Y khoa, y dược - Chapter 15: First aid knowledge & skills

Chapter 15First Aid Knowledge & Skills The NMC Code of Professional Conduct Standards and Ethics (2004): clause 8.5 “In an emergency, in or outside the work setting, you have a professional duty to provide care. The care provided would be judged against what could reasonably be expected from someone with your knowledge, skills and abilities when placed in these particular circumstances”. To preserve life and limbTo prevent the injury / injuries from becoming worse To promote recoveryThis list can be extended to include:The prevention of further injury to the individual or yourselfThe Key Aims of First AidBasic life support is a tried and trusted method of both assessing and, more importantly, applying basic techniques that can preserve life (RCUK 2006). Visit the Resuscitation (UK) website, familiarise yourself with its format and content as this site provides all the information you require!www.Resus.org.uk Applying Basic Life SupportBasic life support should consist of the following sequence of actions-Make sure the casualty, any bystanders, and you are safe. -Check the casualty for a response (AVPU )If the casualty responds They do NOT respondBreathing normally Unresponsive Recovery Position BLS algorithm Theory into PracticeSmall Group Exercise: List 3 Characteristics of a Generalised Seizure... List 3 Characteristics of a Partial Seizure...What to do During a Generalised Seizure· Stay calm · Try and prevent further injury· If possible keep a record of the length of seizure· Try and achieve a safe comfortable environment for the individual·  Look for any medical alert bracelets·  Do not try and restrain the casualty, consider your safety.The casualty might be agitated or be trashing around, try and limit the local risk potentialWhat to do During a Generalised Seizure 2Do not attempt to put anything into the casualty’s mouth (including medication)Remember & apply the ABC approachIf the seizure is not self-limiting call for help or dial 999What to do for a Partial Seizure· Stay calm Place the casualty away from danger, however do not restrain them, as they might get upset or increasingly confusedStay with casualty until they become fully alertReassure the casualty First Aid for a Choking Casualty ·  If you witness someone who finds it difficult to breathe or cough due a potential obstruction in his or her throat what would you do?By identifying your current approach you will be directly able to see how your practice could change for the benefit of those you come into contact with by applying your newly found insight.International Distress SignThe international distress sign for someone physically choking is clinically demonstrated by them clutching at their throat.Treating a Choking Conscious PatientIf the person has the ability to speak encourage them to cough Do not interfere with their throat Encourage the victim to continue coughingIf foreign body if visible remove it Compromised Airway Initial treatment is to give five back slapsThe effectiveness of this procedure can be increased if you bend the casualty forward (RCUK, 2006)Check the mouth after each blow for any obvious dislodged obstruction. If Choking ContinuesAdminister five abdominal thrusts Repeat approximately 6 to 10 times Alternating with the back slaps Complications – Pregnancy/Obesity If the casualty has a misshapen anatomy due to pregnancy or severe obesity you will need to adapt the technique for it to be safe or effective. Abdominal thrusts can be substituted for chest thrustsBe careful to avoid the abdomen as compressing here can lead to damage of vital organs. If the Casualty Becomes Unconscious · Guide them safely to the ground·  Call for help/ambulance·  Begin BLS/CPR  Corneal Abrasions A corneal abrasion is an injury or scratch involving the outer layer of the eye, usually resulting from a superficial scratch to the surface. The cornea has multiple nerve endings under the surface, which can make a corneal abrasion very painful. Signs & Symptoms The feeling of sand in the eyeBlurred vision or distortion of visionIncrease sensitivityRedness around the eyeIncreased watering of the affected eyeThere may be a sensation that there is something in the eye but the casualty can’t get it out. Immediate Treatment Use clean water or a saline solution to immediately wash the eye out Encourage the casualty to repeatedly blink as this natural defence mechanism will remove any small dustGently extend the upper eyelid over the lower lid as the eyelashes can brush and remove foreign bodies from the under surface of the eyelid.If a foreign body appears embedded within the eye do not try and remove the particle; immediately seek medical assistance. If chemicals are involved irrigate the eye vigorously holding the eye open, call assistance and get the casualty to hospital as soon as possible. Anatomy & Physiology in Action Divide into three small groupsEach group identify what potential injuries are involved in the following, start superficially and progress deeper depending on the type of mechanismAbrasions PunctureLacerationsA Superficial Abrasion InjuryAbrasions are classified as a superficial injury where the epidermis is wounded from a rubbing or frictional type injury occurring against its soft outer surfaceAn Incisional Injury Incisional wounds are normally smooth edged and associated with knives or as a result of broken glass. A Puncture Wound Puncture wounds result from a sharp piercing object that goes through the both the epidermis and dermis Skin LacerationLacerations are commonly referred to as ‘cuts’ or ‘gashes’ affecting the skin Lacerations can result from sharp objects or blunt