" First Aid " Community Pharmacy Practice

FIRST AID
Raghavendra S.Hegde, PharmD, R.Ph(KSPC)
COMMUNITY PHARMACY PRACTICE
General Principles of First Aid
Abrasion and Cut
Foreign Particles in Body Nose and Throat
Shock
Burns
Poisoning
Fracture
CPR
Dr.Hegde Lectures(DHL)

Learning Objectives
Contents
 Introduction
 Distinct Areas of First Aid
 General Principles of First Aid
 Abrasion and Cut
 Foreign Particles in Body, Nose and Throat
 Shock
 Burns
 Poisoning
 Fracture
 Cardiopulmonary Resuscitation (CPR)
18/02/2020
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Dr.Hegde Lectures(DHL)

Introduction
18/02/2020Dr.Hegde Lectures(DHL)
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 Assistance, assessments and interventions that can be
performed for benefit of any person suffering from a
sudden illness or injury to preserve his/her life, prevent
the condition
from worsening, and/or promote recovery by an
eyewitness or by the victim with minimal or no medical
equipment is termed as First Aid.
 First aid can be performed by the victim or by
any individual near to the victim.

General Principles of First-
Aid:
4
 The general principles of first aid are:
1. Do not panic and do not harm.
2. Act quickly for rescue and removal of the casualty in the
shortest possible time without worsening existing health
situation.
3. Immediate arrest of hemorrhage, any.
4. Restoration of respiration and circulation.

General Principles of First-
Aid:
5
5. Prevention of shock and treatment of shock if the victim
is already in such a clinical condition.
6. Immobilization of simple and compound fractures and
dislocations, if any.
7. Easing of pain by simple procedures and medication.
8. Providing assurance of getting well quickly to the victim
and moral boosting.

Role of Community Pharmacist
in First Aid:
6
1. Recommend a course of action based on evaluation,
which may include:
a) No Treatment.
b) Self-Care Treatment.
c) Refer to other Healthcare Professionals.
2. Provide confidence and support.
3. Educate and if required, train community about first-aid
techniques.

Distinct Areas of First Aid
7
 There are certain commonest emergencies in day-to-
day life where first aid can prevent the condition of
worsening of any injury or clinical condition and promote
recovery of a person's life.
 The distinct areas of first aid are as follows:
I. Medical Emergencies (Shock, foreign particles in
body, nose and throat)
II.Injury Emergencies (Abrasion and cut, fracture,
burns)
III.Environmental Emergencies (cold, insect bite and
drowning)
IV. Poison Emergencies (chemical and ingested)

Following are the some examples of first aid
treatment for certain commonest emergencies:
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 Abrasion
 Abrasion: An abrasion means
that the surface layers of the skin
(epidermis) has been broken.
 Thin skinned bony areas like
knees, ankles and elbows are
more prone to abrasions.
 The worn out skin of an abrasion
can also contain particles of dirt.
ABRASION AND CUT

First Aid Treatment for Abrasion
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 Basic steps of first aid that should be followed by a
community pharmacist are:
1.Clean the wound with a Non-Fibre shedding material or
sterile gauze, and use an antiseptic such as Betadine
(Povidone-Iodine complex).
 If there is embedded dirt, Savlon (cetrimeide and
chlorhexidine gluconate) may be used, as it contains an
antiseptic and a surfactant to help remove debris.
 Rinse the wound after five minutes with sterile saline or
flowing tap water.

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Do not scrub the affected area otherwise it can injure the
site even more.
2.Topical antibiotics/antibacterials are also applied to
prevent/eliminate infection and produce faster healing.
These includes, bacitracin, neomycin, polymixin B sulfate.
Neosporin contains all three of these.
Even Soframycin cream (Framycetin Sulphate) and
Cetrimide cream are also applied on the abrasion and
cuts to prevent infection.

11
3.Cover the cleaned wound with an
appropriate non-stick sterile
dressing.
4.Change the dressing every day.
 Reapply antiseptic, redress the
wound.

Cut:
12
 A cut is an incised wound
caused by sharp objects, such
as knives or sharps of glass
slicing into the skin. Depending
on the injury, underlying blood
vessels can be punctured,
leading to significant blood
loss.
 A bleeding artery is considered
as a medical emergency.

First Aid Treatment for Cut
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 First Aid Treatment: For CUT
 Basic steps of first aid to be followed by a community
pharmacist are:
1.Remove clothing around the site for easier access.
2.Apply pressure directly to the wound with the hands to
stop the blood flow.
3.Cover the wound with a sterile dressing, if possible, and
continue to apply direct pressure (bandage firmly).

