Quarterly Inservice Test #1: First Aid

Burns are a leading cause of accidental death and injury in the U.S. A burn is an injury that results from heat, chemical agents or radiation. Burns vary in severity and damage to tissue.

Causes of burns:
1. carelessness with matches and smoking
2. scalds from hot liquids
3. burns from heating including space heaters
4. accidents with cooking
5. hot bath water
6. chemicals such as lye, acids and sometimes detergents and bleach
7. using flammable liquids incorrectly

Classification of burns:
1. first degree – redness and mild swelling and pain- caused by sunburn, hot objects and scalding by steam or hot water.
2. second degree – redness and mottled appearance with blisters, more swelling and can be wet due to plasma loss in burned area, much more painful than deeper burns.— caused by deep sunburn, hot liquids, chemicals, flash burns.
3. Third degree – may look white or charred and may resemble a second degree wound, third degree wound beds frequently have a combination of first, second and third degree burns. third degree burns are often less painful as nerve endings are damaged or destroyed.

In first and second degree burns only involve partial thickness of the skin and new skin will grow if infection does not occur. Third degree burns that involve full thickness will not heal except at the edges, the third degree wound bed will develop scar tissue. In general a person who has suffered second or third degree burns over 15 % of his body surface or 10 % for a child, requires hospitalization. Elderly with 30-50% of third degree burns have a high potential of dying from their injuries.

Treatment of burns:

First Degree – -apply cold water or submerge the affected area in cold water. Medical attention is not usually required. Call the office as soon as first aid is completed and the client is settled and report the burn.
Second Degree — immerse the affected area in cold, not iced water or cover the burns with clean cloths which have been soaked in cold water. Call 911 for
assistance and call the office as soon as possible after the client has received first aid for burns.

Third Degree – Do not remove clothing that is adhered to the burned area, cover the burns with clean cloth or sheets, burned hands and feet should be covered and then elevated above the level of the heart. Do not let the victim walk Facial burn victims should sit up or be propped up and monitored for breathing problems. CALL 911

Chemical burns- remove clothing and wash the area for at least 5 minutes with a large steam of water, using a shower of hose if possible. CALL 911

Burns of the eye- Call 911 and wash the eye under a steady stream of water until help arrives do not let water into the unaffected eye.

General rules for burn care- DO NOT USE ANY HOME REMEDIES OR TREATMENTS- NEVER USE OILS, BUTTER OR PETROLEUM JELLY ON BURNS, THEY WILL HOLD IN THE HEAT AND CAUSE DEEPER BURNS. CALL 911 ASAP FOR ANY BURNS GREATER THAN 1 ST DEGREE AND CALL THE OFFCIE AS SOON AS THE CLIENT IS SAFE AND HAS RECEIVED FIRST AID.

Safety Measures to prevent burns-
1. Limit exposure to the sun and use sunscreen
2. Test bath water before bathing client
3. Test hot water and coffee before serving to the client
4. Use care with space heaters and do not leave them near the client
5. Have an emergency evacuation plan for each clients home
6. Know oxygen safety – No smoking or open flames near oxygen source
7. Monitor client in kitchen to prevent cooking accidents
8. Keep chemicals away from elderly or confused clients

WOUNDS:
A wound is a break in the integrity of body tissue internal or external. An external wound is a break in the skin or mucous membranes. A closed wound is under the skin or mucous membrane. Elderly or immobile clients are prone to skin breakdown that is not caused by trauma to the tissues. Be aware and check clients for skin breakdown and report to the office ASAP. Traumatic wounds are caused by injury.

Types of Traumatic wounds
1. abrasions — results from scraping the skin- has a high potential for infection because dirt and bacteria may get ground into the wound
2. incisions – caused by a cut from a knife, glass or other sharp object, may be deep and cause excessive bleeding
3. punctures – caused by pointed objects such as pins, needles, splinters, animal bites, a gunshot etc. Puncture wounds are hard to clean out and are most likely to become infected. Tetanus can grow rapidly in this environment. The victim will need to have a tetanus booster if their immunization is not up to date.
4. avulsions — tearing of tissue from the body. A detached finger , toe, nose tip, ear or limb may be reattached if transported to the hospital with the client.

IMMEDIATE MEDICAL ATTE NTION is required for:
1. blood spurting from a wound
2. uncontrolled bleeding
3. an incision deeper than the outer layer of skin
4. laceration to the face where scars will form
5. animal bites
6. heavily contaminated wounds
7. foreign objects not removed
8. whenever you are in doubt about what to do

SEVERE BLEEDING:
Loss of blood can be a threat to a person’s life, loss of more than a quart of blood may be critical. It is important to control bleeding and call 911 for assistance ASAP. Some methods to control bleeding are:

direct pressure — hold a cloth preferably clean, but in case of severe bleeding use what ever is handy, over the wound and apply pressure. If blood soaks through the cloth apply another but do not disturb the first cloth as clots may form and removing the cloth will cause more bleeding.

elevation – Unless you suspect a fracture, elevate the limb or head where to wound is, elevation uses gravity to slow down the blood pressure to the site and decrease bleeding.

pressure points – if the above measures do not control bleeding try using a pressure point in ADDITION to the above methods- do not release the direct pressure. The pressure point in the arm is the brachial artery. The brachial artery is midway between the elbow and armpit between the large muscles in the upper arm. To apply pressure to the brachial artery grasp the upper arm between your thumb on the back of the arm and your other fingers on the front
and apply pressure. The pressure helps close off the artery and the supply of blood to the wound. If the bleeding is in the leg you may apply pressure to the femoral artery. To apply pressure to the femoral artery place the client on his back and apply pressure to the femoral artery just below the crease of the groin on the front of the thigh. Use the heel of your hand to compress the artery keeping you elbow straight.

