WARD CLASS ON FIRST-AID & WOUND CARE

INTRODUCTION:

FIRST-AID
the immediate assistance or treatment given to someone injured or suddenly taken ill before the arrival of an ambulance, doctor or other appropriately qualified person.

Aims of first-aid To preserve life and limb

To prevent the patients condition from worsening To promote recovery

Priorities
Assess the situation Make the area safe Assess all the casualties and give emergency first aid Get help

Resuscitation
is a procedure indented to revive a heart and lung arrest within 3 to 4 minutes, from the time the heartbeat and breathing stops prevent death or irreversible brain damage.

The ABC of Resuscitation A-irway

B-reathing

C-irculation

The Resuscitation Sequence

Check the casualtys response Open the airway and check breathing Breathe for the casualty Assess for circulation Commence CPR

Common Problems of School-Age Children and their Management

Wounds and Wound Care

Types: According to degree of contamination

Clean Clean-contaminated Contaminated Dirty or infected

According to how they are acquired (extent of tissue layers involved) Incision Contusion Abrasion Puncture

Laceration
Penetrating Wound

Incision
Clean

cut from a sharp edge such as a broken glass Open wound; deep or shallow; painful

Contusion
Closed

wound caused by a blow to body by blunt object; contusion or bruise characterized by swelling, discoloration, and pain

Abrasion
A superficial

wound in which the top layers of the skin are scraped off, leaving raw tender area Open wound involving the skin

Puncture
A wound

with small entry site, but a deep track of internal damage Penetration of the skin and the underlying tissues by a sharp instrument, either intentional or unintentional

Laceration
A crushing

or ripping forces which results in rough tears or lacerations Tissues torn apart, often from accident

Penetrating wound
Penetration

of the skin and the underlying tissues, usually unintentional

Kinds of Wound Drainage/Exudates

Serous Purulent Sanguineous

Mixed Types

serosanguineous purosanguineous

Factors Affecting Wound Healing

Developmental Considerations Nutrition Lifestyle Medications

Wound Care
Guidelines in cleaning wounds
Use solutions such as isotonic saline or tap water to clean or irrigate wounds. If antimicrobial solutions are used, make sure they are well diluted. When possible, warm the solution to body temperature before use. If a wound is grossly contaminated by foreign material, bacteria, slough, or necrotic tissue, clean the wound at every dressing change.

If a wound is clean, has little exudates, and reveals healthy granulation tissue, avoid repeated cleaning. Use gauze squares. Avoid using cotton balls and other products that shed fibers into the wound surface.

Clean superficial noninfected wounds by irrigating them with normal saline.

To retain wound moisture, avoid drying a wound after cleaning it.

Hold cleaning sponges with forceps or with a sterile gloved hand. Clean from the wound in an outward direction to avoid transferring organisms from the surrounding skin into the wound.

Consider not cleaning the wound at all if it appears to be clean.

Burns and Scalds

Burns results to excessive exposure to
thermal, chemical, electric, or radioactive agents

scald is a burn from a hot liquid or

vapour, such as steam.

First-degree burn

Types and Assessment Findings

Second-degree burn

Third-degree burn

First Aid Measures

Remove the child from the cause of burning without endangering yourself. Hold the burn under cold water at least 10 minutes. If the burn is minor remove clothing from the affected area. If the burn is more serious, remove clothing only if it is stuck to the burn and you can do so easily and without doing more harm. Do this after cooling with water.

Loosen tight clothing and removed any jewellery, because the burnt area may swell. Cover the burn with clingfilm or a clean, nonfluffy cloth (handkerchief, pillow case or linen/cotton tea towel). Or put a clean plastic bag over a foot, hand, arm or leg. Do not apply any lotions, creams or fats. Do not burst blisters or use adhesive dressings. Take the child to the neatest Accident and Emergency Watch for signs of shock.

