FIRST AID COURSE

Primary survey
The order of the primary survey is intentional; it allows you to consider each body system in order of
priority, assessing first those injuries that will cause fatality the quickest i.e. Airway and Breathing. The
contents and order of the primary survey can be easily remembered by using the mnemonic DR.ABC:

Danger:
• Before you approach the casualty you MUST check for danger

• YOUR safety is the number one priority

Examples of danger to be aware of:

1. Moving vehicles
2. Broken glass
3. Live electricity - Do not touch patient. Switch off source or disconnect using wood/plastic
4. Fire and smoke
5. Is the area safe?
6. YES: Proceed to help casualty
7. NO: Can you make the area safe?
8. YES: Make it safe and help casualty
9. NO: Stay back and call for help!

Response:
Ask the patient simple questions in BOTH ears- “Can you hear me?” and “Can you open your
eyes?”

• YES: If there is any response then proceed to check airway

• NO: Gently hold shoulders and shake - Still no response? Proceed to check airway…

Airway:
Is the airway open and clear of blockages?

• YES: If patient can talk then the airway is open and clear. Proceed to assess breathing…

• NO:

o Responsive: Do not put your fingers in a conscious casualty’s mouth, encourage them to try and
remove an obvious blockage with their hands or by coughing

o Unresponsive: Finger sweep to remove obvious blockages and open airway by tilting head back
whilst lifting chin (N.B. Head tilt chin lift manoeuvre will be covered in a later video)

Proceed to assess breathing…

Breathing:
Place your ear to the casualty’s mouth and look towards their chest, is the casualty
breathing normally?

• YES: You can hear normal breath sounds, feel breath on your cheek and see chest rising and
falling - Proceed to assess circulation…

• NO: Shout for help and get them to call 999 for emergency services (if alone call yourself) and
immediately begin cardiopulmonary resuscitation (N.B. CPR will be covered in a later video)

Proceed to circulation ONLY if the casualty starts to breathe independently

Circulation:
Is the casualty bleeding severely from anywhere?

• YES: Control excessive bleeding and call 999 for emergency help (N.B. Treating bleeding will
be addressed in a later article)

• NO: If A-C have been successfully dealt with then reassure the patient and wait with them for
emergency services to arrive

obstructed airway
agonal breathing sound like gurgling this is not
normal breathing this is a common feature after a
cariac arrest
Nurses assess circulation by checking:

1. pulse - quick swelling of an artery as blood passes through with each heartbeat.
2. temperature.
3. capillary refill- time it takes for blood to return to a finger or toe after the blood supply is
pinched off.
4. color.

The recovery position

The recovery position is a safe position for the breathing but unconscious adult. Remove glasses
from the casualty's face and any sharp, bulky objects from their pockets, such as mobile phones,
keys, or wallets. With the casualty on their back and both legs straight, place the arm nearest to
you at a 90 degree angle to their body with their palm facing up. Take the other arm over the
casualty's chest and place the back of their hand against the cheek closest to you. Take the leg
furthest away from you with your other hand, holding just above the knee, and pull the leg up
whilst keeping the sole of the foot on the ground.

0:49Skip to 0 minutes and 49 secondsWith the casualty's hand still on their cheek, bring the far
leg towards you until the casualty has rolled onto their side. Ensure the raised leg is bent at 90
degrees in line with their hip. Ensure the casualty's airway remains open by tilting their head
back. Place one hand on their forehead and two fingers of the other hand under their chin. Tilt the
head back gently. Finally, now the casualty is successfully in the recovery position. Ensure
emergency help has been called and monitor the casualty until they arrive. After 30 minutes, if
help has still not arrived, place the casualty on their other side.

Automated external defibrillators

What is an AED?

• An electrical device that aims to restart a stopped heart

• It works by delivering a shock to the casualty

Where can I find an AED?

o Certain shops e.g. pharmacies

o Shopping centres

o Train stations

o Airports

• If you need an AED, make sure to ask!

How do I use an AED?

