Textbook on First Aid Emergency Nursing

Contents
1. Introduction to First Aid 1
1.1 Introduction 2; 1.2 History of First Aid 2; 1.3 Definition 3;
1.4 Meaning of First Aid 3; 1.5 Aims of First Aid 3; 1.6 Objectives of First
Aid 4; 1.7 Philosophy of First Aid 4; 1.8 Scope of First Aid 4;
1.9 Golden Rules of First Aid 4; 1.10 Types of First Aid 5; 1.11 Principles
of First Aid 5; 1.12 Importance of First Aid 6; 1.13 Qualities of a First
Aider 6; 1.14 Responsibilities of a First Aider 7; 1.15 Limitations of the
First Aider 7; 1.16 Safety Measures of the First Aider 8; 1.17 Preparing for
Emergencies 8; 1.18 Goals of Emergency Medical Treatment 9; 1.19 Principles
Applied in Emergency Management 9; 1.20 History Collection from Patient/
Relatives 9; 1.21 Ethical and Legal Consideration in First Aid 10; 1.22 First
Aid Code of Practice 13; 1.23 First Aid Kit 14; 1.24 Solutions Used in First
Aid 14; 1.25 Reporting, Record Keeping and Documenting 15
2. First Aid Assessment 17
2.1 Introduction 18; 2.2 First Aid Assessment Principles 18; 2.3 Emergency
Approachment 19; 2.4 Moving the Injured Victim 21; 2.5 First Aid Assessment
Techniques 25; 2.6 Skills Required for the First Aider 26; 2.7 Casualty
Assessment 27; 2.8 Methods of Victim Assessment 29; 2.9 Diagnosing of
Victim 29; 2.10 Vital Signs 30; 2.11 Blood Pressure 35; 2.12 General
Head-to-Toe Examination 37
3. Bandaging 40
5. Wounds and Hemorrhage 75
5.1 Introduction 76; 5.2 Definition of Wound 77; 5.3 Meaning of
Wounds 77; 5.4 Classifications of Wound 77; 5.5 Principles of First Aid in
Wounds 79; 5.6 Complications of Wounds 79; 5.7 Principles in Wound
Care 80; 5.8 First Aid Measures in Minor Wounds 80; 5.9 First Aid Measures
in Major Wounds 81; 5.10 Prevention of Wounds Infection 83; 5.11 Wound
Care 84; 5.12 Sterile Dressing 86; 5.13 Hemorrhage 86; 5.14 Classifications of
Hemorrhage 87; 5.15 Assessment of Hemorrhage and Bleeding Wounds 89;
5.16 Classification of Blood Loss 90; 5.17 Control of Bleeding by Pressure
Dressing 90; 5.18 Internal Hemorrhage 94; 5.19 First Aid Measures for Bleeding
from Special Parts 95
6. Basic Life Support 103
6.1 Introduction 103; 6.2 Meaning of BLS 104; 6.3 Definition 104;
6.4 Objectives and Goals of BLS 105; 6.5 Steps of BLS 106; 6.6 Chain
of Survival 109; 6.7 Mouth-to-Mouth Method 110; 6.8 Mouth-toNose Method 111; 6.9 Mouth-to-Stoma Method 111; 6.10 Mouth-toBarrier Device 112; 6.11 Check for a Pulse 112; 6.12 Perform External
Chest Compressions 113; 6.13 Two-Rescuer CPR 115; 6.14 Switching
Functions 116; 6.15 Complications of CPR 116; 6.16 Infant BLS 117;
6.17 Nurses’ Role in BLS 121
7. Injuries/Trauma 123
7.1 Introduction 125; 7.2 Definition 125; 7.3 ABCDE of Trauma 125;
7.4 Types of Traumatic Experiences 127; 7.5 Assessment of Injury 128;
7.6 Trauma Scoring Systems 129; 7.7 Multidisciplinary Trauma Team 130;
7.8 Levels of Care Provided in Trauma Center 130; 7.9 Types of Physical
Injuries 132; 7.10 Skeletal Injuries 132; 7.11 Strain 134; 7.12 Sprain 135;
