Sunshine Care Training Sarah Yorwerth & Tara Hollinshead

1. Sunshine Care Training Sarah Yorwerth & Tara Hollinshead Basic Life Support Information supplied by an experienced paramedic to guide you through first aid and a reference for the future.

2. The Aims of First Aid. P P P

3. The Aims • PRESERVE LIFE Not only the casualties life, but your own life too. Far too often only one persons life is in danger when the emergency services are called, but by the time they arrive there are more. If you put your life in danger, you can end up fighting for your own life, instead of your casualty’s. • PREVENT THE SITUATION FROM WORSENING The skilled first aider must take action toe prevent the whole situation from becoming worse. As well as preventing the casualty’s life from deteriorating. • PROMOTE RECOVERY The actions of a first aider should, after preventing things from getting worse, help the casualty to recover from their illness or injury.

4. Priorities- Primary Survey All lives need a constant supply of oxygen to survive. If the oxygen does not get through, brain cells could start to die within 3 to 4 minutes. The priorities of treatment are therefore aimed at ensuring oxygen gets into the blood, ensuring the blood is circulating around the body and preventing the loss of that blood. The Primary Survey is a fast and systematic way to find and treat any life-threatening conditions in a priority order. As a life-threatening condition is found, it should be treated immediately, then you should move onto the next step in the survey. Perform a primary survey first on every casualty you treat and until it’s complete, do not be distracted by more superficial, non-life-threatening conditions.

5. D R A B C DANGER Ensure that the casualty, yourself and others are safe. RESPONSE Quickly check to see if the casualty is conscious. Gently shake or tap the shoulders and ask loudly a simple question. Unconscious casualties take priority! AIRWAY Identify and treat any life threatening airway problems (choking or suffocation) If the casualty is unconscious, tilt the head, lift chin to open airway. When the airway is clear/open, move onto breathing. BREATHING Identify & treat any life-threatening breathing problems (Asthma?) If the casualty is not breathing normally (check for 10 seconds max), start CPR. When life threatening breathing problems have been rule out or treated, move on to circulation. CIRCULATION Identify and treat any life-threatening circulation problems (bleeding, heart attack?) When life-threatening circulation problems have been ruled out the Primary Survey is complete. Then it is important to move on to the Secondary Survey.

6. A V P U Alert: Is the casualty fully alert? Do they know the day/month? Voice: Confused? Inappropriate words? Utters sounds? No verbal response? Pain: Localises pain? Responds to pain? Unresponsive: The casualty is unresponsive to pain and speech stimuli.

7. Resuscitation Flow Chart. DANGER? RESPONSE AIRWAY NORMAL BREATHING 999/112 NO REMOVE DANGER SHOUT FOR HELP NO NO Look, listen & feel 10 seconds! NO

8. The chain of survival- CPR Most casualties feel and look very ill for a while before the heart stops beating (Cardiac arrest). Call for help early if this is the case, so that advanced medical help is there before situation worsens. In a Cardiac Arrest, brain cells die within 3-4 minutes, so check compressions are urgently needed to pump blood around the body and rescue breaths are needed to put more oxygen in. In most Cardiac Arrest cases, the heart goes into a chaotic rhythm called ventricular fibrillation. The best chance of restarting the heart is by using a Defibrillator. The chances of survival deteriorate by up to 10% for every minute delay in delivering a defibrillation. AED have been specially designed for first aiders to use in an emergency. WARNING: In the first few minutes after cardiac arrest, a casualty may be barely breathing, or taking infrequent noisy gasps. These are known as ‘agonal’ breathing. Do not confuse this with normal breathing. (The casualty make take these ‘noisy gasps’ but the chest will not ‘rise and fall’ Start CPR immediately.

9. Not breathing ‘normally’? Ask someone to call for an ambulance and bring an AED if available. If you are on your own, use your mobile phone to call, only leave casualty to call 999. Kneel at the side of casualty. • Place the heal of one hand in the centre of the chest, place your other hand and interlock your fingers. • Position yourself vertically above the casualty’s chest with your arms straight. • Press down on the breast bone, 5-6 cm, release pressure without losing contact between your hands and the chest. • 30 compressions at a rate of 100-120 per minute

10. Combine compressions/breaths • Open the airway, using head tilt and chin lift. • Nip the soft part of the casualty’s nose closed, Allow the mouth to open, but maintain chin lift. • Take a ‘normal’ breath and seal around casualty’s mouth, making sure a good seal. • Blow steadily- the chest should rise. • 2 rescue breaths (5 seconds maximum) • Continue with ratio 30:2 If unable or unwilling- continue with compressions. If able- try and get the casualty onto the floor safely.

