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MB Randa & T Zana ©2015 Revised & Edited Page 1
FACULTY OF HEALTH SCIENCES
MPOM 010: Practice of Medicine 1
SEFAKO MAKGATHO HEALTH SCIENCES UNIVERSITY
Primary Emergency Care Block
2015
THIS LEARNING GUIDE BELONGS TO:
INITIAL)S)NAME : __________________________________________________
STUDENT NUMBER : __________________________________________________
CELL NR : __________________________________________________
E-MAIL : __________________________________________________
GROUP NR : …………………………………………………………………………………………….
MB Randa & T Zana ©2015 Revised & Edited Page 2
LECTURER CONTACT INFORMATION
Course Presenter(s) : Ms MB Randa
: Mr T Zana
Office : Nursing Science Department
Telephone number : 3751 / 4170
Email address : [email protected]
MB Randa & T Zana ©2015 Revised & Edited Page 3
TABLE OF CONTENTS
PAGE
1. CURRICULUM MAP 4
1.1. Introduction 5
2. ORGANISATIONAL COMPONENT 6
2.1. General principles and educational approach 6
2.2. The importance of this module 6
2.3. Instructions for the use of the study manual 7
2.4. Study materials 7
2.5. General behavior 7
3. STUDY / LEARNING COMPONENT 8-13
4. CONTENT GUIDE 13
4.1. Principles of Primary Emergency Care (PEC) 13
4.2. Legal and Ethical responsibilities of a PEC giver 13
4.3. Emergency Scene Management (Priority action approach) 15
5. PRACTICE OF PRIMARY EMERGENCY CARE (PEC) 19
5.1. Asphyxia 19
5.2. Choking 20
5.3. Artificial ventilation / respiration 23
5.4. Cardio pulmonary resuscitation 24
5.5. Automated external defibrillator (AED) 26
5.6. Wounds 27
5.7. Burns 29
5.8. Bleeding 30
5.9. Nose bleed 32
5.10. Shock 33
5.11. Fractures 35
6. LIST OF REFERENCES 36
MB Randa & T Zana ©2015 Revised & Edited Page 4
1. CURRICULUM MAP
Emergency
First Year
Principles of PEC
Legal & ethical responsibilities
Emergency scene management
management
Asphyxia & choking
Fourth Year AV, CPR & AED
Wounds, bleeding& burns
management
Fractures & shock
CPR update
Trauma
Emergency care skills Sixth Year
Medical emergencies Prioritise & initiate emergency treatment
Management of trauma patient
Environmental emergencies
Management of emergencies: infant & adult
Management of cardiac emergencies
MB Randa & T Zana ©2015 Revised & Edited Page 5
1.1. INTRODUCTION
For the purpose of your curriculum First Aid is referred to as Primary Emergency Care. The study
guide has been designed as an aid to assist you in your training. It outlines the specific objectives,
which must be attained for each lesson that will assist you to provide the best First Aid / Primary
Emergency Care.
There are risks in most activities of daily living. The use of mechanical, electrical appliances and
chemicals at work, home and leisure increases the risks of injury. Home and road accidents
increase the risks of injuries. Injuries can be prevented from becoming worse and reduce mortality
rate by applying skills and knowledge acquired during Primary Emergency Training.
Primary Emergency Training forms the basis for pre-hospital care which requires the provider to be
well skilled, knowledgeable and possess skills and ability to use the available equipment. In the
absence of a medical practitioner, nurse or paramedic, a person trained in First Aid must provide
emergency care.
PLEASE ENJOY THE LEARNING EXPERIENCE
OUTCOME
The learner will be able to manage medical emergencies and injuries according to PEC standards.
COURSE OVERVIEW
Duration
Theory and Practica 22 hours
Teaching and learning strategies
Lectures
Demonstration
Group activities
Simulation
Evaluation
Examination of theory and practica at the end of the block
A minimum of 50% in both theory and practica should be obtained
Individual or team – Resuscitation procedures
If less than 50% is obtained the student will have to repeat the skill and / or theory
(As per University General Rules)
MB Randa & T Zana ©2015 Revised & Edited Page 6
2. ORGANISATIONAL COMPONENT
2.1 GENERAL PRINCIPLES AND EDUCATIONAL APPROACH
The purpose of this module is to assist you in acquiring emergency care skills. This will assist you to be
professional and proficient once you start engaging with patients and other health care providers in the
emergency setting.
Although the theory of emergency care will be offered and available on Blackboard, the focus will be on
hands- on experience. You will learn your emergency care skills by performing procedures on simulated
patients and manikins. Your practical sessions will be scenario based and this will help you relate theory
to real life situations. You will find extra reading material on Blackboard by clicking on links to useful
websites. There are also numerous books on emergency care available from the library. You are strongly
encouraged to make use of the library as well as the knowledgeable staff that are ready to assist you.
Also please let me know should you require additional resources to be ordered for the library.
Please note that we have specific supervisors assigned to supervise you during practice sessions and
give you feedback on your performance.
Remember that the Skills Centre personnel are there to assist you in becoming proficient in your
skills; do not hesitate to make an appointment with the lecturer for additional practical learning
sessions and guidance.
2.2 THE IMPORTANCE OF THIS MODULE
There are risks in most activities of daily living. Use of mechanical, electrical appliances and
chemicals at work, home and at leisure increases the risks of injury as well as home and road
accidents. The number of deaths due to injuries could be substantially reduced if every person is
trained in basic emergency care.