7.13 Dislocation 137; 7.14 Chest Injuries 138; 7.15 Rib Fracture 140;
7.16 Flail Chest 141; 7.17 Intra-abdominal Injuries 142; 7.18 Blunt Abdominal
Trauma 146; 7.19 Crush Injuries 148; 7.20 Multiple Injuries 149; 7.21 Head
Injury 151; 7.22 Spinal Cord Injury 154; 7.23 Road Accidents 159; 7.24 Posttraumatic Stress Disorder 160; 7.25 Trauma Case Manager Interventions 163;
7.26 Role of Trauma Nurse 163; 7.27 Emergency Nurse Practitioner (ENP) 164
8. Shock 165
8.1 Introduction 165; 8.2 Definition 166; 8.3 History of Shock 166;
8.4 Effects of Shock 166; 8.5 Stages of Shock 166; 8.6 Causes of Shock 167;
8.7 Progress of Shock 167; 8.8 Types of Shock 167; 8.9 Factors Influencing the
Degree of Shock 168; 8.10 Signs and Symptoms of Shock 169; 8.11 Pathology of
Shock 170; 8.12 Organs Involvement in Shock 170; 8.13 Diagnostic Approach and
Evaluation 172; 8.14 Complications of Shock 172; 8.15 Assessment of Shock 173;
8.16 First Aid in Shock 174; 8.17 Hypovolemic Shock 175; 8.18 Anaphylaxis 177;
8.19 Cardiogenic Shock 179; 8.20 Neurogenic Shock 181; 8.21 Septic Shock 181
9. Fracture 185
9.1 Introduction 187; 9.2 Definition 187; 9.3 Causes of Fracture 187; 9.4 Types
of Fracture 187; 9.5 Signs and Symptoms of Fracture 190; 9.6 Complications of
Bone Fractures 191; 9.7 Principles of Fracture Management 191; 9.8 First Aid
Treatment of Fractures 191; 9.9 Emergency Management 192; 9.10 First Aid
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Measures in Orthotrauma 193; 9.11 Immobilization of the Fractured Part 194;
9.12 Facial Fractures 195; 9.13 Cheekbone and Nose Fractures 197;
9.14 Collarbone Fracture 197; 9.15 Upper Arm Fracture 198; 9.16 Elbow
Fracture 199; 9.17 Fracture of the Forearm and Wrist 200; 9.18 Fractures
of the Hand and Fingers 200; 9.19 Fracture of the Rib Cage 201; 9.20 Flail
Chest Injuries 202; 9.21 Fracture of Backbone/Spine 203; 9.22 Fracture of
Pelvis 206; 9.23 Fracture of Hip and Thigh 206; 9.24 Fracture of the Lower
Leg 208; 9.25 Splints 209; 9.26 Plaster Casts and Application 211;
9.27 Traction 214; 9.28 Methods of Lifting and Transfer the Injured 217;
9.29 Nurses’ Role in Fracture First Aid 218; 9.30 Management of Complications 219
10. Burns and First Aid Measures 221
10.1 Introduction 223; 10.2 Definition 223; 10.3 Burns Classification 223;
10.4 Causes of Burns and Scalds 226; 10.5 Characteristics of Burn Injury 227;
10.6 Complications of Burns 228; 10.7 Preventing All Degrees of Burns 229;
10.8 First Aid Management of Burns 229; 10.9 Wound Care in Burns 231;
10.10 Chemical Burns 232; 10.11 Fires 233; 10.12 Electrical Burns 234;
10.13 Preventive Measures of Electrical Burns 236; 10.14 Lightning and its
Protecting and Preventive Measures 236
11. Poisoning 238
11.1 Introduction 240; 11.2 Definitions 240; 11.3 Goals Poison
Management 240; 11.4 Concept of Poisoning 240; 11.5 Initial Evaluation of
Patient with Poisoning 243; 11.6 Diagnosis of Poisoning 245; 11.7 Physical
