First Aid
Definition and Fundamental Aims of First Aid
First aid is defined as the initial assistance or treatment provided to a casualty who is suffering from any injury or sudden illness. This care is administered before the arrival of an ambulance, a doctor, or any other qualified medical personnel. The delivery of first aid is critical to bridging the gap between the occurrence of an emergency and the professional medical response.
The primary aims of first aid are divided into several key objectives. First and foremost is to save the life of the casualty. Beyond life preservation, first aid seeks to ease pain, limit the effects of the underlying condition, and promote recovery. Furthermore, first aiders must act to prevent complications or conditions that might increase the severity of the original injury. Finally, a critical logistical aim is to arrange for the safe and efficient transportation of the casualty to a hospital environment.
Classification and Assessment of Burns
Burns are injuries resulting from dry heat, which includes exposure to flames or friction, whereas scalds are specifically caused by wet heat, such as steam or boiling liquids. Burns are classified into three primary degrees based on the depth of tissue damage involving the epidermis, dermis, and hypodermis. First-degree burns, also known as superficial burns, damage only the outer layer of the skin, the epidermis. Typical characteristics include red, dry, and painful skin, similar to a standard sunburn. While these usually heal independently, they may require medical intervention if they cover an extensive area.
Second-degree burns, or partial-thickness burns, damage the deeper dermis layer. The skin appears red and may look mottled; it is typically very painful. Blisters are often present and may weep clear fluid. These burns frequently result in scarring after healing. Third-degree burns, classified as full-thickness burns, damage the skin through all layers, including the subcutaneous layer, and may involve underlying muscle or other tissues. The skin appears charred, blackened, or white and leathery. Notably, pain is often absent at the site of a third-degree burn due to nerve damage, though pain may be felt in the adjacent areas. Third-degree burns are considered medical emergencies.
Common causes of burns include dry heat from direct contact with flames or hot objects; scalds from boiling water, steam, hot tea, or coffee; friction from contact with moving wheels, ropes, wire, or asphalt; chemical agents such as acids and alkalies; and radiation from overexposure to the sun or other radiant heat sources. To assess the size and severity of burns in adults and children, the Rule of Nines is utilized to estimate the percentage of Total Body Surface Area (TBSA) affected.
In adults, the Rule of Nines is calculated as follows:
The head is (with the face or back of the head alone being ).
Each arm is (front or back alone is ).
Each leg is (front or back alone is ).
The front of the torso is (divided into for the abdomen and for the chest).
The back of the torso is (divided into for the lower back and buttocks, and for the upper back).
The genital region is .
In children, the percentages differ slightly:
The head is .
Each arm is .
The chest is .
The back is .
Each leg is .
The perineum is .
Management and Classification of Wounds
The fundamental principles of first aid wound management are the control of bleeding and the prevention of infection. Wounds are classified based on their nature, including abrasions, bruises, lacerated wounds, incised wounds, and punctured wounds. Addressing these injuries requires meticulous attention to hygiene and the application of appropriate dressings and bandages.
Types and Identification of Bleeding
Bleeding, or hemorrhage, is classified into external and internal types. External bleeding involves blood escaping through a wound in the skin. Bleeding from injured arteries is generally the most serious, as blood loss can be very rapid; the blood is bright red, and immediate action is required to prevent life-threatening depletion. Bleeding from veins is typically slower and steady, appearing darker red; while it can still be serious, it is easier to control than arterial bleeding. Capillary bleeding occurs with shallow cuts or scrapes, usually stops by itself, but requires attention to prevent infection.
Internal bleeding refers to any bleeding within the body where blood does not escape from an open wound, often caused by blunt impact. Signs and symptoms of internal bleeding include cold and clammy skin, a pale and pinched face, subnormal body temperature, and sunken eyes. The patient's breathing may be deep and sighing, while the pulse remains rapid, weak, and irregular. Low blood pressure is common, and the patient may feel thirsty, anxious, worried, or experience fainting and dizziness.
Principles and Techniques of Bandaging and Dressing
A bandage is any gauze or cloth material used to support, hold, or immobilize a body part. Bandaging is the specific technique of applying a roller bandage to different parts of the body. The purposes of bandaging include controlling bleeding through pressure, immobilizing sprained or fractured limbs, holding dressings in place, securing splints, protecting open wounds from contaminants, and providing support for conditions like varicose veins or impaired circulation.
General principles of bandaging include fixing the bandage with at least two circular turns at the smallest diameter of the limb to ensure it stays in place. One should always bandage to the right and exert even pressure. The application should follow the direction of venous circulation. Importantly, do not cover the ends of fingers or toes unless necessary, as they must be monitored for circulatory changes. Bandages should not be applied too loosely as they may slip, and turns should be made clockwise. Once complete, the bandage is secured with safety pins or adhesive straps, and the area must be examined frequently for pain or swelling.
Wound dressing serves to provide physical and psychological comfort, prevent or control infection, absorb drainage, maintain a moist wound environment, and protect the wound and surrounding skin from further injury. Types of dressing include dry, wet, and pressure dressings. General instructions emphasize maintaining aseptic technique, using sterile materials for anything touching the wound, and performing hand hygiene before and after procedures. Wounds should be cleaned from the cleanest area to the less clean area (center to periphery). First aiders should avoid talking, coughing, or sneezing over an open wound.