Proper pre-hospital care could not only save lives but will also reduce the complications. Some of the
injuries may be minor, but even a slight wound may, in dirty surroundings become infected and may
cost a person’s life. In the absence of a medical practitioner, nurse or paramedic, a person trained in
PEC must provide emergency care.
This module is aimed at making you proficient in the rendering of basic care to victims of trauma,
sudden illnesses and environmental emergencies. The use of drugs and adjuncts is not included in
this module.
MB Randa & T Zana ©2015 Revised & Edited Page 7
2.3 INSTRUCTIONS FOR THE USE OF THE STUDY MANUAL
To participate in class discussions and activities it is essential to bring this learning guide to every
class. The first section of this guide is for your general information. The second part is the study
component which should be used as a workbook. Each section will guide you regarding what
you should know and which activities you should complete. The class notes as set out in this
guide are just a basic outline and you will be required to make supplementary notes during class
discussions as well as additional readings. Please ensure that all the skills are signed off in your
logbook or lecturer’s register. Learners who are not in class will not be able to sign off on the
skills and will therefore forfeit the opportunity to do their practical examination.
2.4 STUDY MATERIALS
Your workbook will form basis for this module. Throughout the workbook you will be led in terms of self-
study and additional readings. All activities should be reviewed when preparing for tests and exams.
2.5 GENERAL BEHAVIOUR
You are expected to act in a professional manner and act ethically responsible at all times. This
includes, but is not limited to:
Conduct in class: Behave appropriately during lectures, respecting Professional, Departmental and
University regulations. Please participate in class discussions. This will help you to form your
thoughts and facilitate learning. Punctuality is of utmost importance and also shows your respect
for both me and your classmates. Unless you make special arrangements you will not be allowed
to join scheduled periods if you arrive late for class. If you missed class, make sure that you catch
up with colleagues and any assessment done in class cannot be completed after the scheduled
session (unless a medical certificate is presented).
Grievance procedures: All complaints to be directed to me personally during the course of this
module.
Academic dishonesty: Please familiarize yourself with the University Rules (G 14, 15, 17 & 21)
regarding supplementary assessment, special summative assessment and assessment fraud. Any
academic dishonesty will be reflected in your academic records.
Only an original medical certificate will be accepted when you are absent from scheduled activities
and has to be submitted within 7 days.
It is your responsibility to check the notice board and Blackboard regularly for notices concerning this
module. Any information presented in this study guide may be changed if necessary.
Students have to wear identification cards at all times.
No eating and drinking is allowed in class in the Skills Centre.
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3. STUDY / LEARNING COMPONENT
Reviewing the outcomes specified for this module will direct you in terms of what we are aiming for i.e. where are we going. You will be able to identify your own part in the learning process. The outcomes also indicate what evidence is needed to prove that certain knowledge and skills have been acquired.
Module name: PRIMARY EMERGENCY CARE (PEC) Contact hours: 16 hours
Lectures per week Clinicals per week Tutorials per week Semester Venue
4 per week per subgroup Practicals Week 1,2 & 3
Practica incorporated
6 subgroups per year Skills Centre
Pre-requisites: learning assumed to be in place
Grade 12, Life Orientation
Must have basic understanding of the definition of First Aid
Co-requisites: units of learning contributing during the current year
Units covering Microbiology, Anatomy, Vital signs and communication as applicable in various departments
Module facilitator Facilitator details provided on page 1
Purpose of the module
To assist the students to:
develop the ability to identify problems and find solutions through critical thinking
be able to render Primary Emergency Care (PEC) to victims of trauma, sudden illness and environmental emergencies.
develop the affective and psychomotor skills when rendering PEC to the victims of trauma
Critical cross-field outcomes / Professional attributes to be developed as generic skills: o Critical thinking skills (reflection and evaluation) o Communication skills (patients, peers, lecturers both verbally and non-verbally-written formats) o Team work (small group work as well as with other professionals such lecturers) o Social responsiveness (responsive to needs of patients, reflect and adapt what is necessary based on the needs of the patient/community)
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Specific Outcomes Assessment Criteria Teaching strategy Assessment task/method
At the end of this module you should be able to :
be able to:
You should be able to answer the following questions :
following questions:
This is the method to study the material
material
This is how you will gain marks and monitor your progress
monitor your progress S01 Apply principles of Emergency
Scene Management (ESM)
AC1 Describe steps taken by the first
person to arrive at an emergency scene
TS1
Formal lecture
Directed Instruction
Demonstration
A AT1
Summative assessment
SO 2 Apply legal and ethical responsibilities of PEC giver
AC2 Describe legal and ethical
responsibilities of a primary emergency care giver
TS2
Formal lecture
Role play on ESM
Self- directed learning
AT2
Summative assessment
SO 3 Perform CPR on an Adult, Child and Infant casualties according to the latest guidelines
AC3 Define the following:
Asphyxia
CPR List signs of successful CPR
TS3
Formal lecture
Audio visual material
Demonstration
AT3
Summative assessment
OSCE
S04 Perform Heimlich
manoeuvre on an adult, child and infant casualties
AC4 Define the following:
Choking
Describe the emergency care to be rendered in a given scenario
TS4
Formal lecture
Directed Instruction
Demonstration
AT4
Summative assessment
OSCE
10
S05 Use Automated External Defibrillation (AED) safely
AC5
Define AED
State indications for the use of AED
TS5
Directed Instruction
Demonstration