First Aid Treatment: For Cut
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4. Try to raise the injured area above the level of the
person's heart or keep the patient in supine position.
5.Do not remove existing dressings if they become
saturated with blood, but instead add fresh dressings
over the top.
6.Some wounds are more likely to encourage the growth of
tetanus bacteria than others, unless the person is
immunized against tetanus, If it is more than five years
since the last dose, then may need a booster.
 A tetanus toxoid dose of 0.5 ml intramuscularly should
be administered immediately, so ask to visit the doctor
without delay.

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7. Seek urgent medical attention if bleeding do not stop or
when patient feeling faint, sweaty or dizzy.
 General suggestions a community pharmacist should
provide to the patient regarding taking care of a cut or
abrasions include:
1.Keep the site dry and clean. It may be covered with an
occlusive thin film waterproof and protective dressing.
2. Only apply lotions or ointments to the wound, if
instructed to do so by medical staff.

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3. Try not to conduct any physical activity that may cause
the site of cut to bleed.
4. Seek medical advice immediately, if the site starts to
produce pus, swell or exude a disagreeable odour.
5. Reassure that skin heals at different rates, depending
on factors such as the person's general health, age, diet
and whether or not the wound becomes infected.

Foreign Particles in Body, Nose
and Throat
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Nose:
Common objects like food material, tissue paper, beads,
part of toys etc. accidently goes into noses.
Most cases of foreign bodies in the nose and nasal cavity
are not serious and Occur in children from 1-8 years of
age.
This is because children develop the ability to pick up
objects at about the age of 9 months, so foreign objects in
the nose are uncommon in children with age of less than 9
months.
However, this may also be seen in adult patients, most
often those with psychiatric disease or developmental
delay.

First Aid Treatment for Nose
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A community pharmacist must follow the basic steps
of first aid as follows:
1. Assess if patient is choking or having difficulty in
breathing, pain and bleeding.
2. Remove object, if possible.
3. Ask the person to breathe through his or her mouth. For
an adult with an object partially out of the nose, try to
remove it with fingers or tweezers.
Care should be taken that object do not get inserted further
into the nose.

First Aid Treatment for Nose
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4. If the object is deeper in the nose, pinch the clear side of
the nose closed. Ask the person to blow his or her nose
hard several times. This may remove the object.
5. Do not try to pull an object that is stuck up in a child's
nose. Try gently closing the unaffected nostril. Blow a puff
of air into the child's mouth. Repeat as necessary.
6. If minor bleeding occurs after object removal, firmly
pinch the nose shut for 10 minutes. Even a cold pack on
the nose or cheeks for bleeding can be applied.
7. Contact a doctor if bleeding is continuous or tear the
nose and object is not removed or a small part of it
remains and unable to
bloody nose, sharp object that can remove it

Throat
First Aid Treatment:
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A community pharmacist should follow the basic steps
of first aid as below:
1. Assess if the person is choking, having trouble in
breathing or has noisy breathing and is unconscious.
Immediately call the assistance for ambulance to shift
the patient to nearby hospital.
2. If the person is conscious but unable to breathe or talk,
first aid actions to be undertaken are as follows:
(i) Give Back Blows: Give upto 5 blows between the
shoulder blades with the heel of your hand as shown in
Fig.
(ii) If the person is still choking, do thrusts.

Throat
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3.If the person is not too obese,
then perform abdominal thrusts.
(i) Stand behind the person and
wrap your arms around the waist.
(ii) Place your grip fist (as shown in
figures) just above the person's
navel. Grab your fist with your
other hand.
(iii) Quickly pull inward and upward
as if trying to lift the person up.
Perform a total of 5 abdominal
thrusts.

Throat
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If he relief from blockage, continue cycles of 5 back blows
and 5 abdominal thrusts until the object is coughed up or
the person starts to breathe or cough. Take the object out
of his mouth only if visible. Never try to insert a finger to
clear the object until it is visible in the person's mouth.
4. If the person is obese do high abdominal thrusts:
5. Give CPR (Cardio pulmonary Resuscitation), if
necessary, if the obstruction comes out, but the person
is not breathing or if the person becomes unconscious.
6. Assist and arrange for medical help, if situation is
uncontrolled or patient is suffocating.

Procedure to conduct abdominal thrust
The 'five-and-five' approach.
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If a person is choking and cannot talk, cry or laugh
forcefully, the American Red Cross recommends a 'five-
and-five' approach to delivering first aid.