11. Secondary Survey After the Primary Survey: History: What happened? Medical History? Injuries? Signs: Clues: Swelling? Pale? Deformity? Symptoms: Conscious? Pain? When did it start? How severe? Sickness/dizziness? Hot/cold/thirsty? Check for medic alert bracelets, needle marks, medication, check pockets. Be careful.

12. Head to toe- Secondary Survey Head & Neck: Assess breathing- too fast/slow? Shallow/deep? Difficult/easy? Assess pulse- fast/slow? Strong/weak? Regular or irregular? Check the Pupil Size. Check whole head and face. Bruising/swelling/deformity/bleeding or fluid from ears/nose. Injury to neck? Shoulders & Chest: Compare shoulders and collar bones? Spongy or normal? Take a deep breath (if conscious), Any pain? Easy to breath? Compare sides. Stab wounds or bleeding? Abdomen & Pelvis: Gently feel, Check for abnormality, boarding, any response to pain? Incontinence or bleeding? Do not squeeze or rock pelvis Legs and arms: Check each leg and then arms, fracture? Bleeding? Deformity? See if they can move without any pain

13. A M P L E Allergies Medication Past Medical History Last Meal Event History.

14. Recovery Position When a person is unconscious and lying on their back, the airway can become compromised by the tongue touching the back of the throat, or vomit. • Remove glasses, straighten both legs. • Move arm (nearest) outwards • Bring farm arm across chest, hold back of hand on cheek. • With other hand, grasp far leg and bend knee, keep foot on ground. • Keep hand against cheek, pull on leg and roll towards you, onto their side. • Adjust upper leg so hip & knee are bent at right angles • Open airway (tilt head) • 999/112 • Check breathing regularly- do not leave alone. N.B: Do Not: Place a pillow under neck if on their back or anything in mouth. Do: Turn casualty every 30 minutes (if prolonged period), heavily pregnant casualty onto left Side to help circulation.

15. Hypoxia During the primary survey. It is important that you recognise and treat life threatening conditions. As a general rule, a condition is life threatening if it interferes with oxygen getting through to the vital organs of the body. If the body has a lack of oxygen it is called HYPOXIA. It is very important that you recognise the signs and symptoms of hypoxia and take immediate action.

16. Causes • Not enough oxygen: • Suffocation • Drowning • Blockage, swelling or narrowing of the airway: • The tongue, Vomit/choking, Burns, Strangulation • Hanging, Anaphylaxis. • Inability of the lungs to function properly: • Crushing of the chest, collapsed lung, chest injury, poisoning, asthma, disease or illnesses. • Failure of the respiratory control centre in brain: • Stroke, head injury, drug overdose, poisoning, spinal injury • Loss of blood, a fall in blood pressure, failure in circulation, or inability to carry oxygen in the blood: • Heart attack, cardiac arrest, heart failure, severe bleeding, poisoning or anaphylaxis. Airway Breathing Circulation

17. Possible Signs & Symptoms ! ? • Pale clammy skin • Cyanosis (blue tinge lips/skin) • Increase in pulse rate • Weakening pulse • Nausea/vomiting • Increased breathing rate • Lowered breathing rate? • Distressed breathing/gasping • Confusion/dizziness • Decline in consciousness. • Clues from the cause. If the body detects low levels of oxygen in the blood Adrenaline is released. The effect of the adrenaline is to: • Increase heart rate • Increase the strength of the heart beat & blood pressure • Divert blood away from the skin, intestines & stomach • Divert blood to the heart, lungs and brain • Dilate the air passage in the lungs (bronchioles) Remove or treat the cause. Follow primary survey, Airway, Breathing then Circulation Do not allow eat/drink/smoke.