Tips on Prevention

Never leave children alone around open flames, stoves or candles. Keep matches, gasoline, lighters and other flammable materials out of childrens reach. Teach children a plan for escaping your home in a fire and practice it! Install smoke alarms in your home on every level and in every sleeping area, testing them once a month and replacing the batteries at least twice a year. Before bathing children in heated water, always run your open hand through the water to check its temperature or use a tub thermometer.

Keep hot foods and liquids away from table and counter edges. Never carry children and hot foods or liquids at the same time. Make sure that pot handles are turned towards the stove when cooking so that a child cannot accidentally grab the handle and spill the contents. Keep things that easily catch fire (such as papers) away from heat sources like stoves, heaters and fireplaces.

Bruises and Sprains

Bruise Sprain

First Aid Measures

Bruises
Raise the injured part
Apply firm pressure with your hand

Sprain (Follow the RICE procedure) Rest

Ice pack or cold compress Compress the injury

Elevate and support the injured limb

Dipped Take or send the casualty to the hospital

Nosebleed
Definition and Cause - a hemorrhage from the nose caused by
the rupture of tiny, distended vessel in the mucous membrane of any area of the nose.

First Aid measures

Let the child sit down Pinch the nostrils. Reassure and encourage her not to sniff, swallow, cough, or even speak.
Release the nostrils to see if the nosebleed has stopped

If the nosebleed has stopped, ask her to remain leaning forward. The child now needs to rest for a while

Fainting
Definition and Cause - caused by a brief restriction in blood flow to the brain, which usually corrects itself quickly. Children may faint out of hunger, fear or pain, or if they have to stand without moving for a long time.

First Aid Measures

Watch for signs of dizziness, sickness or weakness, very pale face, briefly losing consciousness, and slow pulse. Lie the child down, raise his/her legs and support them. Loosen any clothing that is tight-fitting and provide fresh air. Give calm reassurance. Offer a sugary drink or small snack to raise the sugar level in her blood. Do not offer food or drink if she is not fully conscious. If she loses consciousness, monitor her condition (ABC). If she is breathing, place her in the recovery position. Call an ambulance if she doesnt regain consciousness within three minutes.

Hyperventilation
Definition and Cause
- is rapid or deep breathing, usually caused by anxiety or panic.

Signs and Symptoms

Your heart pounds. It feels like you can't get enough air You feel tingling and numbness in the arms, legs, and around the mouth. You feel a sense of doom.

You may pass out.

First aid measures

Have the hyperventilating person breathe slowly into a paper bag that's held closely around his or her mouth and nose The person should breathe like this for five to seven minutes. Talk to the individual the entire time. Try to distract him or her and make the person feel comfortable and safe. If symptoms fail to improve or the person loses consciousness, take him or her to the emergency room.

Animal Bites
Insect Bites First Aid Measure First aid measure: Use antipruritic agents and baths; Administer antihistamines and prevent secondary infection Rinse the area under cool running water or put a cold compress on it for a few minutes to reduce pain and swelling. If the sting is inside the mouth give an icecold drink to sip or ice cubes to suck.

If the swelling gets worse or the child's breathing is affected, call an ambulance and monitor the child's airway, breathing, and circulation (the ABC of resuscitation) until the ambulance arrives.

First Aid Measure Superficial Bites - Bites that puncture only the skin can be safely treated at home.

Dogs and Rodents

Wash the wound thoroughly with warm, soapy water. Wash away any dirt by rinsing the wound under running water for several minutes. Gently pat the wound dry with a clean tissue then cover it with plaster or sterile dressing until it has healed.

Bites that penetrate deep into the tissues beneath the skin needs medical expert. Put a clean pad over the wound and press down on it to control the bleeding. Raise the injured part of the body above the level of the heart to reduce blood flow to the wound. Cover the bite. Use either a clean pad or a sterile dressing. Bandage it firmly. Take the child to the accident and emergency department or to the doctor.

Deep Bites -

Seizures (Convulsions)
Definition and Cause - convulsion, or fit, consists of involuntary contractions of many of the muscles in the body, cause by a disturbance in the function of the brain. Convulsions usually result in loss of, or impaired, consciousness.

