First Aid

First AidChad Peters, MS, ATCRecognizing and Responding to an EmergencyWhats Out of the OrdinarySights, appearances, behaviors, odors, noisesExamples?

Ask QuestionsOvercoming BarriersWhy dont people act?Presence of other peopleSome one else can helpBeing unsure of the ill persons conditionFear Catching DiseaseDoing Something WrongLaw SuitUnsure when to call 911How do we over come these?Good Samaritan LawsProtect citizens who act the same way a reasonable and prudent person would if they were in same situation.Act in good faithNot be deliberately negligent or recklessAct within the scope of his or her trainingNot abandon the person

Obtaining ConsentPrior to giving care, you MUST get consentTo obtain consent:State your nameTell the person you are trained in 1st AidAsk the person if you can helpExplain what you think is wrong and what you are going to doDO NOT give care to some one who refusesDO call 911 anywayUnconscious = Implied Consent, as well as child or infant with out parentPreventing Disease TransmissionAvoid contact with bodily fluidsAssume everyone is infected with somethingThis also includes clothing and surfacesCover your own open wounds and lesionsRemove jewelry prior to putting on glovesAvoid touching your own mouth, nose, or eyesHave gloves, goggles, breathing barriers available

Cleaning Up Blood SpillsUse something to absorb such as paper towels or towelsBleach and Water (1 cup to one gallon of water solution) or other product.Use biohazard bag or container if saturated

Most Common Blood Borne PathogensHep B, Hep C, HIVEmergency Action StepsCHECKSceneWhat Happened# People InvolvedImmediate DangerAny available to help?Unconscious?BreathingBleedingEmergency Action StepsCall911On campus call campus safety - 3229Dial 7 on campusLand line

If you are not sure whether or not you should call, CALL911 Calls...Must give dispatcher following informationType of emergency situationType of suspected injuryPresent condition of athleteCurrent assistance being given (CPR, ect)Location telephonecross streetshow to enter facilityAssessment ProceduresPrimary SurveyABCsBleeding/ShockSecondary SurveyVitalsSigns & Symptoms

Unconscious PersonNote Body PositionDetermine level of consciousnessABCsNeck & SpineDo not remove helmet (face mask o.k.Establish AirwayIf prone and no breathing, role over (supine)If prone and breathing, do not role overWhen consciousness gained, log roll to spine boardMaintain Vitals until EMS arrivesPerson is stabilized, 2ndary survey

External BleedingDirect PressureElevationPressure pointsBrachial/FemoralShockCan occur with any injuryMost likely insevere bleedinginternal injuryfracturesDefinitionNot enough blood available to circulatory systemDilation of blood vessels & imbalance of osmotic pressureShock if untreated can cause DEATHRisky Conditionsextreme fatigueextreme temperatureextreme dehydrationillness

Handling ShockSigns & Symptoms SkinMoist, pale, cool, clammy skinWeak & rapid pulseIncreased & shallow breathingdecreased b.p.extreme thirst

Treating ShockMaintain body temperatureElevate FeetUnless head & neckIf psychogenic, do not allow athlete to see injuryDo not over react, but confident & in control.VITALSPulse60-80 in adultsAccount for activity80-100 in childrenRespiration12 in adults20-25 in childrenBlood PressureTemperatureSkin Color

Blood PressureSystolic over diastolic120/80Temperature98.6Skin ColorPupilsshock, heatstroke, hemorrhagestimulants

State of ConsciousnessMovementHead InjuryStroke (cerebrovascular accident)Abnormal Nerve ResponseNerve damageblocked arteryspinal cord injuryhead injuryMoving an Injured PersonWhen to move an injured person?You are faced with immediate dangerNeed to move to another person who may have more serious injuriesWhen you need to provide proper care and cannot do so where you are located.See pages 8 and 9 for methods of how to move some one.

Skill Card Checking Injured Person

Show Injury Cycle Hand Out24The Physics of InjuryMuscle/tendon injuriesinjured by excessive tensionmuscle/fascia injuries occur during eccentric contractiontendons are strong -- 8700 to 18,000 lb./sq. inch. strains occur most often at the musculotendinous junction (MTJ)MTJ strains -- most common soft tissue sports injuries

25Mechanical Forces of InjuryThree types of forceTensiletendons resist tensile forceCompressivebones resist compressive forceShearligaments resists tensile force