Self -directed learning
AT5
Summative assessment
OSCE
S06 Perform log roll on an adult
and child casualties
AC6
Describe the indications to perform log roll
TS6
Formal lecture
Direct Instruction
Demonstration
Self- directed learning
AT6
Summative assessment
OSCE
S07 Manage burns, wounds
and bleeding
AC7
Name different types of wounds
Describe methods of controlling bleeding
TS7
Formal lecture
Audio visual
Demonstration
Self-directed learning
AT7
Summative assessment
OSCE
S08 Recognise signs and
symptoms of fractures, sprains, strains and immobilise appropriately
AC8
List signs and symptoms of fractures
TS8
Formal lecture
Audio visual
Directed Instruction
Demonstration
Self -directed learning
AT8
Summative assessment
OSCE
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S09 Perform rapid trauma
assessment
AC9 Identify abnormal physical
findings
TS9
Directed Instruction
Demonstration
Self- directed learning
AT9
Summative assessment
OSCE
Critical cross-field outcomes Skills achieved for lifelong learning
Critical thinking skills
Teamwork
Leadership Skills
Communication skills
Resources (prescribed text that you need to read in order to learn what you need to know)
Learner guide
Additional information posted on Blackboard
First Aid books
American Heart Association (AHA) 2010 guidelines (Endorsed by the SA Resuscitation Council)
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Level of cognition Def n on Typical action ver s Skills demonstrated
1. Knowledge
..... %
Remembering previously learned information
Arrange, define, describe, identify, label, list, match, name, outline, show, label, collect, examine, tabulate, quote
observe and recall information
knowledge of dates, events, places
knowledge of major ideas
mastery of subject matter
2. Comprehension
.....%
Understanding the meaning of Information
Classify, discuss, estimate, explain, give example(s), identify, predict, report, review, select, summarise, interpret, ‘in your own words’, contrast, predict, associate, distinguish, estimate, differentiate
understand information
grasp meaning
translate knowledge into new context
interpret facts, compare, contrast
order, group, infer causes
predict consequences
3. Application
..... %
Using the information appropriately in different
situations
Apply, calculate, demonstrate, illustrate, interpret, modify, predict, prepare, produce, solve, use, manipulate, put into practice, calculate, examine, relate, change, classify
use information
use methods, concepts & theories in new situations
solve problems using required skills or knowledge
4. Analysis
..... %
Breaking down the information into the component parts and
seeing the relationships
Analyze, appraise, calculate, compare, criticise, derive, differentiate, choose, distinguish, examine, subdivide, organise, deduce, separate, order, connect, infer, divide
seeing patterns
organisation of parts
recognition of hidden meanings
identification of components
5. Synthesis
..... %
Putting the component parts together to form new
products and ideas
Assemble, compose, construct, create, design, determine, develop, devise, formulate, propose, synthesize, plan, discuss, support, combine, integrate, modify, rearrange,
substitute, design, invent, what if?, prepare, generalize, rewrite
use old ideas to create new ones
generalize from given facts
relate knowledge from several areas
predict, draw conclusions
6. Evaluation
..... %
Making judgements of an idea, theory, opinion, etc., based on criteria
Appraise, assess, compare, conclude, defend, determine, evaluate, judge, justify, optimise, predict, criticise, assess, decide, rank, grade, test, measure, recommend, convince, select, judge, explain, discriminate, support, summarise
compare & discriminate between ideas
assess value of theories, presentations
make choices based on reasoned argument
verify value of evidence
recognise subjectivity
The statements used to define and assess the outcomes are classified in terms of a series of lower to higher-order thinking skills (cognitive domains), in accordance with
Bloom's
Taxonomy of Educational Objectives (Bloom BS and Krathwohl DR, Taxonomy of educational objectives. Handbook 1. Cognitive domain, Addison-
Wesley, 1984): The characterization of the cognitive domain:
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4. CONTENT GUIDE
4.1 PRINCIPLES OF PRIMARY EMERGENCY CARE (PEC)
Learning outcomes
At the end of this block, the student must be able to:
-To preserve life by:
*Ensuring that the patient’s airway is open
*Ensuring that the patient has a heartbeat
*Ensuring that the patient is breathing
*Manage bleeding
-To prevent the illness or injury from becoming worse by:
*Controlling further bleeding
*Immobilizing the casualty’s fractures
*Treating casualty for shock
*Preventing infection
-To promote recovery by:
*Positioning the casualty correctly
*Protecting the casualty from extreme temperatures
4.2 LEGAL AND ETHICAL RESPONSIBILITIES OF A PEC GIVER
When a PEC giver goes to someone’s aid, s/he undertakes to provide any assistance s/he can give and
remain on the scene until the casualty can be handed over to medical assistance or some authority.
Once you give assistance, you should use reasonable skill and knowledge based on your level of
training. In this role of a Good Samaritan, the PEC giver is given certain protections under the law.
Therefore he should not be overly concerned about legal liability.
Identification
The PEC giver must always identify him /herself and indicate to the casualty that s/he is trained
in PEC before attempting to offer help to the casualty in order to gain cooperation and
confidence.
Consent
A person has the right to accept (consent) or to refuse help. A conscious adult or older child who
agrees or makes no objection to your offer or help gives his consent. If a person refuses help,
call for help, stay with him and keep a close eye on his condition until medical assistance arrives.
If he becomes unconscious and his life is threatened, do whatever is necessary to save his life.
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*Obtaining consent on an unconscious person and a young adult
It is assumed that an unconscious person or a young child, whose parents are not
available, would consent to your help if he could. A parent with a young child has a
right to refuse help given to her child. In this case, advise a parent to seek help or to
take the child for medical assistance. If the child’s life is in danger, call for help and
stay with the parent.