Types Seizures

Minor Epilepsy Major Epilepsy

Signs and Symptoms

Minor Epilepsy sudden switching off; like the casualty may be staring blankly ahead. slight or localised twitching or jerking of the lips, eyelids, head or limbs. Odd automatic movements, such as lipsmacking, chewing or making noises

Major Epilepsy
the casualty suddenly falls unconscious, often letting out a cry. Breathing may cease. The lips may show grey-blue tinge (cyanosis) and the face and neck may become congested. Convulsive movement begin. The jaw may be clenched and breathing may be noisy. Saliva may appear at the mouth, blood stained if lips or tongue have been bitten. There may be loss of bladder or bowel control.

First Aid Measures

Minor Epilepsy Help the casualty to sit down in a quiet place. Remove any possible sources of harm, for example hot drinks or sharp objects, from the immediate vicinity.

Talk to her calmly and reassuringly. Do not pester her with questions. Stay with her until you are sure she is herself again. If the casualty does not recognize and know about her condition, advise her to consult her own doctor as soon as possible.

Major Epilepsy
If you see the casualty falling, try to support him or ease his fall. Make space around him and ask bystanders to move away. Loosen clothing around his neck and, if possible, protect his head. When the convulsions cease, place him in the recovery position. Check breathing and pulse, be prepared to resuscitate if necessary. Stay with him until he is fully recovered.

Poisoning
- It can occur as a result of accidents, or be caused by eating contaminated food or poisonous plants. Drugs and alcohol can also poison the body.

First Aid Measures

Swallowed

Poison Inhaled Poison Absorbed Poison

Tips on Prevention

Keep toxic chemicals out of childrens reach and sight (not under the sink). Keep medicines in a locked cupboard. Leave poisonous household substances in their original containers. Never store them in old soft drinks bottles; children are commonly misled by such container and try to drink the contents. Buy medicines and household substances in child-resistant containers. Dispose appropriately of unwanted medicines.

Fractures
Definition a break in the rigid structure and continuity of a bone; and is known as the most common type of bone lesion
Common Types Closed Open

Signs and Symptoms

Types of fracture
simple

fracture - a single break in the bone in which the bone ends maintain their alignment and position comminuted fracture - in which there are multiple fracture lines and bone fragments; fragments may be splintered or crushed compression fracture - common in the vertebrae, occurring when a bone is crushed or collapses into small pieces

Continuation types of fracture

Transverse fracture - a fracture across the bone, fracture line occurs at 90-degree angle to longitudinal axis Linear fracture a break along the axis of the bone, fracture line is intact Oblique fracture - one at an angle to the diaphysis of the bone Spiral fracture a break that angles around the bone, usually due to twisting injury or force

Continuation types of fracture

Stellate fracture line radiate from one central point Longitudinal fracture line extends in the direction of the bones longitudinal axis Burst characterized by multiple pieces of bone, often occurs at bone ends or vertebrae

Closed Fracture
Tell the casualty to keep still and steady and support the injured part with your hands until it is immobilised For firmer support, secure the injured part to a sound part of the body. For upper limb fractures: always support the arm against the trunk with a sling. For lower limb fractures: if removal to hospital will be delayed, bandage the sound leg to the injured one. Call for an ambulance. Treat the casualty for shock, if necessary. If possible, raise the injured limb. Check the circulation beyond any bandages every 10 minutes and loosen if necessary.

Open Fracture

Cover the wound with a clean pad or sterile dressing and apply pressure to control the bleeding. Without touching an open wound with your fingers, carefully place some clean padding over and around the dressing. If bone is protruding, build up pads of soft, non-fluffy material around the bone until you can bandage over the pads. Secure the dressing and padding: bandage firmly, but not so tightly that the circulation is impeded. Immobilize the injured part as for a closed fracture. Treat the casualty for shock. Check the circulation beyond the bandage every 10 minutes.

Drowning
- is the process of experiencing respiratory impairment from submersion/immersion in liquid.

