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THE NERVOUS SYSTEM

➢ One of the smallest yet complex system
➢ Has billions of neurons
➢ 2Kg or 3% of total body weight control communication system

Functions (CRIME)
➢ Controlling muscle and glands
➢ Receiving sensory input
➢ Integrating information
➢ Maintaining homeostasis
➢ Establishing and maintaining muscle activity

Terms
1. Neuropeptide – Specialized protein messenger: mental functions
2. Neuroglia – Nourishes the nerve cells in brain and spinal cord
3. Meninges – membranes that covers the brain
4. Myelin Sheath – Insulates, protects nerve cell which is composed of fats and proteins
5. Myelinated – surrounded by myelin sheath
6. Neuron – nerve cells; receiving. Transmitting impulses
7. Nerve – bundle of neuron fibers outside CNS
8. Instinct – aware of knowing something without having to discover or perceived it; immediate
apprehension of the mind without reasoning
9. Stimulus – agent that directly influence an activity by exciting a sensory organ; evoking muscular
contraction or glandular secretion; positive or negative; capable of exciting functional activity;
produces a response in an organ or part of an organ
10. Impulse – wave excitation transmitted by nerve fibers and muscle
11. Integration – process which messages are analyzed, combined, compared and coordinated; expressed
itself through muscles and glands

Divisions of The Nervous System

I. Central Nervous System – the control system for the entire system; interprets incoming sensory
information, issued transactions based on past and current conditions. Examples include specific
kind of pain
A. Brain - primary center for regulating and coordinating body activities (The Computer)
B. Spinal Cord – center reflex action containing the conducting paths to and form the brain. (The
tail of the brain)
II. Peripheral Nervous System – convey impulses from the brain
A. Spinal Nerves – carries impulses to and from the spinal cord
B. Cranial Nerves – carry impulses to and from the brain; connect to the brain to structures or
head, neck, and trunk
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Spinal Nerves
➢ Originate the spinal cord and connect it to a specific segment of the spinal cord.
➢ Each pair of spinal nerves is connected to a segment of the cord by two pairs of attachments called
roots. The 31 pairs are:
1. 8 Cervical – supplies limbs, neck, and diaphragm
2. 12 Thoracic – supplies the muscle of the chest and back
3. 5 Lumbar – supplies the lower abdomen and some parts of the lower limb
4. 5 Sacral – supplies reproductive organs and bladder
5. 1 Coccygeal – supplies the anus

The Twelve Cranial Nerves

1. Olfactory – sense of smell
2. Optic – for vision, visual acuity
3. Oculomotor – opening of the eyelids, construction of the pupil, upward/downward movement of the
eye
4. Trochlear – oblique movement of the eye
5. Trigeminal – facial sensation; mastication
6. Abducens – lateral movement of the eye
7. Facial – facial movement/facial expression, closing of the eyelids leading to production of tears
8. Vestibulocochlear/auditory/acoustic – hearing and balance
9. Glossopharyngeal – sense of taste; swallowing
10. Vagus – stimulates digestive organs, internal organ functions such as heart rate, respiratory rate,
actions such as coughing, sneezing, vomiting
11. Spinal accessory – muscle control for trapezius and sternocleidomastoid
12. Hypoglossal – tongue movement, for speaking and movement of substance

Functional Classifications of the Peripheral Nervous System

1. Sensory Division (Afferent) – Nerve fibers that convey impulses/conduct information and action
potentials from sensory receptors towards the CNS
a. Somatic Sensory Fibers – delivers impulses from skin, skeletal muscles and joints
b. Visceral Sensory Fibers – Transmits impulses from organs and blood vessels
2. Motor Division (Efferent) – carries impulses/conduct information and action potentials away from
the CNS
a. Somatic Nervous System – voluntary; controls skeletal muscles
b. Autonomic Nervous System – involuntary; controls activity of smooth and cardiac muscles
b. a. Sympathetic
➢ It involves energy in expenditure, the fight-or-flight response
➢ Releases adrenaline and noradrenaline hormones, serves as the arousing state which
lead to increase in the heart rate, blood pressure and blood flow.
b. b. Parasympathetic
➢ Calming state
➢ Maintain homeostasis by seeing that normal digestion and elimination occur an that
energy is conserved
➢ Rest-and-digest response
➢ Lowers heart rate, blood pressure, and blood flow
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Neurons –basic structural and functional unit of the brain/nervous system

Parts of the Neurons
1. Cell Body (Perikaryon) – Source of information for gene expression; metabolic control portion of
the cell
2. Dendrites (Little Trees) – Neuron processes that conducts an action potential towards the cell body
3. Axon (Axis) – generate nerve impulses and conducts away from the cell body
The Brain
➢ Control center of the nervous system
➢ Weighs 3 pounds; soft, spongy, mottled, pinkish gray
➢ Protected by skull and meninges
➢ One of the largest organs of the body with more that 100 billions of neurons
➢ Requires a continuous supply of oxygen and glucose
➢ It consists of brainstem, cerebrum, and cerebellum

Brain Development – during the 4th week of embryonic development, 3 major vesicles are formed.
a. Prosencephalon (Forebrain)
1. Telencephalon – cerebrum with basal ganglia
2. Diencephalon – thalamus, hypothalamus
b. Mesencephalon (Midbrain)
c. Rhombencephalon (Hindbrain)
1. Metencephalon – cerebellum, pons
2. Myetencephalon – medulla oblnogata
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THE DIGESTIVE SYSTEM

Functions (IDEA)
➢ Ingestion of foods
➢ Digestion of foods
➢ Eliminations of waste
➢ Absorption of nutrients