18. The main causes of unconsciousness S H A P E D Stroke Heart Attack Asphyxia Poisoning Epilepsy Diabetes. F I S H Fainting Imbalance of Heat Shock Head injury

19. Head Injury Compression Very Serious- Brain is under extreme pressure (bleed or swelling of cranial cavity). Level of response worsens Intense headache Flushed, dry skin Deep, noisy, slow breathing. Slow, strong pulse One/both pupils may dilate as pressure increases. Fits may occur No recovery Fracturedskull Broken bone could directly Damage the brain, cause bleeding. Bleeding, swelling or bruising. Soft area or depression on scalp. Bruising around eyes Bruising/swelling behind ear. Bleeding/ fluid nose/ear. Blood in white of eye. Concussion Shaking of the brain. Brain can bounce from one side to the other from a blow. Unconsciousness could last up to 3 minutes, levels of response should improve. Short term memory loss Confusion/irritable Mild headache Pale, clammy skin. Shallow/normal breathing Normal pupils/ react to light Nausea/ vomiting Rapid/weak pulse ? ? ?

20. Treatment ! • Useful tips to remember • Constantly monitor breathing and levels of response. • The concussed casualty must be accompanied for the next few hours. • Any deterioration or symptoms persist. Must got to A&E. • Seek advice before eat/drink. • Call 999/112 • Maintain Airway and breathing • If you need to protect airway, place casualty in the recovery position. Keep neck, head and body in line as you turn. • If conscious, help to lie the casualty down. • Control bleeding- gentle pressure around the wound. If there I blood/cerebral discharge from the eat do not plug it. Warning : A casualty suffering from a head injury may also have a neck injury.

21. Stroke There are 2 types of stroke. The most common is caused by a blood clot, blocking blood vessel supplying part of the brain. The other Is caused if a blood vessel in the brain ruptures, resulting in an area of the brain being ‘squashed’ by the pressure of the blood. In both types of stroke, the signs and symptoms are very similar, and an area of the brain will die. This can happen to anyone of any age. F A ST Facial Weakness- Can the person smile? Has their mouth or eye drooped? Arm Weakness- Can the person raise both arms? Speech problems- Can the person speak clearly and understand you? Time- to call 999/112- if they fail any test- its an emergency.

22. Stroke ! A stroke is a medical emergency. An urgent scan in hospital is required to find the cause, so treatment can be given quickly. The speed of treatment makes the difference. Other signs: • Sudden numbness of the face or one side of the body • Loss of balance • Lack of co-ordination • Sudden severe headache • Sudden onset of confusion • Sight problems • Unequal pupil sizes • Tongue falling to one side. ? Maintain Airway, Breathing 999/112 Unconscious? Recovery position Conscious? Lay down with head and shoulders raised. Reassurance Monitor AVPU.

23. Choking One of the most successful skills that can be learned by the first aider is the treatment of a casualty who is choking. Objects such as food, sweets and small objects can easily become lodged if they accidently ‘breathed in’ ? • Ask the casualty: • Are you choking? • The casualty is unable to speak/cough • Grasping their throat • Distressed look on their face • Congestion/reddening on face • Pale skin or cyanosis • Unconsciousness ! First, encourage the casualty to cough. Mild obstructions will clear. If the obstruction is not cleared, it is a severe airway obstruction. The following steps should be carried out:

24. 1. Back Blows. • Shout for Help, but do not leave the casualty • Bend the casualty forwards so head is lower than chest. • Gove up to 5 firm back blows between should blades with the palm of your hand. Check between blows. 2. Abdominal Thrusts • Stand behind the casualty and place both arms around their waist. • Make a fist with one hand and place it just above their belly button, with your thumb inwards. • Grasp with your other hand, then pull sharply inwards and upwards. Repeat up to 5 times. • If pregnant, or obese, try squeezing chest instead. 3. Repeat step 1 & 2. 999/112 ! If casualty falls unconscious, start CPR immediately. The casualty must seek medical attention once obstruction has cleared.

