FIRST AID MANUAL

1. INTRODUCTION FOR THE MANUAL

FIRST AID IS AN ESSENTIAL LIFE SKILL FOR EVERYBODY. IT IS AN ESSENTIAL SKILL IF PRESENT AND USED WILL GIVE YOU SO MUCH OF HAPPINESS AND SATISFACTIONS AS WELL AS IF ABSENT WILL CAUSE YOU IMMENSE GIREF AND GUILT ONE DAY

2. CARDIAC ARREST

CARDIAC ARREST
*1)Checking for unconsciousness
*2)Checking for breathing
*3)Checking for carotid pulse
*4)Checking for spinal injury or back injury

3. AIRWAY CLEARANCE

CLEARING AIRWAY
*4)Opening the mouth
*5)Clearing the airway from mouth to lungs
*6)Head Tilt Chin Lift
*7) Jaw thrusts

4. FOREIGN BODY REMOVAL TECHNIQUES

FOREIGN BODY
8)Back blows
9)Chest thrusts
11) Abdominal thrusts – Heimlich

5. CPR TECHNIQUES

CPR - CARDIO PULMONARY RESUSCITATION

10) Rescue breathing
13) Chest compressions

6. CPR HOWTO

CPR 2
12) Artificial ventilation - mouth to mouth ventilation
12) Artificial ventilation - mouth to nose ventilation
14) CPR - CardioPulmonary Resuscitation

POST CPR

15) Recovery position
16) Severe bleeding

7. UNCONSCIOUSNESS CHECK

UNCONSCIOUSNESS CHECK

1) Shout and ask "Are you OK ?" - Does the victim respond ? Response can be verbal, gestural
2) Shout and ask "Can you hear me ?" - Does the victim respond ?
3) If no response assume victim is unconscious

8. BREATHING CHECK

BREATHING CHECK

Keep your cheek against the nose and mouth of the victim and look for the following :
1) Up and down motion of the chest
2) Up and down motion of the abdomen
3) Feeling the air movement against your cheek
4) Hearing the victims breathing sound
5) If you are not sure assume no respiration

9. CAROTID PULSE

CAROTID PULSE CHECK

1) Keep a finger at the mid-line of chin
2) Slide the finger down the mid-line of throat until you feel the bone of the voice box
or Adam's apple
3) At the first feel of a bone slide the finger to the left or right until the bone feel ends
and a groove is felt
4) Somewhere near the end of the bony feel a pulse is felt if present which is carotid
pulse
5) Absence of carotid pulse is a sure sign of cardiac arrest
6) If you cannot feel the pulse assume it is absent

10. SPINAL INJURY CHECK

CHECKING FOR SPINAL INJURY OR BACK INJURY
1. Visible signs of injury - cuts, bruises, bleeding wounds,
2. Abnormal shape or positioning of spine
3. Twisted spine
4. If victim conscious reports pain in the spine
5. Lifeless limbs
6. Urine, stool leaks
7. Unusual humps and bumps along the spine
8. Breathing difficulty
9. Unable to move body part
10. Consider spinal injury in : raod traffic accident, fall from more than 1 meter height, fall from more than 5 stairs, violence

11. OPEN THE MOUTH HOWTO

OPENING THE TIGHTLY CLOSED MOUTH
1) Slide the index finger into the cheek
2) Push it along the cheek and the gum to the back of the mouth
3) Once behind the row of teeth push the jaw down to open the mouth

OPENING THE CLOSED MOUTH
1) Put your thumb into the victims mouth
2) Rest the other fingers on the chin outside the mouth
3) Now grasping the lower jaw well lift it

OPENING THE CLOSED MOUTH CROSSED FINGER TECHNIQUE
1) Approach the victim from behind and insert the index finger into the mouth
2) Keep the index finger on the upper jaw
3) Using the thumb of the same hand keep the thumb on the lower jaw
4) Now with index finger push the upper jaw up and lower jaw down with the thumb

12. CLEARING THE AIRWAY

CLEARING THE AIRWAY
1) Solids in the mouth - index finger swipes
2) Liquids in the mouth - head tilting and gravity aided
3) Liquids in the mouth - suction if apparatus available
4) Head tilt chin lift to open the airway in all unconscious victims
5) Jaw thrust to open the airway
6) Back blows
7) Manual abdominal thrusts OR Heimlich maneuver (HM)
8) Chest thrusts
9) Use artificial airways - oropharyngeal airway, nasopharyngeal airway if available

CLEARING THE AIRWAY HEAD TILT CHIN LIFT
1) Victim lying face up on a hard surface
2) Keep 1 hand over the forehead
3) Keep the other hand on the chin
4) Slowly push the forehead down WHILE
5) Slowly lifting the chin - lift the chin up AND towards the chest
of the victim. Chin lift should be achieved by lifting the whole
mandible UP AND towards the chest.
6) Tilt the head and lift the chin until the jaw is almost vertical
with chin pointing up