Two Groups of the Digestive System

1. Alimentary Canal – continuous, coiled, hollow tube that runs through the ventral cavity form stomach
to anus:
a. Mouth – also called oral cavity; where food enters, food mixed with saliva and masticated, tongue
initiates swallowing, and taste buds in tongue allows for taste
a.1. Lips/Labia – protects its interior opening
a.2. Cheeks – form its lateral walls
a.3. Hard Palate – forms the anterior roof
a.4. Soft Palate – forms the posterior roof
a.5. Uvula – a fleshy fingerlike projection of the soft palate, which dangles from the posterior edge
of the soft palate.
a.6. Vestibule – a space between the lips and check externally and the teeth and gums internally
a.7. Lingual Frenulum – secures the tongue to the floor of the mouth and limits its posterior
movements
a.8. Lingual tonsils – along with other lymphatic tissues, are part of the body’s defense system
b. Pharynx
➢ 10 inches long
➢ Runs from the pharynx through the diaphragm to the stomach
➢ Conducsts food by peristalsis (slow rhythmic squeezing) tot the stomach
➢ Has 4 tissue layers (Mucosa, Submucosa. Muscularis Externa, Serosa)
c. Stomach – A C-shaped organ located on the left side of the abdominal cavity. Food enters at the
cardio esophageal sphincter from the esophagus
Stomach Regions:
1. Cardial region
2. Fundus
3. Body
4. Pyloric Antrum
5. Pylorus
Functions of Stomach:
1. Temporary storage bank for food
2. Site of food breakdown
3. Chemical breakdown of protein begins
4. Delivers chyme (processed food) to the small intestine
2. Accessory Digestive Organs - An organ that helps with digestion but is not part of the digestive tract.
a. Teeth
b. Tongue
c. Large Digestive Glands – assist in digestion.
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THE RESPIRATORY SYSTEM

➢ Provides oxygen to the blood, disposes of carbon dioxide, and helps regulate blood pH
➢ Gas exchange occurs in the air sacs of the lungs, called, alveoli, and at capillary beds around the body
➢ Shere responsibility for supplying the body with oxygen and disposing of carbon dioxide
➢ Respiratory system organs oversee the gas exchanges that occur between the blood and the external
environment
➢ Using blood as the transporting fluid, the cardiovascular system organs transport respiratory gases
between the lungs and the cells in the rest of the body
➢ If either system fails, cells begin to die from oxygen starvation and accumulation of carbon dioxide

Functions (GROVI)
➢ Gas Exchange
➢ Regulation of Blood pH
➢ Voice Production
➢ Olfaction
➢ Innate Immunity

Upper Respiratory Tract – External nose, nasal cavity, pharynx

Lower Respiratory Tract – Larynx, trachea, bronchi, lungs

Nose – the only externally visible part of the respiratory system; during breathing, air enters by passing through
the nostrils, or nares
a. Nasal Septum – a partition dividing the nasal cavity into right and left parts
b. Nasal Cavity – has a hard palate that’s in the floor of the nasal cavity \; separates the nasal and oral
cavity
c. Sinuses – lighten the skulls and act as resonance chambers for speech; produce mucus, which drains
into the nasal cavities
d. Paranasal sinuses – air-filled spaces within bone (has 4 paranasal sinuses)
Pharynx – common passageway for both the respiratory and digestive systems. Three regions of pharynx are:
a. Nasopharynx – superior portion where air enters from the nasal cavity
b. Oropharynx – extends from uvula to the epiglottis
c. Laryngopharynx – passes posterior to the larynx and extends from the tip of the epiglottis to the
esophagus
Larynx – passageway for air between the pharynx and trachea. Plays a role in speech.
Trachea – Membranous tube attached to the larynx; air entering the trachea from the larynx down its length
(10-12 cm, or about 4 inches) to the level of the fifth thoracic vertebra, which is approximately midchest
a. Cough Reflex – dislodges foreign substances from the traches
b. Smoker’s Cough – results form constant irritation and inflammation of the respiratory passages and
cigarette smoke
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Main Bronchi – right and left main bronchi. Right main bronchus is wider, shorter, and straighter than the
left.
Lungs – principal organs of respiration. Ventilation (breathing) – the process of moving air in and out of the
lungs. Two phases of ventilation:
a. Inspiration – inhalation; movement of air into the lungs
b. Expiration – exhalation; movement of air out of the lungs
Muscle of Inspiration – include diaphragm and the muscles that elevate the ribs and sternum
Diaphragm – a large dome of skeletal muscle that separates that thoracic cavity form abdominal cavity
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CHAPTER 1: INTRODUCTION TO FIRST AID

The Need for First Aid Training

Emergencies are unexpected occurrences that may lead to sudden death and incapacitating injuries,
especially if help is not readily available. Emergencies can be due to accidents, sudden illnesses, natural and
human-induced disasters and situations of armed conflicts and violence. Statistics show that accidents ranked
fourth as the cause of death for all ages in 2006. For children ages 5 to 14 years, accidents topped the list as
the leading cause of death during that same year. Death due to heart disease and diseases of the blood vessels
remain the foremost reason for the death of thousands of Filipinos each year.

Definition
First aid is immediate help provided to a sick or injured person until professional medical help arrives
or becomes available. It is concerned not only with physical injury or illness, but also with other forms of
initial care, including psycho-social support for people suffering emotional distress due to traumatic events.
While Basic Life Support is emergency procedures that recognize respiratory or cardiac arrest or both
and the proper application of CPR to maintain life until a victim recovers, or advanced life support becomes
available.

Objectives of First Aid

First aid aims to accomplish the following goals:
1. Preserve life. The giving of first aid is an attempt to save a life.
2. Prevent further harm and complications. First aid protects patients from further injuries and prevents
injuries or illnesses from becoming worse.
3. Seek immediate medical help. Care for a patient does not end with first aid.
4. Provide reassurance. Psychological support is also as important as physical help.

Concepts and Principles

Scope and Limitation
➢ First aid is still a form of medical treatment and is by no means a replacement for it. its scope and
limitations are generally based on the concept of protection.
➢ Protection includes the application of basic techniques to ensure the comfort, safety, and well-being of
an ill injured person.
Improvisation
Because emergencies are unexpected, first aid kits and other equipment may not always be available.
A first aider should therefore be able to “adapt, improvise, and overcome”. He or she must have the ability to
adapt to the situation and be able to improvise materials and equipment until more help arrives.
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Concepts and Principles

Some common improvisations include:
a. Gloves – plastic bags, dish gloves, leather work gloves. (Wash you hands well with soap and water
especially after using there)
b. Gauze – clean clothing, bedding or towels (but not paper products, such as paper towels or toilet paper)
c. Splints – straight sections of wood, plastic, cardboard, or metal
d. Slings – the patient’s shirt hem pinned to the center of their chest will immobilize a forearm or shoulder
injury
e. Stretcher – a heavy blanket that can be used to move a victim