Examination 245; 11.8 Clinical Laboratory Tests 245; 11.9 Special Procedures
Performed for Patients with Poisoning 246; 11.10 Swallowed Poisons 249;
11.11 Corrosive Poisons 250; 11.12 Noncorrosive Poisons 252; 11.13 Inhaled
Poisons 253; 11.14 Injected Poisons 256; 11.15 Food Poisoning 257;
11.16 Household Poisons 260; 11.17 Drug Poisoning 261; 11.18 Alcohol
Poisoning 262; 11.19 Industrial Poisons 263; 11.20 Common Indian Plant
Poisoning 264; 11.21 Drugs 267; 11.22 Metal Poisoning 267; 11.23 Organic
Chemical Poisoning 267; 11.24 Alcohol Poisoning 268
12. Bites and Stings 270
12.1 Introduction 271; 12.2 Dog Bite 272; 12.3 Snake Bites 274; 12.4 Insect
Sting 276; 12.5 Cat Bite 277; 12.6 Rat Bite 278; 12.7 Bees and Wasp
Bites 278; 12.8 Ticks and Mites Bites 279; 12.9 Spider Bite 280; 12.10 Leech
Bite 281; 12.11 Fish Stings 282; 12.12 Blue-ringed Octopus 284
13. Foreign Bodies 285
13.1 Introduction 287; 13.2 Definition 287; 13.3 Symptoms of
Foreign Body 287; 13.4 Foreign Body Retrieval 288; 13.5 Techniques
Used for Foreign Body Retrieval 289; 13.6 Benefits and Risks of Foreign
Body Retrieval 290; 13.7 Limitations of Foreign Body Detection and
Removal 290; 13.8 Need of Emergency Care 290; 13.9 Foreign Bodies
in the Respiratory Tract 291; 13.10 Foreign Bodies in the Alimentary
Tract 293; 13.11 Foreign Bodies in the Eye 297; 13.12 Foreign Bodies in the
Ear 299; 13.13 Foreign Bodies in the Nose 303; 13.14 Foreign Bodies in the
Throat 305; 13.15 Foreign Bodies in the Skin 306
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14. Common Emergencies and Resuscitation Measures 310
14.1 Introduction 311; 14.2 Meaning of Resuscitation 311; 14.3 Resuscitation
Measures 311; 14.4 Choking 312; 14.5 Asphyxia 314; 14.6 Suffocation 317;
14.7 Hanging, Strangling and Throttling 318; 14.8 Drowning 319; 14.9 Smoke
Inhalation 320; 14.10 Fires 321; 14.11 Shock 322; 14.12 Anaphylactic
Reactions 325
15. Environmental Emergencies 328
15.1 Introduction 329; 15.2 Illness Caused by Heat Exposure 329;
15.3 Effects of Chronic Heat Exposure 330; 15.4 Heat-related Morbidity and
Mortality 330; 15.5 Mechanism of Heat Loss 331; 15.6 Nonfreezing Cold
Injuries 331; 15.7 Freezing Cold Injuries 332; 15.8 Heat Stroke 332; 15.9 Heat
Exhaustion 335; 15.10 Heat Cramps 337; 15.11 Frostbite 338; 15.12 Accidental
Hypothermia 339; 15.13 Sunburn 340; 15.14 Snow Blindness and Welder’s
Flash 341; 15.15 Trench Foot 342; 15.16 Chilblain 343; 15.17 Heat Rash 344
16. Minor Ailments 346
16.1 Introduction 347; 16.2 Headache 347; 16.3 Cough 349;
16.4 Dyspnea 351; 16.5 Hypoxia 354; 16.6 Cheyne-Stokes Respiration 356;
16.7 Cyanosis 357; 16.8 Hypercapnea 360; 16.9 Hypocapnea 361;
16.10 Respiratory Acidosis 363; 16.11 Respiratory Alkalosis 365;
16.12 Hypoglycemia 366; 16.13 Syncope 368; 16.14 Nurses’ Roles in
Minor Ailments 370
17. Handling and Transport of Injured 372
17.1 Introduction 373; 17.2 General Principles 373; 17.3 Lifting Casualty 373;
