First Aid

Question 1

What is CPR?

Answer 1

Cardiopulmonary resuscitation is the emergency procedure used on a person when their heart stops (cardiac arrest). It consists of compressing on the centre of the chest and in some cases, providing rescue breaths either via an ambu-bag, or from another person breathing to the arrested person’s mouth. There is a 30% chance that someone will recover successfully from CPR.

Question 2

Ratio of CPR in different age groups;

Answer 2

Adults; 30:2

Newborn/neonate; initial 5 rescue breaths, then 15:2

Infant/child; initial 5 rescue breaths, then 30:2

Question 3

Paediatric Understanding of terms

Answer 3

Paediatric; relating to the branch of medicine dealing with children and their diseases

Newborn; a child just after birth

Neonate; a child within the first 28 days of life

Infant; a child under 1 years old

Child; between one years old and puberty

Adolescents; the ages between being a child and an adult. ‘No longer a child but not yet an adult’.

Puberty; the physical and emotional changes a child experiencing when becoming an adult.

Question 4

Signs and a cardiac arrest

Answer 4

• Agonal (poor) breathing
• Colour; cyanosis, ashiness, loos of pinkiness, etc.
• Temperature; cold skin
• Unresponsive
• Lack of a pulse/adequate pulse

Question 5

DRSABC- Primary Survey

Answer 5

Danger; check for any

Response; firmly shake their shoulders, raise your voice and seek a response. Never shake small children, always tap their foot.

S; shout for help, both in person and also through a phone (999)

Airways; to assess if they are inhaling and exhaling air, place on hand on their forehead and the fingers of the other hand on their chin, and gently tilt their head back. this will allow you to assess if there is an airway obstruction and that they are in the optimal position to check their airways. In the event of doing this for a newborn, neonate or small child, do not over extend the airways, as this will cause damage and obstruct their airways, having the opposite intended effect.

Breathing; check that someone is breathing by listening, looking and feeling for air entering and exiting their body. You should do this for no more than 10 seconds. During Covid, place a loose material over their face that will not obstruct airways or damage the face before doing this.

Circulation; check for signs of bleeding, and is there are, apply pressure, either direct or indirect depending on the situation and if not, move on to the secondary assessment.

Question 6

ACVPU- response scale

Answer 6

This is used to assess the level of responsiveness by a patient/casualty, both in emergency situations and during regular observation rounds.

• Alert; are they awake? Looking around, responding?
• Confusion; are they suddenly very confused?
• Voice; do they respond to your voice? when you talk to them, do they answer in some way? even if un-typical?
• Pain; do they respond to pain stimuli? when you pinch their earlobe, do they widen their eyes? do they verbally make a noise, e.g. a groan? do they jerk a limb?

Unresponsive; are they unresponsive to all stimuli? are they completely unconscious? do they have 0 responses to any of your attempts throughout this scale?

Question 7

AMPLE- Secondary Assessment

Answer 7

This is carried out after the primary survey and you have a responsive patient/casualty, where you ask for more information about what happened, how, when, and regards pain, the event, past medical history etc. to create a wider picture of the person, the situation and their state of health, all to best treat them.

• Allergies; do they have any?
• Medication; are you on any? have you taken anything? when was the last time you did and how much?
• Past medical history; do they have any known conditions that need to be taken into consideration for treatment? E.g. if they have COPD this will effect their obs and therefore is necessary information.
• Last eaten; when was this? what was it, how much? Will they need surgery? This is important
• Event history; what happened?

Question 8

Choking and signs of

Answer 8

This occurs when a person has an airway obstruction, in that their airways are blocked and cannot breathe sufficiently enough. You will typically know when this occurs as most people with point to their throat and start to panic. Further signs of this;

• coughing suddenly, such as after eating or drinking (may just be aspiration)
• change in the colour of their face

Question 9

How to help a choking person;

Answer 9

Always encourage the person to cough, because it may me a mild blockage and something easily resolved with coughing the object up. Using back blows and abdominal thrusts can cause more harm in these instances.

Adult;

• encourage them to cough as much as possible,
• stand beside but slightly beside them, supporting their front with one arm and with the other, using he heel of your hand, administer 5 back blows between the adult’s shoulder blades
• if choking continues, go behind the person, lean them slightly forward and bring both arms around their abdomen. meet both hands between the bottom of their breast bone and belly button, clasping one fisted hand with the other and thrust upwards and inwards, until the airways clear.

Question 10

What are seizures?

