FIRST AID - Principles of Health Sciences 1 – 2 - ثاني ثانوي

Link to digital lesson CHAPTER www.ien.edu.sa 4 FIRST AID Case Study Investigation Khalid and Abdullah were playing soccer in the park with friends. Suddenly, two players, Mohammed and Rashed, ran into each other; Mohammed was knocked down and got right up, but Rashed stayed down and complained of left leg pain. At the end of this chapter, you will be asked what Khalid and Abdullah should do for their teammates until help arrives. I LEARNING OBJECTIVES After completing this chapter, you should be able to: •Identify the basic principles of first aid. • Demonstrate cardiopulmonary resuscitation. ⚫ Describe first aid for: • Bleeding and wounds. • Shock. • Poisoning. • Burns. . Heat and cold exposure. • Bone and joint injuries, including fractures. • Sudden illness including heart attack, stroke, fainting, convulsions, and diabetic reactions. KEY TERMS abrasion dislocation infection burn first aid poisoning cardiopulmonary resuscitation fracture shock (CPR) heart attack stroke defibrillator hemorrhage wound diabetic coma 72 CHAPTER 4 وزارة التعليم Ministry of Education 2022-1444 DESIFAWWWWC 32 HI TH 58 othe 18012023 14:30

وزارة التعليم 4:1 PROVIDING FIRST AID First aid is not full and complete treatment but is the immediate care that is given to a person who has been injured or is suddenly taken ill. This is to minimize the effect of the injury or illness until medical professionals can take over their care. Application of correct first aid can often mean the difference between life and death, or recovery versus permanent disa- bility. In addition, by knowing the proper first-aid measures, you can help yourself and others in a time of emergency. BASIC PRINCIPLES OF FIRST AID Comm In any situation where first-aid treatment is necessary, it is essential that you remain calm. Avoid panic. Evaluate the situation thor- oughly. Always have a reason for anything you do. The treatment you provide will vary, depending on the type of injury or illness, the environment, others present, equipment or supplies on hand, and the availability of medical help. Step 1 Recognize that an emergency exists. Sometimes, signs of an emergency are clearly evident. Other times, signs are less obvious and require an alert individual to note that something is different or wrong. Many senses can alert you to an emergency: . Listen for unusual sounds, such as screams, calls for help, breaking glass, or screeching tires. . Look for unusual sights, such as damaged electrical wires, a stalled car, smoke, or fire. Note any unusual, unfamiliar, or strange odors, such as those of chemicals, natural gas, or pungent fumes. ⚫ Watch for unusual appearances or behaviors in others, such as difficulty in breathing, clutching of the chest or throat, abnormal skin colors, slurred or confused speech, unex- plained confusion or drowsiness, excessive perspiration, signs of pain, and any symp- toms of distress. Step 2 Safety Check the scene and make sure it is safe to approach (Figure 4-1): FIGURE 4-1 Check the scene and make sure it is safe to approach before checking any accident victim. Mintyor ECODON 2022 1444 GE44.PATHWAYS.002.S2.HLTH.58.indb 73 FIRST AID 73 18/01/2023 14:30

74 'CHAPTER 4 وزارة التعليم Ministry of Education" 2022-1444 GE44 PATHWAYS.G02.82.HLTH.58.indb 74 . A quick glance at the area can provide information on what has occurred, dangers present, number of people involved, and other important factors. If the scene is not safe, call the appropriate emergency service. . Do not endanger your own life or the lives of other bystanders. ⚫ Allow professionals to handle fires, dangerous chemicals, damaged electrical wires, and other life-threatening situations. Step 3 If the scene appears safe, approach the person. Determine whether they are conscious: . Shake the person by tapping their shoulder; ask, "Are you OK?" If they do not respond, call the emergency medical services (EMS) immediately. If the person is conscious, breathing, and able to talk, reassure them and try to determine what has happened: ⚫ Ask about pain or discomfort. . Check for other types of injuries, such as fractures (broken bones), burns, shock, and specific injuries. Note any abnormal signs or symptoms. ⚫ Check vital signs. ⚫ Note the temperature, color, and moistness of the skin. Check and compare the pupils of the eyes. ⚫Look for fluids or blood draining from the mouth, nose, or ears. ⚫ Gently examine the body for cuts, bruises, swelling, and painful areas. Report any abnormalities noted to the EMS when they arrive. Never move an injured person unless they are in a dangerous area, such as an area filled with fire and/or smoke, flood waters, carbon Safety monoxide, or poisonous fumes, or one with dangerous traffic, where vehicles cannot be stopped. If it is necessary to move the person, do so as quickly and as carefully as possible. People have been injured more severely by improper movement at the scenes of accidents, so avoid any unnecessary movement. Step 4 In an emergency, it is essential to call the EMS as soon as possible. The time factor is critical. Early access to advanced medical care Comm increases the person's chance of survival: 18/01/2023 14:30

وزارة التعليم Dial 997 to contact the EMS ambulance service. Describe the situation, actions taken, exact location, telephone num- ber from which you are calling, assistance required, number of people involved, and the condition of the person(s). . Do not hang up until the EMS has all the necessary information. If you are alone, call the EMS immediately before attempting to pro- vide any care to: An unconscious adult. ⚫ An unconscious adolescent. ⚫ An unconscious infant or child with a high risk for heart problems. Anyone who you see with a sudden cardiac arrest. If you are alone, call the EMS and start cardiopulmonary resuscita- tion (CPR) if needed for: • Any unconscious infant or child from 1 year of age to puberty. ⚫ Any victim of submersion or near drowning. Anyone with cardiac arrest caused by trauma. ⚫ Continue providing care by giving 5 cycles of CPR (about 2 minutes) until the EMS arrive. Step 5 After calling for help, provide care to the person: If possible, obtain the person's permission before providing any care. Introduce yourself and ask if you can help. If they are a child or adolescent, and a parent is present, obtain per- mission from the parent. If the person is unconscious, confused, or seriously ill and unable to consent to care, and no other relative is available to give permission, you can assume that you have permission. Remember that every individual has the right to refuse care. . If a person refuses to give consent for care, do not proceed. . If possible, have someone witness the refusal of care. . If a life-threatening emergency exists, call the EMS, alert them to the situation, and allow the professionals to take over. Ministry or Emicition 2022-1444 GE44.PATHWAYS.002.82.HLTH.58.indb 75 FIRST AID 75 | 18/01/2023 14:30

76 CHAPTER 4 وزارة التعليم Ministojor EmicuDon 2022-1444 GE44 PATHWAYS.G02.82.HLTH.58.indb 76 Step 6 At times, it may be necessary to triage the situation. Triage is a method of prioritizing treatment. If a person has more than one injury or illness, the most severe injury or illness must be treated first. If two or more people are involved, triage also determines which person is treated first. Life- threatening emergencies must be treated first. Examples include: . No pulse. ⚫ No breathing or difficulty in breathing. ⚫ Severe bleeding. .Persistent pain in the chest or abdomen. Vomiting or passing blood. ⚫ Poisoning. Head, neck, or spine injuries. Open chest or abdominal wounds. ⚫ Shock. ⚫ Severe partial-thickness and all full-thickness burns. Step 7 Comm Obtain information regarding the accident, injury, or illness. This information can then be given to the correct authorities: Information can be obtained from the person or other people present, or by examination of items present at the scene. Emergency medical identification contained in a bracelet, necklace, or medical card is an important source of information. ⚫ Empty medicine containers, and in case of poison, bottles of chemicals or solutions, or similar items can also reveal important information. ⚫Be alert to all such sources of information. General Principles Some general principles of care should be observed when first aid is necessary: ⚫ Obtain qualified assistance as soon as possible. . Report all information obtained, observations noted, treatment given, and other important facts to the correct authorities. ⚫ Avoid any unnecessary movement of the injured/ill person. • Reassure the person. A calm attitude will help relieve their anxiety. 18/01/2023 14:30