17.4 Carries for One First Aider 374; 17.5 Carries for Two First Aiders 375;
17.6 Lifting a Casualty in a Wheelchair 376; 17.7 Stretchers 377; 17.8 Preparing
a Stretcher or Trolley Bed 379; 17.9 Loading a Stretcher 380; 17.10 Manual
Lifts 381; 17.11 Loading a Casualty in the Recovery Position 382;
17.12 Loading an Ambulance 384
18. Sports Injuries 386
18.1 Introduction 387; 18.2 Definition 387; 18.3 Risk Factors that Causes
Injury 387; 18.4 Causes of Sports Injuries 388; 18.5 Types of Sports
Injuries 389; 18.6 Most Common Sports-related Injuries 389; 18.7 Symptoms
of Sports Injuries 391; 18.8 Prevention of Sports Injuries 393; 18.9 Soft Tissue
Injuries 394; 18.10 Managing Soft Tissue Injuries 395; 18.11 Immediate
Treatment of Skin Injuries 396; 18.12 Hard Tissue Injuries 396; 18.13 Assessment
of Injuries 397; 18.14 Knee Injuries 398; 18.15 Jumper’s Knee 401;
18.16 First Aid for Sprains, Strains and Joint Injuries 402; 18.17 Osgood-Schlatter’s
Syndrome 402; 18.18 Bursitis 403; 18.19 Shin Pain 404; 18.20 Tennis
Leg 405; 18.21 Achilles Tendinitis 407; 18.22 Retrocalcaneal Pain 408;
18.23 Plantar Fasciitis 409; 18.24 Blisters 410; 18.25 Athlete’s Foot 411;
18.26 Frozen Shoulder 412; 18.27 Tennis Elbow 413; 18.28 Wrist Pain in
Gymnasts 414; 18.29 Finger Tendon Injury 415; 18.30 Eye Injuries 416;
18.31 Dental Injury 417; 18.32 Ear Injury 419; 18.33 Under Water Diving
Injury 420; 18.34 Maxillofacial Injuries 421; 18.35 Nasal Injuries 421;
18.36 Treatment Modalities of Sports Injuries 422; 18.37 Cold 424;
18.38 Ultrasonic 424; 18.39 Faradic Stimulation 424; 18.40 Manual Therapy 425
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19. Disaster Nursing 427
19.1 Introduction 428; 19.2 Meaning of Disaster 429; 19.3 Definition 429;
19.4 Definitions of Disaster Nursing 429; 19.5 Goals of Disaster Nursing 430;
19.6 Principles of Disaster Nursing 430; 19.7 Health Effects of Disaster 430;
19.8 Factors Affecting Disaster 431; 19.9 Types of Disaster 431; 19.10 Levels of
Disaster 432; 19.11 Natural Disaster 432; 19.12 Man-made Disaster 433;
19.13 Psychological Reaction to a Disaster 436; 19.14 Disaster Management of
Health Sector in India 437; 19.15 Important Agencies in India 437; 19.16 Nurse’s
Role during Disaster 438; 19.17 Prevention, Mitigation and Preparedness
Activities 438; 19.18 Relief Response 439; 19.19 Stages of Disaster
Involvement 439; 19.20 Steps of Safety Measures during Disaster 440; 19.21 Role
of Community Health Nurse in Disaster Management 441; 19.22 Disaster
Response 442; 19.23 Disaster Recovery 442; 19.24 Disaster Management 443;
19.25 International Agencies in Disaster 444; 19.26 Impact of Disaster on
Community 445; 19.27 Hospital Disaster Manual 445; 19.28 Disaster
Plan 447; 19.29 Management of Mass Casualties 448; 19.30 Role of Nursing
in Disaster 449
20. Triage and Ambulance Service in Disaster 452
20.1 Introduction 452; 20.2 Meaning of Triage 452; 20.3 Triage Category 453;
20.4 Objectives of Triage Nursing 453; 20.5 Goals of Triage 454; 20.6 Principles of