Answer 10

A seizure occurs when a sudden burst of electricity occurs in someone’s brain. The location in which this occurs in one’s brain relates to how they act during their seizure.

Question 11

Common types of seizures and their signs; symptoms depend on where the electricity takes place on the brain regardless of type of seizure.

Answer 11

Focal seizrues;
- entail a large variety of symptoms depending on which section of the brain the seizure (electrical burst) kicks off.

Tonic seizures;
- this type often occurs during sleep, it can cause the person’s muscles to tighten, their whole body, arms or legs and if they are aware and standing, they will likely fall over.

Atonic seizures;
- (also called drop attacks), as the person will lose all muscle tone and drop heavily to the ground. these seizures are brief, and the person will recover quickly.

Absence seizures;
- this type can cause the person to lose consciousness for a few second and appear ‘daydreaming’. they will be unaware as to what is going on around them and they are hard to identify.

Tonic-clonic seizures;
- the most common and widely recognised seizure, with two phases:

1. ) tonic phase; they’ll lose consciousness, go stiff and fall to the floor
2. ) clonic phase; their limbs will jerk, and they may lose control of their bladder/bowel

Myoclonic seizuires;
- very brief and can cause the person’s limbs, head, body, etc. to ‘jerk’, e.g. they may randomly jerk and spill a drink, but this is still a seizure.

Question 12

How to help in the event of a seizure;

Answer 12

You should;

• Move objects away incase they fall/collapse to avoid injury, e.g. a table corner can cause damage
• be calm and reassuring at all times/throughout
• inform them of what happened if they do not recall/you believe they don’t know
• check for medical jewellery that may identify if they have epilepsy
• stay with them until they have fully recovered
• place them into recovery position if they go unconsciouses, which will aid their breathing
• cushion their head to avoid head injury

Do not;

• Do not restrain them
• give them food/drink (choking hazard)
• leave them if worried about their state/during their seizure
• attempt too hard to bring them around
• do not assume they are aware of whats happening
• do not shout at them

Call 999 if;

• it is their first ever seizure
• if it lasts longer than 5 minutes
• if the person is injured
• if you believe they need medical attention
• if another seizure occurs after the initial one without the person regaining consciousness

Question 13

ACTION- Seizures

Answer 13

This is an anagram used in the event of epileptic tonic-clonic seizures (the most common type);

Assess; the situation. are they in danger of hurting themselves?

Cushion; their head to prevent a head injury, with a cushion, jumper, etc. that is soft and protective

Time; check the time the seizure starts at or when you found the person. If it lasts longer than 5 minutes, call an ambulance.

Identify; look for medical jewellery on the person, as it may provide vital information about them

Over; once the seizure has stopped, place the person on their side (recovery position) to ensure they keep breathing

Never; restrain the person, put something in their mouth or attempt to give them food or drink

Question 14

What is shock?

Answer 14

Shock is a serious, life-threatening condition which happens when vital organs of the body do not receive an adequate blood flow, which can lead to organ failure. It is a complex clinical syndrome which is the result of acute circulatory failure; in that the metabolic needs of cells of the body do not receive an adequate blood flow.

Shock is the reduction in circulating blood volume, blood pressure and cardiac output. This causes tissue hypoxia, an inadequate supply of nutrients and the accumulation of waste products.

Adequate blood flow to the cells requires three components;

• An effective pump; a well functioning heart
• An effective circulatory system
• Adequate blood volume

Question 15

Signs and Symptoms of Shock

Answer 15

• pale, cold and clammy skin
• sweating
• tachycardia (rapidly weak pulse)
• tachypnea; (rapid breathing that may also become shallow)
• cyanosis (blueish tint to the skin/ mucous membranes, e..g mouth)
• naseua and/or vomiting
• restless and aggressive behaviour
• unresponsiveness

Question 16

Treating shock;

Answer 16

To treat shock in nay casualty (regardless of age) we need to try and reverse the cause of shock, e.g. stopping a severe bleed, whilst reassuring the casualty.