وزارة التعليم If the person is unconscious or vomiting, do not give them anything to eat or drink. It is best to avoid giving anything to eat or drink while providing first-aid treatment, unless the specific treatment requires that fluids or food be given. ⚫ Protect the person from cold or chilling but avoid overheating them. ⚫ Work quickly but in an organized and efficient manner. . Do not make a diagnosis or discuss the person's condition with observ- ers at the scene. It is essential to maintain confidentiality and protect the person's right to privacy while providing treatment. . Make every attempt to avoid further injury. checkpoint 1. What is the first step of first aid? 2. What is triage? 4:2 PERFORMING CARDIOPULMONARY RESUSCITATION When you administer CPR, you breathe for the person and circulate the blood. The purpose is to keep oxygenated blood flowing to the brain and other vital body organs until the heart and lungs start working again, or until medical help is available. Clinical death occurs when the heart stops beating, and the person stops breathing. Biological death refers to the death of the body cells. Biological death occurs 4-6 minutes after clinical death and can result in perma- nent brain damage, as well as damage to other vital organs. If CPR can be started immediately after clinical death occurs, the person may be revived. COMPONENTS OF CPR CPR is a life-saving technique used for people who have no pulse and have stopped breathing. A common sequence is circulation, airway, breathing, defibrillation. The goal is to start compressions within 10 seconds of recog- nizing cardiac arrest. This sequence is used for adults, children, and infants, and includes: ⚫ Circulation: By applying pressure to a certain area of the sternum (breastbone), the heart is compressed between the sternum and ver- tebral column. Blood is squeezed out of the heart and into the blood vessels. In this way, oxygen is supplied to body cells. Ministinjor Em.cution 2022-1444 GE44.PATHWAYS.002.S2.HLTH.58.indb 77 FIRST AID 77 | 18/01/2023 14:30

FIGURE 4-2 Open the airway by using the head-tilt/ chin-lift method. FIGURE 4-3 Use a CPR barrier mask to prevent the transmission of disease while giving respirations. FIGURE 4-4 When cardiac arrest occurs, an auto- mated external defibrillator (AED) can be used to ana- lyze the electrical rhythm of the heart and to apply a shock to try to restore the normal heart rhythm. Airway: To open the airway, use the head- tilt/chin-lift method (Figure 4-2): ⚫ Put one hand on the person's forehead and put the fingertips of the other hand under the bony part of the jaw, near the chin. Tilt the head back without closing the person's mouth. This action prevents the tongue from falling back and blocking the air passage. ⚫ Breathing: While using a barrier device, you breathe into the person's mouth or nose to supply needed oxygen or provide ventilations: . Each breath should take about 1 second, and the chest should rise. ⚫ Rapid or forceful breaths should be avoided because they can force air into the esopha- gus and stomach, causing gastric distension (expansion of the stomach when air enters it). This can cause serious complications, such as vomiting, aspiration of fluids into the lungs, and even pneumonia. ⚫. Health care providers should use a CPR pocket face mask with a one-way valve to provide a barrier and prevent the transmission of disease while giving res- pirations (Figure 4-3). Special training is required for the use of this mask. ⚫ Defibrillation: One of the most common causes of cardiac arrest is ventricular fibril- lation, which is an arrhythmia, or abnormal electrical conduction pattern in the heart. When the heart is fibrillating, it does not pump blood effectively. A defibrillator is a machine that delivers an electric shock to the heart to try to restore the normal electrical pattern and rhythm. Automated external defibrillators (AEDs) are now available for use by trained emergency medical respond- ers, emergency medical technicians, and even citizens (Figure 4-4): 78 CHAPTER 4 وزارة التعليم Missing or ECHOE 2022 1444 GE44 PATHWAYS.G02.82.HLTH.S8.indb 78 18/01/2023 14:30

وزارة التعليم Electrode pads are positioned on the patient's chest (follow the placement diagrams shown on the AED or the pads). The AED determines the heart rhythm, recognizes abnormal rhythms that may respond to defibrillation, and sounds an audible or a visual warning telling the operator to push a "shock" button. ⚫ Some AEDs are fully automatic and even administer the shock. Anytime a shock is administered with an AED, it is essential to make sure that no one is touching the patient. ⚫ The rescuer should state, "Clear the victim," and look carefully to make sure no one is in contact with the person before pushing the shock button. ⚫ Serious injuries, such as cardiac arrest, could occur in other rescu- ers if they are shocked by the AED. The sooner the defibrillation is provided, the greater the chances of survival are from a cardiac arrest caused by an arrhythmia. ⚫ CPR should continue until an AED is available. BASIC PRINCIPLES OF CPR Extreme care must be taken to evaluate the injured/ill person's condition before CPR is started: ⚫ They should be assessed for responsiveness first (see Step 3 above). ⚫ Position the person on their back. If you must turn them, support their head and neck, and keep their body in as straight a line as possible. . Check the pulse and breathing simultaneously. At the same time, check breathing by watching for the chest to rise and fall. . If you do not feel a pulse within 5-10 sec- onds, or you are not sure if you feel a pulse, start compressions: Correct hand placement is essential before performing chest compressions. For adults, place one hand in the middle of the chest, place the heel of the other hand on top of the first hand, and inter- lock the fingers with your hands to ensure pressure is not applied on the ribs, the abdomen, and the lower tip of the breast bone. (Figure 4-5). FIGURE 4-5 To position hands correctly for chest compressions, place one hand in the middle of the chest, place the heel of the other hand on top of the first hand, and interlock the fingers with your hands to ensure pressure is not applied on the ribs, the abdo- men, and the lower tip of the breast bone. Minisingo Emuc000 2022-1444 GE44.PATHWAYS.002.82.HLTH.58.indb 79 FIRST AID 79 | 18/01/2023 14:30

وزارة التعليم Electrode pads are positioned on the patient's chest (follow the placement diagrams shown on the AED or the pads). The AED determines the heart rhythm, recognizes abnormal rhythms that may respond to defibrillation, and sounds an audible or a visual warning telling the operator to push a "shock" button. ⚫ Some AEDs are fully automatic and even administer the shock. Anytime a shock is administered with an AED, it is essential to make sure that no one is touching the patient. ⚫ The rescuer should state, "Clear the victim," and look carefully to make sure no one is in contact with the person before pushing the shock button. ⚫ Serious injuries, such as cardiac arrest, could occur in other rescu- ers if they are shocked by the AED. The sooner the defibrillation is provided, the greater the chances of survival are from a cardiac arrest caused by an arrhythmia. ⚫ CPR should continue until an AED is available. BASIC PRINCIPLES OF CPR Extreme care must be taken to evaluate the injured/ill person's condition before CPR is started: ⚫ They should be assessed for responsiveness first (see Step 3 above). ⚫ Position the person on their back. If you must turn them, support their head and neck, and keep their body in as straight a line as possible. . Check the pulse and breathing simultaneously. At the same time, check breathing by watching for the chest to rise and fall. . If you do not feel a pulse within 5-10 sec- onds, or you are not sure if you feel a pulse, start compressions: Correct hand placement is essential before performing chest compressions. For adults, place one hand in the middle of the chest, place the heel of the other hand on top of the first hand, and inter- lock the fingers with your hands to ensure pressure is not applied on the ribs, the abdomen, and the lower tip of the breast bone. (Figure 4-5). FIGURE 4-5 To position hands correctly for chest compressions, place one hand in the middle of the chest, place the heel of the other hand on top of the first hand, and interlock the fingers with your hands to ensure pressure is not applied on the ribs, the abdo- men, and the lower tip of the breast bone. Minisingo Emuc000 2022-1444 GE44.PATHWAYS.002.82.HLTH.58.indb 79 FIRST AID 79 | 18/01/2023 14:30

وزارة التعليم Qualified medical help arrives and takes over. A physician or other legally qualified person orders you to discon- tinue the attempt. The rescuer is so physically exhausted that CPR cannot be continued. The scene suddenly becomes unsafe. CPR FOR ADULTS CPR should be performed on adults, children, and infants at a rate of 30 compressions followed by 2 ventilations, for a cycle ratio of 30:2. Five 30:2 cycles should be completed every 2 minutes. Pressure should be applied straight down to com- press the sternum between 5 cm (2 inches) and 6 cm (2.4 inches). CPR FOR INFANTS AND CHILDREN CPR is different for infants and children because of their size: Infants: Check the brachial (inside forearm) pulse site in the arm (Figure 4-8A). . Give compressions by placing two fingers on the lower half of the sternum just below an imaginary line drawn between the nipples (Figure 4-8B). Compress the sternum at least one third the depth of the chest, approximately 4 cm (1½ inches) at a rate of at least 100-120 per minute. Once 30 compressions have been given, open the airway using the head-tilt/chin-lift method. The infant's head should be in a neutral posi- tion and not tilted as far back as an adult's because this can obstruct the infant's airway. Give ventilations by using a barrier device and covering both the infant's nose and mouth, until the infant's chest visibly rises (Figure 4-8C). Extreme care must be taken to avoid overinflating the lungs and/or forcing air into the stomach. (A) (C) FIGURE 4-8 (A) Use the brachial pulse site in the arm to check for a pulse in an infant. (B) Use two fingers to give hard and fast compressions to the infant, at a rate of at least 100-120 compressions per minute. (C) If the infant is not breathing, give two breaths. Missing of Enco 2022-1444 GE44.PATHWAYS.002.82.HLTH.58.indb 81 FIRST AID 81 18/01/2023 14:30

