Exercise First Aid

1. Sara and Mit Exercise First Aid!

2. What we�ll be covering Pain and Swelling: Strains and Sprains Cuts and abrasions Fractures Dislocations Concussion Heat Exhaustion Blisters Nipple Bleeding

3. First things first� D R A B C

4. 1. PAIN / SWELLING

5. Pain/Swelling What should you look out for�? Pain Warmth Swelling Redness Most Frequently: Strains Sprains

7. Strain Muscles attach to bones via tendons If a muscle is pulled too hard, the tendon becomes damaged � a strain Pain occurs whilst the tendon heals Can occur around: neck, ribs, upper arm, fingers, groin� Muscles do not attach to bones directly, they do so by means of tendons � like connecting ropes between the muscle and its relevant bone. Get the audience to look at the back of their hand with the wrist cocked upwards � the tendons that connect the arm muscles with the fingers can be seen. If a muscle is pulled too hard by an abnormal force, the tendon can be damaged, which is a strain. The muscle might also be damaged (i.e. a pulled muscle!). The strain is painful whilst the body heals the tendon. Rarely tendons can snap, but they are very strong so this is uncommon. Key common factor is that the muscles are often used in day-to-day life, thus are more vulnerable to straining them over what is normal. Muscles do not attach to bones directly, they do so by means of tendons � like connecting ropes between the muscle and its relevant bone. Get the audience to look at the back of their hand with the wrist cocked upwards � the tendons that connect the arm muscles with the fingers can be seen. If a muscle is pulled too hard by an abnormal force, the tendon can be damaged, which is a strain. The muscle might also be damaged (i.e. a pulled muscle!). The strain is painful whilst the body heals the tendon. Rarely tendons can snap, but they are very strong so this is uncommon. Key common factor is that the muscles are often used in day-to-day life, thus are more vulnerable to straining them over what is normal.

8. Recognising a strain History of injury e.g. casualty slipped over Pain and tenderness Swelling � usually not much Reddening of the skin Reduced movement due to the pain Location � often away from a joint unlike a sprain Ask the audience to consider how a casualty with a strain might present to them. History of injury � usually a pulling movement on the body e.g. due to slipping over or stretching a limb, rather than direct impact. Pain � can be severe, usually an aching. Swelling usually minimal. Reddening of the skin around the tendon affected. Casualty will be unwilling to move the affected muscle due to pain. Location is important � the pain is usually away from a joint unlike sprains as will be seen.Ask the audience to consider how a casualty with a strain might present to them. History of injury � usually a pulling movement on the body e.g. due to slipping over or stretching a limb, rather than direct impact. Pain � can be severe, usually an aching. Swelling usually minimal. Reddening of the skin around the tendon affected. Casualty will be unwilling to move the affected muscle due to pain. Location is important � the pain is usually away from a joint unlike sprains as will be seen.

9. What is a sprain? A sprain occurs when the ligament around a joint is damaged The joint fluid can leak out This causes pain and swelling Quickly revise joint structure, go back to the previous slide if necessary. A sprain occurs when a joint is damaged e.g. pulled on or twisted. This damages the ligaments that cover the outside of the joint and can cause leakage of the joint fluid. The joint swells and it is painful whilst it heals. The bones themselves are not damaged (key point).Quickly revise joint structure, go back to the previous slide if necessary. A sprain occurs when a joint is damaged e.g. pulled on or twisted. This damages the ligaments that cover the outside of the joint and can cause leakage of the joint fluid. The joint swells and it is painful whilst it heals. The bones themselves are not damaged (key point).