Standard of care
This is the manner in which the PEC giver must act or behave. It depends on the level of training,
experience and circumstances around the scene. One has a moral and legal responsibility to
respond to legitimate calls for help, but should not act improperly to give treatment that is beyond
his/her scope of practice.
Allegations of negligence
Assault and improper conduct form the basis of most legal actions brought against emergency
care personnel by the public. Make sure that your actions are in the casualty’s best interest.
There is no need to neither hesitate nor be concerned about legal liability provided that:
PEC is not forced on a conscious adult or older child who refuses such help.
You give the help you would hope to receive if you were in a similar circumstance.
You use caution when giving PEC so that you do not aggravate or increase injury.
A casualty is not abandoned. When the offer of help is accepted it must be given and
continued until the casualty can be handed over to a more qualified person.
A common sense approach is adopted when giving PEC, if/when the casualty’s life is not
in danger.
Suspected child abuse
Be on the alert for signs of child abuse when giving PEC to children.
Unusually shaped bruises or burns, injuries that would not be normal for a child and
fractures in children and infants, where the cause is not readily apparent or is suspicious
in nature, should alert you to look for other signs. The child’s apparent fear of a parent or
babysitter should reinforce suspicions of child abuse.
Insist on medical attention for the child’s injuries, no matter how minor they may be, to permit
a full medical assessment. If the parent or babysitter refuses medical assistance, you have
a duty to notify local child welfare agencies or authorities (e.g. Child line or FAMSA). Do not
accuse anyone of child abuse, but for the child’s welfare do not hesitate to report suspected
cases.
Child line: 080 005 5555
FAMSA: 082 231 0370
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Confidentiality and Privacy
PEC giver shall maintain all confidential matters entrusted to him by the casualty without
divulging them to any unauthorised persons. He shall also respect the casualty’s privacy and
avoid exposing the casualty unnecessary when giving treatment.
Abandonment
Never abandon (leave) a casualty who is in your care. Once the casualty accepts your offer of
help, stay with her/him until you hand him over to medical help, another PEC giver, or she/he
no longer wants your help. This is when the problem is no longer an emergency and further
care is not needed.
Declaration of death
Only a qualified authorized health care practitioner can certify death.
4.3 EMERGENCY SCENE MANAGEMENT (PRIORITY ACTION APPROACH)
PEC is given safely in a proper sequence according to life threatening conditions. At times the
sequence might be changed depending on the patient’s condition. This is also called Priority
Action Approach.
Below are the five steps and related actions taken in Emergency Scene Management (ESM)
Step 1. Scene survey
Calmly approach the scene
Identify all the possible risks and hazards
Take charge in the absence of a person senior to you, if there is someone ask if they
can help
Quickly assess the situation accurately and decide on the priorities of action
Call out for help to attract attention of by standers
Assess and remove all hazards to make area safe for self, casualty and bystanders
Find out the history of the accident (what happened), how many casualties there
are and determine the mechanism of injury (how & where the injury occurred)
Identify self as PEC giver and offer to help so as to obtain consent
Assess responsiveness to determine level of consciousness (LOC), [AVPU i.e. If
casualty is alert, responds by making noise when spoken to, responds to painful
stimulus, no eye, voice or motor response on painful stimuli]
In adults a GCS is used whilst in newborns an APGAR score is used to assess LOC
Send for medical help
Don gloves
N.B Priorities of action means start treating the casualties according to this sequence:
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i. Manage life threatening bleeding
ii. Unconsciousness – no pulse start CPR immediately
iii. Airway- open, protect and maintain
iv. Breathing – ensure adequacy
v. Circulation – control minor bleeding
vi. Deformities- manage fractures
vii. Evaluation - continuous patient evaluation
N.B Making the scene safe means: in case of:
i. Police officers- to control traffic, switch off the ignition, watch out for petrol spillage
and ask people not to smoke
ii. Body fluids -wear appropriate personnel protective clothing (PPC) i.e. head
gear, rubber gloves, plastic goggles, protective closed shoes, mouth mask)
iii. Initiate preventive measures and alert the appropriate departments (SAPS, METRO, FIRE
and EMS)
Step 2. Primary survey (assessment)
Prioritise the casualty (P1, P2, P3, P4) by assessing life threatening conditions
Medical patient (conscious vs unconscious)
Assess the nature of the illness
Trauma patient (conscious vs unconscious)
Assess the mechanism of injury
Circulation
Control any life threatening bleeding
Palpate for circulation by feeling for the carotid artery on a unconscious adult, radial
artery on a conscious adult or brachial pulse on the infant for 5-10 seconds
If pulse is absent or unsure of pulse start chest compressions and attach AED
If pulse and breathing are present, check vital signs. Continue with treatment according
to clinical condition of casualty
Airway
For a medical casualty
Open the airway using Head tilt jaw lift manoeuvre
For a trauma casualty
Open the airway using the Jaw Thrust Manoeuvre
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Clear any obstructions that might be obstructing the movement of air
(Suction or use your smallest finger to remove the obstruction while visualizing it
Breathing
Assess breathing by placing your ear near the casualty’s mouth and nostrils. Look for
chest movement and feel for any signs of air movement
Position the casualty on his back on a firm flat surface (provided there are no
suspected head and spinal injuries, in case rather support his head in
alignment with his spine and continue with the next action
Step 3. Secondary survey (Focused assessment)
Focus on the chief complaint
Assess the nature or mechanism of the chief complaint
Assess the affected system as well as the related systems
Manage the chief complaint
After 15 minutes do perfusion assessment to unstable patient
After 15 minutes do perfusion assessment to stable patient
NB: Secondary assessment can be done only on condition the life of the casualty is not in danger.