Legal Concerns
Consent
People have the basic right to decide what can and cannot be done to their bodies. They have the
legal right to accept or refuse emergency care. Therefore, before giving care to an injured or ill person,
you must obtain the person’s permission.
➢ When a conscious person who understands your questions and what you plan to do gives you
permission to give care, this is called expressed consent.
➢ Do not touch or give care to a conscious person who refuses care or withdraws consent at any time.
Instead, step back and call for more qualified medical personnel.
➢ Sometimes, adults may not be able to give expressed consent. These include people who are
unconscious or are unable to respond, are confused, mentally impaired, seriously injured or
seriously ill. In these cases, the law assumes that if the person could respond, he or she would agree
to care. This is called implied consent. If the conscious person is a child or an infant, permission
to give care must be obtained from a parent or guardian when one is available. If the condition is
life threatening and a parent or guardian is not present, consent is implied. If the parent or guardian
is present but does not give consent, do not care. Instead, call a local emergency number.
Duty to Act
This is our duty to respond to an emergency and to provide care. Failure to fulfill these duties
could result in legal action. This is an obligation that professional rescuers must observe, especially if
they are officially on duty. Lay responders assume this accountability when they start to give first aid
care to a patient in an emergency.
Standard of Care
This is the public’s expectation that personnel summoned to an emergency will provide care
with a certain level of knowledge and skill.
Negligence
Pertains to the failure to follow a reasonable standard of care, thereby causing or contributing to
injury or damage.
➢ A first aider can be held liable for negligence especially if his or her actions were deliberately
negligent, reckless, or if the first aider abandons the person after starting care.
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Abandonment
This refers to discontinuing care once it has begun. Care must continue until someone with equal or
more advanced training takes over.

Confidentiality
This is the principle that information learned while providing care to a victim is private and should not
be shared with anyone except to those healthcare professionals directly associated with the victim’s
medical care.

Health Hazards and Risks

Disease Transmission
Helping others is not without risks and hazards, the most important of which is the risk of contracting
an infectious disease. Infectious diseases are those that can spread from one person to another and
develop when germs invade the body and cause illness.
The most common germs are bacteria and viruses. These can spread from one person to another
through the following ways:
➢ Direct contact. This occurs when a person touches an infected person’s body fluids. This type of
transmission presents the greatest risk of infection for the first aider.
➢ Indirect contact. This occurs when a person touches objects that have been contaminated by the
blood or body fluids of an infected person. These include soiled dressings, equipment, and other
surfaces which an infected person met.
➢ Airborne transmission. This occurs when a person inhales droplets that have become airborne as
an infected person coughs or sneezes.
➢ Bites. Animals, including humans and insects, can also spread diseases through bites. Acquiring a
disease from a bite is rare in any situation and uncommon when giving first aid care.
Common Transmittable Diseases
As a first aid, it is important to be familiar with diseases that can have severe consequences if transmitted,
especially when responding to emergencies. These include the following:
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➢ Herpes is a viral infection that causes eruptions of the skin and mucous membranes.
➢ Meningitis is an inflammation of the brain or spinal cord which is caused by a viral or bacterial
infection.
➢ Tuberculosis is a respiratory disease caused by certain bacteria.
➢ Hepatitis is a viral infection of the liver. It can be caused by any of the 3 variants of the Hepatitis virus
HAV, HBV, and HCV.
➢ Human Immune Deficiency Virus (HIV) is the virus that destroys the body’s ability to fight infection.
The resultant state is referred to as Acquired Immune Deficiency Syndrome (AIDS).

Prevention and Protection

Universal Precautions are a set of strategies developed to prevent transmission of blood borne pathogens.
These preventive measures focus on blood and selected body fluids such as cerebrospinal fluid, pleural fluid
and amniotic fluid. Body Substance Isolation (BSI) are precautions taken to isolate or prevent risk of exposure
from body secretions and other body substances such as urine, vomit, feces, sweat, or sputum. Personal
Protective Equipment (PPE) are specialized clothing, equipment and supplies that keep you from directly
contacting infected materials.
Regardless of the type of exposure risk, you must observe the following basic precautions and safe
practices each time you prepare to provide care:
➢ Avoid contact with blood and other body fluids or objects that may be soiled with them.
➢ Use barriers, such as disposable gloves, between the person’s blood or body fluids and yourself.
➢ Use protective CPR breathing barriers.
➢ Before putting on personal protective equipment (PPE) like disposable gloves cover all of your own
cuts, scrapes or sores with bandages.
➢ Do not touch extremities like the mouth, nose or eyes when being taken care of. After care has been
given, wash hands prior to eating or drinking.
➢ Avoid handling any of your personal items, such as pens or combs, while giving care. Ensure that you
wash your hands prior to contact with these objects.
➢ Do not touch objects that may be soiled with blood or other body fluids.
➢ Be prepared by having a first aid kit handy and stocked with
➢ PPE, such as disposable gloves, CPR breathing barriers, eye protection and other supplies.
➢ Wash your hands thoroughly with soap and warm running
➢ Water when you have finished giving care, even if you wore disposable gloves. Alcohol-based hand
sanitizers allow you to clean your hands when soap and water are not readily available, and your hands
are not visibly soiled. (Keep alcohol- based hand sanitizers out of reach of children.)
➢ Tell advanced medical personnel at the scene or your health care provider if you have met an injured
or ill person’s body fluids.
➢ If an exposure occurs in a workplace setting, follow your company’s exposure control plan for
reporting incidents and follow-up (post exposure) evaluation.

Types of Situations
There are two types of situations that may pose a security risk to Red Cross first aiders and emergency
responders.
➢ Situations of armed conflict – are armed confrontations which may be of an international or non-
international character.
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➢ Situations of violence – includes internal disturbances and tensions such as riots, isolated and sporadic
acts of violence, and other acts of a similar nature.

Actions in Hazardous Situations

A hazardous situation can happen when you find yourself in one or more of the following situations:
➢ Interrogated by the police or military or other armed entities.
➢ Under shelling or gunfire;
➢ In the vicinity of an explosion;
➢ In a minefield (landmines, improvised explosive devices, booby-traps, etc.);
➢ In a burning or collapsing building;
➢ Surrounded by a crowd of bystanders.
If being questioned by authorities:
➢ Stay calm.
➢ Cooperate.
➢ Show your identity card and National Society card.
➢ Explain why you are there.
➢ Avoid any argument.