10. Common sites for sprains What joints are commonly sprained? Ankle Knee Elbow Wrist Finger joints Ask the audience to think of the joints which sprain most often. Ankle � e.g. due to falling and twisting, the most common sprain. Knee � e.g. during football/rugby matches � big joint so easy to damage. Elbow � e.g. playing tennis or cricket. Wrist � e.g. falling onto hand. Finger joints � e.g. catching a ball, trapped fingers in a door. Ask why arm and leg joints are affected most? Because they are used more and are more exposed than other joints thus are easier to damage. Note hip and shoulder are rarely sprained as are covered in muscles as well as ligaments.Ask the audience to think of the joints which sprain most often. Ankle � e.g. due to falling and twisting, the most common sprain. Knee � e.g. during football/rugby matches � big joint so easy to damage. Elbow � e.g. playing tennis or cricket. Wrist � e.g. falling onto hand. Finger joints � e.g. catching a ball, trapped fingers in a door. Ask why arm and leg joints are affected most? Because they are used more and are more exposed than other joints thus are easier to damage. Note hip and shoulder are rarely sprained as are covered in muscles as well as ligaments.

11. Recognising a sprain History of injury e.g. fell awkwardly Pain and tenderness Swelling � more than in a strain Reddening of the skin Reduced movement due to the pain Location � around a joint, by definition The recognition of a sprain is similar to that of a strain, this can make differentiating them hard. Sprains often swell more than strains due to the leakage of joint fluid. Most importantly, sprains only affect joints, by definition. Strains can affect places away from joints.The recognition of a sprain is similar to that of a strain, this can make differentiating them hard. Sprains often swell more than strains due to the leakage of joint fluid. Most importantly, sprains only affect joints, by definition. Strains can affect places away from joints.

12. Primary Survey RICE How to treat Pain/Swelling/Strain/Sprain Rest � advise the casualty to avoid excessive movements of the body part affected; but to keep moving it occasionally so it doesn�t seize up. Ice � ice packs are available on most duties (try and have one available for the session to demonstrate); the casualty can use a bag of frozen peas or similar at home. Compress � a crepe dressing can be given; Tubigrip bandages aren�t used much nowadays. Elevate � the casualty should keep the area elevated when resting to stop swelling.Rest � advise the casualty to avoid excessive movements of the body part affected; but to keep moving it occasionally so it doesn�t seize up. Ice � ice packs are available on most duties (try and have one available for the session to demonstrate); the casualty can use a bag of frozen peas or similar at home. Compress � a crepe dressing can be given; Tubigrip bandages aren�t used much nowadays. Elevate � the casualty should keep the area elevated when resting to stop swelling.

13. Primary Survey RICE: Rest the affected area Ice-pack the affected area Compress the affected area Elevate the affected area How to treat Pain/Swelling/Strain/Sprain Rest � advise the casualty to avoid excessive movements of the body part affected; but to keep moving it occasionally so it doesn�t seize up. Ice � ice packs are available on most duties (try and have one available for the session to demonstrate); the casualty can use a bag of frozen peas or similar at home. Compress � a crepe dressing can be given; Tubigrip bandages aren�t used much nowadays. Elevate � the casualty should keep the area elevated when resting to stop swelling.Rest � advise the casualty to avoid excessive movements of the body part affected; but to keep moving it occasionally so it doesn�t seize up. Ice � ice packs are available on most duties (try and have one available for the session to demonstrate); the casualty can use a bag of frozen peas or similar at home. Compress � a crepe dressing can be given; Tubigrip bandages aren�t used much nowadays. Elevate � the casualty should keep the area elevated when resting to stop swelling.

14. Advise the casualty they can buy simple painkillers from a pharmacy Strains can take a few days to a week to get better (if RICE is followed) Sprains often take longer to heal � up to two weeks Resting the joint is most important If it doesn�t get better they can see their GP or go to A&E How to treat Pain/Swelling/Strain/Sprain The casualty can be told to go to a pharmacy to get painkillers e.g. paracetamol, ibuprofen � emphasise these shouldn�t be given by the first aider. They should be advised the injury will take time to heal, but that strict RICE treatment will make it heal quicker. If things don�t get better, the casualty should seek further medical advice from their GP or local A&E. Strains *don�t* need to go to A&E otherwise.The casualty can be told to go to a pharmacy to get painkillers e.g. paracetamol, ibuprofen � emphasise these shouldn�t be given by the first aider. They should be advised the injury will take time to heal, but that strict RICE treatment will make it heal quicker. If things don�t get better, the casualty should seek further medical advice from their GP or local A&E. Strains *don�t* need to go to A&E otherwise.