It can only be done if medical help is delayed by more than 20 minutes.
Secondary survey has four sub-steps:
Obtain the history of condition or accident e.g. symptoms, allergy, medications, past medical
history, last meal, events leading to incident –from the casualty, bystander or relative
Assess and record the casualty’s vital signs- i.e. LOC , breathing, pulse, skin temperature
and colour
Conduct a head to toe examination without repositioning the casualty
Give first aid treatment for injuries or illness found e.g. wounds, fractures and
bleeding
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Step 4. Head to toe assessment
It is done to identify injuries that might have been missed, starting at the head of the casualty until
the planter of the foot using the palms of your hands to assess for any deformities, contusion,
abrasions, puncture wounds, burns, trauma, lacerations and swelling (DCAPBTLS)
Step 5. Ongoing casualty care
Once PEC for injuries and illnesses that are life threatening has been given, the
PEC giver will do the following:
Remain with the casualty until medical help arrives
Record the events of the situation including casualty’s condition and the PEC given
Continue to monitor vital signs
Check casualties CAB
Give nothing by mouth (NPO)to unconscious patient
Protect and take care of the casualty’s belongings
Step 6. Handing over of the casualty
Give full report to whoever is taking over from you
This includes the casualty’s particulars-name, address, telephone
number, etc.
History taken from the casualty (what happened, what kind of injuries are involved
and what PEC has been given)
Hand over all the casualty’s belongings and sign for such belongings
N.B Once the PEC giver has decided that assistance is required, it must be done
immediately. When calling the ambulance, police, fire brigade, the following information
must be conveyed by the caller:
* Telephone number from which the call is made and the caller’s name
* Address and location of the incident giving nearby road junctions or landmarks to assist the
paramedics to reach the scene as quickly as possible
* Circumstances of the incident and conditions of the casualties e.g. road traffic accident,
two cars involved, three people trapped
* Number of casualties involved
* Help that is being given
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5. PRACTICE OF PRIMARY EMERGENCY CARE (PEC)
5.1 ASPHYXIA
Learning outcomes
At the end of this lesson the student must be able to:
- Define asphyxia
- Discuss the causes of asphyxia
- Discuss the signs and symptoms of asphyxia
- State the aim of treatment of asphyxia
- Outline the assessment and treatment of asphyxia
Definition of asphyxia
Asphyxia is lack of oxygen to the tissues of the body
Causes of Asphyxia
G- Gas e.g. fumes, and smoke inhalation
O -obstruction e.g. choking, strangulation, drowning, suffocation.
N- nerve poisons e.g. bites of certain snakes, stings of spiders and scorpions, causing the tissues
of the throat to swell
E – electricity e.g. shock by electric current
N.B The tongue is the most common cause of choking leading to asphyxia
Signs and symptoms of asphyxia
- Difficulty in breathing
- Breathing may become noisy or snoring
- Breathing may stop (apnea)
- Possible frothing at the mouth
- Blueness of lips, finger tips, gums (cyanosis)
- Increase in rate and depth of breathing
- Anxiety and restlessness
- Confusion
- Possible unconsciousness
- Coughing
Aim of treatment
- To improve oxygen supply to the tissues
Assessment and treatment of Asphyxia
Assessment entails the first two steps that you take as outlined in ESM
Remove the cause of asphyxia and if possible remove the casualty from the cause
Open the casualty’s airway and remove any obvious obstructions
Assess the casualty’s breathing – look, listen and feel for 10 seconds
Do head -to-toe examination and place the casualty in the recovery position
Send for medical help
Treatment is administration of oxygen (O2)
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5.2 CHOKING
Learning outcomes
At the end of this lesson the student must be able to:
Define Choking
State the causes of Choking
List the signs and symptoms of Choking
Describe measures that can be implemented to prevent choking in the elderly and young
children
Describe step by step PEC of a choking adult who is:
- Conscious
-Unconscious
Describe step by step PEC of a choking infant who is:
-Conscious
-Unconscious
Definition of Choking
Choking is a life threatening emergency whereby the casualty’s airway is partly
or completely blocked and airflow to the lungs is reduced or cut off resulting in poor
gaseous exchange
NB : When air supply to the lungs is cut off, the person’s face immediately changes colour
If not corrected, the face becomes grey and lips and ears bluish = cyanosis
Causes of choking
Foreign bodies e.g. food and objects
- Adults: gulping drinks with food
- In children and infants: toys, button and coins
- In elderly: food and pills
Laryngeal oedema (swelling)
Unconscious casualties: the tongue falling back, saliva, blood or vomit pools in the throat
Laryngo-tracheal bronchitis in children
Injury: tracheal or throat
Illness causing swelling e.g. asthma, croup and allergic reactions
Signs and symptoms of choking
Noisy breathing (stridor)
Coughing, gaggling indicate difficulty in breathing
Restlessness
Vigorous use of accessory muscles of respiration
Cyanosis
Marked distension of the neck veins
Casualty may collapse
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Measures that can be implemented to prevent choking
Adults
- Cut food into smaller pieces that can be easily chewed
- Drink alcohol in moderation. Alcohol causes one to lose the coordination of the muscles
used in swallowing thus making it easier to choke
- Do not talk, laugh, or gulp drinks with food in your mouth
Children
- Supervise children when they are eating
- Do not feed children less than four years with nuts, popcorn, round sweets,
grapes
- Advice children not to run or move about when eating
- Supervise children when they are playing with balloons and marbles
Infants
- Keep small toys out of the baby’s cot