82 CHAPTER 4 وزارة التعليم Ministry of Education" 2022-1444 GE44 PATHWAYS.G02.82.HLTH.58.indb 82 A lone rescuer gives 30 compressions followed by 2 ventilations in a ratio of 30:2. The infant's back must be supported at all times when giving compressions. If two rescuers are available to perform CPR on an infant, a two-thumb technique can be used by one rescuer to perform compressions while the second rescuer gives breaths. The rescuer providing compressions stands at the infant's feet and places their thumbs next to each other on the lower half of the sternum just below the nipple line. The res- cuer then wraps their hands around the infant to support the infant's back with the fingers. Children: Cardiopulmonary resuscitation for children depends on the size of the child. Health care providers should use child CPR methods for any child from 1 year of age to puberty (approximately 12 years of age). If a child shows signs of puberty, adult CPR methods should be used. The initial steps of CPR for a child are the same steps used in adult CPR, except that the head is not tilted as far back when the airway is opened. The main differences relate to compressions: ⚫The heel of one hand (or two hands) is placed on the lower half of the sternum in the same position used for adult compressions. If only one hand is used, the other hand remains on the forehead to keep the airway open. The sternum is compressed at least one third the depth of the chest, approximately 5 cm (2 inches). Compressions are given at a rate of at least 100-120 per minute. ⚫ After each set of 30 compressions, 2 breaths are given until the chest visibly rises. This provides a 30:2 ratio. ⚫ Approximately five cycles of CPR should be completed every 2 min- utes. For two-rescuer child CPR, a ratio of 15:2 is used. . If a child has a pulse and is receiving rescue breathing, a ventilation rate of 25 per minute (1 breath every 2-3 seconds) is recommended. CHOKING A person who is choking has an obstructed airway (an object blocking the airway). Special measures must be taken to clear this obstruction. ⚫ If an adult is conscious, coughing, talking or making noise, and/or able to breathe, the airway is not completely obstructed. Encourage the per- son to remain calm. Encourage them to cough hard. Coughing is the most effective method of expelling the object from the airway. 18/01/2023 14:30

وزارة التعليم If the adult is conscious but not able to talk, make noise, breathe, or cough, the airway is completely obstructed. The person usually grasps their throat and appears cyanotic (blue discoloration of the skin). Immediate action must be taken to clear the airway. Call the EMS, give up to five firm blows between their shoulder blades (Figure 4-9A), then give abdominal thrusts to provide a force of air to push the object out of the airway: ⚫ Stand behind the choking person. Wrap both arms around their waist. Make a fist of one hand (Figure 4-9B). Place the thumb side of the fist in the middle of the choking person's abdomen, slightly above the navel (umbilicus) but well below the xiphoid process at the end of the sternum. ⚫ Grasp the fist with your other hand. ⚫ Use quick, upward thrusts to press into the abdomen (Figure 4-9C). The thrusts should be delivered hard enough to cause a force of air to push the obstruction out of the airway. Continue the cycle of up to five back blows followed by five chest thrusts until the EMS arrive or the person becomes unresponsive. If the adult has an obstructed airway and becomes unresponsive, administer adult CPR. The rescuer should look in the mouth for the object. If the object is visible, the rescuer should remove it. If the object is not seen, the rescuer should try to admin- ister breaths and then continue with chest compressions. .If the adult is pregnant or obese, or you can- (A) (B) (C) FIGURE 4-9 (A) Give up to five back blows. (B) Make a fist of one hand. Place the thumb side of the fist above the umbilicus but well below the xiphoid process at the end of the sternum. not reach around them to give abdominal (C) Grasp the fist with your other hand and use quick, thrusts, perform chest thrusts. upward thrusts to press into the victim's abdomen. Mousting or Emicution 2022-1444 GE44.PATHWAYS.002.S2.HLTH.58.indb 83 FIRST AID 83 | 18/01/2023 14:30

(A) (B) FIGURE 4-10 (A) To give an infant back blows, position the infant face down, with the head lower than the chest. (B) Give the infant up to five chest thrusts, keeping the head lower than the chest. If an infant (birth to 1 year) has an obstructed air- way, a different sequence of steps is used to remove the obstruction: Quickly bare the infant's chest to expose the sternum (breastbone). . Give up to five back blows. Hold the infant face down, with your arm supporting the infant's body and your hand supporting the infant's head and jaw. Position the head lower than the chest (Figure 4-10A). Use the heel of your other hand to give up to five back blows between the infant's shoulder blades. Support the infant's head to turn the infant face up. Hold the infant with your forearm resting on your thigh. Keep the infant's head lower than the chest. . Give up to five chest thrusts: Position two to three fingers on the sternum just below an imaginary line drawn between the nipples. Press straight down up to five times (Figure 4-10B), each time with the intention of creating enough force to dislodge the obstruction. ⚫ Continue the cycle of up to five back blows fol- lowed by up to five chest thrusts until the EMS arrive or the infant becomes unresponsive. If the infant becomes unresponsive, place the infant on a firm surface. Open the airway and look for an object. If an object is visible, remove it. Then perform CPR starting with compres- sions-do not check for a pulse. Follow the nor- mal procedure for an infant, except look in the mouth every time you are ready to give breaths. If a child aged 1 to puberty (approximately 12 years of age) has an obstructed airway, the same sequence of steps used for an adult is fol- lowed. A finger sweep of the mouth is not performed unless the object can be seen in the mouth. checkpoint 1. What is the usual ratio of compressions to breaths in CPR? 2. What is a defibrillator? 84 CHAPTER 4 وزارة التعليم Meisingo E 2022 1444 GE44 PATHWAYS.G02.82.HLTH.58.indb 84 18/01/2023 14:30

وزارة التعليم PROVIDING FIRST AID FOR BLEEDING AND WOUNDS A wound involves injury to the soft tissues. Wounds are usually classified as open or closed: With an open wound, there is a break in the skin or mucous membrane. With a closed wound, there is no break in the skin or mucous mem- brane but injury occurs to the underlying tissues. An example of a closed wound is a bruise or hematoma. Wounds can result in bleeding, infection, and/or tetanus (lockjaw, a seri- ous infection caused by bacteria). First-aid care must be directed toward controlling bleeding before the bleeding leads to death, and toward either preventing or obtaining treatment for infection. TYPES OF OPEN WOUNDS Open wounds are classified into types according to the injuries that occur: ⚫ Abrasion: The skin is scraped off. Bleeding is limited, but infection must be prevented because contaminants often enter the wound. ⚫ Incision: A cut or injury caused by a sharp object, such as a knife, scissors, or razor blade. The edges of the wound are smooth and reg- ular (Figure 4-11A). If the cut is deep, bleeding can be heavy and can lead to excessive blood loss. In addition, damage to muscles, nerves, and other tissues can occur. ⚫ Laceration: Tearing of the tissues by way of excessive force. The wound often has jagged, irregular edges (Figure 4-11B). Bleeding may be heavy. If the wound is deep, contamination may lead to infection. . Puncture: An injury caused by a sharp object, such as a pin, nail, or pointed instrument. Avulsion: Tissue is torn, separated, or hanging from the body. Bleeding is heavy and usually extensive. It is important to preserve the body part while treating the wound as a surgeon may be able to reattach it. Amputation: A body part is cut off and separated from the body. Bleeding can be heavy and extensive. Care must be taken to preserve the amputated part because a surgeon may be able to reattach it. The part should be wrapped in a cool, moist dressing and placed in a plas- tic bag. The plastic bag should be kept cool or placed in ice water and transported with the injured person. The body part should never be placed directly on ice because ice can freeze the tissue. (A) (B) FIGURE 4-11 Open wounds include (A) an incision that has smooth, regular edges and (B) a laceration that has jag- ged, irregular edges. Maistingor Educpions 2022-1444 GE44.PATHWAYS.002.82.HLTH.58.indb 85 FIRST AID 85 | 18/01/2023 14:30