• You do not need any prior experience to operate an AED

• AED’s guide the user through each step via visual and/or audible prompts

• Each AED has two shock pads: these must be placed on the chest at the areas shown on them

• Make sure to STAND WELL AWAY from the casualty when shocking them

In the subsequent video you will see CPR and an AED in action!

Performing CPR

Ensure you have performed DR AB to confirm the casualty is not breathing. Shout for help and
request they ring 999, explaining both the situation and location. After they have called
emergency services, get the helper to retrieve an AED. Help. Can someone help, please? Is
everything OK? This person is not breathing. Can you please phone 999 and ask for an
ambulance. And you get an AED. I'm going to start CPR. Step 1, Place the heel of one hand
directly between the two nipples. Place the other hand over the top whilst interlocking the fingers.
Keep the heel of your hand pressed down and your fingers raised. Step 2. Lean directly over the
casualty with the arms locked straight.

0:55Skip to 0 minutes and 55 secondsPush straight down towards the breast bone with the heel of
your hand to begin chest compressions. After each compression, release pressure whilst keeping
your hands on the casualty's chest, letting the chest return to its normal position before the next
compression. Compression should be performed at a rate of 100 to 120 beats per minute. This can
be achieved by singing the song "Staying Alive" in your head. Chest compressions should be
performed 30 times in a row at a depth of 5 to 6 centimeters. This requires some force and ribs
can be broken. Step 3. After 30 chest compressions have been completed, performed two rescue
breath.

1:38Skip to 1 minute and 38 secondsPerform the head tilt chin lift and pinch the casualty's nose
using the hand from the forehead. Create a seal around the mouth and blow whilst watching the
chest rise for two breaths. A complete rescue breath should take one second. If the chest doesn't
rise, ensure a tight seal and the airway's open by adjusting the position. Step 4. Continue the cycle
of 30 compressions to 2 rescue breath until either emergency help arrives, you are too exhausted
to carry on, or the casualty starts to breath. If there are other people available to help you, they
should take turns to perform CPR every one to two minutes.

2:19Skip to 2 minutes and 19 secondsIf an AED becomes available, it should be used

immediately, even if you are in the middle of chest compressions. Step 5. Open up the AED and
read the instructions. Ensure casualty's chest is exposed and dry. Switch on AED and remove
pads from their packaging. Remove the paper on the back of the pads and place them in the
position shown. One pad is placed beneath the collarbone on the right side of the casualty. And
the other is placed slightly lower on the left side. Stand clear make sure no one has stood near the
casualty, as you will get shocked. Follow the vocal or visual prompts given by the device to
shock the casualty. Shock advised. Deliver shock now.

3:07Skip to 3 minutes and 7 secondsPress the orange button now. Shock delivered. Start CPR.
After the shock, immediately return to CPR, performing for two minutes and then shocking
again. Repeat this until the emergency help arrives or the casualty begins to breathe. CPR
keypoints. Call for help. Get your help to call 999 and retrieve an AED. Remember, 30
compressions to 2 rescue breaths with a depth of 5 to 6 centimeters and a rate of 100 to 120 beats
per minute. Change person every one to two minutes if possible and stop when you are
exhausted. As soon as an AED is available, use it.

What injuries are most common?

Sprains breaks bleeding

What is bleeding?
What causes bleeding?

Bleeding occurs when an injury causes a break in the skin and damage to blood vessels.

Most of the time when we cut ourselves, we bleed and the body forms a clot(a solidified mass of
blood) to stop it. In severe bleeds when a large vessel is damaged, the bleeding can flow too
quickly for a clot to form. If the bleeding is not controlled then the casualty may lose too much
blood and go into shock - a state in which there is not enough blood in the body to supply all of
your organs with enough oxygen, shock can quickly prove fatal.

Shock is the state of insufficient blood flow to the tissues of the body as a result of problems
with the circulatory system. Initial symptoms of shock may include weakness, fast heart rate, fast
breathing, sweating, anxiety, and increased thirst. ... Cardiogenic shock may be due to a heart
attack or cardiac contusion.