Triage 454; 20.7 Triage Process 454; 20.8 Triage Priorities 455; 20.9 Patients
Assessment 456; 20.10 Phases of Disaster 456; 20.11 START Model of Triage 457;
20.12 The Impact of Disaster First Aiders 458; 20.13 Triage Nurse 462; 20.14 Role
of Triage Nurse 463
21. Emergency Department 464
21.1 Introduction 465; 21.2 Definition 466; 21.3 Meaning of Emergency
Department 466; 21.4 Goals of Emergency Department 466; 21.5 Need of
Emergency Care 467; 21.6 Function of Emergency Care/Casualty 467;
21.7 Designing for Accident and Emergency Department (A and ED) 468;
21.8 Infrastructure and Design of Casualty 469; 21.9 Site, Area and Design 470;
21.10 Staff Requirement in Emergency Department 476; 21.11 Common Problem
Faced in Emergency Department 477; 21.12 Managerial Issues in Emergency
Departments 477; 21.13 Medicolegal Aspects of Emergency Department 478;
21.14 Infection Control Practices for Emergency Department 478
22. Nursing Process 481
22.1 Introduction 482; 22.2 Definition 482; 22.3 The Purpose of Nursing
Process 482; 22.4 Characteristics of a Nursing Process 482; 22.5 Steps in the
Nursing Process 483; 22.6 Benefits of Nursing Process 484; 22.7 Nursing
Assessment 485; 22.8 Nursing Diagnosis 487; 22.9 Nursing Planning 489;
22.10 Nursing Implementation 491; 22.11 Nursing Evaluation 492;
22.12 Emergency Nursing Practice 493
23. Physical Examination 494
23.1 Introduction 495; 23.2 Definition 495; 23.3 Meaning of Physical
Examination 495; 23.4 Purpose 496; 23.5 Methods of Examination 496;
23.6 Head-to-Toe Examination 498; 23.7 Preparation of the Environment 502;
23.8 Preparation of the Equipment 502; 23.9 Preparation of the Patient 505;
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23.10 Assistance in the Examination 505; 23.11 General Physical Examination: Quick
Reference Guide 509; 23.12 Nurse’s Responsibilities during Physical Examination 514
24. Pharmacological Therapy in Emergencies 515
24.1 Introduction 519; 24.2 Purpose and General Action of Drugs 519;
24.3 Routes of Drug Administration 519; 24.4 Side Effects and Toxic Effects of
Drug 520; 24.5 Important Antidotes 521; 24.6 Adverse Effects of Drugs 521;
24.7 Factors Involved in Adverse Effects of Drugs 522; 24.8 Scientific Principles 523;
24.9 Responsibilities of the Nurse 523; 24.10 Routine Times of Administration 524;
24.11 Drugs are Classified according to their Action 524; 24.12 Special Points to be
Noted during any Injection 525; 24.13 Drugs Used in Cardiac Arrest 526;
24.14 Emergency Drug Management 527
25. Medical-Surgical Emergencies 540
25.1 Introduction 543; 25.2 Epistaxis (Nosebleed) 543; 25.3 Esophageal
Varices 544; 25.4 Status Epilepticus 547; 25.5 Increased Intracranial Pressure
(ICP) 551; 25.6 Cerebral Venous Thrombosis (CVT) 554; 25.7 Stroke 556;
25.8 Aortic Aneurysm 565; 25.9 Asystole 567; 25.10 Cardiogenic Shock 569;
25.11 Cardiac Arrest 573; 25.12 Hepatic Encephalopathy (HE) and Coma 576;
