Providing First Aid To Patients

SESSION 4:APPLYING NURSING CARE CONCEPTS IN PROVIDING FIRST AID TO PATIENTS DURING RADIOLOGICAL PROCEDURES

At the end of this session students should be able to:

• Describe first aid techniques and procedures
• Perform basic first aid procedures

Performing procedures in managing radiology emergencies Perform immobilization and procedures in fractured and patients with possible spinal injuries Learning objectives

First aid procedure follow an abbreviation of DRABC

• D Danger – ensure the area is safe and find out what has happened

Make sure that it is safe for you to approach the casualty.

Do not put yourself in any danger, because if you get injured you won’t be able to help the casualty.

Remove any danger from the casualty, or if that is not possible, and it is safe to do so, try to move the casualty away from the danger area.

Try to find out what happened, making sure that you are safe doing so. DO NOT PUT YOURSELF IN ANY DANGER.

Basic first aid procedures

R Response – is the casualty conscious?

Try to get a response from the casualty. Gently shake their shoulders, shout and clap your hands in front of them, pinch their underarm or fingernail to get a pain response.

If they do not respond, immediately shout for help

A Airway – clear the airway

Clear the airway by placing your fingertips under the casualty’s chin and lifting, so the front of the neck is extended. Simultaneously placing your other hand on their forehead to gently tilt the head back.

B Breathing – is the casualty breathing normally?

When their airway is cleared, check if they are breathing normally. You are looking for two breaths in ten seconds.

• Take no longer than this to assess their breathing, as every second counts.
• Check whether their chest and abdomen are rising and falling.

Listen for breath (more than a sporadic gasp).

Use the back of your hand (lick the back of your hand if that will help) or your cheek to feel for any breath from the casualty

C Circulation-check for any pulse

• Also assess any bleeding to the patient.

If any bleeding compress the site with pressure to stop bleeding.

Performing procedures in managing radiology emergencies

CARE OF PATIENT WITH SHOCK

a)Define Hemorrhagic shock.

• Outline causes of bleeding.
• Identify signs of shock in a bleeding patient
• Provide measures to control bleeding.
• Administer Intravenous fluid to a patient in shock due to bleeding.
• Link a bleeding patient for further management.

Learning Tasks

Shock

Is a life-threatening condition that occurs when the body is not getting enough blood flow.

Lack of blood flow means the cells and organs do not get enough oxygen and nutrients to function properly.

Introduction

Many organs can be damaged as a result of shock.

Shock requires immediate treatment and can get worse very rapidly.

1.Hypovolemic shock

• Neurogenic shock
• Anaphylactic shock
• 4.Septic shock
• Carcinogenic shock

Types of shock

Hypovolemic shock

Is the type of shock which occurs if there is significant loss of body fluids like water, blood and electrolytes.

Or

Hypovolemic shock is caused by severe blood and fluid loss, such as a blood and fluid loss from traumatic bodily injury, which makes the heart unable to pump enough blood to the body, or severe anemia where there is not enough blood to carry oxygen through the body.

• Causes
• Severe bleeding
• Severe persistence diarrhea

Persistence vomiting

2. Septic shock

Is the type of shock which results from bacteria multiplying in the blood and releasing toxins.

• Common causes are
• Pneumonia
• Urinary tract infections
• Skin infections (cellulitis)
• intra-abdominal infections (such as a ruptured appendix).

Meningitis.

3. Anaphylactic shock

• Is a type of shock caused by severe hypersensitivity or allergic reaction of the body.

Causes include allergy to insect stings medicines, or foods (nuts, berries, seafood)

4.Cardiogenic shock

• Happens when the heart is damaged and unable to supply sufficient blood to the body.

This can be the end result of a heart attack or congestive heart failure.

5.Neurogenic shock.

Occurs when blood vessels stop working properly and don’t push enough blood through the body. You don’t experience blood loss, but the blood does not circulate correctly.

This shock is caused by spinal cord injury usually as a result of a traumatic accident or injury.

Hemorrhagic shock

Is a type of hypovolemic shock that’s caused by heavy blood loss, which can be caused by internal or external bleeding.

Hemorrhagic shock is life threatening condition which needs to be treated as a medical emergency.

Severe burns

• Deep cuts
• Gunshot wounds
• Trauma
• Amputations
• Surgical procedure
• Ante partum hemorrhage
• Post-partum hemorrhage

Causes of bleeding

Blue lips and fingernails

• low or no urine output
• Excessive sweating
• Shallow breathing
• Dizziness or loss of consciousness
• Confusion
• Chest pain
• low blood pressure
• Rapid heart rate
• weak pulse

External signs of shock in a bleeding patient

Abdominal pain

• Abdominal swelling
• A blood in the stool
• Blood in the urine
• Vaginal bleeding, which is heavy and usually occurs outside of normal menstruation
• Vomiting blood
• Chest pain

Internal signs of shock in a bleeding patient

Do not remove embedded glass, knife, stick and arrow or any other object that stuck in the wound.