Shock
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 Shock is defined as "a condition where the tissues in the
body do not receive enough oxygen and nutrients to
allow the cells to function".
 It is a life-threatening condition.
 Hypovolemic shock
 Cardiogenic shock
 Distributive shock
 Obstructive shock
Types of Shock are as follows:

Hypovolemic shock:
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 Hypovolemic shock, also known as hemorrhagic shock,
is a life-
threatening condition that results when there is loss of
more than 20% (one-fifth) of body's blood or fluid supply.
 This severe blood/fluid loss makes it impossible for the
heart to pump a sufficient amount of blood to your body.
Hypovolemic shock can lead to organ failure.
 This condition requires immediate emergency medical
attention.

Cardiogenic shock:
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 When the heart has been severely damaged that it is
unable to supply enough blood to the organs of the
body, cardiogenic shock appears.
 The causes include:
 Dangerous heart rhythms
 Damage of valves, and
 Pressure on heart due to building of body fluid and
damage of heart muscles.

Distributive shock:
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 Distributive shock results from excessive dilation of
blood vessel and the impaired distribution of blood flow.
 Septic shock is the most common form of
distributive shock and is characterized by considerable
mortality.
 Even neurogenic shock is a type of distributive shock
which due to disturbance of the autonomic pathways
within the spinal cord result into low blood pressure.
 It can occur after damage to the central nervous system
such as spinal cord injury.

Obstructive shock:
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 It is characterized by physical obstruction of blood
circulation and inadequate blood oxygenation.
 Pulmonary embolism and cardiac tamponade are
considered as forms of obstructive shock.
 Septic shock, a form of distributive shock, is the most
common form of shock among Patients admitted to the
intensive care unit, followed by cardiogenic and
hypovolemic shock.
 obstructive shock is rare type of shock documented.

Causes of Shocks:
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 In general
 Severe infections
 Allergic reactions
 Trauma
 Poisoning and
 injury are various
causative factors for shocks.

Symptoms of Shocks:
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 Cool clammy skin
 Dull eyes,
 Dilated pupils
 Vomiting/nausea
 Feeling weak
 Confusion
 Anxiety shallow/slow breathing or rapid/deep breathing
 Weak and rapid pulse
 Trembling
 Temporary loss of consciousness etc.

First Aid Treatment
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A community pharmacist should follow certain first aid
principles until medical help arrives:
1. Make the person lie down on the back.
2. Raise the legs above head level.
3. If raising the legs is painful, keep the person at rest.
4. Check for breathing. If not breathing, do
Cardiopulmonary Resuscitation (CPR).
5. Make the person comfortable by loosening tight clothes
6. Cover the person with a blanket.
7. If vomiting or bleeding from mouth - turn the patient on
the side. Do not feed the person orally.

Burns
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 A burn is a type of injury to skin, or other tissues,
caused by exposure to heat or flame,
electricity, sunlight or radiation.
 Open cooking fires, and unsafe cook stoves used in
rural and semi-urban areas, alcoholism and smoking
are risk factor for burn.
 The most serious consequence of burns is shock,
and second is infection.

Types of burns:
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 First-degree burns damage only
the outer layer of skin. They
appear red without blisters with
mild pain typically lasting for 3
days.
 Second-degree burns damage
the outer layer and the layer
underneath. Blisters are present
with severe pain and healing
occurs within 6-8 weeks.
 Third-degree burns damage or
destroy the deepest layer of skin
and tissues underneath. Injury
extends to all layers of the skin.

Burns
34
 Burns can cause swelling, blistering, scarring and, in
serious cases, shock and even death.
 Infection can happen due to extensive skin damage.
 Treatment for burns depends on the cause of the burn,
how deep it is, and how much of the body it covers.
 Antibiotic creams can prevent or treat infections.

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 For more serious burns, treatment may be needed to
clean the wound, replace the skin, and make sure the
patient has enough fluids and nutrition.
 Scalds are the injuries caused by moist heat like boiling
water, steam, hot oil and hot wax etc.
 These are most common occurring emergency in
households.

First Aid Treatment: For Burn
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 A community pharmacist should follow the first aid
principles, as follows:
1. Stop the burning process. Cool the burn by soaking in
cool water or put cool and clean wet cloth. The water
reduces swelling and pulls heat away from the burned
skin.
2. Provide pain and swelling relief.
3. Protect the burn area from injury.
4. Reassure the patient.