Skill 1-1 Removing Gloves

After giving care, make sure to never touch the bare skin with the outside of either glove.
1. Pinch the glove
➢ Pinch the palm side of one glove near the wrist.
➢ Carefully pull the glove off so that it is inside out.
2. Slip the two fingers under the glove.
➢ Hold the glove in the palm of the remaining gloved hand.
➢ Slip two fingers under the glove at the wrist of the remaining gloved hand.
3. Pull the glove off.
➢ Pull the glove until it comes off, inside out, so that the first glove ends up inside the glove
just removed.
4. Dispose of gloves and wash hands.
➢ Dispose of gloves in the appropriate biohazard container. Do not reuse gloves.
➢ Wash your hands thoroughly with soap and warm running water, if available. Otherwise,
use an alcohol-based hand sanitizer to clean the hands.
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CHAPTER 2: EMERGENCY ACTION PRINCIPLES

Emergency Action and Principle

An emergency scene can be overwhelming. In order for the first aider to help effectively, it is important that
actions have to be prioritized and planned well. The Emergency Action Steps serves as a guide for responders
to follow in situations that demand immediate but careful and calculated response. It has four parts:
➢ Scene Size-up
➢ Primary Assessment
➢ Activating Medical Help
➢ Secondary Assessment

The Emergency Action Steps generally involve both scene and patient assessment. Scene assessment focuses
on scene and rescuer safety. Patient assessment follows the ABCDE approach which stands for
A. – Airway
B. – Breathing
C. – Circulation
D. – Disability (mental status and peripheral nervous system)
E. – Extremities/Exposure (for further assessment)

Scene Size-up
Scene Safety
Before helping an injured or ill person, make sure that the scene is safe for yourself and everyone else,
including bystanders.
➢ To determine if the scene is safe, check for hazards that may pose an immediate or potential
threat to life such as poisonous gases, toxic and corrosive chemicals, explosive materials,
downed electrical lines, fire, water, traffic, weapons, and other dangers.
➢ If any of these are present, stay at a safe distance and call the local emergency number
immediately.
➢ Do not move a seriously injured person at the scene unless:
➢ There is an immediate danger, such as fire, lack of oxygen, risk of explosion or a collapsing
structure.
➢ There is a need to move a person with minor injuries to reach someone needing immediate
care.
➢ There is a need to move the injured person to give proper care.

Knowing What Happened

Careful evaluation of the scene, including the possible cause of injury and/or the nature of the illness,
along with any other information that you gather, will help determine the condition of the victim and what the
next possible action of the first aider should be.
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Knowing the cause of injury allows you to predict various injury patterns. Certain injuries are common
to particular accident situations. Injuries to bones and joints are usually associated with falls and vehicle
collisions. Burns are common to fires and explosions, while penetrating soft tissue injuries are often associated
with gunshot wounds.
The nature of illness is often best described by the patient’s chief complaint: the reason for providing
care. To quickly determine the nature of the illness, talk with the patient, family, or bystander’s bout the
problem. But at the same time, use your senses to check the scene for clues as to the possible problem.

Role of Bystanders
The presence of bystanders does not often mean that a patient is receiving help. They may have to be
asked to help. Bystanders may be able to tell you what happened or make the call for help while you provide
care.
If a family member, friend, or co-worker is present, he or she may know if the person is ill or has a
medical condition and can also help to comfort the person. The patient may be too upset to answer your
questions. Anyone who awakens after having been unconscious may also be frightened, especially if it’s a
child.

Number of Casualties
Look carefully for more than one person who might be injured. You might not spot everyone who
needs help at first. If one person is bleeding or screaming, you may not notice someone who is unconscious.
It also is easy to overlook a small child or an infant. In an emergency with more than one injured or ill person,
you may need to prioritize care (in other words, decide who needs help first).

Primary Assessment
The purpose of the primary assessment is to check for immediate life-threatening conditions like
unconsciousness, absence of breathing, absence of pulse and severe bleeding. Primary assessment can be done
with the patient in the position where you find him or her and begins with checking the patient’s
responsiveness.

Assessing Responsiveness
A patient’s response level can be summarized in the AVPU mnemonic as follows:
➢ A – Alert
➢ V – Responsive to Voice
➢ P – Responsive to Pain
➢ U – Unresponsive/Unconscious

For a visibly alert and talking patient, ask the patient for his or her name and what happened. If the patient
responds, then the patient is alert, and depending on what you asked, is also oriented (to time, person, place
and event).
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For someone who appears to be inactive/incapacitation, you can tap or gently shake the patient on the
shoulder and ask if he or she is okay. Use the person’s name if you know it and speak loudly.
If the person responds, leave the person in the position where you found him or her, provided there is no
further danger, and then try to determine what is wrong with the person. If the person does not respond in any
way, assume that he or she is unconscious.
However, if the patient is found in a face-down position, you may have to position the patient on his or
her back to using the log-roll technique to facilitate the opening of the airway and to check for breathing.