CONTROLLING BLEEDING Controlling bleeding is the first priority in caring for wounds because it is possible for someone to bleed to death in a short period of time. Bleeding can come from arteries, veins, and capillaries. It is possible to differentiate between the types of bleeding, as follows: • ⚫ Arterial blood usually spurts from a wound, results in heavy blood loss, and is bright red. Arterial bleeding is life-threatening and must be controlled quickly. • ⚫ Venous blood is slower, steadier, and dark red or maroon. Venous bleeding is constant and can lead to a large blood loss, but it is easier to control. ⚫ Capillary blood "oozes" from the wound slowly, is less red than arte- rial blood, and clots easily. The main methods for controlling bleeding are listed in the order in which they should be used: direct pressure, pressure bandage, and a tourniquet in extreme emergencies. CAUTION: If possible, use some type of protective barrier, such as gloves or plastic wrap while controlling bleeding. If this is not Precaution possible in an emergency, use thick layers of dressings, and try to avoid contact of blood with your skin. Wash your hands thoroughly and as soon as possible after giving first aid to someone who is bleeding. FIGURE 4-12 Use some type of protective bar- rier, such as gloves or plastic wrap, while apply- ing direct pressure to control bleeding. ⚫ Direct pressure: Using your gloved hand over a thick dressing or sterile gauze, apply pressure directly to the wound (Figure 4-12). If no dress- ing is available, use a clean cloth or linen-type towel. In an emergency, it may be necessary to use a piece of clothing or another material from the environment. Continue to apply pressure for 5-10 minutes or until the bleeding stops. If blood soaks through the dressing, apply a second dressing over the first, and continue to apply direct pressure. Do not disturb blood clots once they have formed. Direct pressure will usually stop most bleeding. ⚫ Pressure bandage: Apply a pressure bandage to hold the dressings in place. Maintain direct pres- sure while applying the pressure bandage. Tourniquet: A tourniquet should not be used unless all other methods to control bleeding have not been effective, it is a life-threatening situation, medical help will be delayed, or you have been instructed on how to apply it. Commercial tour- niquets are available in many first-aid kits. Follow the directions provided with it. 86 CHAPTER 4 وزارة التعليم Minising or Educision 2022 1444 GE44 PATHWAYS.G02.82.HLTH.S8.indb 86 18/01/2023 14:30

وزارة التعليم After severe bleeding has been controlled, obtain medical help. Do not disturb any blood clots or remove the dressings that were used to con- trol the bleeding because this may result in additional bleeding. Make no attempt to clean the wound because this too is likely to result in additional bleeding. MINOR WOUNDS In treating minor wounds that do not involve severe bleeding, prevention of infection is the first priority: ⚫ Wash your hands thoroughly before treating the wound. Put on gloves to avoid contamination from blood or fluid draining from the wound. • Use clean water and sterile gauze, if possible, to wash the wound. Wipe in an outward direction, away from the wound. Discard the wipe after each use. Rinse the wound thoroughly with cool water. Use sterile gauze to gently blot the wound dry. ⚫ Apply a sterile dressing or bandage. Watch for any signs of infection. Medical help should be sought if any signs of infection appear. Infection can develop in any wound. It is important to recognize the signs of infection and to seek medical help if they appear. Some signs and symptoms are swelling, heat, redness, pain, fever, pus, and red streaks leading from the wound. Prompt medical care is needed if any of these symptoms occur. Tetanus bacteria can enter an open wound and lead to serious illness and death. Tetanus infection is most common in puncture wounds and wounds that involve damage to tissue underneath the skin. With some wounds, objects can remain in the tissues or become embed- ded in the wound. Examples of such objects include splinters, small pieces of glass, small stones, and other similar objects. If the object is at the sur- face of the skin, remove it gently with sterile tweezers or tweezers wiped clean with alcohol or a disinfectant. Any objects embedded in the tissues should be left in the skin and removed by a physician. CLOSED WOUNDS Closed wounds (those not involving breaks in the skin) can occur any- where in the body as a result of injury (Figure 4-13). If the wound is a bruise, cold applications can be applied to reduce swelling. Other closed wounds can be extremely serious and cause internal bleeding that may lead to death. Signs and symptoms may include pain, tenderness, swell ing, deformity, cold and clammy skin, rapid and weak pulse, a drop in FIGURE 4-13 Closed wounds can occur any- where in the body as a result of injury. FIRST AID 87| Ministry of Eduction 2022-1444 GE44.PATHWAYS.002.S2.HLTH.58.indb 87 18/01/2023 14:30

88 CHAPTER 4 وزارة التعليم Maisingor Education 2022-1444 GE44 PATHWAYS.G02.82.HLTH.S8.indb 88 blood pressure, uncontrolled restlessness, excessive thirst, vomited blood, or blood in the urine or feces. Get medical help as soon as possible. Check breathing, treat for shock, avoid unnecessary movement, and avoid giving any fluids or food. While caring for anyone with severe bleeding or wounds, always be alert for the signs of shock (see Section 4:4). Be prepared to treat shock while providing care to control bleeding and prevent infection in the wound. At all times, remain calm while providing first aid. Reassure the person. Obtain appropriate assistance or medical care as soon as possible in every case requiring additional care. checkpoint 1. List four types of wounds. 2. If a finger is amputated, how would you handle the severed part? 4:4 PROVIDING FIRST AID FOR SHOCK Shock is a state that can exist with any injury or illness requiring first aid. It is important that you are able to recognize it and provide treatment. Shock, also called hypoperfusion, is a clinical set of signs and symptoms associated with an inadequate supply of blood to body organs, especially the brain and heart. If it is not treated, shock can lead to death, even when the injuries or illness might not themselves be fatal. After just 4-6 min- utes of hypoperfusion, brain cells are damaged irreversibly. CAUSES OF SHOCK Many different things can cause shock: hemorrhage (excessive loss of blood); excessive pain; infection; heart attack; stroke; poisoning by chem- icals, drugs, or gases; lack of oxygen; psychological trauma; and dehydra- tion (loss of body fluids) from burns, vomiting, or diarrhea. All types of shock impair circulation and decrease the supply of oxygen to body cells, tissues, and organs. The main types of shock and their causes are: ⚫ Anaphylactic: Hypersensitive or allergic reaction to a substance, such as food, medications, insect stings or bites, or snake bites. . Cardiogenic: Damage to heart muscle from heart attack or cardiac arrest. ⚫ Hemorrhagic: Severe bleeding or loss of blood plasma. ⚫ Hypovolemic: Excessive loss of fluids due to bleeding, prolonged diar- rhea, excessive vomiting, protracted diaphoresis, and severe burns. 18/01/2023 14:30

وزارة التعليم Metabolic: Loss of fluids from severe vomiting, diarrhea, or a heat illness; or disruption in acid-base balance as occurs in diabetes. ⚫ Neurogenic: Injury and trauma to the brain and/or spinal cord. ⚫ Psychogenic: Emotional distress, such as anger, fear, or grief. ⚫ Respiratory: Trauma to respiratory tract; respiratory distress or arrest (chronic disease, choking). ⚫ Septic: Acute infection (toxic shock syndrome). SIGNS AND SYMPTOMS When shock occurs, the body attempts to increase blood flow to the brain, heart, and vital organs by reducing blood flow to other body parts. This can lead to the following signs and symptoms that indicate shock: ⚫Skin is pale or cyanotic (blue) in color. Check the nail beds and the mucous membrane around the mouth. ⚫ Skin is cool to the touch. Excessive perspiration may result in a wet, clammy feeling when the skin is touched. ⚫ Pulse is rapid, weak, and difficult to feel. Check the pulse at one of the carotid arteries in the neck. .Respirations are rapid, shallow, and may be irregular. ⚫ Blood pressure is very low or below normal, and may not be obtainable. ⚫ General weakness: As shock progresses, the person becomes listless and confused. Eventually, they lose consciousness. Anxiety and extreme restlessness. Excessive thirst, nausea, and/or vomiting. Blurred vision: As shock progresses, the eyes may appear sunken and have a vacant or confused expression. The pupils may dilate or become large. TREATMENT FOR SHOCK It is essential to get medical help as soon as possible because shock is a life-threatening condition. Treatment for shock is directed toward: 1. Eliminating the cause of shock. 2. Improving circulation, especially to the brain and heart. 3. Providing an adequate oxygen supply. 4, Maintaining body temperature. Minustojo EmucoDoo! 2022-1444 GE44.PATHWAYS.002.82.HLTH.58.indb 89 FIRST AID 89 | 18/01/2023 14:30