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5. Remove any jewellery or clothing at the site of the burn.
If clothing is stuck to the burn, do not remove it. Carefully
cut around the stuck fabric to remove loose fabric
Remove all jewellery, because it may be hard to remove
it later if swelling occurs.
6. Give any liquid to the victim to drink if he/she is
conscious.
7. Caution patients to avoid rupturing the blisters.

38
8. Do not use absorbent cotton, oily substances,
antiseptics, flour or butter on the burn.
9. If burn exudes a serous fluid, soak in cool tap water
three to six times daily for 15-30 minutes.
10. If skin is broken, advise topical antibiotics to prevent
infection. Silver sulfadiazine is used for treating and
preventing bacterial infection in second and third degree
burns.

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11. If burn not healed or worsened within 7 days, ask to
refer primary care provider.
12. Minor burn injuries (first degree burns) can be treated
with OTC drugs. Recommend ibuprofen or
acetaminophen for pain relief. Ask to apply Aloe Vera
creams

The burn specific recommendations are
as follows:
40
 Heat burns (thermal burns): Extinguish any flames by
covering them with a blanket or water. If clothing catches
fire, ask not to run: stop, drop, and roll on the ground to
put out the flames.
 Cold temperature burns: Try first aid measures to warm
the areas. Small areas of the body (ears, face, nose,
fingers, toes) that are really cold or frozen can be
warmed by blowing warm air on them, tucking them
inside your clothing or putting them in warm water.
 Liquid scald burns (thermal burns): Run cool tap water
over the bun for 10 to 20 minutes. Do not use ice.

Electrical burns:
41
 Switch off the current and remove plug from the socket.
 Separate the Victim from the source of current with long
wooden stick.
 Never try to separate the Victim with naked hands or
bare-footed.
 After the person has been separated from electrical
source, check for breathing and a heartbeat. Treat the
burn.
 If the person is not breathing or does not have a
heartbeat, immediately call for medical assistance.

Chemical burns:
42
 This can be caused by many substances, such as
 strong acids
 paint thinner and
 gasoline.

The first aid principles are as follows:
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 Wash the area with water for atleast 20 minutes until all
chemical has been washed away.
 Remove jewellery or article of clothing with chemical on
them, unless they are stuck to the person's body.
 Do not put antibiotic ointment on the burn.
 Certain chemicals or toxins like sodium, potassium
phosphorus, dry lime, phenols etc. should not be
washed immediately with water
 Immediately call for a medical help.

Poisoning
44
 A poison is any substance that is harmful to
the body if consumed, in a dose that is
sufficient to produce unfavorable effects.
 The poison may enter into the body orally,
by inhalation, injection, skin and bites.
 Poisons can include: prescription or over-
the-counter medicines taken in doses that
are too high, overdoses of illegal drugs,
carbon monoxide from gas appliances,
household products, such as laundry
powder or furniture polish, pesticides,
indoor or outdoor plants, metals such as
lead and mercury.

45
 The effect of poisoning can range from short-term illness
to brain damage, coma and death.
 To prevent poisoning it is important to handle and store
products exactly according to the instructions on like
labels.“ Keep dangerous products beyond reach of children" or
"keep out of reach of children" or severe eye or skin
irritant".
Labels can even indicated relative toxicity like on
pesticides for example: "DANGER POISON: HIGHLY TOXIC"
or WARNING-MODERATELY TOXIC" or "CAUTION-SLIGHTLY
TOXIC

Signs and Symptoms:
46
 Poisoning signs and symptoms can mimic other
conditions, such as seizure, alcohol intoxication, stroke
and insulin reaction.
 Bums or redness around the mouth and lips
Breath that smells like chemicals, such as gasoline or
paint Thinner
Vomiting
Difficulty in breathing
Drowsiness
Confusion or other altered mental status
Poisoning may include:

First Aid Treatment for POISON
47
A community pharmacist should follow the first aid
principles until medical help arrives:
1. patient is conscious then enquire about what he or she
has swallowed, in what quantity and at what time ?
2. Search for clues such as empty pill bottles or
packages, scattered pills, and burns. stains and
odours on the person or nearby objects. It will help to
get right treatment.
3. Remove anything remaining in the person's mouth.
4. If the suspected poison is a household cleaner or
other chemical, read the container's label and follow
instructions for accidental poisoning

48
5. If person is conscious and co-operative try to induce
vomiting by tickling the back of patient's throat or by
administering glass of warm water containing 2
teaspoonful of common salt.
6. If the patient is unconscious or is suspected to have
consumed strong acid or alkali then do not induce
vomiting as these are corrosives and can corrode mouth
and throat.
7. If poison on the skin then remove any contaminated
clothing using gloves. Rinse the skin for 15 to 20
minutes in a shower and ask the patient to take plenty of
water.