Airway
An open airway allows air to enter the lungs for the person to breathe. If the airway is blocked, the
person cannot breathe. A blocked airway is a life-threatening condition when someone is unconscious and
lying on his or her back, the tongue may fall to the back of the throat and block the airway. To open an
unconscious person’s airway, perform the procedure known as the head- tilt/chin-lift technique. This moves
the tongue away from the back of the throat, allowing air to enter the lungs.
Sometimes you may need to remove food, liquid or other objects that are blocking the person’s airway.
These are called foreign-body airway obstructions and will be discussed in detail in the next chapter.
Breathing
While maintaining an open airway, quickly check an unconscious person for breathing by doing the
LLF technique for no more than 10 seconds simultaneously with pulse checking. Normal breathing is regular,
quiet and effortless. This means that when breathing normally, the person is not making noise, breaths are not
fast (although it should be noted that normal breathing rates in children and infants are faster than normal
breathing rates in adults) and it does not cause discomfort or pain.
If an adult is not breathing or is having irregular, gasping or shallow breaths (also known as agonal
breath) and if the emergency is not the result of nonfatal drowning or other respiratory cause such as a drug
overdose, assume that the problem is a cardiac emergency. In this case, the person needs CPR and chest
compressions must not be delayed.
In some cases, the person may be unconscious but breathing normally.
In such situations, maintain an open airway by using the head-tilt/chinlift technique as you continue to
look for other life-threatening conditions.
Generally, patients should not be moved from a face-up position, especially if there is a suspected spinal
injury. However, there are a few situations where you should move a person into a recovery position whether
or not a spinal injury is suspected, such as when:
➢ You are alone and must leave the person (e.g., to call for help), or
➢ You cannot maintain an open and clear airway because of fluids or vomit.
Circulation
A. Pulse
Check for definitive pulse at carotid area for adult or child, while brachial for infant (Applicable
for Professional Rescuers and Healthcare Providers). Each time the heart beats the arteries expand
and contract with the blood that rushes through them. The pulse is the pressure wave generated by
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the heartbeat. It directly reflects the rate, relative strength, and rhythm of the contractions of the
heart.
B. Bleeding
Quickly look for severe bleeding by looking over the person’s body from head to toe for signals
such as blood-soaked clothing or blood spurting out of a wound. Be meticulous. It is not always easy
to recognize severe bleeding. If there is a case of severe bleeding, it must be controlled as soon as
possible.
C. Shock
When someone becomes suddenly ill or is injured, normal body functions may be interrupted.
In cases of minor injury or illness, the interruption is brief, and the body can compensate quickly.
With more severe injuries or illness, however, the body is unable to meet its demand for oxygen. The
condition in which the body fails to circulate oxygen-rich blood to all the parts of the body is known
as shock. If left untreated, shock can lead to death. Always look for signs of shock whenever you are
giving care. You will learn how to recognize and treat a victim for shock in Chapter 4.

D. Skin color, temperature, and moisture.

Assessment of skin temperature, color, and condition can tell you more about the patient’s circulatory system.
Normal body temperature is 37 °C (98.6 °F). The most common way that a first aider takes temperature is by
touching a patient’s skin with the back of the hand. This is called relative skin temperature. It does not measure
the exact temperature, but you can tell if it is very high or low.
Skin color can tell you a lot about a patient’s heart, lungs, and other problems well. For example:
➢ Paleness may be caused by shock or heart attack. It also may be caused by fright, faintness, or
emotional distress, as well as impaired blood flow.
➢ Redness (flushing) may be caused by high blood pressure, alcohol abuse, sunburn, heat stroke, fever,
or an infectious disease.
➢ Blueness (cyanosis) is always a serious problem. It appears first in the fingertips and around the mouth.
Generally, reduced levels of oxygen as shock, heart attack, or poisoning can be the cause.
➢ Yellowish color may be caused by a liver disease.
➢ Black-and-blue mottling is the result of blood seeping under the skin. It is usually caused by a blow or
severe infection.

If your patient has dark skin, be sure to check for color changes on the lips, nail beds, palms, earlobes,
whites of the eyes, inner surface of the lower eyelid, gums, and tongue. One way to assess adequacy of
circulation is by assessing capillary refill.
To assess capillary refill, you have to measure the time it takes for the color to return under the nail. Two
seconds or less is normal. If refill time is greater than two seconds, suspect shock or decreased blood flow to
that extremity.
Capillary refill is recommended only for children under six years of age. Research has proven that it is not
always accurate in adults. Capillary refill may be checked on infants by squeezing the palm of the hand or sole
of the foot and watching for color to return.
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If medical assistance is not available and if you decide to take the injured or ill person to a medical facility,
➢ Ask someone to come with you to keep the patient comfortable.
➢ Be sure you know the quickest route to the nearest medical facility capable of handling emergency
care.
➢ Pay close attention to the injured or ill patient and watch for any changes in his or her condition.
➢ Discourage an injured or ill person from driving himself or herself to the hospital.

Secondary Assessment
Secondary assessment involves the rest of the DE of the
ABCDE If you determine that an injured or ill person is not in an immediately life-threatening condition, you
can begin to check for other conditions that may need care. Checking a conscious person with no immediate
life-threatening conditions involves two basic steps:
➢ Interviewing the person and bystanders
➢ Checking the person from head to toe.
➢ Checking vital signs
Interview
Ask the person and bystanders simple questions to learn more about what happened and to learn more about
the person’s medical history. Keep these interviews brief. Begin by asking for the person’s name. This will
make him or her feel more comfortable.

To gain essential information about the patient’s medical history, ask the patient questions based on the
SAMPLE approach:
➢ S – Signs and symptoms (How do you feel? Do you feel pain or discomfort anywhere?)
Signs are physical manifestations of the injury or illness that can be observed by the first aider,
i.e. bruising, swelling, fever, open wound, etc.
Symptoms are indicators that only the patient can feel or experience, i.e. pain, dizziness, chills,
weakness, etc.
➢ A – Allergies (Do you have any known allergies or allergic reactions? Has there been any recent
exposure?)
➢ M – Medications (What medications are you taking? Are they over-the counter or prescription? What
is the medication for? When was it last taken? Can you tell me where the medication is so we can keep
it with you?)
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➢ P – Pertinent past medical history (Has anything like this happened before? Are you currently under
a health care provider's care for anything? Could you be pregnant (if a woman)?)
➢ L – Last intake and output (When did you last eat or drink? How much? Are you cold, hungry or
exhausted? When did you last urinate and defecate? Were they normal?)
➢ E – Events leading up to the injury or illness (What led to the illness or injury? When did it happen?
How did it happen, in order of occurrence?)
Write down the information you learned during the interview or, preferably, have someone else write it
down for you. Be sure to give the information to advanced medical personnel when they arrive.

If the person feels pain, ask him or her to describe it and to tell you where it is located. Descriptions often
include terms such as burning, crushing, throbbing, aching or sharp pain. Ask when the pain started and what
the person was doing when it began. Ask the person to rate his or her pain on a scale of one to ten (one being
mild and ten being severe).
Remember to question family members, friends, or bystanders as well. They may be able to give you
helpful information or help you to communicate with the person. Children or infants may be frightened. They
may be fully aware of you but still unable to answer your questions. In some cases, they may be crying too
hard and be unable to stop. Approach slowly and gently and give the child or infant some time to get used to
you. Use the child’s name, if you know it. Get down to or below the child’s eye level.

