shock. Carry the
casualty in the recover position,
should vomiting occur.
3. Give plenty of fresh air and monitor
ABC.

140. Treatment
Inhaled Poison
1. Look for possible sources that cause
inhaled poison before you try to save life,
because your life comes first. Make sure
it is safe for you to enter any building or
area that I contaminated.
2. Remove the casualty from the source,
give plenty of fresh air.
3. Maintain an open airway, monitor the
casualty’s ABC.
4. Prepare for shock and take to the
hospital.

141. Treatment
Absorbed Poison
1. Remove the casualty from the
source, remove clothing, wash the
affected area with soap and water.
2. Monitor ABC and prepare to take to
hospital, give elixir to prevent allergic
reactions

142. Treatment
Injected Poison
1. Prepare for (anaphylactic) allergic shock.
2. Scrape away bees and wasp stingers and
venom sacs.
3. Place and ice-pack over the area to lessen
the pain and reduce swelling.
4. An aspirin moistened and applied to the
area as a dressing will take away the pain.
5. Give a dose of elixir, observe for
symptoms of allergic reactions. Monitor
ABCs.

143. Dressing
Dressing: Any material used to cover a wound
that will help to control bleeding and
reduce contamination and infection.
Bandage: Any material that is used to hold a
dressing in place.
Rules for Using Dressing
1. Always wear disposable gloves.
2. Place the dressing over the would.
3. If blood seeps through the dressing, place another
over it.
4. Dispose of gloves, used dressing and soiled items
properly.

144. Types of Dressing
1. Non-sterile
2. Adhesive
3. Cold compress

145. Bandaging
There are a number of different, first aid
uses for bandages. Bandages used to
secure dressings, control bleeding, support
and immobilize limbs and reduce swelling in
an injured part.
3 main types of bandages
1. Roller Bandages – Secure dressing and support
injured limbs.
2. Tubular Bandages – Holds dressing on fingers
and toes or support injured events.
3. Triangular Bandages – This can be used in may
ways, to make a dressing a pressure pad and
immobilize limbs.

146. Types of Bandages
1. Round bandage
2. Arm bandage
3. Hand bandage
4. Amputation bandage
5. Chest/back bandage
6. Head bandage
7. Wrist/ankle bandage
8. Knee bandage
9. Foot bandage
10. Arm sling bandage
11. Elevated arm sling bandage
12. Clavicle bandage
13. Dislocation bandage

147. Types of Bandages

148. Bones, Muscles & Joints
Joint - Where 2 or more bones are joined
Muscles - A soft tissue that lengthens and shortens to
create movements. There are 2 types of
muscles - Voluntary (controls movements)
and Involuntary (control internal organs, heart
etc.)
Sprain - The stretching and tearing of ligaments and
other soft tissue at a joint. This is caused by
sudden or awkward wrenching movements.
Ligament - Tough, fibrous tissue that hold bones together
at a joint.
Strain - The stretching and tearing or muscles and
tendons caused by sudden or awkward
movements.
Tendons - Fibrous bands of tissues that attach muscles
to bones.

149. Signs & Symptoms of Sprains
and Strains
A. Pain and tenderness
B. Difficulty in moving the injured
part.
C. Swelling and bruising in the area if
the muscles are torn.
Treatment
R – Rest the injured part.
I – Immobilize
C – Cold compress (15 – 20 minutes)
E – Elevate the injured part
Advise the casualty to go to the doctor

150. Fractures
A Fracture is a cracked, chipped, splintered or broken
bone caused by direct or indirect forces, strong twisting
forces. Any strong force to the extremities can cause a
fracture, a dislocation, a sprain, a strain and damage to
soft tissues.
Types of Fractures
Simple (closed) - A simple fracture is when the bone is
clearly broken.
Compound - A compound fracture is when the bone
is Commuted (Open) broken in more than one
place and into
many pieces.
Angulated - And angulated fracture is an injury to
an extremity that causes the bone to
bend.
Dislocation - This is when one end of the bone is

151. Fractures
Types of Fractures cont’d
Complicated - This is when the fractured bone
interferes with an organ.
Greenstick - Greenstick fractures are
commonly associated with infants,
toddlers whose bones are soft and
bend like a greenstick.
Depressed - A depressed fracture is referred to
as a dent. The bones are driven
inwards mainly in the skull.
Linear - This type of fracture mainly occurs
in the head. Linear fracture is a
crack.