25.13 Diabetic Ketoacidosis (DKA) 580; 25.14 Myxedema Coma 586;
25.15 Altered Level of Consciousness (LOC) 588; 25.16 Unconsciousness 595
26. Psychiatric Emergencies 601
26.1 Introduction 602; 26.2 Meaning of Psychiatric Emergencies 603; 26.3 Role of
the ED in Managing Mental Illness 603; 26.4 Mental State Examination 603;
26.5 Overactive Patients 604; 26.6 Violent Patient 605; 26.7 Underactive or
Depressed Patients 606; 26.8 Suicidal Patients 607; 26.9 Sexual Assault 608;
26.10 Delirium Tremens (Alcoholic Hallucinosis) 610; 26.11 Hysteria 612;
26.12 Rape 613; 26.13 Sudden Infant Death Syndrome (SIDS) 614
27. Emergencies in Reproductive, Maternal and Childbirth 617
27.1 Introduction 618; 27.2 Definition 618; 27.3 Types of Obstetric
Emergencies 618; 27.4 Immediate Assessment 619; 27.5 Obstetric Emergencies
during Labor and Delivery 619; 27.6 Clinical Manifestations of Obstetric
Emergencies 620; 27.7 Diagnostic Evaluation in Obstetrical Emergency 620;
27.8 Emergency Care Activities 621; 27.9 Preventive Measures 621; 27.10 Vasa
Previa 621; 27.11 Cord Presentation and Prolapse 623; 27.12 Shoulder
Dystocia 625; 27.13 Amniotic Fluid Embolism (AFE) 629; 27.14 Obstetrical
Shock 632; 27.15 Rupture of Uterus 637; 27.16 Obstructed Labor 640;
27.17 Miscarriage 642; 27.18 Childbirth 642
28. Pediatric Emergencies 649
28.1 Introduction 650; 28.2 Pediatric Emergency Nursing Care 650; 28.3 Pediatric
Triage 650; 28.4 Pediatric Triage Approach 651; 28.5 Assessment Skills 652;
28.6 Child Abuse 653; 28.7 Infantile Convulsions 656; 28.8 Burns 658;
28.9 Drowning 662; 28.10 Foreign Bodies 664; 28.11 Poisoning 665;
28.12 Naphthalene Poisoning 667; 28.13 Asphyxia Neonatorum 668;
28.14 Idiopathic Respiratory Distress Syndrome (RDS) 670
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29. Community Emergencies 672
29.1 Introduction 673; 29.2 Definition 674; 29.3 Factors Affecting Disaster 674;
29.4 Types of Disaster 675; 29.5 Natural Disaster 675; 29.6 Man-made
Disaster 678; 29.7 Triage 679; 29.8 Earthquakes 680; 29.9 Floods 681;
29.10 Cyclones 682; 29.11 Lightning 683; 29.12 Civil Defense 684; 29.13 High
Explosive (HE) Bombing 685; 29.14 Incendiary Bombs 685; 29.15 Nuclear
Weapons 685; 29.16 Chemical Warfare 686; 29.17 Biological Warfare 686;
29.18 Emergency Management Continuum 687; 29.19 Disaster Management 688;
29.20 Disaster Response 689; 29.21 Disaster Interventions 690; 29.22 Community
Measures in Disaster 692; 29.23 Nurses’ Role in Disaster Management 692
30. Advanced Lifesaving Procedures 696
30.1 Advanced Cardiac Life Support 697; 30.2 Cardioversion and
Defibrillation 702; 30.3 Pacemakers 705; 30.4 Arterial Blood Gas (ABG)
Analysis 711; 30.5 Mechanical Ventilation 714; 30.6 Ventilator Setting
Up 721; 30.7 Artificial Airway Management 727; 30.8 Endotracheal
Intubation 730; 30.9 Suctioning Techniques 734; 30.10 Endotracheal
Extubation 737; 30.11 Tracheostomy Care 739; 30.12 Tracheostomy Suctioning 744
Glossary 747
Index 753