90 CHAPTER 4 وزارة التعليم Ministry or Em.cution 2022-1444 GE44 PATHWAYS.G02.82.HLTH.58.indb 90 Some of the basic principles for treatment include: . Reduce the effects of or eliminate the cause of shock: control bleeding, provide oxygen if available, ease pain through position change, and/ or provide emotional support. CAUTION: If neck or spine injuries are suspected, the person should not be moved unless it is necessary to remove them from Safety danger. • ⚫ The position for treating shock must be based on the person's injuries. ⚫ The best position for treating shock is usually for the person to lie flat on their back because this improves circulation. Raising the feet and legs approximately 30 cm (12 inches) can also provide additional blood for the heart and brain (Figure 4-14). However, if they are vomiting or have bleeding and injuries of the jaw or mouth, the person should be positioned on their side to prevent them from choking on blood or vomit. FIGURE 4-14 Position a shock victim flat on the back and elevate the feet and legs approximately 30 cm. Do not use this position if the victim is vomiting or has bleeding and injuries of the jaw or mouth. If a person is experiencing breathing problems, it may be necessary to raise their head and shoulders to make breathing easier. If there is a head (not neck) injury, and the person has difficulty breathing, they should be positioned lying flat or with the head raised slightly. It is very important to position the person according to the injury or illness involved. . Cover the person with blankets or additional clothing to prevent chilling or exposure to the cold. Blankets may also be placed between the ground and the injured person. However, it is important to avoid overheating them. If the skin is very warm to the touch and perspira- tion is noted, remove some of the blankets or coverings. Avoid giving anything to eat or drink. If the injured person complains of excessive thirst, a wet cloth can be used to provide some comfort by moistening the lips and mouth. 18/01/2023 14:30

وزارة التعليم Remember that it is important to look for signs of shock while providing first aid for any injury or illness. Provide care that will reduce the effect of shock. Obtain medical help as soon as possible. checkpoint 1. List three causes of shock. 2. What does cyanotic mean? PROVIDING FIRST AID FOR POISONING Poisoning can occur anywhere, anytime-not only in health care set- tings, but also in your daily life. Poisoning is a condition that occurs when contact is made with any chemical substance that causes injury, illness, or death. It can be caused by ingesting (swallowing) various substances, inhaling poisonous gases, injecting substances, or contacting the skin with poison. Any substance that causes a harmful reaction when applied or ingested can be called a poison. Anaphylactic shock is a common reac- tion to poisoning. Immediate action is necessary for any poisoning victim. Treatment varies depending on the type of poison, the injury involved, and the method of contact. If the person is unconscious, check for pulse and breathing. Provide CPR if there is no pulse and/or artificial respiration if they are not breath- ing. Obtain medical help as soon as possible. If the unconscious person is breathing, position them on their side so that fluids can drain from the mouth. Obtain medical help quickly. INGESTION POISONING Comm If a poison has been swallowed, immediate care must be provided before the poison can be absorbed into the body. Basic steps of first aid include: Call 911, the unified emergency telephone number or a physician immediately. . Save the label or container of the substance taken so this information can be given to the poison control center or physician. ⚫ Calculate or estimate how much was taken and the time at which the poisoning occurred. . If the person vomits, save a sample of the vomit. Ministry or Emiciting 2022-1444 GE44.PATHWAYS.002.82.HLTH.58.indb 91 FIRST AID 91 | 18/01/2023 14:30

92 CHAPTER 4 وزارة التعليم Maisinjor Emicition 2022-1444 GE44 PATHWAYS.G02.82.HLTH.58.indb 92 INHALATION POISONING If poisoning is caused by inhalation of dangerous gases, the person must be removed immediately from the area before being treated. Safety A commonly inhaled poison is carbon monoxide, an odorless, colorless gas that is very difficult to detect. If excessive amounts of gas or fumes are present, and the scene is not safe, do not enter the area. Wait for the EMS to arrive. If a quick rescue can be achieved without inhaling the gases, the basic steps of first aid include: . Before entering the danger area, take a deep breath of fresh air, and do not breathe the gas while you are removing the person from the area. ⚫ After rescuing the person, immediately check for pulse and breathing. • Provide CPR and/or artificial respiration if needed. Obtain medical help immediately; death may occur very quickly with this type of poisoning. CONTACT POISONING If poisoning is caused by chemicals or poisons coming into contact with a person's skin, care includes: . Use large amounts of water to wash the skin for at least 15-20 minutes to dilute the substance and remove it from the skin. Remove any clothing and jewelry that contain the substance. Call the poison control center or a physician for additional information. • Obtain medical help as soon as possible for burns or injuries that may result from contact with the poison. Contact with a poisonous plant can cause a serious skin reaction if not treated immediately. Basic steps of first aid include the following: Wash the area thoroughly with soap and water. ⚫If the condition is severe and affects large areas of the body or face, obtain medical help. INJECTION POISONING Injection poisoning occurs when an insect or spider stings or a snake bites an individual. If a person's arm or leg is affected, place the limb in a gravity-neutral position, close to heart level. For an insect sting, first-aid treatment includes: 18/01/2023 14:30

وزارة التعليم Remove any embedded stinger by scraping the stinger away from the skin with the edge of a rigid card, such as a credit card, or a tongue depressor. Do not use tweezers because tweezers can puncture the venom sac which is attached to the stinger, injecting more poison into body tissues. Wash the area well with soap and water. . Apply a sterile dressing and a cold pack to reduce swelling. For a snakebite or spider bite, first-aid treatment includes: Wash the wound. ⚫ Immobilize the injured area, and place the limb in a gravity-neutral position, close to heart level. Do not cut the wound or apply a tourniquet. • Monitor the person's breathing, and give artificial respiration if necessary. Obtain medical help as soon as possible. .If possible, try to obtain a description of the snake so it can be identi- fied, and the correct anti-snake venom can be given. For any type of injection poisoning, watch for allergic reaction (Figure 4-15). Signs and symptoms of aller- gic reaction include redness and swelling at the site, itching, hives, pain, swelling of the throat, difficult or labored breathing, dizziness, and a change in the level of consciousness. Maintain respirations and obtain medical help as quickly as possible for anyone who experiences an allergic reaction. In all cases of poisoning, observe the person for signs of anaphylactic shock, and treat for shock, Comm if necessary. Try to remain calm and confident while providing first aid for poisoning. Reassure as needed. Act quickly and in an organized, effi- cient manner. checkpoint 1. What are three ways that a person can be poisoned? 2. What agency do you contact when poisoned? FIGURE 4-15 Watch for allergic reactions in injection-poisoning victims. Missing or Em cupon) 2022 1444 GE44.PATHWAYS.002.82.HLTH.58.indb 93 FIRST AID 93 | 18/01/2023 14:30

94 CHAPTER 4 وزارة التعليم - Missing or Education 2022 1444 GE44 PATHWAYS.G02.82.HLTH.58.indb 94 4:6 PROVIDING FIRST AID FOR BURNS TYPES OF BURNS A burn is an injury that can be caused by fire, heat, chemical agents, radi- ation, and/or electricity. Burns are classified as superficial, partial thick- ness, or full thickness (Figure 4-16). Skin dry, red -Epidermis -Dermis Subcutaneous fat, muscle First-degree (superficial) Blistered, skin moist, pink or red Second-degree (partial thickness) Charring, skin black, brown, red FIGURE 4-16 Types of burns. Third-degree (full thickness) 18/01/2023 14:30

وزارة التعليم The characteristics of each type of burn are as follows: . Superficial (or first-degree) burn, the least severe type of burn. This involves only the top layer of skin, the epidermis, and usually heals in 5-6 days without permanent scarring. The skin is usually reddened or discolored. There may be some mild swelling and pain. Three com- mon causes are overexposure to the sun (sunburn), brief contact with hot objects or steam, and exposure of the skin to a weak acid or alkali. . Partial-thickness (or second-degree) burn: This type of burn involves injury to the top layers of skin, including both the epidermis and der- mis. A blister forms, and the skin is red or has a mottled (blotchy with many shades of color) appearance. Swelling usually occurs, and the surface of the skin frequently appears to be wet. This is a painful burn and may take 3-4 weeks to heal. Frequent causes include excessive exposure to the sun, a sunlamp, or artificial radiation; contact with hot or boiling liquids; and contact with fire. ⚫ Full-thickness (or third-degree) burn: This is the most severe type of burn and involves injury to all layers of the skin plus the underlying tissue. The area involved has a white or charred appearance. This type of burn can be either extremely painful or, if nerve endings are destroyed, relatively painless. Full-thickness burns can be life-threat- ening because of fluid loss, infection, and shock. Frequent causes include exposure to fire or flames, prolonged contact with hot objects, contact with electricity, and immersion in hot or boiling liquids. TREATMENT First-aid treatment for burns is directed toward removing the source of heat, cooling the affected skin area, covering the burn, relieving pain, observing and treating for shock, and preventing infection. Medical treat- ment is not usually required for superficial and mild partial-thickness burns. However, medical care should be obtained if more than 15% of the surface of an adult's body is burned (10% in a child). The "rule of nines" is used to calculate the percentage of body surface burned (Figure 4-17). For example, if an adult has burns on both legs, this would equal 18% of the body surface, and medical treatment should be obtained. Medical care should also be obtained if the burns affect the face or respiratory tract; if the person has difficulty breathing; if burns cover more than one body part; if the person has a partial thickness burn and is under 5 or over 60 years of age; or if the burns resulted from chem- icals, explosions, or electricity. Anyone with full-thickness burns should receive medical care. Ministry of Eduction 2022-1444 GE44.PATHWAYS.002.82.HLTH.58.indb 95 FIRST AID 95 | 18/01/2023 14:30