25. Anaphylaxis Anaphylaxis is an extremely dangerous allergic reaction. The name ‘anaphylaxis’ literally means ‘without protection’, and indeed, the condition is caused by a massive over reaction to the body’s protection (immune) system. Severe anaphylactic reactions are very rare. The most common are drug related reactions (e.g. Penicillin). Histamine has several effects on the body when it is released in massive quantities. • Makes blood vessels dilate • It constricts the bronchioles in the lungs • Makes blood capillary walls ‘leaky’ causing severe swelling and shock. • Weakens strength of heart contractions • Makes skin itchy • Rashes on skin

26. ? • 999/112 • Lay casualty in comfortable position. • Breathing problems? sit casualty upright • Feels faint? Lay down and raise legs. • Auto injector- the casualty should be able to inject this, if needed, assist them to use it. • Unconscious? Check Airway/ Breathing • The dose of adrenaline (epinephrine) can be repeated at 5 minutes intervals if there is no improvement • Sudden swelling of face, tongue, lips, neck and eyes. • Hoarse voice (lump in through) developed into loud pitched noisy breathing • Difficult, wheezy breathing, tight chest (similar to an asthma attack) • Rapid weak pulse • Nausea, vomiting, stomach cramps, diarrhoea. • Itchy Skin • Red, blotchy skin eruption • anxiety,- a feeling of ‘impending doom’

27. Asthma Asthma is a condition caused by an allergic reaction in the lungs, often to substances such as dust, traffic fumes or pollen. Muscles around the bronchioles, go into spasm and constrict, making it very difficult for breathing. Most asthma patients should carry medication with them. The blue inhaler is the reliever. ? • Help to sit upright or lean on a table in front • Help the casualty use their inhaler (can be repeated every few minutes) • Light conversation • Reassurance. • If no improvement, 999/112 • Difficulty breathing • Wheezy breath sounds • Difficulty speaking • Pale, clammy skin • Cyanosis • Exhaustion • Unconsciousness Do not take casualty outside into cold air, this can worsen the attack. Use a spacer device to enable easy inhale.

28. Angina Angina is a condition is usually caused by the build up of a cholesterol plaque on the inner lining of a coronary artery. It is a hard, thick substance caused by deposits of cholesterol on the wall, over time, this can build up and narrow the artery. During exertion, the heart needs more oxygen, but these narrowed arteries cannot increase the blood supply to meet the demand. This can result in chest pain. Heart Attack Is often caused when the surface of a cholesterol plaque in a coronary artery cracks and has a rough surface. This can lead to the formation of a blood clot on the plaque, which completely blocks the artery, which results in death of an area of the heart muscle. Unlike angina, this will not ease with rest.

30. Sit the casualty down and make them comfortable. • Allow the casualty to take their GTN spray (glyceryl tri-nitrate) • Reassure the casualty. • If you suspect a heart attack • If the casualty is not allergic to asprin and older than 16, allowing them to chew on an asprin tablet slowly may help limit the extent of damage to the heart. • Continuously monitor the casualty. If a heart attack victim becomes on unconscious- CPR. • If angina pain has not relieved after 15 minutes call 999/112 • Call 999/112 if in any doubt. Asprinreduces the clotting ability of the blood. Chewing the tablet allows to drug to absorb quickly into the blood through the skin of the mouth, so it works quicker. The ideal dose is 300mg. A first aider is not allowed to ‘prescribe’ drugs to a casualty. A fully conscious casualty is capable to consent to this treatment. !

31. Shock To most people the word shock means an unpleasant surpise. The medical term is ‘a lack of oxygen to the tissues of the body, usually caused by a fall in blood pressure of blood volume’. Shock is a serious and critical condition that can quickly end up a fatality! Hypovolaemic shock Hypo (low) vol(volume) aemic(blood) This shock is caused by loss of body fluids, which results in a low volume of blood. External bleeding, internal bleeding, burns, vomiting/diarrhoea, sweating. Cariogenic shock This is a fall in the blood pressure, the heart is not beating effectively. Heart attack, cardiac failure, heart valve disease, tension pneumothorax, cardiac arrest.

32. Fainting Fainting is caused by poor nervous control of the blood vessells and heart. When a casualty faints, the blood vessels in the lower body dilate and the heart becomes slow. This results in blood pressure falling and casualty has a temporary reduction in blood supply. Pain or fright, lack of food, emotional stress, long periods of inactvity (sitting or standing) and heat exhaustion. ? • Lay casualty down and raise their legs • Check Airway & Breathing • Remove causes of stress. • Reassurance • If they feel fain again, repeat. • Look for the cause • Loosen tight clothing. • Keep casualty insulated. • Pale, clammy skin • Slow pulse • Falling to the floor • Blurred vision/ dizziness prior. • Cyanosis (shock) • Air Hunger (deep sighing) ! Lay a heavily pregnant casualty down leaning towards her left hand side to prevent the baby restricting blood flow.