152. Sign & Symptoms of Fractures
a. Pain – nerves surrounding the injury
have been pressed by swelling tissue
or broken bone ends.
b. Swelling – the injured area begins to
swell because blood from ruptured
blood vessels is collecting inside the
tissues.
c. Deformity – a part of the limb looks
different in size or shape (always
compare both arms and legs to one
another)

153. Sign & Symptoms of Fractures
SPLINT –
Any hard/rigid material used to immobilize a
fracture
S - Swelling
P - Pain
L - Loss of use
I - Irregularity
N - Numbness
T - Tenderness
S - Shortening

154. Sign & Symptoms of Fractures
D - Deformity
D - Dislocation
E - Exposed bone
P - Patient heard sound of
broken bones

155. Treatment of Fractures
During your initial assessment, do not
focus on obvious injuries, but
first assess responsiveness, then
airway, breathing and circulation.
Control all major bleeding,
check and correct life-threatening
problems as quickly as possible

156. Sign & Symptoms of Fractures
After correcting and stabilizing life-threatening
injuries, first priority is given to
possible injury to the Spine.
a. Skull – because it protects the brain and
contains a portion of the airway.
b. Pelvis – because it protects reproductive and
urinary organs and major nerves and blood
vessels.
c. Thigh – because it I the longest, sturdiest
bone (femur) in the body, major nerve and
blood vessels surround it.
d. Rib Cage – because it protects the heart and
lungs, broken bone may damage these
organs and the patient may have difficulty
breathing.

157. Sign & Symptoms of Fractures
e. Extremity Injury – where no distal pulse is
detected during the initial assessment,
extremities should be straightened.
f. Injuries to the arm, lower leg and
individual ribs – are considered and
managed last.

158. Treatment
1. Assess the casualty before you focus on
any particular injury. Treat life threatening
problems first. Prioritize and manage other
injuries.
2. Apply a dressing if there is an open wound.
Check for distal pulse (radial), sensation
and motor function. Distal pulse
(circulation), sensation (feeling) motor
function (ability to move) check before and
after splinting.
3. Immobilized the extremity
4. Tie bandages above and below the injury
5. Check ABC
6. Prepare casualty for the hospital

159. Why Splint
Pain – A splint can reduce much of the
casualty’s because it immobilizes the broken or
dislocated bones in place and prevents them
from damaging nerves and tissues.
Bleeding – Fractured bone ends, dislocated
bones and moving bone fragment can damage
blood vessels and cause internal and external
bleeding.
Rules for Splinting
1. Assess and reassure casualty and explain
what you plan to do.
2. Expose the injury site.
3. Control bleeding by dressing the wounds.

160. Why Splint
Rules for Splinting cont’d
4. Check distal pulse, sensation and motor
function before and after splinting.
5. Reposition limb and apply splint if allowed to
do so, tie above and below the wound.
6. Firmly secure the splint, and reassess distal
pulse and sensation.
7. Monitor casualty – ABC – and prepare to
take to the hospital.
8. The reason for straightening closed
angulated fractures is to improve circulation.
It makes splinting easier.
9. Make no attempt to straighten angulation.

161. Why Splint
Rules for Splinting cont’d
10. Do not attempt to straighten angulations if
the injuries involve the shoulder, pelvis, hip,
thigh, wrist, hand, foot or a joint immediately
above or below the injury site.

162. Injuries to the Spine
Injuries to the spine can cause one
to become paralysed and reduces
normal body function and
movement. Spinal injuries are
caused by forces to the head,
neck, back, chest, pelvis or legs. A
whiplash is caused by motor
vehicle accidents. The spine is a
column made up of 33 bones
called vertebrates.

163. The Spine
The spine is a column made up of 33
bones called vertebrates.
Cervical spine – 7 bones in neck
Thoracic spine – 12 bones in the upper
back
Lumbar spine – 5 bones in the lower
back
Sacrum – 5 fused bones
Coccyx – 4 fused bones

164. Signs & Symptoms of Spinal
Injuries
A. Weakness, numbness or tingling sensation or
a loss of feeling in arms or legs.
B. Paralysis to the arms or legs.
C. Painful movements of arms and legs or no pain
sensation.
D. Pain or tenderness along the back of the neck
or the backbone.
E. Burning sensation along the spine or an
extremity.
F. Deformity of the spine, angle of head and neck.
G. Loss of bladder and bowel control, difficulty
breathing.
H. Persistent erection priapism

165. Treatment for Injuries of the Spine
1. Make certain the airway is open by using
the jaw-thrust manoeuvre.
2. Control serious bleeding – avoid moving
the injured part when applying dressing.
3. Always presume that an unconscious
accident patient has spinal injuries. Check
distal pulse, check sensation (feeling),
motor function (ability to move)
4. Do not attempt to splint fracture if there are
indications of spinal injuries.

166. Treatment for Injuries of the Spine
5. Never move a casualty with spinal
injuries unless you must do so to
provide A.R. or CPR and to treat severe
bleeding.
6. Keep the casualty still, stabilize or
immobilize the casualty’s head, neck
and as much of the body as possible.
7. Monitor casualty with possible spinal
injury. These casualties will go into
shock. Sometimes their chest muscles
will be paralyzed and they will go into
respiratory arrest.

167. Head to Toe Examination
Injuries and illnesses usually manifest
themselves as groups of distinctive features.
There a 2 types of features:
1. Sign: Surface of the body, which you may
detect
2. Symptom: what is coming from inside the
body.