Adult

• call 999
• lie them down flat
• raise their legs above heart level, which increase blood flow to vital organs heart and brain (only in case of no leg/spinal cord injuries)
• if casualty is pregnant, lie them on their side, to prevent obstruction of blood flow back to heart
• loosen any tight clothing, particularly around head, neck and waist
• stay with casualty, reassure and attempt to keep them warm (prevent hypothermia)
• ensure constant checking of their response levels, prepare to check airways/start CPR if necessary

Baby

• lay them down flat
• raise their legs above chest level, you can maintain this position by placing a rolled up towel or cushion under their legs
• do not leave them alone
• call 999
• loosen any tight clothing around head, neck and waist
• check response levels, talk to them, reassure them
• prepare to do CPR if necessary

Question 17

Anaphylactic Shock & signs/symptoms;

Answer 17

This is a severe allergic reaction. During this, provoked by the systematic release of inflammatory mediators, e.g. antihistamine, causes hypotension and venous pooling. Severe bronchoconstriction leads to breathing difficulties and hypoxia;

(during this type of shock, the pump (heart) and blood volume will remain effective.the same, but due to the widespread vasodilation, there is a larger ‘container’ for the blood volume to fill).

• red, itchy, watery eyes
• swelling of body parts, e.g. hands, face, feet, neck, etc.
• a red, itchy rash or raised area of skin (weals)
• facial oedema
• abdominal pain, vomiting or dioreah
• swelling of tongue and or throat
• difficulty breathing
• eye puffiness
• confusion and agitation
• signs of shock, leading to collapse and unresponsiveness

Question 18

Cardiac Output (CO)

Answer 18

This is measured in Litres per minute (L/min), and is the amount of blood the heart pumps through the circulatory system in one minute; HR X SV

Stroke volume; the amount of blood pushed out by the left ventricle of the heart in one contraction.

Heart rate; the number of times the heart beats per minute.

E.g. if Jack’s SV is 70mLs and their HR is 60bpm;

CO = HR X SV
SV = 70mLs
HR = 60bpm

70 X 60 = 4,500mL/min and because CO is measured in L, we divide our answer in mLs by 1000 to make it Litres of units, and our answer is CO for jack = 4.5Ls.

Question 19

Peripheral resistance

Answer 19

Peripheral resistance is the resistance of arteries to the flow of blood through them;

• when the arteries constrict, the resistance increases (BP goes up)
• when the arteries dilate, the resistance decreases, (BP goes down)

Question 20

Mechanisms of Shock (three components)

Answer 20

Blood pressure (pump;heart)
- CO = HR X SV 

Blood pressure (fluid volume)

• CO is dependant on venous return. the blood returns in large veins and fills the right chambers of the heart, and as the heart’s walls stretch during this, this is detected by stretch receptors. Cardiac contraction is determined by myocardial stretching (starling’s law of the heart).
• if venous return drops (less coming back from the body to the heart), BP will be lowered as it feeds back to CO.
• if venous return increases, so therefore will CO, but in the vent of too much venous return, the heart will not cope (fluid overload)
• small volume of blood; small contraction (less to pump out to the rest of the body)
• large volume; large contraction (more force needed to get the blood pushed out to rest of body)
• volume overload; heart won’t cope and will be overloaded with fluid

Blood pressure (container; peripheral resistance, after load)
- systemic vascular resistance;
-increased vr; increased BP
decreased vr; decreased BP

Question 21

What are burns/causes of;

Answer 21

A burn is an injury to the skin or other organic tissue. The following factors can cause burns;

• heat
• cold
• friction
• electricity
• radiation
• corrosive chemicals

Question 22

Classification of burns

Answer 22

Burns can be classified according to their depth;

First degree;
- this is when only the epidermis is affected. This outer layer is moist and there will be signs of inflammation, redness, swelling pain (blisters in this degree as less likely as tissue damage here is unlikely).

Second degree;
- this is when the epidermis and upper dermis layers are both affected. in addition to redness, swelling, pain and inflammation, blistering is often present, indicating tissue damage.

Third degree;
- this is also known as deep or full thickness burns and when the epidermis and dermis are both destroyed. these burns are relatively painless as the sensory nerve endings are destroyed by the cause of the burn. a few days after the initial burn, the destroyed tissue will coagulate, form a thick scar and slough off after 2-3 weeks.