Source of Bleeding

The three sources of bleeding are:

Arterial Arterial blood is oxygenated and carried away from the heart. A bleeding artery tends to
produce profuse bright red blood that spurts out in time with the casualty’s heartbeat.

Venous Venous blood is deoxygenated and is carried back towards the heart. A bleeding vein
tends to produce dark red blood that pours out of the wound and doesn’t pulsate.

Capillary Capillaries are small blood vessels just under the skin. They are damaged in even the
least severe wounds and do not tend to produce enough bleeding to be of concern. When
capillaries burst(to break from internal pressure) underneath the skin, bruising develops.

Types of wound
Wounds can be caused in a number of different ways by a variety of different objects, be it blunt, sharp
or projectile. They are classified into several categories dependent on the cause and resulting injury:

Incised wound - A clean, straight cut caused by a sharp edge (i.e. a knife). Tends to bleed
heavily as multiple vessels may be cut directly across. Connecting structures such as ligaments
and tendons may also be involved.

Anatomy

plural noun: ligaments

1. a short band of tough, flexible fibrous connective tissue which connects two bones or cartilages
or holds together a joint.
o a membranous fold that supports an organ and keeps it in position.
o archaic

a thing which unites people or things; a bond

Laceration - A messy looking wound caused by a tearing or crushing force. Doesn’t tend to
bleed as much as incised wounds but often causes more damage to surrounding tissues.
Abrasion - A wound caused by a scraping force or friction. Tends not to be very deep but can
often contain many foreign bodies such as dirt (i.e. after a fall on loose ground).
Puncture - A deep wound caused by a sharp, stabbing object (i.e. a nail). May appear small from
the outside but may damage deep tissues. Particularly dangerous on the chest, abdomen or head
where major organs are at risk.

Avulsion - A wound caused by a tearing force in which tissue is torn away from its normal
position. May bleed profusely depending on the size and location. The tissue is often completely
detached.

Amputation - The loss of a distinct body part such as a limb, finger, toe or ear. Often very severe
with profuse bleeding. In the cases of limb loss this is a medical emergency.

Controlling a severe bleed

Controlling a severe bleed is vital to prevent shock and save lives!

Step 1 - EXPOSE:

If the wound is covered by clothing expose it to assess the type and severity

Step 2 - PRESSURE:

Is there a foreign body in the wound? (i.e. a piece of glass)

o YES

DO NOT APPLY DIRECT PRESSURE ON WOUND - this could push object deeper

DO NOT REMOVE THE OBJECT - this may cause more damage inside the wound

APPLY PRESSURE EITHER SIDE OF FOREIGN BODY - pushing the wound edges together

o NO

Apply direct pressure over wound, preferably with a clean dressing. If not then ask the patient to
apply the pressure themselves with their hand

Step 3 - RAISE:

Maintain pressure on the wound and raise it above the level of the heart - reduced blood flow to
wound

• Injured arm: raise over casualty’s head

• Injured leg: lie the casualty down and gently raise and hold the leg up

• Severe bleed/suspected shock: lie casualty down and raise both legs above the level of the heart

Step 4 - WARM:

Blood loss puts the casualty at risk of hypothermia (dangerously low body temperature) so keep
them warm using a blanket or rug if one is available. If not then use a jumper or jacket.

Step 5 - BANDAGE:

DO NOT tourniquet the limb

If a sterile bandage available then use it to dress the wound

Wrap tight enough to maintain pressure but don’t cut off the circulation - this may threaten the
limb

If blood seeps through then apply another one on top or change the bandage if saturated

Secure limb in a raised position and check occasionally to ensure circulation is not cut off

Tourniquet a device for stopping the flow of blood through a vein or artery, typically by
compressing a limb with a cord or tight bandage.
These recommended practices provide guidelines for use of pneumatic tourniquets , which
primarily are used to occlude blood flow and obtain a near bloodless field for extremity surgery.
the limbs an arm or leg of a person or four-legged animal, or a bird's wing.