96 CHAPTER 4 وزارة التعليم Minisinjor EmicoDoo 2022-1444 412% -412% 412% 412% FIGURE 4-17 The rule of nines is used to calculate the percentage of body surface burned. Superficial and mild partial-thickness burns are treated as follows: . Cool the area by flushing it with large amounts of cool water. Do not use ice or ice water on burns because doing so causes the body to lose heat. Apply a dry, sterile dressing to prevent infection. . If possible, elevate the affected part to reduce swelling caused by inflammation. If necessary, obtain medical help. Severe partial-thickness and full-thickness burns are treated as follows: ⚫ Call for medical help immediately if the person has severe par- tial-thickness or full-thickness burns. . Cover the burned areas with thick, sterile dressings. ⚫ Elevate the hands or feet if they are burned. ⚫ If the feet or legs are burned, do not allow the person to walk. If clothing is attached to the burned areas, do not attempt to remove it. Watch the person closely for signs of respiratory distress and shock. GE44 PATHWAYS.G02.82.HLTH.58.indb 96 18/01/2023 14:30

وزارة التعليم Provide artificial respiration and treatment for shock, as necessary. ⚫ Watch the patient closely until medical help arrives. Chemical burns are treated as follows: For burns caused by chemicals splashing on the skin, use large amounts of water to flush the affected areas for a minimum of 20 minutes or until medical help arrives. Remove any clothing, socks and shoes, or jewelry that contains the chemical to minimize the area of injury. ⚫Continue flushing the skin with cool water and watch for signs of shock until medical help can be obtained. If the eyes have been burned by chemicals or irritating gases, flush the eyes with large amounts of water for a minimum of 20 minutes or until medical help arrives (Figure 4-18). If only one eye is injured, be sure to tilt the head in the direction of the injury so the injured eye can be properly flushed. Start at the inner corner of the eye and allow the water to run over the surface of the eye and to the outside. Continue flushing the eye with cool water and watch the person for signs of shock until medical help can be obtained. FIGURE 4-18 To irrigate an eye, hold the eyelid open and irrigate from the inner part of the eye toward the outer part. checkpoint 1. Which type of burn involves injury to the top layer of skin, including both the epidermis and dermis? 2. What should you do if burns cover more than one body part? 4:7 PROVIDING FIRST AID FOR HEAT EXPOSURE Excessive exposure to heat or high external temperatures can lead to a life-threatening emergency. Overexposure to heat can cause a chemical imbalance in the body that can eventually lead to death. Harmful reac- tions can occur when fluids such as water or electrolytes (minerals found in the blood) such as salt are lost through perspiration or when the body cannot eliminate excess heat. Missing or Educon 2022 1444 GE44.PATHWAYS.002.82.HLTH.58.indb 97 FIRST AID 97 | 18/01/2023 14:30

98 CHAPTER 4 وزارة التعليم Ministry of Education 2022-1444 GE44 PATHWAYS.G02.82.HLTH.S8.indb 98 Heat cramps are muscle pains and spasms that result from the loss of fluids and electrolytes through perspiration. Firm pressure applied to the cramped muscle will provide relief from the discomfort. Rest and moving to a cooler area, in addition to small sips of water or an elec- trolyte solution, such as sport drinks, will help to relieve symptoms. ⚫ Heat exhaustion occurs when a person experiences a loss of fluids through sweating. Signs and symptoms include pale and clammy skin, profuse perspiration (diaphoresis), fatigue or tiredness, weak- ness, headache, muscle cramps, nausea and vomiting, dizziness and fainting. Body temperature is about normal or just slightly elevated. If heat exhaustion is not treated, it can develop into heat stroke. Treatment includes: Moving the person to a cooler area whenever possible. . Loosening or removing excessive clothing. Applying cool, wet cloths. ⚫ Laying the person down and elevating their feet 30 cm (12 inches); and giving them small sips of cool water, approximately 118 mill- iliters (ml) (4 fluid ounces) every 15 minutes if they are alert and conscious. If they vomit, develop shock, or experience respiratory distress, medical help should be obtained immediately. ⚫Heat stroke is caused by prolonged exposure to high temperatures. It is a medical emergency. The body is unable to eliminate the excess heat, and the internal body temperature rises to 40.6°C (105°F) or higher. Normal body defenses such as the sweating mechanism no longer function. Signs and symptoms in addition to the high body temperature include red, hot, and dry skin. The pulse is usually rapid but may remain strong. The person may lose consciousness. Treatment is to cool the body quickly because a high body temperature can cause convulsions or death in a very short period of time. The person can be placed in a tub of cool water, or the skin can be sponged with cool water. Ice or cold packs can be placed on their wrists, ankles, in each axillary (armpit) area, and in the groin. Be alert for signs of shock at all times. Obtain medical help immediately. ⚫ After someone has recovered from any condition caused by heat exposure, they must be warned to avoid abnormally warm or hot tem- peratures for several days. They should also be encouraged to drink sufficient amounts of water or electrolyte solutions. checkpoint 1. What are the three main conditions that can occur from heat exposure? 2. What is the body's internal temperature in heat stroke? 18/01/2023 14:30

وزارة التعليم 4:8 PROVIDING FIRST AID FOR COLD EXPOSURE Exposure to cold external temperatures can cause body tissues to freeze and body processes to slow. If treatment is not provided immediately, the exposed person can die. Factors such as wind velocity, amount of humid- ity, and length of exposure all affect the degree of injury. HYPOTHERMIA Prolonged exposure to the cold can result in hypothermia, a condition in which the body temperature falls below 35°C (95°F). Elderly individuals are more susceptible to hypothermia than are younger individuals. SIGNS AND SYMPTOMS: Shivering, numbness, weakness, or drowsiness. ⚫Low body temperature. ⚫ Poor coordination. ⚫ Confusion. ⚫ Loss of consciousness. If prolonged exposure, body processes slow down, and death can occur. FIRST AID: Move the patient to a warm area. Remove wet clothing. ⚫ Slowly warm the patient by wrapping in blankets or putting on dry clothing. . If the patient is fully conscious, give warm noncaffeinated liquids by mouth. Avoid warming a hypothermic person too quickly-this can cause dangerous heart arrhythmias. Ministry of Em.con 2022-1444 GE44.PATHWAYS.002.82.HLTH.58.indb 99 FIRST AID 99 | 18/01/2023 14:30

FIGURE 4-19 Frostbite is actual freezing of tissue fluids accompanied by damage to the skin and under- lying tissues. FROSTBITE Frostbite is actual freezing of tissue fluids accompa- nied by damage to the skin and underlying tissues (Figure 4-19). It is caused by exposure to freezing or below-freezing temperatures. Small areas of the body are often affected by frostbite. Common sites include the fingers, toes, ears, nose, and cheeks. SIGNS AND SYMPTOMS: Initially, redness and tingling. Pale, glossy skin that is white or grayish yellow in color. ⚫ Blisters. Skin that is cold to the touch. 100 CHAPTER 4 وزارة التعليم Moving or Emuching 2022 1444 GE44 PATHWAYS.G02.82.HLTH.58.indb 100 ⚫ Numbness. ⚫Pain that gradually subsides until the person does not feel any pain. . If exposure continues, the person may become confused, lethargic, and incoherent. ⚫ Shock may develop, followed by unconsciousness and death. FIRST AID: • Maintain respirations. ⚫ Treat for shock. . Warm the affected parts. Because people with frostbite do not usually feel pain, the part must be warmed carefully, taking care not to burn the injured tissue. The parts affected may be immersed in warm water at 37.8-40°C (100-104°F) until normal color returns to the skin and/ or feeling returns. Prevent further injury. Extreme care must be taken to avoid further injury to areas damaged by frostbite. Get medical help as quickly as possible. checkpoint 1. What does the term "hypothermia" mean? 2. What temperature should the water be for immersing a frostbitten part of the body? 18/01/2023 14:30