Head-to-toe exam
Check the patient head to toe during the hands-on physical exam, going by the following order: head, face,
ears, neck, chest, abdomen, pelvis, genitals, each arm, each leg and back.
Look for DOTS, which stands for deformity, open injuries, tenderness, and swelling. Do not move any areas
where there is pain or discomfort, or if you suspect a head, neck, or spinal injury.
Vital Signs
Vital signs can tell you how the body is responding to injury or illness. Note anything unusual. Recheck vital
signs about every 5 minutes during life threatening conditions, at least 15 minutes for stable patient.

Skill 2-2 Checking for a Unconscious Patient

1. Check for scene safety and use PPE.
2. Introduced yourself and get consent.
3. Check for responsiveness by tapping the shoulder and shout “Are you OK?” and activate medical
help.
4. Perform ABC’s Check
➢ Check for Airway
➢ Head tilt-chin lift
➢ Check for Breathing
➢ Look, Listen and Feel-LLF
➢ Check for Circulation
➢ Pulse check for Healthcare or Professional Rescuer
➢ Bleeding, shock & skin condition
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5. Identify other injuries and/or interview the patient.

➢ Interview
➢ Head-to-toe exam

Skill 2-3 Head-Tilt/Chin-Lift Technique

1. Place your hand on the victim’s forehead and gently tilt his or her head back.
2. With your fingertips of your other hand under the point of the victim’s chin, lift the chin to open the
airway.

Skill 2-4 Look, Listen and Feel Technique

Position yourself beside the victim and place your face near the person’s mouth and nose. And then:
➢ Look to see if the person’s chest and/or abdomen clearly rises and falls,
➢ Listen for escaping air, and
➢ Feel for it against the side of your face.

Skill 2-5 Capillary Refill Check

1. Squeeze one of the patient’s fingernails or toenails.
➢ When squeezed, the tissue under the nail turns white.
2. When you let go, the color returns to the tissue.
➢ To assess capillary refill, you have to measure the time it takes for the color to return under
the nail.

Skill 2-6 Head-To-Toe Examination

1. Check the person’s head by examining the scalp, face, ears, mouth and nose.
2. Look over the body.
➢ Ask again about any areas that hurt.
➢ Ask the person to move each part of the body that does not hurt.
➢ Ask the person to gently move his or her head from side to side.
➢ Check the shoulders by asking the person to shrug them.
➢ Check the chest and abdomen by asking the person to take a deep breath.
3. Ask the person to move his or her fingers, hands and arms; and then the toes, legs and hips in the
same way.
➢ Watch the person’s face and listen for signals of discomfort or pain as you check for
injuries.

Skill 2-7 Log-Roll Technique

1. Kneel at the person’s side.
2. Extend the person’s arm that is closest to you over his or her head.
3. Place the other arm close to the body and place the farthest leg on top of the closest leg.
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4. Hold the shoulder and hip that are farthest from you then carefully roll the person towards you.
5. Reposition the arms at each side of the body once the victim is now in the faceup position.

Skill 2-8 High Arm IN Endangered Spine (H.A.I.N.E.S.)

1. Kneel beside the patient and make sure that both his legs are straight.
2. Lift the patient’s arm nearest to you up next to the head with the person’s palm facing up.
3. Bring the farthest arm and place it next to his or her side across the chest and hold the back of the
hand against the victim’s cheek nearest to you.
4. Grasp the leg farthest from you and cross it over the other leg.
5. Using your hand that is closest to the person’s head, hold the person’s shoulder farthest from you.
6. Place your other hand on the hip farthest from you.
7. Using a smooth motion, roll the person towards you until the person is on his or her side.
➢ Make sure the person’s head remains in contact with the extended arm.
8. Position the other arm in front of the torso and adjust the upper leg so that both the hip and knee
are bent at right angles to support and prevent the patient from rolling further.
9. Stop all movement once the person is already in position.
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SOFT TISSUE INJURIES

Soft tissues make up the inner layers of the skin. These are the fat and muscles beneath the skin’s outer
layer. Soft tissue damage may occur at the skin’s surface or deep within. If this happens, severe bleeding may
occur either on the skin’s surface or underneath it, where detection is hardest. Germs can also enter the body
through wounds and become the cause of infection.
The skin is composed of many layers. The two primary layers of the skin are the outer layer, the
epidermis, which provides a barrier against bacteria and other organisms which may cause infection; and a
deeper layer, called the dermis, which contains the nerves, hair roots, sweat, oil glands and blood vessels.
Because the skin is well supplied with blood vessels and nerves, most soft tissue injuries are likely to
bleed and be painful. The hypodermis, located beneath the epidermis and dermis, contains fat, blood vessels
and connective tissues. This layer insulates the body to help maintain body temperature. The fat layer also
stores energy.

Wounds
A wound is any physical injury involving a break in the layers of the skin. Wounds are generally
classified as either closed or open.
Complications
➢ Wounds have the following complications:
➢ Bleeding (external and internal) and shock.
➢ Infection - Open injuries are potentially risky for serious bacterial wound infections or even
fatal illnesses.
➢ Tetanus is a severe infection that can result from a puncture or a deep cut.
➢ Tetanus is a disease caused by certain bacteria. These bacteria produce a powerful poison in
the body. The poison enters the nervous system and can cause muscle paralysis. Once tetanus
reaches the nervous system, its effects are highly dangerous and can be fatal. Fortunately,
tetanus can be successfully treated with medicines called antitoxins.
➢ Rabies is a disease caused by a virus transmitted commonly through the saliva of diseased
mammals, such as dogs and cats. If not treated, rabies is fatal. Anyone bitten by a wild or
domestic animal must get professional medical attention as soon as possible.
Closed Wound
A closed wound is a wound where the outer layer of the skin is intact and the damage lies below the
surface. It is usually caused by the application of external force, such is common in motor vehicle
accidents, falls or from blunt objects, resulting in contusions or bruises. A closed wound may bleed
internally.
Signs and Symptoms
➢ Tender, swollen, bruised or hard areas of the body, such as in the abdomen
➢ Rapid, weak pulse
➢ Skin that feels cool or moist or looks pale or bluish
➢ Vomiting of blood or coughing up blood
➢ Excessive thirst
➢ An injured extremity that is blue or extremely pale
➢ Altered mental state, such as the person becoming confused, faint, drowsy or unconscious
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First Aid Management

➢ Apply an ice pack to the area to decrease bleeding beneath the skin and to help control both pain and
swelling. Fill a plastic bag with ice and water or wrap ice in a wet cloth and apply it to the injured area
for about 20 minutes. Place a thin barrier between the ice and the bare skin.
➢ Remove the ice and wait for 20 minutes before reapplying. If the person is not able to tolerate a
➢ 20–minute application, apply the ice pack on and off for periods of 10 minutes. Keep the person from
getting chills.
➢ Elevating the injured part may help to reduce swelling. However, do not elevate the injured part if it
causes more pain. Be sure that a person with an injured lower extremity bears no weight on it until
advised to do so by a medical professional
➢ Do not assume that all closed wounds are minor injuries. Take the time to find out whether more serious
injuries could be present.
➢ With all closed wounds, help the person to rest in the most comfortable position possible.
➢ It is also helpful to comfort and reassure the person.