33. Wounds & Bleeding A wound is defined as an abnormal break in the continuity of the tissues of the body. If blood loss is severe, this could result in shock.

34. Wounds & bleeding The amount of blood in our body varies in relation to our size. Rough rule is approximately one pint of blood per stone. Average adult is 8-12 pints. (does not apply to overweight) Arterial bleed- Blood in the arteries is under direct pressure from the heart pumping and can ‘spurt’ with the heart beat, this can be several metres to a major artery. It is bright red in colour. Venous bleed- Veins are not under direct pressure from the heart but veins carry the same volume of blood. A wound to a vein may ‘ooze’ profusely and darker red. Capillary bleed- Bleeding from capillaries occurs in all wounds. Although the flow may appear fast at first, it is easily controlled, and ‘trickles’.

35. S E E P Sit or lay the casualty down Examine the wound for objects and how it is bleeding. Elevate the wound. Above the heart- gravity! Direct/indirect pressure to stem bleeding. 10 minutes to stop bleeding. Dressings A dressing should be sterile and just large enough to cover wound and not stick to the clotting blood. Firmly applied to stem bleeding. Embedded Objects. Should not be removed. Build up with dressings around the wound to stem bleeding. Nose Bleeds. Sit casualty down. Nip the soft part of the nose for 10 minutes. Breathe through mouth. It persists longer than 30 minutes, seek medical attention.

36. Poisons ? Look for clues- containers, drugs, syringes, smells. Vomiting or retching Abdominal pain Burns, breathing, headache. Try to dilute the substance or wash it away. 999/112- take advice. Monitor airway breathing DO NOT MAKE THE CASUALTY VOMIT.

37. Burns & Scalds. Estimating the severity of a burn Size- The larger the area- the more severe. The size is given as a percentage of the body’s surface area. The open palm (one side) is equal to 1% of the body area. Cause- The cause can affect the severity. Electrical can leave the casualty with deep internal burns. Age- Age can affect recovery rate. Elderly people may take longer to heal and be more susceptible to infection. Location- Burns to the airway from inhalation can be an instant fatlity. Depth- Superficial, intermediate and full thickness burns.

38. Causes Dry heat & wet heat burns Any direct contact with a dry heat source or friction. • Do not put yourself in danger • Ensure Airway and Breathing is maintained • Cool the burn immediately with cold water, at least 10 minutes or until pain is relieved. If not available, use a cold harmless liquid (milk). • Remove rings and watches as the area could swell. • Dress with a sterile dressing that will not stick. • Or use cling film/clean plastic bag. • 999/112 • Never: • Burst blisters • Touch burn • Apply lotions • Remove clothing • Adhesive dressings !

39. Broken Bones Fractures Closed Fracture- a clean break or crack. Complicated fracture- Trapped blood vessels or nerves. Open fracture- The skin has become broken by the bone which may be protruding from wound. High risk of infection. Green stick fracture- common in children, bone is split. May be mistaken for sprains/strains.

40. ? Pain- At the site of fracture. This may be masked by nerve damage, strong pain killers or alcohol. Loss of power- not being able to lift anything. Unnatural movement.- Classed as unstable and care should be taken to prevent fracture from movement. Swelling or bruising- around the site Deformity- if a leg is bent in the wrong place Irregularity- lumps or depressions along surface of the bone. Crepitus- Bone grating on bone- creaking sound. Tenderness- At the sight of injury. • Reassure the casualty, tell them to keep still • Keep injury supported with your hand • Do not move casualty • Support sling for upper limb injury/collar bone • Lower limb injury- keep warm and still. • 999/112

41. Sprains & Strains A sprain is defined as an injury to a ligament at a joint. A strain is defined as an injury to muscle. Usually casued by sudden wrenching movements, the joint over stretches, tearing the surrounding muscle of ligaments. R I CE Rest the injury- do not carry on. Apply an ice pack (wrapped up) to the injury for 10 minutes every 2 hours for 24 hours. Apply a firm bandage to compress to reduce swelling Elevate the injury. This also reduces swelling. ! Always wrap ice in cloth to prevent frost bite!

