Emergency Care of the Injured
– Goals of first aid treatment
– Initial care of the injured
• Modus operandi in first aid
• Management at the hospital
First aid techniques are the basic technique in managing an injured patient should be learnt first and not last. Proper care may be a skill, which must be learnt and developed.
First aid is that the initial care of the injured at the scene of accident. Anybody can give care , but to hold out CPR measures one should be trained in care and will possess a legitimate certificate issued by a competent body. First aid executed by a medical person is named medical care .
GOALS OF FIRST AID TREATMENT
Three Ps. aptly describes goals of first aid treatment:
• Preserve life by carrying out appropriate resuscitative measures.
• Prevent further injuries by careful handling.
• Promote recovery.
INITIAL CARE OF THE INJURED
At the Scene of Accident
• Remove the victim from the accident spot.
• Check his or her vital parameters quickly (pulse, BP, consciousness, etc.).
• Seek the help of bystanders if trained in first aid.
• make sure that police and ambulance are informed.
• Remember to carry out first aid according to MacMurthy’s A to F regimen
• Ensure personal safety.
MODUS OPERANDI IN FIRST AID
First, clear the airway as follows:
• Clear the patient mouth of clots, loose teeth, dentures, etc.
• Extend the patient neck slightly as this opens up the pharynx.
• If the patient isn’t breathing, begin emergency procedure . First keep a skinny cloth over the patient’s mouth, blow into the patients mouth keeping his or her nostrils closed.
Blow at the speed of 16 per minute and see for the chest raise. Mouth to nose respiration is carried out if there is extensive injury to the mouth. If the patient has suffered extensive facial injuries, put the patient prone, turn the face towards one side and apply pressure over the lower aspect of the chest (Holger-Nelson method).
Examine the radial pulse and the carotid pulse for the function of cardia. If the pulse is absent, initiate cardiac resuscitative measures as follows:
|Mouth to mouth respiration|
• Ensure that the patient is lying on a hard surface.
• Then pressure is applied slow with the heel of the palm at the lower end of sternum.
• Optimum pressure should be applied and therefore the depth of every pressure should be 1¼ inch.
• Perform external heart massage at the speed of 72 per minute. It is preferable to hold out both external heart massage and emergency procedure simultaneously by two persons trained in care . Nevertheless, if there’s no assistance available then CPR should be administered by one person as follows: –
First emergency procedure is given once then the same person should quickly change position and carry out external cardiac massage 5 times. So, this 1 : 5 ratio should be maintained throughout. – The cardiopulmonary resuscitation (CPR) should be carried out until the patient recovers or at least for half an hour.
It is advising to arrest the bleeding by the elevated or direct application of pressure over the bleeding area. Tourniquet should be also avoided and used only as the last resort.
EXAMINE THE VITAL STRUCTURES
Examine the patient for head injuries, cover the skull injuries with a clean cloth, and examine pupils and therefore the level of consciousness. Look for neurological deficits.
Open chest injuries are dangerous as they’ll cause tension pneumothorax. Application of a clean cloth with firm pressure over the open wounds is all that’s required.
All injured patients should be examined for intraabdominal injuries, because it is an emergency. Board like rigid abdomen suggests the blunt injury the abdomen and there may be damage to the liver, spleen, colon, etc. Arrangement should be made to shift the patient immediately to a hospital. In open wounds of the abdomen, a clean cloth should apply firm pressure.
Suspect pelvic fracture if the patient complains of pain during compression test or distraction test, which is performed by applying pressure over the iliac bones. Tenderness over the symphysis pubis is also suggestive.
Injuries to the Genitourinary System
Supra pubic swelling indicated the bladder injury, and the injury to the scrotum or perineal haematoma indicates urethral rupture.
Cervical spine injury should be finded if the patient is lying still turning the neck. Injuries to thoracic and the lumbar spine should be founded if the patient has been developed paraplegia or complains of pain when individual spinous processes are palpated. Extreme care should done in managing and shifting a patient with the spinal injuries.
Deformity, pain, swelling, loss of function of a limb are implicational fracture. Fracture must be splinted with whatever material is out there at the scene of accident (Figs 5.4 to 5.6). Fracture can be managed by electively after shifting the patient to the hospital.
|Splinting of the fracture site: A make shift sling|
• Fracture is not an emergency.
• Most of them can be managed electively later.
• In A to F management of injured fracture treatment comes last.
• Prepare and improvise splints with available materials at the scene of accident.
About fractures in the first aid. The management of fractures at the scene of accident are.
• Sling for clavicle fractures, shoulder fractures, etc.
• Strap for clavicle and rib fractures.
• Splint, usually improvised.
• Shift the patient with utmost care.
• Seek professional help at the earliest.
Remember the priority in first aid
• Shock to be corrected first.
• Systemic injuries to be tackled next.
• Spine injuries call for extreme caution.
MANAGEMENT AT THE HOSPITAL
MacMurthy has been find down the A to F management guidelines to be followed within the institutional care of the injured within the order of importance:
• Airway management
• Blood and fluid replacement
• Central nervous system management
• Digestive system management
• Excretory system management
• Fracture management.
Other emergency administration are of antitoxin, antibiotics, antigas gangrene serum, and wound debridement should be administered. Appropriate the radiography should be taken before treating the fractures patient. The treatment of bone and joint injuries are discussed intimately within the relevant chapters.
AID as prerequisites of a good first aider
•Decisions AID as mnemonic of a bad first aider
Remember in first aid
• Delay is dangerous.
• If improperly executed, first aid will become the last aid!
• Always aid the patient to recovery and do not send him to mortuary by being apathetic.
• Shifting the patient to a hospital is extremely important.
• Terminate care measure once medical assistance arrives or after shifting the patient to the hospital.