First aid measures

Carry the child out of the water with the head lower than the chest. Get another adult to call an ambulance. Don't bother trying to get water out of the lungs . the child will cough it out as she starts to breathe.

If the child is conscious:

Wrap her in dry clothes coats or towels and get her into clothes. Take her to the hospital. She might have inhaled some water, which may damage her lungs.

If the child is unconscious: Call an ambulance. Assess her airway, breathing and circulation.

HYDROGEN PEROXIDE
MOA: - is generally recognized as safe (GRAS)

as an antimicrobial agent, an oxidizing agent and for other purposes by the U.S. FDA. For example, 35% hydrogen peroxide is used to prevent infection transmission in the hospital environment, hydrogen peroxide vapor is registered with the US EPA as a sporicidal sterilant.

All about hydrogen peroxide

it is a common misconception that hydrogen peroxide is a disinfectant or antiseptic for treating wounds it is an effective cleaning agent, hydrogen peroxide is not an effective agent for reducing bacterial infection of wounds. hydrogen peroxide applied to wounds can impede healing and lead to scarring because it destroys newly formed skin cells

What is Hydrogen Peroxide?

Hydrogen peroxide has a slightly blue color,

though it looks clear if diluted in water. It is a weak acid, which means it has a pH somewhat lower than 7. It is a very strong oxidizer, which means it can easily change the chemical components of many substances, which is why it is often used to bleach paper.

 Because hydrogen peroxide has

oxygen in it and is very reactive, it is classified as a "reactive oxygen species" (ROS), which is the type of molecule that antioxidants are thought to combat. Hydrogen peroxide is also able to work as a disinfectant due to its highly reactive nature.

How does H2O2 acts as an antimicrobial agent?

Hydrogen peroxide works very well as a

disinfectant because of its ability to act as an antimicrobial agent. This means that it is able to quickly kill bacteria. When hydrogen peroxide encounters bacteria, it quickly oxidizes some of the components of the outside of the bacteria. This can not only be toxic to them, but can punch holes in the membrane that the bacteria use to protect and contain themselves. As a result, the bacteria quickly die. The United States Food and Drug Administration considers hydrogen peroxide an approved and safe way to kill bacteria.

Advantages and Disadvantages

One of the advantages of using hydrogen peroxide as a disinfectant is that it is cheap, easy to find and relatively safe. However, like all oxidizing agents, it will cause some damage to the wounded tissue. This can be a benefit, however, as it can help close capillaries and other small blood vessels to slow bleeding. On the other hand, hydrogen peroxide stings. Some people also find the smell to be unpleasant. Another side effect of hydrogen peroxide use is that, as it reacts with things, it creates a gas, forming bubbles.

Thank you for listening!!!!

Evaluation

Bibliography:

Bale, S. & Jones, V. (1197). Wound Care Nursing. London: Balliere Tindall. First Aid and CPR. 3rd ed. Sudbury Massachusetts: Jones and Barlett Pub. First aid manual. (1997). London: Dorling Kinderseley Limited. Hockenberry, M. & D. Wilson. (2007). Wong's nursing care of infant's and children. (8th ed.). Singapore: Elsiever Pte. Limited. Gould, B.E. (2006). Pathophysiology for the health professionals. Philadelphia, PA: Saunders Elsevier. 3rd ed Kozier, B. (2004). Fundamentals of nursing: Concepts, process and practice. Phil.: Pearson. Middlemiss, P. (1998). The Hamlyn encyclopedia of child health. London: Reedd Consumers Books. Thott, A.T. (1997) Wounds and lacerations. 2nd ed. St. Louis: Mosby Co. West, R. (2003). Family guide to children's ailments. London: Quantum Publishing Limited. Wound care. Lippincott Williams and Wilkins: Wolters Kluwer Co. First aid: aims. (June 8, 2011). http://en.wikipedia.org/wiki/First_aid Hydrogen peroxide. (July 31, 2011). http://en.wikipedia.org/wiki/Hydrogen_peroxide