Tag: SAFE approach first aid

The way first aid for trauma is delivered differs based on which specific body site was affected in the injury.

Trauma related to the musculoskeletal system (bones, joints, muscles, ligaments, and tendons) include the following:

• FRACTURES: when the continuity of the bone is disrupted, influencing its function
• DISLOCATIONS: when the normal structure of a joint is disrupted, causing a difference in the shape, posture, and movement related to it
• SPRAINS : overstretching a ligament, influencing the movement of the area
• STRAINS: overstretching a muscle or tendon

Patient Assessment

1. Conduct primary assessment using the S.A.F.E. and D.R. A.B.C. approach
2. Attend to unconsciousness, serious bleeding, and cardiac arrest
3. Position patient in a comfortable position with caution
4. Perform secondary assessment and provide first aid for main complaint
5. Look for D.O.T.S. – deformities, open wounds, tenderness, and swelling
6. Take vital signs – pulse and respiratory rate especially if casualty is in a lot of pain
7. Take S.A.M.P.L.E. history

First Aid for Fractures

Signs & Symptoms of a fracture

• history in relation to the injury
• loss of function
• locked joint
• abnormal movement
• exposed musculoskeletal fragments
• signs of pain, tenderness, and area guarding
• swelling, bruising, deformity, or crepitus (popping, clicking or cracking sounds in a joint)

Fracture Complications

• bleeding
• loss of function
• instability
• injury to the covering soft tissue
• limb loss – amputation

First Aid for Fractures

1. provide support to the fractured area
2. expose injury site (eg. remove shoes)
3. touch the area to assess sensation
4. test circulation within the injured limb by pressing on area and determining whether normal colour is restored in 2 seconds
5. address bleeding and cover wound
6. immobilise area
7. following any intervention on the area, reassess sensation and circulation
8. reassure casualty
9. seek medical help

First Aid for Sprains

Signs & Symptoms of a Sprain

• pain, swelling and bruising
• inability to use limb appropriately

NOTE: signs and symptoms of a sprain are very similar to a fracture…if in doubt, treat as a fracture!

First Aid for Sprains & Strains

• follow the R.I.C.E. acronym…
• R – rest (and remove footwear)
• I – use ice packs on area for not more than 10 minutes to reduce pain and swelling
• C – compress using bandage
• E – elevate affected limb

Trauma Amputation First Aid

First Aid on Stump

1. control bleeding
2. address shock
3. irrigate area using saline water or water
4. remove gross debris
5. apply dressing
6. elevate limb
7. ensure casualty comfort and reassurance

Care for Amputated Part

1. remove gross debris
2. wrap in a saline-moisted gauze
3. place in a plastic bag
4. store in a container with ice and water, ensuring that ice does not come into direct contact with severed part
5. DO NOT CLEAN OR WASH AMPUTATED PART WITH WATER!

Trauma to the Head, Neck & Back

If a casualty falls from a height at least double his or her own weight, head injury should be suspected, even if there are no visible signs and symptoms. In such case, head injury should only be excluded following medical investigations.

Possible Head Trauma Consequences

• surface injury – bruising or actual wounds
• skull fracture – leading to lack of protection to the brain
• facial fracture – causes bleeding and possible bone fragments which may lead to airway obstruction
• brain injury – may lead to epidural & subdural haematoma as well as intracerebral haematoma
• intracranial bleeding – eg. subarachnoid haemorrhage in the brain
• concussion – soft tissue damage to the brain without evident bleeding

Indications

• history of head trauma
• headache
• dizziness
• nausea
• vomiting
• limb weakness and/or loss of sensation (may be a sign of neurological damage)
• disorientation and/or confusing
• altered level of response
• seizures

Further signs may include:

• unequal and/or unresponsive pupils
• ecchymosis (racoon eyes)
• battle’s sign (bruising around the eyes or behind the ear
• rhinorrhoea (bleeding or clear liquid emerging from the nose)
• otorrhoea (bleeding or clear liquid emerging from the ear/s)
• halo sign (can be seen on the bedsheet under a casualty’s head)
• abnormal posture (eg. stretching, flexing etc)

Assess further for…

• intoxication (ask relatives if available, and look for obvious intoxication signs)
• evidence suggesting a possible suicide attempt
• casualty’s age (risks increase when over 65 years of age)
• current treatments eg. anticoagulants
• history of coagulation disorders

First Aid for Head Trauma

NOTE: prior to first aid, consider possible trauma to the cervical spine and neck…signs include an altered level of response, pain and/or tenderness, weakness, or loss of sensation in the neck/back area.

1. if casualty is unresponsive and not breathing, perform CPR
2. use sterile or, if unavailable, clean dressings for head wounds
3. in case of severe facial trauma clear casualty’s mouth from foreign material, blood and fragments
4. in case of eye injuries, DO NOT REMOVE any embedded fragments; just cover both eyes
5. apply ice packs on haematomas for a maximum of 15 minutes
6. apply pressure ALWAYS with caution
7. elevate the casualty’s head and shoulders

IMPORTANT: manually stabilise the head and neck, maintaining alignment to avoid complications or further damage.

Trauma to the Neck & Back

1. prevent movement of the casualty’s head and neck
2. use the jaw-thrust technique to open the airway of an unresponsive casualty
3. turn the casualty using the log-roll method to perform a secondary assessment or for putting into the recovery position OR
4. use the Haines recovery position if log-roll method cannot be used

Trauma to the Chest

Complications

Trauma to the chest may lead to complications such as:

• rib fracture
• flail chest – consists of 2 or more broken ribs
• pneumothorax – air trapped in chest that compresses the lung causing a collapsed lung, whilst also pressing onto the heart; evident in an x-ray as a dark space in the lungs; visually evident as chest asymmetry during breathing
• haemothorax – same as a pneumothorax, except that blood is trapped in the chest instead of air
• cardiac tamponade – build-up of blood between the pericardium and the myocardium which increases pressure on the heart, causing obstructive shock

Signs of Chest Trauma

• history of trauma to the chest
• severe pain
• severe dyspnoea
• bruising
• open chest wound
• shock

First Aid for Chest Trauma

1. leave any foreign bodies embedded in the chest – DO NOT REMOVE!
2. leave chest wound uncovered if not bleeding
3. if chest wound is oozing blood, cover with a non-occlusive dressing such as a gauze swab and apply pressure with caution
4. stabilise affected chest side with an arm sling
5. if possible, help casualty into a semi-sitting position, supporting the back
6. if available, administer high-concentrated oxygen
7. if oxygen is unavailable open windows to increase air circulation

Trauma to the Abdomen

Complications

• bleeding
• shock

First Aid for Abdominal Wounds

1. leave any foreign bodies embedded in the abdomen – DO NOT REMOVE!
2. cover wound with moist sterile dressing
3. if there are any visible protruding organs DO NOT PUSH BACK INSIDE as this may cause further complications and damage

First Aid for Abdominal Trauma Without Visible WOunds

• assist casualty in a comfortable position, preferably with legs pulled towards the abdomen
• monitor for deterioration
• address shock if evident

Fractured Pelvis & Hips

Signs & Symptoms

• history of trauma to the pelvis or the hips
• pain and tenderness
• swelling
• bruising
• wounds
• deformity
• shortening/external rotation
• unable to bear weight

First Aid for the Pelvis and Hips

1. limit casualty’s movement of the back, the pelvis, and the lower limbs
2. control external bleeding
3. splint open fractures or use body splinting for lower limbs
4. monitor for shock and provide first aid for shock if necessary

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