CLEARING THE AIRWAY IN SPINAL INJURY - JAW THRUST
1) Approach the victim from behind the head
2) Keep 2-3 fingers under each angle of the lower jaw
3) Lift the jaw up AND outward
4) If this does not open the airway immediately follow with head
tilt and chin lift maneuver

13. BACK BLOWS HOWTO

BACK BLOWS (For a choking conscious infant)
1) Place the infant face down on your forearm
2) Keep the baby and the forearm on your thigh
3) Use the thumb and fingers to steady the jaw and the baby
4) Hold the baby such that head is lower than the buttocks
5) Using the heel of your hands give 5 back blows between the baby's
shoulder blades

BACK BLOWS (For a choking conscious adult)
1. Stand on the side and littel towards the back of the victim
2. Support the patient by putting one arm from behind across the front of the victims chest
3. Get the patient ot bend at wiast until the chest is parallel to the ground
4. Give five back blows to the area between the shoulder blade

14. CHEST THRUSTS INFANT

CHEST THRUSTS (For a choking conscious infant)
1) Place the infant face up on your forearm
2) Keep the baby and the forearm on your thigh
3) Make sure the head end is lower than the buttocks
4) Keep the thumb on the breastbone in between the nipples
5) Slide down the midline of the breastbone until you come to the
end pit of the breastbone - this is xiphisternum
6) Go up about 1 finger length above the xiphisternum and you come
to the chest thrust point
7) At the chest thrust point - using the pads of your fingers press
the infants chest about 1/2-1 inch down and then let the chest return
to the normal position
8) Give 5 chest thrusts

15. RESCUE BREATHING

RESCUE BREATHING ADULTS ( Unconscious victim not breathing but pulse
felt)(Only trained personnel)
1) Use the head tilt and chin lift to open the airway
2) Pinch the nostril
3) Place your mouth over the victim's mouth making an effective seal
4) Breath slowly into the victim's chest slowly until the chest rises
(If the chest does not rise retilt the head and try and still if no
chest rise there is airway obstruction and try abdominal thrusts)
5) Take a pause to let the chest return to the normal position
6) Give 1 breath every 5 seconds - counting seconds as
"one - one thousand", "two - one thousand", "three - one thousand",
"four - one thousand", "five - one thousand".
7) After every 12th breath check for pulse ie after every 1 minute
8) If pulse still felt and the victim not breathing continue steps 1-7,
if pulse disappears start CPR

RESCUE BREATHING INFANTS/CHILDREN ( Unconscious victim not breathing but pulse
felt)
1) Use slight head tilt and chin lift to open the airway
2) Pinch the nostril
3) Place your mouth over the victim's mouth making a effective seal -
in an infant make a seal over both the mouth and the nose
4) Breath slowly into the victim's chest slowly until the chest rises
(If the chest does not rise retilt the head and try and still if no
chest rise there is airway obstruction and try abdominal thrusts)
5) Take a pause to let the chest return to the normal position
6) Give 1 breath every 3 seconds - counting seconds as
"one - one thousand", "two - one thousand", "three - one thousand",
"four - one thousand", "five - one thousand".
7) After every 20th breath check for pulse ie after every 1 minute
8) If pulse still felt and the victim not breathing continue steps 1-7,
if pulse disappears start CPR

16. ABDOMINAL THRUSTS - HEIMLICH MANEUVER

ABDOMINAL THRUSTS - HEIMLICH MANEUVER (HM)
HM IN STANDING OR SEATED VICTIM
1) Stand behind the victim
2) Put your arms round the waist
3) Keep your fist over the center of the abdomen in between the lower
end of the breastbone and navel
4) Fist is kept with the thumb over the abdomen
5) Put your other hand over the fist
6) Give several rapid thrusts directed little upwards towards the heart
7) Thrusts should be separated by a several seconds pause
8) Keep on giving the manual thrusts until the foreign body is ejected
or the victim becomes unresponsive
9) Then follow the HM in an unconscious victim
8

HM IN AN UNCONSCIOUS VICTIM
1)Place the victim on back face up
2) Kneel over the victim with your knees by the side of the victim's
thighs
3) Place the heel of 1 hand over the center of the abdomen in between the lower
end of the breast bone and navel
4) Place your other hand over the first
5) Give a thrust directed down and up using your body weight without
bending the elbows
6) Give 6-10 thrusts hard and fast in quick succession
7) There should be complete release of pressure in between the thrusts
8) Open the victim's mouth and see whether FB can be removed from
the mouth
9) Put victims head into head-tilt and chin lift
10) Try ventilating the victim
11) Continue steps 5-10 until FB is ejected and victim breathes normal
or until you succeed in ventilating the victim even if the FB is in