Open Wound
In an open wound, the outer layer of skin is broken. The break in the skin can be as minor as a scrape
of the surface layers or as severe as a deep penetration. External bleeding is often a factor when treating
open wounds. The amount of bleeding depends on the location and severity of the injury.
Types, Causes and Signs and Symptoms
1. Abrasions are the most common type of open wound. These are usually caused by objects
rubbing roughly against the skin and thereby scraping the outer layers. Abrasions do not bleed
much but are usually painful due to the exposure of sensitive nerve endings.
2. A laceration is a cut in the skin which is commonly caused by an object such as a knife, a pair
of scissors or glass penetrating the skin. It can also occur when blunt force splits the skin. Deep
lacerations may cut layers of fat and muscle in the body which results in both nerve and blood
vessel damage. There may be heavy bleeding or none. Lacerations are not always painful
because damaged nerves cannot send pain signals to the brain. But infections can easily occur
through lacerations if proper care is not given.
3. An avulsion is a serious soft tissue injury. It happens when a portion of the skin and its soft
tissues is partially or completely torn. This type of injury often damages deeper tissues, causing
significant bleeding.
4. An amputation occurs when a violent force completely tears away a body part.
5. In some cases, bleeding is easier to control because the tissues close around the vessels at the
injury site. If there is violent tearing, twisting, or crushing of the extremity, bleeding may be
harder to control.
6. Punctures usually occur when objects such as nails or gunshots pierce the skin. Puncture
wounds do not bleed much unless a blood vessel has been injured. However, an object that goes
into the soft tissues beneath the skin can carry germs deep into the body. These germs can cause
infections—sometimes serious ones. If the object remains in the wound, it is called an
embedded object.
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First Aid Management

General care for open wounds includes controlling bleeding, preventing infection and using dressings
and bandages correctly.
Minor Open Wounds
➢ Use a barrier between your hand and the wound. If readily available, put on disposable gloves and
place sterile dressings on the wound.
➢ Apply direct pressure for a few minutes to control the bleeding.
➢ Wash abrasions and other superficial wounds with clean, warm, running tap water for about five
minutes.
➢ Apply a Povidone-iodine (PVP-I) antiseptic solution or, if available, a triple antibiotic ointment or
cream. Make sure that the person has no known allergies or sensitivities to these medications.
➢ Cover the wound with a sterile dressing, either with a gauze or with an adhesive bandage.
➢ Wash your hands immediately after giving care.
Major Open Wounds
➢ Call the local emergency number.
➢ Put on disposable gloves. Wear eye and face protection if you suspect that blood may splatter from the
open wound. Control bleeding by applying direct pressure or employing a pressure bandage.
➢ Monitor airway and breathing. Observe closely for signals that may indicate that the person’s condition
is worsening. Look closely at these signs: faster or slower breathing, marked changes in skin color,
and extreme restlessness.
➢ In cases where the injured party is in shock, keep him or her from experiencing chills or feeling
overheated.
➢ Have the person rest comfortably and provide reassurance.
➢ Wash your hands immediately after giving care, even if gloves were worn.
Special Considerations
Open chest wound
➢ Call the local emergency number.
➢ Put on disposable gloves.
➢ Help the patient sit down properly. Encourage him to lean towards the injured side and cover the wound
with the palm of his hand.
➢ Place a sterile dressing or clean non-fluffy pad over the wound and surrounding area. Cover with an
occlusive dressing (plastic bag, foil or kitchen film). Secure firmly with adhesive tape on three edges
only so that the dressing is taut. A taped-down dressing keeps air from entering the wound when the
person inhales. See that there is an open corner which allows air to pass through when the person
exhales.
➢ Take steps to minimize shock.
➢ Monitor the person’s breathing.
An open chest wound is a life-threatening injury that occur when an object, such as a knife or bullet,
penetrates the chest wall, or when a fractured rib breaks through the skin.
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Open abdominal wounds.

➢ Put on disposable gloves or use another barrier.
➢ Carefully position the person on his or her back with the knees bent, if that position does not cause
pain.
➢ Do not apply direct pressure.
➢ Do not push any protruding organs back into the open wound.
➢ Remove clothing from around the wound.
➢ Apply moist, sterile dressings loosely over the wound. Tap water that is clean and has been warmed
can be used to moisten the dressings.
➢ Cover dressings loosely with plastic wrap, if available.
➢ Take necessary steps to minimize shock.

Avulsion
If the victim has an avulsion in which a body part has been completely severed;
➢ Call the local emergency number.
➢ Put on disposable gloves.
➢ Wrap the severed body part in sterile gauze or any clean material, such as a washcloth. Place the
wrapped part in a plastic bag. Keep the body part cool by placing the bag on ice. Do not place the
bag on dry ice or in ice water.
➢ Make sure the part is transported to the medical facility with the victim.

Embedded Object
➢ If the victim has an embedded object in the wound:
➢ Call the local emergency number.
➢ Put on disposable gloves.
➢ Do not remove the object yourself.
➢ Use bulky dressings to stabilize the object.
➢ Any movement of the object can result in further tissue damage.
➢ Control bleeding by bandaging the dressing in place around the object.
➢ If the object is lodged in the airway of the injured party, transport the patient immediately to the hospital
if there is no medical help available.
➢ Wash your hands immediately after giving care

Bullet wounds
Military assault rifles and handguns shoot bullets at high speed. Under international humanitarian law,
all bullets used by armies must be manufactured to prevent exploding or fragmenting when these hit a
human body. However, due to various factors such as ricocheting off a wall, a tree, or the ground, some
bullets do break up into fragments in the body.
Characteristics of bullet wounds:
➢ The amount of tissue damage varies according
➢ To the size and speed of the bullet, its stability in flight, and the bullet’s construction.
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➢ It is usually single.
➢ It is usually a small entry wound.
➢ There may or may not be an exit wound but, if there is, the size is variable.