MINOR WOUNDS:
Wounds that are minor and do not have a lot of bleeding and do not extend deeper than the skin require cleaning. After washing your own hands with soap and water, gently wash the wound with soap and water and rinse under running water and pat dry with a clean cloth or gauze. Call the office for further instructions.

ANIMAL BITES:
If your client gets an animal bite from and unknown animal, call 911for assistance immediately. Try and monitor the animal’s whereabouts in case is has rabies. If rabies is suspected and they animal is not caught and tested the victim will have to have a series of rabies vaccinations. There is not cure for rabies once symptoms develop and it is fatal. Your responsibility is first aid to the client, do not put yourself in danger trying to trap a stray or wild animal. An animal bite should be washed thoroughly with soap and water, use gloves when handling the bite area. Any animal bite will require medical attention due to the high potential for infection.

CLOSED WOUNDS:
Examples of closed wounds are internal injuries, closed fractures and bruises. Discoloration and pain at the site are common symptoms of a closed wound. Symptoms of internal injuries are cold clammy skin, rapid weak pulse, rapid breathing, light headedness or dizziness, vomiting blood or blood in the urine or stool, restlessness or excessive thirst. Call 911 if internal injury or fracture is suspected. Do not move a fracture victim unless he is in an unsafe environment.

NOSE BLEEDS:
Nosebleeds often occur during or after a upper respiratory infection or allergies which involve repeated blowing of the nose. They are also caused by high blood pressure and other diseases. Nose bleeds are usually not serious, if they occur frequently a doctor’s evaluation is needed.
First aid for a nose bleed — Keep the client quiet and in a sitting position if possible lean the client forward, otherwise recline them with the head raised, apply pressure by gently pinching the nostrils closed, apply a cold compress to the nose and face. If bleeding does not stop call 911 and notify the office once the client has received care.

SHOCK:
Shock is a life threatening condition and results from poor supply of blood and oxygen to the tissues, There are many causes of shock ranging from blood loss to infection and allergic reactions and more.
Signs of shock:
1. pale or bluish skin that is cold to the touch and may be clammy and damp
2. weakness
3. pulse over 100 usually very faint and weak
4. restlessness and anxiety
5. irregular breathing, may be fast or slow
First aid for shock – Call 911- lie the victim down with legs and feet elevated on a pillow or rolled up blanket, cover with a blanket to reduce body heat loss but do not overheat the victim, if there is oxygen in the home administer oxygen, stay with the victim and remain calm.

POISONING
If your client has ingested or swallowed poison call 911 and get instructions on what to do until the ambulance arrives. Do not attempt to treat the client yourself every poison has a different treatment and you can cause more harm by doing the wrong thing. The most common type of inhaled poison in the home is carbon monoxide. Carbon monoxide is produced from gas heat and stoves as well as car engines. Carbon monoxide is odorless, symptoms of carbon monoxide poisoning are dizziness, weakness, headache and cherry red color to the lips and skin.

First aid- remove the victim from the source of the poisoning. Call 911, give mouth to mouth if the victim stops breathing. If oxygen is available administer it if the client is breathing.

Safety tips- If you smell a gas odor in a home investigate the source and evacuate the home if the source is not found and stopped. Check gas stoves to be sure they are off when not in use. Carbon monoxide detectors can be installed in the home to detect carbon monoxide before it causes harm. Do not run automobiles in a closed garage, open the door before starting and warming up the car.

BONE AND JOINT INJURIES
A break or crack in a bone is called a fracture. The displacement of a bone end in a joint is called a dislocation, it includes damage to the ligaments. An injury to the muscles and tendons not resulting in a fracture or dislocation is called a sprain. A muscle strain is injury to the muscle from over stretching.

Fractures are closed or open, closed fractures do not involve open wounds, an open fracture will have bone protruding through the skin. Open wounds are the most serious due to the chance of infection.

Signs or a Fracture
1. legs or arms are different lengths
2. limb is crooked or not in the normal place, open wound over a bone
3. swelling at the site bruising
4. pain or tenderness
5. bones are rotated inward or outward.
First Aid for fractures
1. Call 911
2. do not move victim unless they are in danger where they are
3. if the fracture is an open fracture control bleeding
4. Do not try and replace a bone that is protruding through the skin cover the open area with a bandage or clean sheets.
After first aid is administered call the office and report injury. Any injury should be evaluated by X-Ray to determine the type of injury and appropriate treatment.

HEAT CONDITIONS
Heat conditions include heat cramps, heat exhaustion and heat stroke.
Symptoms of heat cramps are pains and spasms in the muscles due to loss of salt from sweating, the client may also be confused. Heat exhaustion will have symptoms of heat cramps as well as weakness due to the severe loss of fluid and dehydration. Heat stroke is a life threatening condition with extremely high body temperature and hot dry skin, body temp may be as high as 105-106 and the pulse will be bounding and rapid. The elderly, small children, alcoholics and overweight individuals are most likely to suffer heat symptoms.
First aid for heat conditions:

Heat cramps- get to a cooler air-conditioned area if possible drink salted water or sport drinks (salted water is 1 tsp salt to 8 oz water) drink 4 oz every 15 mines over an hour. Keep offering fluids frequently after treatment, call the office and report heat cramps. Massage affected muscles

Heat exhaustion- treatment as above and lie victim down and elevate feet 8 -12 inches, loosen clothing, apply cool wet cloths, if the victim vomits call 911 and go to the emergency room. An elderly or frail person who suffers heat exhaustion needs to see a doctor or go to the emergency room.

Heat Stoke is a true emergency call 911- get the client to a cooler area, remove clothing, sponge the client with cool cloths, use fans if available to cool client, cover loosely with a sheet for modesty. Call the office when the emergency has passed and the client is getting treatment.