- Do not let infants play with balloons and marbles
- Only give small bite size pieces of food
- Check pacifiers (baby’s dummy) for small parts or worn nipples
Step by step PEC of a choking adult and child who is:
Conscious and has partial obstruction
Determine if the casualty is choking
Assess if he/she is able to cough talk or breath
Monitor vital signs
Encourage him/her to cough repeatedly
If the casualty cannot cough forcefully, cannot breath, makes a high pitched noise and
starts to turn blue, give (5) five back blows
If obstruction persists call for help
Stay with the casualty
Do abdominal thrusts (Heimlich manoeuvre)
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If victim is unable to cough, talk or breath, stand behind him and place arms around his
waist with your thumbs positioned just above his navel and well below ribcage
Perform sudden inward and upward abdominal thrusts
Repeat the abdominal thrusts until obstruction is relieved or until the casualty
becomes unconscious
Unconscious and has complete obstruction
NB: Lower the casualty to the ground and send for medical help and apply AED
* Determine if casualty is breathing
Remove any visible objects using hooked finger in small children and infants, and index
finger in adults
Lift chin up and tilt head backwards
Look , listen and feel for breathing with ear just above the mouth
If not breathing, ventilate using a face mask
NB Ensure that there is chest rise with each breath
If unsuccessful, reposition the head, check if the mask is fitting properly and ensure a good
seal then re-ventilate
Do chest compressions
Step by step PEC of a conscious infant with:
Partial obstruction
If the casualty can cough forcefully or breath, stand by and don’t interfere
Let the casualty try to cough up object
If a partial blockage lasts for more than a few minutes, get medical help
If the casualty cannot cough forcefully, cannot breath, makes a high pitched noise and
starts to turn blue, give (5) five back blows
For infant casualty
Pick the baby up and turn her/him over
Support the head and neck throughout the movement
Give five (5) back blows between the shoulder blades
Turn the baby face up and bring her close to you
Give five (5) chest thrusts to create an artificial cough
Open the mouth, remove any visible matter
Look, listen and feel for breathing
Ventilate the infant
Keep giving back blows and chest thrusts until either the airway is cleared or the baby
becomes unconscious
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Unconscious infant with complete obstruction
Repeat steps 1-7 of partial obstruction then:
Pick the baby up and turn her over
Support the head and neck throughout the movement
Give five (5) back blows between the shoulder blades
Turn the baby’s face up and bring her close to you
Give five (5) chest thrusts to create an artificial cough
Open the mouth and remove any visible matter
Look, listen and feel for breathing, ventilate the baby
Keep giving (5) back blows and (5) chest thrusts until either the airway is cleared or
medical help arrives
Commence CPR if necessary
5.3 ARTIFICIAL VENTILATION /RESPIRATION
Learning Outcomes
At the end of this lesson the student must be able to:
- Define Artificial Ventilation (AV)
- State indication for Artificial Ventilation
- List different techniques of AV
- Describe and demonstrate step by step administration of artificial
ventilation on an adult casualty
Definition of Artificial Ventilation
- Artificial Ventilation is a way in which air is supplied to the lungs of a
casualty who is breathing ineffectively or not breathing at all
Indication for AV
- No breathing
Different techniques of AV
- mouth to mouth
- mouth to nose
- mouth to mouth-and –nose
- bag valve mask ventilations
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Step by step administration of Artificial Ventilation
Adult casualty
Begin with scene survey
Assess responsiveness CAB
Assess breathing for up to 10 seconds
Call for help
Place the casualty face up, protecting the head and neck during movement
Establish a clear airway immediately using a finger sweep to remove
secretions
Open the airway using a head tilt-chin lift manoeuvre or jaw thrust in suspected neck and
spinal injury
Re -assess breathing
Ventilate the casualty twice (two rescue breaths), Blow for about two seconds or
enough air to make the chest rise adequately
If pulse is present ventilate the casualty – give one slow full breath every 5 seconds X
10 breaths until help comes
5.4 CARDIO PULMONARY RESUSCITATION
Learning Outcomes
At the end of this lesson the student must be able to:
- Describe the concept of Cardio Pulmonary Resuscitation (CPR)
- State and recognise the need for CPR
- Describe and perform all steps of CPR, in their correct sequence for an adult casualty
- List signs of successful CPR
Definition of Cardio Pulmonary Resuscitation
- CPR is two basic life support skills put together-artificial respiration and artificial circulation.
Artificial respiration provides oxygen to the lungs. Artificial circulation causes blood to flow
through the body, but flows only enough to give a person a chance for survival.
Purpose of CPR: is to circulate oxygenated blood to the brain and other organs until either the
heart starts beating, or medical help takes over.
Indications for CPR
- If a casualty has stopped breathing and absence of heartbeat
Signs of successful CPR / Recovery
Spontaneous breathing without series of gasping irregularities
Presence of pulse
Skin colour changes to normal
Pupils size will return to normal; both pupils will be equal and react to light
Level of consciousness will improve
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5.5 AUTOMATED EXTERNAL DEFIBRILLATOR (AED)
Learning Outcomes
At the end of this lesson the student must be able to:
Define AED
Discuss the principles of defibrillation utilising an AED
Describe the safety precautions that form part of the safe use of the AED
Utilise the AED correctly and safely
Definition of AED
AED is the application of an electric shock to a heart that has stopped breathing using a portable
electronic device as part of the CPR protocol.