Apply pressure to the area. If you can, tie or tape the fabric to the injury.

If the area is clear of debris and no visible object is sticking out from it, tie fabric, such as a shirt, towel, or blanket, around the site of injury to minimize blood loss.

• Elevate the site injured especially the lower and upper limbs.

Measures to control bleeding

Providing First Aid To Patients

Our bodies are made up of 60% water. Did you know that 40% of that water sits inside our cells? meaning that the other 20% sits somewhat outside our cells.

The inside of the cell is called intracellular (IC) and the outside is called extracellular (EC). The fluid inside the cell is called intracellular fluid (ICF), while the fluid outside the cell is called extracellular fluid (ECF).

The body always wants to maintain an equal fluid balance between the IC and EC. For this reason, these fluids in the body are able to move between both compartments, through a semi-permeable membrane. This movement occurs due to OSMOSIS.

THE BODY

OSMOSIS

Osmosis occurs in response to the quantity of solutes in each of these compartments. When a compartment contains high amounts of solutes, it is considered “hypertonic.” Also, the compartment with low amounts of solutes, is considered “hypotonic.” When both compartments have equal amounts of solutes, it is considered “isotonic.” Osmosis is the movement of water from an area of low concentration of solutes (hypotonic) to an area of high concentration of solutes (hypertonic).

Providing First Aid To Patients

Now let’s apply the concept of osmosis here, and properly think about this. If the outside of the cell is hypertonic, osmosis causes water to move from the inside of the cell to the outside of the cell, to dilute it.

In the same way, if the inside of the cell is hypertonic, osmosis causes water to move from the outside of the cell to the inside of the cell to dilute it.

Providing First Aid To Patients

The word “Iso” means equal or same, while the word “tonic” refers to the amount of solute concentration. Therefore “isotonic” can also mean “equal or same tonic.” By definition, the aim of an isotonic IV fluid is to replace fluid to the EC area, because it is depleted. It is not going to cause any kind of osmotic shift of water.

Essentially, it is replacing what the EC has lost due to conditions such as diarrhea, blood loss due to injury or surgery, and dehydration.

• Examples of isotonic fluids.
• 0.9% Nacl,

Lactated Ringer,

• 5% Dextrose in 0.225% saline (D5W1/4NS),
• 5% Dextrose in water.

ISOTONIC IV FLUIDS.

Providing First Aid To Patients

The word “hypo” means low. Therefore, “hypotonic” can also mean “low tonic.” By definition, a hypotonic EC area has a low amount of solutes and a high quantity of water and the IC area has a high amount of solutes and a low quantity of water. Applying the osmosis concept, you know that the fluid will shift from the EC area which is “hypotonic” to the IC area which is “hypertonic” in order to dilute it. These are given in conditions where the cell is shrunk or dehydrated, as with Diabetic Ketoacidosis & Hyper-osmolar Hyperglycemia.

When you infuse the hypotonic solution into the EC compartment, it will cause the movement of water into the IC compartment.

• Examples of hypotonic fluids I
• 0.45% Nacl,
• 0.33% saline (1/3 NS)
• 0.25% Nacl.

HYPOTONIC IV FLUIDS

HYPERTONIC IV FLUIDS

The word “hyper” means high. Therefore, “hypertonic” can also mean “high tonic.” By definition, a hypertonic EC compartment has high amounts of solutes and a low quantity of water while the IC compartment has a low amount of solutes, and a high quantity of water. Applying the osmosis concept, you know that the fluid will shift from the IC compartment which is “hypotonic” to the EC compartment which is “hypertonic” in order to dilute it. These are used for conditions where the cell is swollen, and we need to shrink some of that swelling. Example is a patient with cerebral edema, where the brain cells are swollen and we need to reduce the swelling.

This is what the hypertonic aims to promote. When you infuse the hypertonic solution into the EC compartment, it will cause the movement of water into the EC compartment.

• Examples of hypertonic fluids include
• 3% saline,
• 5% saline,
• 10% Dextrose in water (D10W),
• 5% Dextrose in 0.9%,
• 5% Dextrose in 0.45% saline,

5% Dextrose in Lactated Ringers.

Fluids to administer are:

• Normal saline (NaCl)

Ringer Lactate.

Fluid administration to patient who is bleeding.

Normal Saline.

Ringer Lactate

CARE OF PATIENT WITH BURN

A burn is a tissue injury resulting from excessive exposure to thermal, chemical, electrical or radioactive agents.

Scald is to burn with hot liquid. A burn of the skin or flesh caused by moist heat and hot vapors such as steam.

• Sometimes a scald is deeper than a burn from dry heat.
• Healing is slower and scar formation is greater in scalds.