وزارة التعليم 4:9 PROVIDING FIRST AID FOR BONE AND JOINT INJURIES Injuries to bones and joints are common in accidents and falls. Examples of injuries to bones and joints include fractures, dislocations, sprains, and strains. FRACTURES A fracture is a break in a bone. A closed, or simple, fracture is a bone break that is not accompanied by an external or open wound on the skin. A compound, or open, fracture is a bone break that is accompanied by an open wound on the skin. SIGNS AND SYMPTOMS: . Deformity. ⚫ Limited motion or loss of motion. Pain and tenderness at the fracture site. ⚫Swelling and discoloration. The protrusion of bone ends through the skin. ⚫ The injured person heard a bone break or snap, or felt a grating sen- sation (crepitation). ⚫ Abnormal movements within a part of the body. FIRST AID: •Maintain respirations. ⚫ Treat for shock. . Keep the broken bone from moving. Prevent further injury. ⚫ Use a sling to prevent movement of the injured part. Obtain medical help whenever a fracture is evident or suspected. DISLOCATIONS A dislocation is when the end of a bone is either displaced from a joint or moved out of its normal position within a joint. This injury is frequently accompanied by a tearing or stretching of ligaments, muscles, and other soft tissue. Ministry or Emuction 2022-1444 GE44.PATHWAYS.002.82.HLTH.58.indb 101 FIRST AID 101 | 18/01/2023 14:30

102 CHAPTER 4 وزارة التعليم Ministry or Emucion 2022-1444 GE44 PATHWAYS.G02.82.HLTH.58.indb 102 SIGNS AND SYMPTOMS: . Deformity. ⚫Limited or abnormal movement. ⚫ Swelling. ⚫ Discoloration. Pain and tenderness. . A shortening or lengthening of the affected arm or leg. FIRST AID: ⚫ Same as for fractures. • ⚫ No attempt should be made to reduce the dislocation (replace the bone in the joint). The affected part must be immobilized in the position it was found. ⚫ Immobilization is accomplished by using splints and/or slings. ⚫ Movement of the injured part can lead to additional injury to nerves, blood vessels, and other tissue in the area. • Obtain medical help immediately. SPRAINS A sprain is an injury to the tissues surrounding a joint; it usually occurs when the part is forced beyond its normal range of movement. Ligaments, tendons, and other tissues are stretched or torn. Common sites for sprains include the ankles and wrists. SIGNS AND SYMPTOMS: ⚫ Swelling. . Pain. ⚫ Discoloration. • Impaired motion. . May resemble a fracture or dislocation. ⚫ If in doubt, treat the injury as a fracture. FIRST AID: ⚫ Apply a cold application to decrease swelling and pain; place a barrier, for example, a thin towel between the cold container and the skin. Elevate the affected part. 18/01/2023 14:30

وزارة التعليم Encourage the person to rest the affected part. . Apply an elastic bandage to provide support for the affected area but avoid stretching the bandage too tightly. • Obtain medical help if swelling is severe or if a fracture is suspected. STRAINS A strain is the overstretching of a muscle; it is caused by overexertion or lifting. A frequent site for strains is the back. SIGNS AND SYMPTOMS: . Sudden pain. ⚫ Swelling. ⚫ Bruising. FIRST AID: ⚫ Encourage the person to rest the affected muscle while providing support. Recommend bed rest with a backboard under the mattress for a strained back. . Apply cold applications to reduce the swelling; place a barrier, for example, a thin towel, between the cold container and the skin. ⚫ After the swelling decreases, apply warm, wet applications because warmth relaxes the muscles. Obtain medical help for severe strains and all back injuries. SLINGS Slings are available in many different forms. Commercial slings usually have a series of straps that extend around the neck and/or thoracic (chest) region (Figure 4-20). A common type of sling used for first aid is the triangular band- age. Slings are usually used to support the arm, hand, forearm, and shoulder. They may be used when casts are in place. In addition, they are also used to provide immobility if a fracture of the arm, collar- bone, or shoulder is suspected. FIGURE 4-20 Commercial slings usually have a series of straps that extend around the neck and/or thoracic region. Muistojo EduCUDOO 2022-1444 GE44.PATHWAYS.002.82.HLTH.58.indb 103 FIRST AID 103 18/01/2023 14:30

NECK AND SPINE INJURIES Injuries to the neck or spine are the most dangerous types of injuries to bones and joints. CAUTION: If a person who has injuries to the neck or spine is moved, permanent damage resulting in paralysis can occur. If at all Safety possible, avoid any movement of a person with neck or spinal inju- ries. Wait until a backboard, cervical collar, and adequate help for transfer are available. checkpoint 1. What is a fracture? 2. What is a sling used for? 4:10 PROVIDING FIRST AID FOR SUDDEN ILLNESS The victim of a sudden illness requires first aid until medical help can be obtained. Sudden illness can occur in any individual. At times, it is difficult to determine the exact illness being experienced. However, by knowing the signs and symptoms of some major disorders, you should be able to provide appropriate first-aid care. Information about a specific condition or illness may also be obtained from the person themself, med- ical alert bracelets or necklaces, or medical information cards. Be alert to all of these factors while caring for someone who has a sudden illness. FIGURE 4-21 Severe pressure under the sternum with pain radiating to the shoulders, arms, neck, and jaw is a common symptom of a heart attack. HEART ATTACK A heart attack is also called a coronary thrombosis, coronary occlusion, or myocardial infarction. It may occur when one of the coronary arteries supplying blood to the heart is blocked. If the attack is severe, the person may die. If the heart stops beating, CPR must be started. SIGNS AND SYMPTOMS: Signs and symptoms vary, depending on the amount of heart damage. ⚫ Severe, painful pressure under the breastbone (sternum) with pain radiating to the shoulders, arms, neck, and jaw (Figure 4-21). • Intense shortness of breath. ⚫Pale or cyanotic skin, especially near the lips and nail beds. 104 CHAPTER 4 وزارة التعليم Missing or Eductions 2022 1444 GE44 PATHWAYS.G02.82.HLTH.S8.indb 104 18/01/2023 14:30

وزارة التعليم The patient feels very weak but is also anxious and apprehensive. Nausea, vomiting, diaphoresis (excessive perspiration), and loss of consciousness may occur. The signs and symptoms of a heart attack in females are often more subtle: They may experience unusual fatigue and sleep disturbances for weeks prior to the attack. . Cold sweats are common, as is pain in other areas than the chest, such as the arms, back, stomach, neck, and jaw. ⚫Heart attacks are often misdiagnosed in females. FIRST AID: Encourage the patient to relax. . Place the person in a comfortable position to assist breathing. Obtain medical assistance as soon as possible. ⚫ Shock frequently occurs, so provide treatment for shock. Prevent any unnecessary stress and avoid excessive movement because any activity places additional strain on the heart. ⚫ Reassure the person constantly. CEREBROVASCULAR ACCIDENT OR STROKE A stroke is also called a cerebrovascular accident, or CVA, apoplexy, or cerebral thrombosis. It is caused by the presence of a clot in a cerebral artery that provides blood to the brain, or hemorrhage from a blood vessel in the brain. SIGNS AND SYMPTOMS: ⚫ Signs and symptoms vary, depending on the part of the brain affected. ⚫Numbness (especially on one side of the body). ⚫ Paralysis (especially on one side of the body). ⚫Eye pupils unequal in size. ⚫ Mental confusion. ⚫ Sudden severe headache. . Loss of balance or coordination. ⚫ Slurred speech. Nausea and vomiting. ⚫ Difficulty breathing and swallowing. Eoss of consciousness. Ministinjor Em.cupion 2022-1444 GE44.PATHWAYS.002.82.HLTH.58.indb 106 FIRST AID 105 18/01/2023 14:30

106 CHAPTER 4 وزارة التعليم Ministry or Em.cution 2022-1444 GE44 PATHWAYS.G02.82.HLTH.58.indb 106 A quick and easy way to remember the signs and symptoms of stroke is to think FAST: ⚫ F = Face: Ask the person to smile. If one side of the face appears to be drooping or crooked, it may be a sign of stroke. • ⚫ A = Arms: Ask the person to raise both of their arms. If they have difficulty lifting one, or keeping one raised, it may be a sign of stroke. ⚫ S = Speech: Ask the person to speak. If the words are slurred or they have difficulty speaking, it may be a sign of stroke. ⚫ T = Time: If they have any of these symptoms, call 997 (EMS) immediately. FIRST AID: •Maintain respirations. ⚫ Lie the person flat on the back with the head slightly elevated or on the side to allow secretions to drain from the mouth. Avoiding giving any fluids by mouth. ⚫ Reassure the person, prevent any unnecessary stress, and avoid any unnecessary movement. Always remember that although the person may be unable to speak or may appear to be unconscious, they may be able to hear and Comm understand what is going on. It is very important to know exactly when the symptoms started and to obtain medical help as quickly as possible. Immediate care during the first 3 hours can help prevent brain damage. FAINTING Fainting occurs when there is a temporary reduction in the supply of blood to the brain. It may result in partial or complete loss of consciousness. The person usually regains consciousness after being in a supine position (lying flat on their back). SIGNS AND SYMPTOMS: ⚫ Dizziness. • Extreme pallor. ⚫ Excessive sweating for no apparent reason (called diaphoresis). .Coldness of the skin. • Nausea. • Numbness and tingling of the hands and feet. 18/01/2023 14:30