trauma involving the various layers of the skin.Avulsions result in a noticeable absence of tissue, rapid bleeding and can involve a large surface area depending on the mechanism of injury.Amputations can occur when a body part such as a toe or finger are partially or completely cut off. Other Injuries The Initial Treatment/First Aid Stop or control any bleeding/haemorrhagePrevent contamination i.e. clean and cover/dress the wound to avoid further infection potential Be aware that further medical assistance may be needed if the patient is demonstrating signs of haemodynamic compromise or if the mechanism of injury is significant  Applying Theory to Practice Clinical Signs of Haemodynamic collapseWhen confronted by a casualty who is potentially seriously ill, regardless of the setting, a nurse is expected to make a quick but factual assessment of the casualty’s circulation.Many ways exist to assess circulation, the last tool you require is a DINAMAP! These signs include:An increased respiratory rate and depthAn absent or weak radial pulseA prolonged capillary refill time (CRT)A decreased level of consciousnessA sweaty/clammy appearanceA pale, cyanosed or mottled appearanceSlings This is probably one of the most useful pieces of equipment in first aid Providing localised support and reducing further damage and painSlings are multipurpose There are 2 types: Broad arm sling High arm sling · Slings can also be used in innovative ways, the army use improvised slings for battlefield first aid dressings that can be adapted to suit almost every circumstance.The Application of a Broad Arm SlingBroad Arm SlingsAre normally used in arm (wrist/elbow) injuries and can be applied to support the arm if the casualty has a suspected fracture of the clavicle (collar bone) The Application of a High Arm Sling High Arm Slings:The primary purpose is to provide elevation to facilitate haemostasis and the reduction of swelling. High arm slings will also provide support for the hand and forearm.First Aid for Nose Bleeding (epistaxis)Applying First AidRegardless of the amount of blood loss, stay calmSit with the casualty and loosen any tight clothing around their neckAssist the casualty in tilting their head slightly forward, encouraging the casualty to breathe through their mouthIf the casualty is able to: assist them to apply their thumb and index finger over the soft portion of the nose (just under the bridge, if you apply pressure too low it will fail to be effective), and firmly squeeze the nostrils together.EpistaxisApply this pressure for at least 10 minutes, this is essential as every time you remove the localised pressure and assess for bleeding the newly formed clot may dislodge and the casualty is in the same situation as you found them. Resisting the temptation to look can prove difficult for both the rescuer and casualtyReassess after ten minutes, if the bleeding does not stop continue to apply pressure for a further 10 minutes and if available apply an ice pack across the bridge of their nose or to the back of their neck, be careful not to burn the skin.Applying Theory to PracticeThere are several different causes for epistaxis: Identify at least three causes Identify the most common origin of epistaxisTreating Burns SCALDS - Stopping the burning processC - Cooling the burnA - Analgesia L - Last tetanusD - Dressing the burn Stopping the Burning Process Remove the casualty from the heat source Affected area should be submerged in wateror rolled on the ground to smother the flames, this can also be achieved with a blanket or coat In an event of an electrical burn turn the electricity off at the mains before assisting the casualty. Cooling the Burn It is suggested that the affected area be cooled for a minimum of 20 minutes This cooling process eliminates the heat and prevents further damage to the tissues. Attention should be taken when cooling large areas as this can lead to hypothermia. Recommendations vary with regards to the water temperature, temperatures between 5 and 25 degrees Celsius have been proven to be the most effective method of cooling burn wounds  Analgesia In major burns with moderate to severe pain opioids are indicated for the initial pain control Superficial or mild burns effective first aid in the form of cooling may bring instant relief. NSAIDs such an Ibuprofen or combination drugs involving Paracetamol and codeine may be effective (all of which are easy to obtain).Developing and Delivering Expert Care Categorical Rating Scale for Acute Pain Pain Score Appropriate analgesia0 = No Pain1 = Mild pain 2 = Moderate Pain3 = Severe pain 4 = Very SevereNone indicated Non opioid analgesiaWeak opioids combinationsStrong opioid combinationOpioids titrated to pain Last Tetanus Booster Check tetanus immunisation status for casualties sustaining burns, particularly those who originate from outside the UK, as they may not have had childhood immunisation.Dressings Initially wrap the burn with cling film or a clean plastic bag as it is non adherent water resistant keeps the wound clean, prevents air flow over the skin and is translucent for further examination. Cling fling should be applied in layers this is to prevent a tourniquet effect. Many different nationalities have traditional remedies for burns many involve applying toothpaste to the burnt area. Avoid putting anything on the wound other than water.SummaryIn and out of their work setting nurses have a professional obligation to provide immediate first aid to the injured.This can be a frightening experience, but can also be extremely rewardingFirst aid skills are essential to nurses, thereby making the content of this presentation potential life saving information.