Principles of defibrillation
AED is able to automatically diagnose a potentially life threatening cardiac arrhythmia
(ventricular fibrillation and ventricular tachycardia) and advise the operator to deliver a shock.
The application of electrical therapy stops the arrhythmia, allowing the heart to re-
establish a perfusing rhythm.
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5.6 WOUNDS
Learning Outcomes
At the end of this lesson the student must be able to:
- Define a wound
- Name and classify wounds
- Name and recognise different types of wounds
- State the dangers of wounds
- Describe aim of treatment
- Describe general PEC of wounds
- Discuss the specific PEC of wounds with embedded or impacted object
Definition of a Wound
A wound is any break in the continuity of the tissue of the body, resulting in bleeding,
which can lead to shock. Germs also get a chance to enter the body resulting in
infection.
Types of wounds
Open
When there is a break in the outer layer of the skin resulting in bleeding
Closed
When there is no break in the outer layer of the skin with the possibility of internal bleeding
which may be severe
Burns wounds
Closed Open Burns
Classification of wounds
Incision = Clean cut caused by a knife
Laceration = Torn wound caused by machinery
Puncture = Wound caused by pointed instrument
Abrasion/scape = Open wound whereby the outer protective layer and tiny underlying
blood vessels are exposed e.g. in accidents
Gunshot = Bullet wound
Bruise = Caused by a fall or blow from something blunt
Contusion = Bruise caused by blunt violence
Avulsions = Wound with a large piece of skin torn away
Amputations = Complete or partial loss of a body part
Burn = Caused by heat, radiation, chemicals and electricity
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Complications of wounds
Bleeding
Infection
Shock
Aims of management
To stop or control hemorrhage
To prevent infection
To prevent or treat shock
General PEC of wounds
Safety
CAB
Expose and examine the wound for foreign objects
Apply direct pressure on the affected area using gauze swab
Clean around and away from the wound with a clean material and water
Apply a clean dressing
Assess for vital signs i.e. pulse, perfusion, temperature, colour and motor sensation
especially when the wound is on the limb
Treat for shock if necessary
Specific PEC of a wound with embedded object
Do not remove embedded foreign objects from the wound
Control serious bleeding by applying pressure around the object
Clean around and away from the object with a clean material and water
Place a clean dressing around the object without disturbing the object
Cover the object around with a ring pad that is large enough to cover the object
Bandage the ring pad in place with a bandage to stabilize the object
Do not apply pressure on the object
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5.7 BURNS
Learning outcomes
At the end of the lesson, the student must be able to:
Define the concept burns
Discuss classification of burns
List the causes of burns
Identify different types of burns
Discuss the management of burns
Definition of burn
They are injuries to a person’s body tissue that were caused by heat, chemicals or radiation.
Classification of burns
Causes and types of burns
Type of burn Causes
Dry
Wet
Chemical
Electrical
Cold
Radiation
Fire
Steam, hot oil or water
Acids, alkalis
Lightning and electricity
Compressed gas
X Rays and sunburn
Electrical Chemical Wet Dry
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PEC management of burns
NB: Never use ice to cool the burnt area as it will make the burn worse
Check the casualty’s SCAB ( Safety, Circulation, Airway, Breathing)
Maintain breathing and check vital signs every 5-10 minutes
Determine the level and depth of burn injury
Cover the burnt area with a clean wet dressing
Call for medical help if necessary
Treat the casualty for shock
5.8 BLEEDING
Learning Outcomes
At the end of this lesson the student must be able to:
Define the concept bleeding
Name and explain types of bleeding
Describe three classification of bleeding
List the signs and symptoms of bleeding
Describe and recognise different methods of controlling bleeding
Describe PEC for severe external bleeding
Describe PEC treatment for epistaxis (nose bleed)
Describe PEC treatment for - Partial Amputation
-Complete Amputation
Definition of bleeding
Bleeding is escape of blood from intravascular space to the extra vascular space.