وزارة التعليم FIRST AID: Help the patient to lie down or to sit in a chair and position their head at the level of the knees. If the patient loses consciousness, try to prevent injury. ⚫ Keep the patient in a supine position (lying down). If no neck or spine injuries are suspected, use a pillow or blankets to elevate their legs and feet by 30 cm (12 inches). Loosen any tight clothing and maintain an open airway. • Use cool water to gently bathe their face. ⚫ Check for any injuries that may have been caused by the fall. Permit the patient to remain flat and quiet until color improves and they have recovered. Then, allow the patient to get up gradually. If recovery is not prompt, if other injuries occur or are suspected, or if fainting occurs again, obtain medical help. Fainting can be a sign of a serious illness or condition that requires medical attention. CONVULSION A convulsion, which is a type of seizure, is a strong, involuntary contrac- tion of muscles. Convulsions may occur in conjunction with high body temperatures, head injuries, brain disease, and brain disorders such as epilepsy. SIGNS AND SYMPTOMS: ⚫ Convulsions cause a rigidity of muscles followed by jerking movements. . During a convulsion, a person may stop breathing, bite the tongue, lose bladder and bowel control, and injure body parts. The face and lips may develop a cyanotic color. The person may lose consciousness. ⚫ After regaining consciousness at the end of the convulsion, the person may be confused and disoriented, and complain of a headache. FIRST AID: ⚫ Help to prevent self-injury. Remove dangerous objects from the area. Provide artificial respiration as necessary. Do not try to place anything between the teeth. This can cause severe njury to your fingers, and/or damage to the person's teeth or gums. Ministry or Em.cupon 2022-1444 GE44.PATHWAYS.002.82.HLTH.58.indb 107 FIRST AID 107 18/01/2023 14:30

Face flushed Fruity odor to breath Tongue dry Labored, prolonged respirations Blood pressure low Weak and rapid pulse Diabetic coma (Hyperglycemial Appears to be in stupor or coma High blood glucose levels • • Do not use force to restrain or stop the muscle move- ments; this only causes the contractions to become more severe. . When the convulsion is over, watch the person closely. If fluid, such as saliva or vomit, is in the mouth, position the person on their side to allow the fluid to drain from the mouth. Allow them to sleep or rest. • Obtain medical help if the seizure lasts more than a few minutes, if there are repeated seizures, if other severe injuries are apparent, if the person does not have a history of seizures, or if they do not regain consciousness. Urine positive for sugar and acetone Skin dry Insulin shock (Hypoglycemia) -Excited, nervous, dizziness, confused, imitable, inappropriate responses -Low blood glucose levels -Headache -Face pale -Shallow or rapid respirations Blood pressure normal -Full and pounding pulse DIABETIC REACTIONS Diabetes mellitus is a metabolic disorder caused by an insufficient production of insulin (a hormone produced by the pancreas). Insulin helps the body transport glu- cose, a form of sugar, from the bloodstream into body cells, where the glucose is used to produce energy. When there is a lack of insulin, sugar builds up in the blood- stream. Insulin injections can reduce and control the level of sugar in the blood. Individuals with diabetes are in danger of developing two conditions that require first aid: diabetic coma and insulin shock (Figure 4-22). Diabetic Coma Diabetic coma, or hyperglycemia, is caused by an increase in the level of glucose in the bloodstream. It may result from an excess intake of sugar, failure to take insulin, or insufficient production of insulin. SIGNS AND SYMPTOMS: ⚫ Confusion. Urine negative for sugar and acetone -Skin moist- excessive perspiration • Weakness or dizziness. Nausea and/or vomiting. • Rapid, deep respirations. -Lack of coordination, trembling • ⚫ Dry, flushed skin. ⚫ A sweet or fruity odor to the breath. 108 CHAPTER 4 FIGURE 4-22 Diabetic coma (hyperglycemia) versus insulin shock (hypoglycemia). وزارة التعليم Mousing or Education 2022-1444 GE44 PATHWAYS.G02.82.HLTH.58.indb 108 18/01/2023 14:30

وزارة التعليم Ministinjor Em.cupons 2022-1444 FIRST AID: The person will eventually lose consciousness and die unless the con- dition is treated. ⚫ Medical assistance must be obtained as quickly as possible. Insulin Shock Insulin shock, or hypoglycemia, is caused by an excess amount of insulin (and a low level of glucose) in the bloodstream. It may result from failure to eat the recommended amounts, vomiting after taking insulin, or tak- ing excessive amounts of insulin. SIGNS AND SYMPTOMS: ■ Muscle weakness. ⚫ Mental confusion. Restlessness or anxiety. ⚫ Diaphoresis. • Pale, moist skin. ⚫ Hunger pangs. Palpitations (rapid, irregular heartbeats). The person may lapse into a coma and may develop convulsions. FIRST AID: The onset of insulin shock is sudden, and the person's condition can deteriorate quickly. Immediate care is required. If the person is conscious, give them a drink containing sugar, such as sweetened orange juice. A cube or teaspoon of granulated sugar can also be placed in the mouth. If the person is confused, avoid giving hard candy. Unconsciousness could occur, and they could choke on the hard candy. Many individuals with diabetes use tubes of glucose that they carry with them. If the person is conscious and can swallow, and a glucose tube is available, it can be given to them. ⚫ The intake of sugar should quickly control the reaction. If the person loses consciousness or convulsions start, provide care for the convul- sions and obtain medical assistance immediately. By observing symptoms carefully and obtaining as much information as possible from the person, you can usually determine whether the condi- tion is diabetic coma or insulin shock. Ask, "Have you eaten today?" and "Have you taken your insulin?" If the person has taken insulin but has not eaten, insulin shock is developing because there is too much insu- GE44.PATHWAYS.002.82.HLTH.58.indb 109 FIRST AID 109 | 18/01/2023 14:30

lin in the body. If they have eaten but not taken insulin, diabetic coma is developing. In cases when you know that the person is diabetic, but they are unconscious, and there are no definite symptoms of either condition, you may not be able to determine whether the condition is diabetic coma or insulin shock. In such cases, the recommendation is to put granulated sugar under the person's tongue and contact the EMS. If the patient is in diabetic coma, the blood-sugar level can be lowered as needed when the person is transported for medical care. If the person is in insulin shock, however, brain damage can occur if the blood-sugar level is not raised immediately. Medical care cannot correct brain damage. checkpoint 1. What is a myocardial infarction? 2. When evaluating stroke, what does the acronym FAST stand for? Today's Research Tomorrow's Health Care A Skin Gun to Treat Burns? Researchers have developed a device that is similar to a paint spray gun or airbrush. The process begins with surgeons using a dermatome, a special knife that can remove a very thin layer of the patient's healthy skin. Skin stem cells are isolated from this layer of skin and put into a water solution for approximately 90 minutes. This mixture of cells and water is put into syringes and inserted into the nozzle of the gun. The gun is attached to a processor-controlled pneumatic (air) device that produces an even flow of solution. The skin cells are then sprayed directly onto the burn. The sprayed wound is covered with a specially created dressing that contains tubes connected to a source of nutrients and antibiotics that provide nourishment for the cells and help prevent infections. The process takes less than 2 hours for most patients. In clinical trials, the burns heal in days instead of weeks for skin grafts. In addition, there is less scarring of the tissue. Research continues to improve the method so it can be used to treat full-thickness burns. Instead of a full skin graft, a very small donor skin sample is taken from the patient. Stem cells from the sample are then suspended in a special solution, which is then gently sprayed onto the wound. In addition, researchers are working on finding a way to restore full pigmentation on patients with darker skin pigmentation. With these new devices, treatment of burns will be more efficient and effective in the future. In addition, researchers are hopeful that they will be able to treat other types of skin damage or scarring, such as acne scarring and wounds, and surgical incisions that fail to heal with traditional treatments. Case Study Investigation Conclusion What did you decide Khalid and Abdullah should do? If Rashed is bleeding because of his injury, what should they do? Do they need to check Mohammed for injury? Who is responsible for calling the EMS? What items could they use to improvise if they don't have medical supplies? 110 CHAPTER 4 وزارة التعليم Minising or Educabine 2022 1444 GE44 PATHWAYS.G02.82.HLTH.58.indb 110 18/01/2023 14:30