Walking may be more familiar and is a whole body exercise compared with cycling where the
lower limbs are the primary effector muscles.

Step 6 - HELP:

Call 999 for emergency help if the bleeding continues. Continue to apply pressure and pay
attention to the casualty’s breathing and consciousness level until help arrives

https://www.youtube.com/watch?v=NxO5LvgqZe0

What is shock?

The commonest type of shock is called hypovolemic shock - this occurs due to loss of fluids,
usually blood. The body begins to go into shock when more than 2 pints of blood has been lost. It
is life-threatening and requires immediate management! Here are some of the features which
suggest shock is present in order to help you to recognize it.

Immediate:

Quick heart rate (feel at wrist)

Pale skin and cold, sweaty hands

Worsening:

Quick and shallow breathing

Weakening of pulse at wrist

Blue/grey skin - check lips and fingertips

Weakness and drowsiness

Nausea and vomiting

Extreme thirst

Critical:
Change in behaviour e.g. aggressive

Gasping for a breath

Complete loss of consciousness

Death!

Now that you have a better understanding of what shock is, in the next step you will learn more
about how to deal with it.

1 Brit pint is equal to 0.568 litre, 1 US pint to 0.473 litre

Drowsiness a feeling of being sleepy and lethargic; sleepiness.

Nausea a feeling of sickness with an inclination to vomit.

Managing shock

In dealing with shock there are some key things that is important to remember.

DO

1. TREAT - Check for any obvious cause (bleeding) and aim to treat it. Call 999 for emergency
help!

2. FLOOR - Lie casualty down on back, preferably on a soft and warm surface (e.g. a blanket)

3. RAISE - Lift casualty’s legs up and hold in position to improve blood supply to vital organs

4. WARM - Undo tight clothing but cover the casualty in warm jumpers or blankets

5. MONITOR - Keep an eye on casualty’s consciousness, breathing and heart rate until help
arrives

DO NOT:

Give the casualty food or drink - they may need an anaesthetic at a later stage

Leave casualty unattended

Attempt to warm casualty with a direct heat source

Anaesthetic Today, the most common modern general anesthetics are mixtures of inhalable
gases, which include nitrous oxide (laughing gas) and various derivatives of ether, such as
Isoflurane, Sevoflurane, and desflurane to prevent aspiration of stomach contents, resulting in
pneumonia

Dealing with a choking patient

Firstly, confirm if the casualty is choking by asking them if they are choking. Check for signs of
choking:

Partial obstruction:

o Able to speak, cough and breathe

o Encourage coughing

o No need for physical intervention unless casualty worsens

Complete obstruction:

o Unable to speak, cough and breathe: MEDICAL EMERGENCY

Managing the Choking Casualty

Step 1: Encourage casualty to keep coughing if possible and check their mouth for obstruction
Remove any obstruction if possible

Step 2: If casualty worsens (i.e. is turning blue or stops breathing or coughing) then perform 5
back blows. Whilst supporting casualty lean them forward and use the heel of your hand to give
five firm blows directly between the two shoulder blades. If this works and the obstruction clears,
stop immediately.

Step 3: If back blows fail then perform the Heimlich manoeuvre (chest thrust). To perform this,
stand directly behind the casualty. Place both arms around the casualty, to get the correct position
place your little finger at the belly button and clench your fist with one hand, place the other hand
over the fist to create a tight grip. In one firm and quick motion, pull your fist inwards and
upwards. Repeat this up to five times.

Step 4:

Recheck the mouth to see if obstruction has cleared. If not, call 999 for emergency help and
repeat Steps 2 and 3

Continue until casualty stops choking, loses consciousness or help arrives

https://www.redcross.org.uk/first-aid/learn-first-aid-for-babies-and-children/choking-child

https://www.redcross.org.uk/first-aid/learn-first-aid-for-babies-and-children/choking-baby

Bystander first aid in trauma – prevalence and quality: a prospective

observational study

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4744764/