Blast Injury
The detonation of high-energy explosives creates a blast wave in the air that can travel around objects
such as buildings or walls. The wave causes rapid and large changes in atmospheric pressure. As this
blast of air circulates around the area where someone is passing through, this action may affect parts
of the body that normally contain air.
There may be rupture of:
➢ An eardrum which can cause deafness and blood to ooze from the ear;
➢ The lung sacs (alveoli) which can cause respiratory distress;
➢ The intestines which can lead to the contents of the gut spilling into the peritoneum
➢ Solid organs, such as the liver, can cause internal hemorrhage.

Burns
Burns are injuries to the skin and to other body tissues that is caused by heat, chemicals, electricity, or
radiation.
Prevention
➢ Heat burns can be prevented by following fire safety practices. Being careful around sources
of heat is also a good deterrent against injury.
➢ Chemical burns can be prevented by following safety practices on the use of chemicals and
following manufacturers’ guidelines when handling them.
➢ Electrical burns can be prevented by following safety practices around electrical lines and
equipment. Vacating outdoor areas where lighting could strike may also help.
➢ Sunburn can be prevented by wearing appropriate clothing and applying sunscreen to the skin.
Sunscreen should have a sun protection factor (SPF) of at least 15.
Classification:
Generally, burns are classified according to its depth:
Superficial (first-degree) burns
➢ Involve only the top layer of skin
➢ Cause skin to become red and dry
➢ Usually painful and swollen
➢ Usually heal within a week without permanent scarring
➢ Sunburn is a good example of a superficial burn.
Partial-thickness (second-degree) burns
➢ Involve the top layers of skin
➢ Cause skin to become red
➢ Usually painful
➢ Have blisters that may open and weep clear fluid, making the skin appear wet
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➢ May appear mottled and may often swell

➢ Usually heal in 3 to 4 weeks and may scar
Full-thickness (third-degree) burns
➢ May destroy all layers of skin and some or all of the underlying structures—fat, muscles, bones
and nerves.
➢ The skin may be brown or black (charred) with the tissue underneath sometimes appearing
white.
➢ It can either be extremely painful or relatively painless (if the burn destroys nerve endings)
➢ Healing may require medical assistance, and scarring is likely.
Critical burns are those burns that require immediate medical care. These are based on factors such as
depth, area, and location. The following are considered critical burns:
➢ Full thickness burns that cover more than five percent of the body’s surface area. The Rule of
Nine and The Rule of Palm is used to determine the extent of injury of the affected area.
• The Rule of Nine assigns a percentage value to each part of an adult body and is
modified taking
➢ into account the different bodies of small children and infants.
• The Rule of Hand considers the victim’s hand proportions, with the exclusion of the
finger and thumb; to represent about one percent of his or her total body surface.
➢ Partial thickness burns that cover more than 10 percent of the body’s surface area or those that
can be found in multiple locations.
➢ Burns to the face, genitals, and injuries that completely encircle the hands or feet which may
cause possible constriction and prevent circulation.
➢ Burns are caused by chemicals, electricity, and explosives.
➢ Burns involving someone under five years old or older than five who have thinner skin and
often burn more severely.
➢ Burns involving people with chronic medical problems such as heart or kidney ailments. People
who may be undernourished. People who are exposed to burn sources may not be able to leave
the area.

First Aid Management

Thermal burns
➢ Check the scene for safety.
➢ Stop the burning by removing the victim from the source of the burn.
➢ Check for life-threatening conditions.
➢ Cool the burn with large amounts of cold running water. Do not use ice or ice water except on a small,
superficial burn and then for no more than 10 minutes. Ice causes the body to lose heat rapidly and
further damages delicate tissues.
➢ Cover the burn loosely with a sterile dressing. The bandage should not put pressure on the burn surface.
➢ Prevent infection. Do not break blisters. Do not touch a burn with anything except a clean covering.
Do not put ointments, butter, oil or other commercial or home remedies on blisters, deep burns or burns
that may require medical attention.
➢ Apply a triple antibiotic ointment if the person has no known allergies or sensitivities to the medication.
➢ Take steps to minimize shock. Keep the victim from getting chilled or overheated.
➢ Comfort and reassure the victim.
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Chemical Burns
➢ Remove the chemical from the skin as quickly as possible. It is important to remember that the
chemical will continue to burn as long as it is on the skin. If the burn was caused by dry chemicals,
brush off the chemicals using gloved hands or a towel and remove any contaminated clothing before
flushing with tap water (under pressure). Be careful not to get the chemical on yourself or on a different
area of the person’s skin.
➢ Flush the burn with large amounts of cool running water. Continue flushing the burn for at least 20
minutes or until advanced medical personnel take over.
➢ If an eye is burned by a chemical, flush the affected eye with water until advanced medical personnel
take over. Tilt the head so that the affected eye is lower than the unaffected eye as you flush.
➢ If possible, have the person remove contaminated clothes to prevent the spread of infection while you
continue to flush the area. Be aware that chemicals inhaled can be potentially damaging to the airway
or lungs
Electrical Burns
➢ Never go near the person until you are sure that he or she is no longer in contact with the power source.
Turn off the power at its source and be aware of any life-threatening conditions.
➢ Call the local emergency number. Any person who has suffered from an electrical shock needs to be
evaluated by a medical professional.
➢ Be aware that electrocution can cause cardiac and respiratory emergencies. Therefore, be prepared to
perform CPR or use an automated external defibrillator (AED).
➢ Take care for shock and thermal burns.
➢ Look for entry and exit wounds and give appropriate care.
➢ Remember that anyone suffering from electric shock requires advanced medical attention.
Radiation Burns
➢ Care for a radiation burn, i.e. sunburn, as you would for any thermal burn.
➢ Always cool the burn and protect the area from further damage by keeping the person away from the
burn source.