17. CHEST THRUSTS IN OBESE VICTIMS

CHEST THRUSTS IN PREGNANT OR VERY FAT VICTIMS
1) Stand behind the victim
2) Put your arms round the chest under the armpits
3) Keep your fist over the center of the chest in between the upper and
lower ends of the breastbone
4) Fist is kept with the thumb over the chest
5) Put your other hand over the fist
6) Give several rapid thrusts directed towards the heart
7) Thrusts should be separated by a several seconds pause
8) Keep on giving the manual thrusts until the foreign body is ejected
or the victim becomes unresponsive
9) Then follow the HM in an unconscious victim

18. ARTIFICIAL VENTILATION MOUTH TO MOUTH

ARTIFICIAL VENTILATION - Mouth-to-mouth ventilation
1) Keep palm of your hand on the forehead of the victim
2) Keep the other hand behind the neck and tilt the victims head a little to open the
mouth slightly
3) Now bring the hand behind the neck to the chin
4) Hold the head of the victim at forehead and chin - tilted back a little
5) Pinch the victims nostrils shut with the fingers of the hand on the forehead of the
victim
6) Take a regular breath (not a deep breath)
7) Place your mouth over that of the victim enclosing the all of the victim's mouth
8) Now breathe out into the chest of the victim looking at the victims chests from the
corner of the eye until the chest rises
9) When the vicitm's chest rises stop breathing into the vicitms chest and let air escape
out of the victim's chest
10) Take a break for a while and repeat steps 6-10.
11) Note - if mouth to mouth ventilation is not possbile switch onto mouth to nose
ventilation

19. ARTIFICIAL VENTILATION MOUTH TO NOSE

ARTIFICIAL VENTILATION - Mouth-to-nose ventilation
1) Tilt the head back using head-tilt/chin-lift method
2) Close the victim's mouth tightly with one hand
3) Keep the other hand on the forehead of the victim
4) Take a deep breath
5) Put your mouth over the victim's nose and breathe out into the victim's chest until it
rises
6) When the vicitm's chest rises stop breathing into the vicitms chest and let air escape
out of the victim's chest through the mouth and nose
7) It is important to open the mouth of the victim in this procedure

20. CHEST COMPRESSION HOWTO

CHEST COMPRESSIONS
1) Place the victim on the back on a hard surface with head
lower than the chest
2) Raise the victims leg to above 30 degrees
3) Kneel by the side of the victim and remove the clothing on the chest
4) Touch the breastbone with a finger and move it down the breastbone until the end of
the bone is felt - this is called xiphisternum
5) Mark 2 finger breaths above the xiphisternum - this is the chest compression point
6) Keep the heel of 1 hand on the chest compression point so that fingers lie along the
breastbone
7) Keep the heel of the other hand on the hand already on the breastbone - again
fingers along the breastbone
8) Fingers should not touch the chest nor the ribs
9) Keeping the elbows straight use the body weight to press the breastbone about 1
1/2-2 inches
10) Press the breastbone for about 1/2 a sec and take off pressure completely for about
1/2 a sec for the chest to recoil back to normal position
11) Achieve a compression rate of 100 per minute
12) How to achieve the necessary compression rate - do the chest
compression at a rate of 1 per second, counting seconds as
"one - one thousand", "two - one thousand", "three - one thousand",
"four - one thousand", "five - one thousand".
13) Some advise 80-100 compressions per minute with 2 lung inflations
in rapid succession for every 15 compressions

21. CHEST COMPRESSIONS IN CHILDREN

CHEST COMPRESSIONS IN CHILD
1) Compression point is lower half of sternum
2) Use 2 or 1 hand for chest compression
3) Rest as above

CHEST COMPRESSIONS IN INFANT
1) Compression point is just below the line joining 2 nipples over the mid breastbone
2) Use 2 fingers for the compression
3) Use 2 thumb encircling hands technique when 2 rescuers are present
4) Encircle the infants chest with both hands, spread your fingers around the thorax
and place your thumbs together over the lower half of the sternum. Forcefully
compress the sternum with your thumbs as you squeeze the thorax with your fingers
for counter-pressure
5) Rest as above

22. CPR - 1 OPERATOR

CARDIOPULMONARY RESUSCITATION (1-Operator CPR)
1) 15 chest compressions at the chest compression position
2) Move onto the ventilation position
3) 2 Slow breaths 1 after the other, allow air to escape between the 2 breaths, delivered
within 5 seconds
4) Move onto the chest compression position
5) Continue chest compressions
6) Continue for 4 cycles of chest compressions
7) Reassess the victim - carotid pulse felt ?
8) If no continue CPR
9) If yes stop chest compressions
10) Reassess the victim - natural breathing started ?
11) If no continue artificial respiration 12 breaths per minute
12) If yes stop artificial ventilation