168. Head to Toe Examination
Always start at the head and work down to the
toes using DCAPT-BTLS or DOTS method
D - DEFORMITIES
C - CONTUSION
A - ABRASIONS
P - PUNCTURE/PENETRATIONS
B - BURNS/BLOOD
T - TENDERNESS
L - LACERATIONS
S - SWELLING

169. Head to Toe Examination
Always start at the head and work down to
the toes using DCAPT-BTLS or DOTS
method
D - DEFORMITIES
O - OPEN WOUNDS
T - TENDERNESS
S - SWELLING

170. Head to Toe Examination
To begin your assessment:
1. Check the head and scalp for cuts, bruises and
depressions.
2. Examine the patient’s eyes using a penlight.
Look for foreign objects and check the size of
the pupils. Dilation or constriction may
indicate a brain or spinal injury.
3. Inspect the ears and nose for blood, bloody
fluid or clear fluid. The clear fluid is called cere-bro
spinal fluid and indicates severe head
injury.
4. Inspect the mouth for possible airway
obstructions: bleeding, broken teeth, bridges,
dentures, crowns, chewing gums, food, vomit
or other foreign objects.

171. Head to Toe Examination Cont’d
To begin your assessment cont’d:
5. Check the cervical spine bones for tenderness
and deformities. Check the neck for injury or
deformities.
6. Feel clavicles for tenderness and deformities,
inspect the chest for cuts, bruises,
penetrations and impaled objects. Check for
possible fractures and equal expansion of the
chest and rib cages.
7. Inspect the abdomen for cuts, bruises,
penetrations, distension and impaled objects.
Fee abdomen for tenderness and pain.
8. Feel the upper back. Check the thoracic spine
– 12 bones – for point tenderness and
deformities

172. Head to Toe Examination Cont’d
To begin your assessment cont’d:
9. Feel the lower back lumbar spine – 5 bones –
for point tenderness and deformities.
10. Fee the pelvis for possible injuries and
incontinence.
11. Examine the legs and feet individually. Do not
lift or move the legs or feet. Compare both
legs – length, shape, swelling or deformities.
12. Check distal pulse for circulation. Check the
posterior tubial pulse. Feel behind the ankle
or the dorsalis-pedis pulse, locutid lacteral to
the large tnedons of the big toe.

173. Head to Toe Examination Cont’d
To begin your assessment:
13. Examine the upper extremities from the
shoulders to the fingertips. Feel each
hand and note any cuts bruises, impaled
objects, bleeding, deformities, swelling,
dislocations, protruding bones or
fractures. Check the radial pulse. Check
for sensation by the touch of a finger and
motor function by asking the casualty to
grasp your hand.
14. If there are no injuries to the head, neck,
spine or extremities, inspect the back
surface.

174. Rapid Physical Assessment
Medical Trauma
Asthma Laceration
Fainting Abrasion
Seizure Burns
Stroke Fractures
Heart Attack Amputation
Cardiac Arrest Motor Vehicle Accident
Fall
Neck: Neck vein, distension and medical identification
devices.
Chest: Presence and equality of breathing sound
Abdomen: Distension, firmness or rigidity
Extremities: Pulse, motor function, sensation and medical
alert devices.

175. Vital Signs
The vital signs include:
1. Pulse
2. Respiration
3. Temperature
4. Blood Pressure
5. Skin Colour

176. Lifting & Moving Casualties
a. Position your feet properly – They
should be on a firm, level surface
and positioned shoulder-width
apart.
b. Use your legs, not your back, to do
the lifting – Keep your back straight
and bend your knees.
c. Never twist or attempt to make any
moves other than the lift – Attempts
to turn or twist while you are lifting
are a major cause of injury.

177. Lifting & Moving Casualties

178. Lifting & Moving Casualties
cont’d
d. When lifting with one hand, do not
compensate – avoid leaning to
either side. Keep your back straight
and locked.
e. Keep the weight as close to your
body as possible – This is part of
good body mechanics and allows
you to used your legs rather than
your back, while lifting. The farther
the weight is from your body, the
greater your chance of injury.

179. Lifting & Moving Casualties

180. Lifting & Moving Casualties
cont’d
f. When carrying a patient on stairs,
use a stair chair instead of a
stretcher whenever possible –
keep your back straight. Flex your
knees and lean forward from the
hips, not the waist. If you are
walking backwards down stairs,
ask a helper to steady your back.

181. Lifting & Moving Casualties
cont’d
When lifting or moving patients you
should:
 Explain to the patient what you are
doing.
 Not lift, or move too fast or in ways
that will make the injury or illness
worse.
 Not grasp the injured area.
 Move by grasping clothing or
specialist equipment.
 Keep you back straight.

182. Lifting & Moving Casualties cont’d
When lifting or moving patients you
should:
 Bend your knees and hips in order to
make good use of your leg muscles
and lift with arms straight.
 Keep you chin and elbows tucked in
and grip shoulder width.
 Stand with your feet apart to allow a
balanced distribution of your body
weight.
 Stand close to the patient.

183. Lifting & Moving Casualties
cont’d
When lifting or moving patients you
should:
 The load should be held as close to
the body as possible to allow for
central gravity.
 Break down lifting in stages as to
allow for rest and proper control
during the movement.
 Lift with your feet straight and one
foot slightly forward