Clinical Procedures for Burn Care
Care for first-degree burns involves stopping the burning process by removing the heat source and cooling the area with cold water. Small areas can be immersed in a sink or bucket, while larger areas should be covered with a wet cloth for at least . Do not use ice, as extreme cold can damage the skin further, and do not use ice-cold water for longer than . Clothing and jewelry should be removed before swelling begins. Aloe vera gel may be used for comfort.
Care for second-degree burns follows similar initial steps: stopping the burn and cooling the area with cold water for at least or until pain persists. For large burns, emergency services () must be contacted. It is vital not to break skin blisters, as this increases infection risk. A nonstick dressing should be applied loosely without taping it directly to the skin.
Care for third-degree burns requires stopping the heat source and cooling only the surrounding first- and second-degree burns. Because of the risk of hypothermia and shock, do not cool more than of an adult's body surface area ( for a child) with water. Jewelry and clothing should be removed before swelling. Emergency medical services () must be called immediately. To prevent shock, the victim should lie down with legs elevated. The burn should be covered with a nonstick dressing without any creams or ointments. Do not touch the burn or allow the victim to drink anything.
Chemical burns require brushing off dry chemicals (using gloves) before moving the victim to a ventilated area due to fume risks. The area must be washed with running water for at least using a sink, hose, or shower. Clothing and jewelry must be removed during the flushing process, and medical attention must be sought.
Procedure for Applying a Dry Dressing
Applying a dry dressing requires a sterile disposable dressing set, clean gloves, a waterproof bag, sterile gauze or cotton balls, cleansing solutions (like sterile saline), micropore tape, and protective gear (gown, mask, goggles). After hand washing and positioning the patient, the old dressing is removed by pulling tape parallel to the skin and then disposing of the gloves. A sterile tray is opened, and cleansing solution is poured over cotton swabs using aseptic technique.
Forceps are used to handle materials: yellow forceps remove the old dressing, and blue forceps are used to prepare and apply cleansing swabs. The wound is cleaned from the least contaminated to the most contaminated area using separate swabs for each stroke. After cleaning, the wound is blotted dry with gauze and covered with a loose woven gauze contact layer, followed by additional layers as needed, and finally secured with tape.
Application of Gauze and Elastic Bandages
Before applying bandages, the patient must be identified using at least two identifiers, and their medical record should be reviewed for specific orders. Initial assessment includes checking the pain scale ( to ) and observing circulation (skin temperature, pulses, edema, sensation, color, and movement). Impaired circulation may manifest as cyanosis, pallor, or numbness.
For gauze or elastic bandages used to secure dressings, the limb should be elevated for first to promote venous return. Application begins at the distal point of the body part using two circular turns to anchor the bandage. The bandage is wrapped toward the proximal boundary, overlapping each layer by one-half to two-thirds the width of the bandage. It should be snug but not tight. For compression, a highly elastic bandage is applied using a figure-eight turn from the distal point (above toes) to the proximal boundary. Circulation must be evaluated at least twice during an period by checking skin color, warmth, and distal pulses.
Procedure for Applying a Triangular Sling
To apply a sling, place one end of the base of an open triangular bandage over the shoulder of the uninjured side. The bandage hangs in front of the chest so the apex is behind the elbow of the injured arm. The arm is bent at the elbow with the hand elevated to , keeping fingertips exposed to monitor circulation. The lower end of the bandage is brought over the injured side's shoulder and tied in a square knot at the side of the neck. The apex at the elbow is then twisted and tucked or pinned.
Methods for Controlling External and Internal Bleeding
Method 1 for external bleeding involves direct pressure and elevation. A sterile dressing is pressed firmly over the site for at least . The part is elevated above heart level, except in cases of fracture, dislocation, impaled objects, or spinal injuries. Cold pads may be used to reduce blood flow. If a dressing is blood-soaked, do not remove it; add another on top. If an object is embedded, use a doughnut-shaped pad (made by looping a bandage around fingers) to apply pressure around the object rather than on it.
Method 2 involves a pressure bandage, where a thick dressing is secured tightly with a roller bandage. Distal pulses and skin condition must be checked frequently. Method 3 utilizes indirect pressure at specific points. The brachial artery point is located in the groove between the armpit and elbow; pressure is applied by pressing the fingers toward the thumb against the humerus. The femoral artery point is at the center of the groin crease; pressure is applied using the heel of the hand while the victim is supine.
Internal bleeding management involves having the patient lie on their back with legs raised approximately (). Emergency services () should be called. The patient must be monitored for vomiting and placed in the recovery position if necessary. It is critical to keep the victim from becoming chilled or overheated and to give them nothing to drink, despite their thirst.
Case Study and Clinical Application Scenario
A scenario involving Mdm Candy Mo, a patient, illustrates the application of these skills. After spilling hot milo, she sustained a scald burn on her right hand with visible blisters, requiring second-degree burn care (cooling and nonstick dressing). Following a fall, she experienced pain and immobility in her left ankle (potentially requiring immobilization) and a laceration on her left forearm with dark red blood flow. The forearm injury indicates venous bleeding, requiring Method 1 (direct pressure and elevation). Due to the ankle pain, elevation of the leg may be contraindicated if a fracture is suspected, necessitating careful assessment of circulation and stabilization.