Question 23

How to treat burns in adult & baby (1)

Answer 23

• cool the burn immediately, which can decrease its severity for at least 10 minutes or until pain feels better, under cold running water (not submerged)
• move them away from the source of the burn, e.g. fire to prevent others/further damage
• gently remove any jewellery or clothes near the burn if not directly in contact, as this will peel off stuck skin
• don’t use ice, gels or creams as this could cause tissue damage and increase risk of infection
• cover the burn vertically with cling film once it has cooled and after the first two rolls of it (cleanest). scrunch edges and do not wrap around the limb. a plastic bag can be used also.
• don’t burst and blisters
• special gels/dressings for burns are not recommended
• prepare to treat casualty for shock

when to call 999;

• if the burn is serious/large
• is the casualty is a child
• if the location of the burn is hand/feet/or face
• if the burn is deep

Question 24

Types of burns

Answer 24

Burn;
- usually caused by dry heat, such as a flame or fire, hot iron or the sun (sunburn)

Scald;
- usually caused by wet heat, such as steam or a hot cup of tea

Circumferential burns;

• this is where full thickness (third degree) burns have encircled any part of the body and where complications may arise from constriction of the eschar (thick scab)
• an example of this is a circumferential burn on the chest which results in respiratory impairment
• another example is the blood circulation to a distal part of the burned/affected limb may be impaired

Question 25

Burns; ‘Rule of 9s’

Answer 25

The extent of burns are often estimated using the ‘rule of nines’. in adults, hypovolemic shock usually develops when 15% of the surface area is affected. Fatality is likely in adults with third degree burns if the surface area is added to the patients age and the total is greater than 80.

The rule of nines divides the body’s surfaces into percentages.

Question 26

How to treat specific burns (2)

Answer 26

Minor burns & scalds;
- cool under cold, running water for at least ten minutes

Chemical burns;

• flush the burn with cool running water for at least 20 minutes
• remove contaminated clothing is safe to do so

Severe burns;
- cool burns for at least ten minutes under cool, running water

Question 27

What is bleeding & its causes?

Answer 27

bleeding is when blood escapes from the circulatory system;

• trauma
• haemorrhage
• burns
• surgery

Question 28

Treatment of severe bleeding

Answer 28

• wear gloves when/where possible, to prevent transmission and infection of microbes and diseases
• if the wound/source of the bleed is covered by clothing, remove this to uncover the bleed.
• if there is an object within the source of the bleed, do not remove it, as it will be acting like a ‘plug’ and removing it will cause the bleed to become worse, risking shock and other problems. in this case, apply indirect pressure at either side of the object and push together.
• if there is not an object within the wound, apply direct pressure with your hands/fingers and if you can, use a sterile dressing or dressing pad to stop/slow down the bleed. if you don’t have a sterile dressing, ask the casualty (if they are able) to apply pressure themselves (reduced risk of infection/transmission from them to you).
• secure the dressing with a bandage that is firm enough to support the pressure but not too tight that it cuts of circulation. follow this up with a CRT (capillary refill test) on a nearby nail bed or the surrounding skin, and if colour does not return, the bandage is too tight.
• call 999
• help the casualty to lie down if possible, as they may develop shock and standing can make this worse. Have them raise their legs (if an injury is not preventing this, e.g. spinal or leg) and support them in this position either yourself or with a chair, to encourage blood flow back to the vital organs; heart and brain.
• if bleeding seeps through the dressing, apply a second bandage and if this occurs again through both, remove all dressings and reapply fresh ones, re-bandaging it.
• continuous checks of adequate circulation and casualty’s response levels, alongside reassurance is vital.

Question 29

Hypovolemic Shock

Answer 29

Hypo- low
Vol- volume
Aemic- blood

Low blood volume within the CVS can cause shock. Hypovolemia refers to the state of low ECF volume, often combined with sodium and water loos, In other words, this term relates to the lack of blood volume circulating in the body.

Shock will occur when blood volume is reduced by 15-25%. As a result, CO may fall because of low blood volume and hence, low venous return, as a result of various reasons;

• severe haemorrhage; (bleeding) in that whole blood is lost
• extensive burns; serum is lost
• severe vomiting and direeoeah; water and electrolytes are lost

Question 30

Difference between hypoveolemic shock and hypovolemia

Answer 30

First;
Although there is no distinct difference, severe hypovolemia may be present when loss of blood or ECF results in decreased peripheral perfusion.

Second;
Hypoveomic shock is considered present when severe hypoveomia results in organ dysfunction as the result of inadequate tissue perfusion.

Question 31

How to help a choking baby

Answer 31

You will know a baby is choking when they are unable to cry or respond.

Back blows;
- place them on their front onto your thick, supporting their head and neck and using the heel of your hand, administer 5 back blows between their should blades

Chest thrusts;
- turn the baby over onto their back on your thigh and using two fingers, directly in line with their armpits on the centre of their chest, administer 5 chest thrusts, pushing inwards and upwards 1/3rd of the depth