Two major categories of bleeding
Internal bleeding
External bleeding
Three classifications of bleeding
Arterial - blood spurts out with each heart beat and is bright red
Venous - blood flows out more steadily and is dark red
Capillary - blood oozes out in minor wounds
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Signs and symptoms of bleeding
Pallor of the skin and mucous membrane
Cold clammy skin
Rapid pulse gradually becoming weaker
Rapid shallow respiration
Yawning and sighing
Gasping for air
Anxiety and restlessness
Thirst
Nausea
Fainting and dizziness
Possible unconsciousness
Methods of managing bleeding
Direct pressure with a bandage to the wound to stop blood flow and allow clots to
form(coagulation)
Indirect pressure by bandaging
Splint and elevate
PEC management for severe external bleeding
Scene survey : assess mechanism of injury
Do primary survey
Apply directed pressure to the wound as quick as possible
If the wound is large and wide open, you may have to bring the edges of the wound
together first
Elevate the injury while keeping pressure on the wound
Place the casualty at rest
Quickly apply clean dressing direct onto the wound
Check circulation below the injury
Bandage the dressing tight enough to stop bleeding and not to cut off circulation
Treat for shock if necessary
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PEC treatment for:
Partial amputation
Scene survey
Control and manage bleeding
Send for medical help
Reposition the partial amputated part as near to normal position as possible
Cover the area with sterile dressing gauze
Bandage in position
Splint
Complete amputation
Stop bleeding by applying direct pressure
Place the casualty at rest
Bandage the dressing in place
Care of the amputated part
It needs to be preserved
Do not try and clean the amputated part
Attach a record of date and time and send together with the casualty
Place the amputated part in clean watertight bag and seal the bag
Place the first bag in another bag with cold water or crushed ice if available
Keep it in a cool place and get both the casualty and the amputated part to the
medical help
Label amputated part with casualty’s particulars i.e. name, date and time of incident
Treat for shock
Reassure the casualty
5.9 NOSE BLEED
Definition of nose bleed
Nose bleed is a common condition of bleeding from rupture of blood vessels in the nostrils
Causes
A hit to the nose
Sneezing or blowing the nose
An infection e.g. cold or flu
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PEC management of nose bleed
Put on gloves and let the casualty sit upright with head well forward
Loosen any tight clothing around the neck and chest
Advice casualty to breathe through the mouth
Tell the casualty not to swallow, speak, cough or sniff as blood clotting will be
disturbed
Pinch soft part of the nose for a maximum of 10 minutes and release
If bleeding has not stopped, re-apply the pressure for another 10 minutes
Do not allow casualty to stoop over a basin or blow the nose
When the bleeding stops, with the casualty’s head still tilted forward, wipe around
the nose and mouth with a gauze
If bleeding continues for more than 30 minutes or bleeding re-starts, then medical
help is required
5.10 SHOCK
Learning outcomes
At the end of the lesson the student should be able to:
• Define the concept shock
• Discuss the types and causes of shock
• Recognise the signs and symptoms of shock
• Discuss the management of shock
Definition of shock
A state of acute circulatory insufficiency characterized by reduced circulating blood volume,
with inadequate tissue perfusion and resultant low oxygen in the tissues
In order to maintain an adequate circulation and blood pressure there must be:
1 an efficient pump
2 an adequate volume of circulating fluid
3 sufficient tone in the blood vessels to prevent excessive vasodilatation
Types and causes of shock
Types of shock Causes Clinical picture
Cardiogenic Ineffective pumping of the heart ↓cardiac output=hypotension
Hypovolemic Inadequate circulating blood
volume
Low urine output, low CVP
Septic Infections Rigor, oliguria, hypothermia
Neurogenic Drugs, spinal shock, painful
physical & emotional experiences
Hypotension
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Common presenting signs and symptoms of shock
Skin may be cold, pale and clammy
Cyanosis
Decreased urinary output
Tachypnoea
Decreased LOC
Diminished urinary output
Mental confusion and apprehension
Low SBP
Tachycardia
Hypothermia
PEC treatment for shock
• Reassure the casualty if he/she is conscious
• Keep the patient in a flat or semi-recumbent position or the position best suited for
his condition
• Remove the cause of shock if possible or treat the cause e.g. control bleeding
• Keep the casualty warm
• Give nothing by mouth if unconscious
• Maintain airway patency
• Administer supplementary oxygen
• Relieve or minimise the pain and anxiety
• Monitor vital signs
• Handle the casualty gently to avoid fluid shifts
• Seek for medical help
• Administer supplementary fluids guided by haematocrit, urinary output and blood
pressure
5.11 FRACTURES
Learning Outcomes
At the end of this lesson the student must be able to:
Define a fracture
State causes of fractures
Name the classification of fractures
List and describe the types of fractures
List the sign and symptoms of fractures
Describe PEC management for Closed and Open Fractures
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Definition of a fracture
A fracture is a break or crack in a bone
Causes of fractures
Directed impact
Transmitted impact
Classification of fractures
Closed fracture - the skin over the fracture is not broken
Open fracture - the skin over the fracture is broken and this can cause serious
Infection
Types of fractures
Oblique :bone is broken at a steep angle
Greenstick : bone is not broken right through
Comminuted : bone is crushed
Spiral : bone is broken by twisting
Depressed : skull is fractured inward
Complicated: broken bone has cause damage to internal organs
Transverse: bone is broken straight across
Signs and symptoms of a fracture
Pain and tenderness
Loss of movement
Mobility of limb at site of fracture
Deformity /shortening
Swelling
Discolouration (bruising)
Crepitus (grating)
Shock increases with severity of injury
Bleeding wound in open fractures
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PEC management for:
Closed fracture
Steady and support the fracture
Assess neurovascular function on affected part
Immobilise the fracture with a splint
Splints the fractured limb
Open fracture
N.B Add the following treatment to the above:
Stop bleeding if there is an open wound
Do not put pressure on the protruding bone
Clean the wound around and away from the protruding bone
Apply a clean dressing around the protruding bone
Or make a tent to cover the bone depending on the length of the protruding bone
Make a ring pad large enough to cover the protruding bone
Support the ring pad with bandages
Treat for shock
LIST OF REFERENCES
American Heart Association. 2001: BLS for Healthcare Providers. Fighting Heart Disease and
Stroke. Dallas. USA.
Bledsoe BE; Porter RS & Cherry RA. 2007.Essentials of Paramedic Care.2nd edition. New
Jersey.Pearson Prentice Hall.
SAMDC.1994. Curriculum for the basic ambulance course. The professional boards for
emergency care personnel. Doc 3. (Part 1, August).
St John Ambulance. 1992. Standard First Aid and Safety Orientated. Calvin & Sales. Cape
Town.
St. John Ambulance. 1999. First on the scene. The complete guide to first aid and CPR.
Canadian cataloguing in publication data. South Africa.