First aid to a patient with burn

Dry burn

• Caused by frames, contact with hot objects or friction
• Scald burn
• Caused by hot fluids, steam or hot fat or hot cooking oil
• Electrical burn
• Caused by low and high voltage currents, lighting strikes
• Cold injury burn
• Caused by frostbite, contact with freezing products

Types of burns

Chemical burn

Caused by domestic chemicals eg bleaching and industrial chemicals including fumes/corrosive gases Radiation burn

• Caused by sunburn, over-exposure to sunlamp ultraviolent rays

Defective product

The most commonly recalled products that are associated with burn injury are fire extinguishers, space heaters, tea kettles and candleholders.

Inhalation burn

Inhalation burn/injury is a nonspecific term that refers to damage to the respiratory tract or lung tissue from heat, smoke, or chemical irritants carried into the airway during inspiration.

Burns are usually classified as:

First degree

A superficial burn in which damage is limited to the outer layer of the epidermis and is marked by redness, tenderness, and mild pain Blisters do not form and the burn heals without scar formation. A common example is sunburn.

Second degree

A burn that damages epidermal and some dermal tissue but does not damage the lower lying hair follicles, sweat, or sebaceous glands. The burn is painful and red; blisters form and wounds may heal with scars.

Classification of Burns

Third degree

A burn that extends through the full thickness of the skin layer and often into underlying tissues The skin has pale brown gray or blackened appearance.

The burn is painless because it destroys nerves in the skin. Scar formation is likely.

Small children are quite likely to get burned or scalded as they often play close to fires and cooking pots and have not learned wisdom through experience

Stop the burning process

Rescuers must also protect themselves from being injured.

In the case of electrical and chemical injuries, initial management involves removal of the patient from contact with the electrical or chemical source.

At the scene of the injury, priority is given to removing the person from the source of the burn and stopping the burning process.

Chemical burns are best treated by quickly removing any chemical particles or powder from the skin.

Remove all clothing containing the chemical because the burning process continues while the chemical is in contact with the skin.

First aid to the patient with burn

Cooling

Cooling of the injured area (if small) within 1 minute helps minimize the depth of the injury.

To prevent hypothermia, cool large burns for no more than 10 minutes.

Do not immerse the burned body part in cool water because it may cause extensive heat loss.

Flush the affected area with copious amounts of water to irrigate the skin anywhere from 20 minutes to 2 hours post exposure.

Covering/dressing

Wrap the patient in a dry, clean sheet or blanket to prevent further contamination of the wound and to provide warmth Never cover a burn with ice, since this can cause hypothermia and vasoconstriction of blood vessels, thus further reducing blood flow to the injury.

• Leave adherent clothing in place until the patient is transferred to a hospital.
• Covering burn wound to prevent infection
• Minimizes the risk of infection and promote healing

Blisters should be left intact

Small thermal burns (10% or less of TBSA) should be covered with a clean, cool, tap water dampened towel for the patient’s comfort and protection until medical care is available

Assessment of ABC

If the burn is large (greater than 10% TBSA) or an electrical or inhalation burn is suspected, first focus your attention on the ABCs:

Airway: Check for patency, soot around nares and on the tongue, singed nasal hair, darkened oral or nasal membranes.

Breathing: Check for adequacy of ventilation.

Circulation: Check for presence and regularity of pulses, and elevate the burned limb(s) above the heart to decrease pain and swelling.

Assessment of burns severity

Helps to identify the extent of the burn, Types of burn and mechanism of the care and reduce delay Always remember that the burn patient may also have sustained other injuries that could take priority over the burn itself.

Analgesics

• Relieving pain to the casualty

Transport

Individuals involved in the pre hospital phase of burn care must adequately communicate the circumstances of the injury to hospital providers It should be arranged as quick as possible It should be to the nearest health facility Helps to serve patient’s live

Read on Management of patient with poisoning, musculoskeletal injuries, Fainting and collapse.

Assignment

Immobilization –stopping of something to move

• Fracture immobilization –preventing movement of fractured bone after realignment.
• Common techniques used for immobilization are Casts, splints, and bandages.

IMMOBILIZATION PROCEDURES IN FRACTURE AND PATIENTS WITH POSSIBLE SPINE INJURY

Casts

Splint

Splint Cont…

Bandage

Providing First Aid To Patients

It involves the use of number of devices and strategies to stabilize the spinal column after injury and thus preventing spinal cord injury.

• These devices includes backboards, splints, cervical collars.
• Avoid to move the patient unnecessary

Spinal injury immobilization

Alexander, M. F., Fawcett, J. N. & Runciman, P. J. (2002). Nursing Practice: (2nded). London, Churchill Livingstone.

Bewes, P. (2003). Surgery. A manual for rural health workers. (2nded.). Nairobi. AMREF.

Black, J. M.& Hawks, J.H. (2009). Medical surgical Nursing. (8thed.). Philadelphia: W.B Saunders Company Brunner and Suddath. S. (2010). Medical Surgical Nursing (12th ed.), New York, Lippincott

REFERENCES