42. Spinal Injury Spinal injury occurs in approximately 2% of trauma casualties. Poor treatment of a casualty with a spinal injury could result in paralysis or even death. The spinal cord is an extension of the brain stem and travels down the back of the spinal vertebrae, Controlling breathing and movement The weakest part of the spinal column is the neck and is the most severe type ? • Sustained a blow to the head, neck or back • Fallen from a height • Dived into shall water • Speed • Crushing accident • Multiple injuries • Pain or tenderness • Or if you are in doubt.

43. Pain or tenderness in neck or back • Signs of a fracture • Loss of control • Loss of feeling • Sensations such as pins & needles • Breathing difficults • Incontinence. ? Conscious casualty Reassurance. Do not move Keep in save position- only move if in serious danger. Hold their head still 999/112 Unconscious and breathing normally Do not move unless severe danger Breathing normally? Airway is clear 999/112 Hold head still If casualty starts to vomit, place casualty in the recovery position. Keep the head, neck and back inline when rolling. Will take more than one person. Not breathing? Open airway and start CPR.

44. The Log roll

45. Diabetes Diabetes is the name for a condition suffered by a person who does not produce enough of a hormone called insulin. Insulin works in the blood stream to break down the sugars that we eat. Without it, sugar cannot be used by the cells or stored for later use. Insulin reduces the amount of sugar in the blood. Diet Controlled This casualty still produces some natural insulin, so they can control it by what they eat Tablet Controlled Produces a small amount of insulin naturally, but needs tablets to reduce level of sugar Insulin dependant. Produces little or no insulin, so have to inject themselves 2 or more times to keep under control.

47. High blood Sugar- Hyperglycaemia Arrange for GP to visit A.S.A.P Unconscious? Maintain airway/breathing and 999/112 Low blood sugar- Hypoglycaemia Give a sugary drink, sweet food or sugar lumps. Or glucose gel If responds quickly, give more food or drink. Stay with them and monitor If no response within 10 minutes called 999/112 Unconscious casualty- Open airway/breathing. CPR if not breathing normally. Place casualty into the recovery position 999/112 ! Unlike other cells, the brain can only use glucose (sugar) as its source of energy. If the sugar in the blood becomes low, the brain will starve.

48. Epilepsy A seizure (fit) is caused by a temporary burst of excess electric activity in the brain. It interrupts the brains normal function. It will depend on where in the brain this starts, and how rapidly it spreads. Epilepsy is currently defined as a tendency to have recurrent seizures. Can happen in hypoxia, stroke and head injuries. Partial and absence seizures. This happens in a part of the brain. Absence seizures are common in children and will look like ‘day dreaming’ and may only last a few seconds. The casualty may pluck their clothes, smack their lips, swallow repeatedly or wander around. • Guide the casualty away from any danger, • Sit in a quiet place, and lots of reassurance • Stay until fully alert • If it is unusual- advise them to see their GP,

49. Generalised Seizures. Involves electrical activity in the whole brain so usually the whole body is affected. It can be a frightening experience. Aura- Very rarely, the casualty may have a sensation before the seizure such as a strange feeling, taste of smell. Although a majority have no warning. Tonic Phase- ever muscle in the body becomes rigid suddenly. May let out a cry and will all to the floor. The back may arch and lips go blue. Usually lasts for 30 seconds Clonic Phase- The limbs will make a sudden violent jerk-like movements, the eyes may roll, teeth may clench and may drool. This phase can last from 15 seconds to hours- although seizures should stop after a couple of minutes. Anything over 15 minutes as a medical emergency. Recovery phase- The body relaxes- though the casualty is still unresponsive. The casualty may not be fully alert for 20 minutes or so. They may want to sleep and be unaware of what just happened.

50. During the Seizure • Gently cushion the casualties head. Hands or an item of clothing • Loosen tight clothing • Move any objects from around the casualty • Roll onto their side to protect airway • Note the duration of the seizure, Call 999/112 • If it lasts longer than 3 minutes. • Level of response does not improve within 10 minutes. • Has a second seizure • Not diagnosed/ or first seizure. • You are unsure. After Seizure Check Airway/Breathing Recovery Position and keep casualty warm. Check levels of response regularly. Call 999/112 if they do not improve within 10 minutes. ! Never place anything in casualties mouth, Never restrain them or move them during seizure.