49
8. If poison in the eye then gently flush the eye with cool
or lukewarm water for 20 minutes or until help arrives.
9. In case of inhaled poison, get the person into open
space for fresh air as soon as possible. Avoid crowding
near the patient so as to provide fresh air.

Fracture
50
 A fracture is a broken bone.
 It requires medical attention.
 During an accident bones may
break (fracture) or may displace
from the joints (dislocation).

Types of Fracture:
51
 Simple fracture: It is a fracture of
the bone only, without damage to the
surrounding tissues or breaking of
the skin. It is also known as closed
fracture.
 Compound fractures: Also called
open fractures, where broken bones
penetrate through the skin and
expose the bone and deep tissues to
the exterior environment.
These are more serious form of
fractures and involve extensive
damage to the tissues and may
become infected.

Types of Fracture:
52
 Complicated fracture: Any
fracture in which the bone or
bones which have been broken
causes damage to other organs or
structures, such as the lungs,
kidneys, major blood vessels,
spleen or liver is known as
complicated fracture.

Sign and Symptoms:
53
 Pain at or near the site of fracture
 Tenderness
 Swelling may be deformity and
 Immobility.

First Aid Treatment for Fracture
54
For any type of fracture a community pharmacist should
reassure and keep the patient warm.
1. In case of bleeding, the first step should be to stop any
bleeding.
2. For that apply pressure to the wound with sterile
bandage, a clean cloth or a clean piece of clothing.
3. Cover all the wounds with sterile dressings.

55
2. Immobilize the injured area.
 Do not try to restore the bone or push a bone that's
sticking out back in.
 If you have been trained in how to splint and if
professional help is not readily available, apply a splint
(support) to the area above and below the fracture sites.
 Padding the splints can help reduce discomfort.

56
3. Apply ice packs to limit swelling and help relieve pain.
Do not apply ice directly to the skin. Wrap the ice in a
towel, piece of cloth or some other clean material.
4. If the person feels faint or breathing is short or rapid
breaths, lay the person down with the head slightly lower
than the trunk and, if possible, elevate the legs.
5. Analgesics (Diclofenac, Ibuprofen) may be given if the
patient is having pain.
6. Transfer the patient immediately to a nearby hospital.

Cardio Pulmonary Resuscitation (CPR)
57
 Many accidental cases needs Cardio Pulmonary
Resuscitation (CPR) which is a first aid technique.
 CPR is a life saving technique useful in many
emergencies, including heart attack or near drowning, in
which someone's breathing or heartbeat has stopped.
 Chest compressions and rescue breaths keep blood and
oxygen circulating in the body. Before starting CPR, a
community pharmacist must check that the person is
conscious. If
the person appears unconscious, tap or shake his or her
shoulder and ask loudly, "Can you hear me?" or "Are
you OK?"

Revised Guidelines for CPR:
58
 New cardiopulmonary-resuscitation guidelines
show the importance of starting chest
compressions immediately instead of opening
the victim's airway and breathing into their
mouth first.
 The order to perform CPR is as follows (as
shown in Fig.)

Compressions:
59
 Kneel next to the person's neck and
shoulders.
 Place the heel of one hand over the
center of the person's chest, between
the nipples.
 Place other hand on top of the first
hand.
 Keep elbows straight and position the
shoulders directly above hands.
 Push atleast 2 inches on adult breast
bone, 100 times per minute, to move
oxygenated blood to vital organs.
 A hard blow and improper technique
can break a patient's chest bone and
can make him/her asphyxiate.

Airway:
60
 Open the airway and check
for breathing or blockage (5-
10 sec).
 Watch out for chest
movement upwards, and also
listen for air movement.
 Clear the airway and clean
the mouth to start with
breathing process.

Breathing:
61
 Place mouth on top of the patient
mouth and blow two full breaths,
and then again resume chest
compressions.
 Completely cover the mouth of the
patient.
 Precautions must be taken if
mouth infections exist.
 Then place a cloth/handkerchief
and perform breathing.
 A community pharmacist must
have a formal training and acquire
skill in performing light
cardiopulmonary resuscitation
(CPR) for adults and children.

References
62
 Community Pharmacy For New Age Pharmacist by
Dr.Atmaram Pawar and Bijoy Kumar Panda
 Wikipedia
 Mayo Clinic
 Taber’s Encyclopedia

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