CompressiveTensionShear26Critical ForceCritical Force: Defined: How much force can tissue withstandVaries for each type of tissueMay vary within the same tissue, depending upon: agetemperatureskeletal maturitygenderbody weight27The Physiology of InjuryThe inflammatory processWhenever damaged, the body reacts with a predictable sequence of physiologic actions, commonly called swelling.begins during the first few minutes following an injury28The Physiology of Sports InjuryNormal signs/symptoms include swellingpainreddening of skinincreased local temperatureloss of functionseveral specific stages:Acute inflammatory phaseResolution (Healing) phaseRegeneration & Repair

29Intervention ProceduresControlling the inflammatory processcryotherapy (crushed ice bags, aerosol coolants, ice cups, ice water baths, commercial cold packs)After the acute phase, application of heat is appropriate (hydrocolator packs, warm towels, and ultrasound).30

31Pain and Acute InjuryEveryone copes with pain differently.Pain is as much psychological as physiological.Pain results from sensory input received through the nervous system and indicates location of tissue damage.Messages concerning sensory information that travel quickly through nervous system are given higher priority than pain messages that travel more slowly.Pain is not a useful indicator of injury severity. Injuries at WorkLeading causes of injury related death at workMotor Vehicle accidentsHomicidesFallsAccidents with machineryInjuries from falling objectsElectrocutionsTypes of Open Wounds

Care for Open Wound1. Stop BleedingDirect Pressure with gauze (if available)Stack gauze, do not remove it.Pressure points in severe cases (arteries)Clean with soap and water, irrigate with water, 5 min if possibleOintment (neosporin, triple antibiotic, etc.)Cover with band aide or other non stick product.Stitches? inch long or skin does not naturally come together.

Pressure PointsBurn CareTypesSuperficial, or 1st degreeInvolves top layer, red, dry skin, painfulPartial thickness, or 2nd degreeInvolves top layers of skin, swelling, blisters, heals in 3 to 4 weeks, scarring possibleFull thickness, or 3rd degreeMay destroy all layers of skin and underlying structures, such as muscle, fat, bones, and nervesSkin brown and charred, healing may need assistanceCritical BurnsCause trouble breathingCovering more than one body part or large surface areaHead, neck, hands, feed, or genitalsBurns to the airwayChildren and elderlyResulting from chemicals, explosions, or electricity

All the above are life threatening, Burn CareThermalMust act quickly to cool skin with cool water After checking scene, of course!ChemicalIf Powder, brush off prior to rinsingIf liquid, rinse with water until EMS arrives or symptoms cease.ElectricalDo not touch until sure power source is removed911InfectionExamples of Staph Infections

www.spapex.org/spapex/ impetigobulloso.jpgStaph Infection

MRSA

Special SituationsEmbedded object in eyeDo not attempt to remove embedded objectUse cup or something similar to protect the eyeCover both eyes to avoid movement

Severed Body PartWrap in gauze, place over ice, 911!

NosebleedPressure, lean forward to allow clottingFind out why bleeding, dry air or injuryTeetheIf misplaced, try to correctIf knocked out, place in milk or water and get to dentist quickly.44Acute and Chronic InjuriesAcute injury - injury characterized by rapid onset, resulting from a traumatic eventAcute injuries typically involve trauma followed by pain, swelling and loss of function.Critical force -- magnitude of a single force for which the anatomical structure of interest is damaged45Acute and Chronic InjuriesChronic injury - injury characterized by a slow, insidious onset, implying a gradual development of structural damageChronic injuries develop over time and are often associated with repetitive, cyclic activities, such as running.These injuries are commonly called overuse injuries. Common sites include the Achilles tendon, patellar tendon and the rotator cuff.

46Soft tissue includes:muscle, fascia, tendon, joint capsule, ligament, blood vesselsnervesSoft Tissue and Skeletal Injury47Soft Tissue and Skeletal InjuryMajority of injuries involve: Bruises (contusions)SprainsStrainsSkeletal injuries involve bony structures 48Standard Nomenclature of Athletic Injuries (AMA) 1968.Sprains - injuries to ligaments (three levels)1st degree: Slightly torn ligament2nd degree: Significantly torn ligament3rd degree: Completely torn ligamentStrains - injuries to tendon, muscle or musculotendinous junction (Same 3 levels as above)Contusions - commonly called a bruise Connective Tissue Injury49Connective Tissue InjuryFractures - break or crack in bone -- two types: closed and openStress fracture - break or crack in a bone which develops over a relatively long time periodDislocations - the displacement of contiguous surfaces of bones comprising a joint -- two types:subluxation - partialLuxation or dislocation - total displacement

Care of musculoskeletal injuriesSevere injuries must be splinted until extent of injury is determinedSplinting always consists of the joint above and below the injury

RICERest, Ice, Compression, ElevationOr the ARC VersionRest, Immobilize, Cold, ElevateShow slides from other lectures.