23. CPR - 2 OPERATORS

CARDIOPULMONARY RESUSCITATION (2-Operator CPR)
1) "Compressor" carry out chest compressions 90/minute
2) Every 5th chest compression stop for 1 1/2 seconds
3) In that pause "ventilator" gives 1 deep breath
4) Ventilator checks for carotid pulse in between deep breaths
5) Feel for carotid pulse during a chest compression - is it felt ?
6) If yes chest compression effective
7) If no check the victim's position, compression point, compression force
8) Correct the problem until the carotid is felt during the chest compression
9) Feel for carotid pulse after a chest compression - is it felt ?
10) If yes stop chest compressions and monitor for sometime
11) If no continue CPR
12) Lay rescuers skip - 1 is a health care provider and the other is
a trained person in first aid techniques, compression and breathing
ratio is 15:2. This ratio is applicable for infants and children upto
puberty. Do not compress and ventilate simultaneously.

24. POSITIONING OF INJURY VICTIMS

POSITIONING OF THE PATIENT
INITIAL POSITION
DO NOT MOVE the victim unless required because :
Area is unsafe for the rescuer to reach the victim then move the victim to a safer place
If the victim lies face down and is unresponsive then turn the victim face up
If the victim has breathing difficulty because of copius secretions or vomiting
If the victim unresponsive and you have to leave for help
Put patient into modified HAINES recovery position :
Straighten 1 arm above the head
Roll the body to that side untilthe head rests on the arm
Bend both legs to stabilize the victim

RECOVERY POSITION FOR ALL EXCEPT SPINE INJURED
1) Turn the victim to a side
2) Position the victim head dependent
3) Avoid pressure on the chest

25. BLEEDING MANAGEMENT

EMERGENCY BLEEDING MANAGMENT
1) If possible wash your hands and wear synthetic gloves
2) Go down the sequence if the injury is in the limbs
3) Lower the head than the trunk
4) Elevate the legs
5) Elevate the site of bleeding
6) Remove any obvious easily removed dirt and debris
7) Do not remove any embedded objects or try to explore the wound
8) Using a sterile bandage OR a clean cloth OR even a piece of
clothing apply pressure directly over the wound
9) Hold continuous pressure for 20 minutes - either manually, or
binding the wound tightly with a bandage or any clothing, or using an
adhesive tape
10) If bleeding continues go down the sequence
11) Use more bandages or clothing over the ones already there without removing the initial bandages/clothing
12) If bleeding continues go down the sequence
13) Squeeze the main artery at the pressure point for the limb.
Pressure points in the upper limb are inside the arm just above the
elbow and another point just below the arm pit. Pressure points of
the lower limb are back of the knee and the groin.

14) At the pressure point press the main artery against the bone
while continuing to apply direct pressure over the wound
15) Immobilize the injured part
16) Arrange for emergency transport to a medical care facility

IDENTIFYING INTERNAL BLEEDING
1) Bleeding from ear, nose, throat, rectum, vagina
2) Vomiting or coughing up blood
3) Neck, chest, abdomen,flanks bruising
4) Penetrated wound of skull, chest, abdomen
5) Fractures
6) Shock (weakness, anxiety, thirst, cold skin)
ADULTS

26. ALLERGIC REACTIONS

ALLERGY CHECK
Look for the following :
1. Lips, face and eyes swollen
2. Hives
3. Tingling and numbness around mouth
4. abdominal pain and vomiting
5. Itchy red watery eyes
6. Wheezing
7. Chest tightness
8. Breathing difficulty
9. Identification bracelets, tags, documents, tools like autoinjectors, keeping tablets for the allergy

27. unconscious patient management

LOOKING AFTER AN UNCONSCIOUS PATIENT
1. Make sure it is unconcsiousness not cardiac arrest, faint, shock
2. Look for the spinal injury signs - see the skills mastery
3. Put the patient into recovery position - see the skills mastery
4. Activate the local EMS system and call for 1990 Suwsariya Ambulance
5. Check for the breathing and pulse frequently and start CPR as soon as cardiac arrest sets in - see the cardiac arrest bot
6. If breathing becomes diffult and noisy follow these steps in sequence :
try opening the mouth, clearing the airway, head tilt and chin lift.
7. At any stage of monitoring if breathing stops immediately roll back the patient and start CPR snd go to cardiac arrest bot
8. Do not leave the victim, do not give anything by mouth, do not place pillows under the head, do not slap or splash water onto the face of the victim

https://medlineplus.gov/ency/article/000022.htm Reviewed 2021. Accessed 11:13 AM 8/16/2022