15. 2. CUTS and ABRASIONS

17. Cuts and abrasions What should you look for�? Cut Abrasion Cut Abrasion- superficial layer of skinCut Abrasion- superficial layer of skin

18. Cuts and abrasions What should you do�? Primary survey Rinse wound Pressure Elevate Bandage SHOCK Primary survey WASH HANDS AND GLOVES Treat for shock � lay down blanket Primary survey WASH HANDS AND GLOVES Treat for shock � lay down blanket

19. Treatment for Shock

20. 3. FRACTURES

22. Recognising a fracture How would you recognise a fracture? History of injury e.g. fell onto arm Snapping or cracking noise heard Lots of pain Swelling of the area Obvious deformity e.g. bone looks bent Inability to move the area Bone sticking out or a wound if open fracture The key recognition features for a fracture include the history of the injury, with a large force sustained to the area e.g. someone falling onto their arm; the casualty might describe hearing a snapping or cracking noise as they hurt themselves; the casualty will complain of lots of pain, more than for a strain or sprain; the area will be swollen; the area may look deformed, e.g. the limb might look bent where it shoudn�t be bent; the casualty will be reluctant to move the area due to the pain; and if it is an open fracture, there may be a bone sticking out of the skin, or a wound where a bone has stuck out and gone back inside again.The key recognition features for a fracture include the history of the injury, with a large force sustained to the area e.g. someone falling onto their arm; the casualty might describe hearing a snapping or cracking noise as they hurt themselves; the casualty will complain of lots of pain, more than for a strain or sprain; the area will be swollen; the area may look deformed, e.g. the limb might look bent where it shoudn�t be bent; the casualty will be reluctant to move the area due to the pain; and if it is an open fracture, there may be a bone sticking out of the skin, or a wound where a bone has stuck out and gone back inside again.

23. Fractures What should you look for�? Closed fracture Open fracture Closed- Skin above # is intact Open- bone exposed at surface where it breaks the skinClosed- Skin above # is intact Open- bone exposed at surface where it breaks the skin

24. a) Closed fracture What should you do? Primary survey Immobilise joint Arm sling for arm or wrist fracture Elevation sling for a collar bone fracture Blanket padding for a leg fracture AIM: PREVENT MOVEMENT @ INJURY SITE. Immobilise- tell them to stay still / support with yr hands / get someone to help stabilise and keep still. Prevents further damage and it becoming an open #. Also bandage both legs together for example. For arm bandage against trunk Shock- don�t raise the #. Check circulation beyond bandage every 10minutes AIM: PREVENT MOVEMENT @ INJURY SITE. Immobilise- tell them to stay still / support with yr hands / get someone to help stabilise and keep still. Prevents further damage and it becoming an open #. Also bandage both legs together for example. For arm bandage against trunk Shock- don�t raise the #. Check circulation beyond bandage every 10minutes

25. b) Open fracture What should you do? Primary survey Dressing + Pressure Cover any bone ends with dressings soaked in sterile saline (infection) �Tent technique� Immobilise injured part like closed fracture AIM: PREVENT BLOOD LOSS, MOVEMENT AND INFECTION Primary survey � gloves! Dressing- use sterile gauze. DO NOT PRESS ON PROTRUDING BONE Shock- don�t raise the #. Check circulation beyond bandage every 10minutes AIM: PREVENT BLOOD LOSS, MOVEMENT AND INFECTION Primary survey � gloves! Dressing- use sterile gauze. DO NOT PRESS ON PROTRUDING BONE Shock- don�t raise the #. Check circulation beyond bandage every 10minutes

26. How to treat a fracture (both) The casualty needs to go to hospital as soon as possible Don�t let the casualty eat or drink, smoke or walk around Treat for shock if necessary The casualty needs to be taken to hospital, ideally by ambulance so that proper support of the bone and strong painkillers can be given. The casualty must not eat or drink as they may need an operation. They shouldn�t smoke or walk around as they are at risk of fainting and causing more injuries. The casualty may need to be treated for shock � ask the audience to recall how to do this (lie down, elevate legs if possible, keep warm, keep talking to casualty etc.).The casualty needs to be taken to hospital, ideally by ambulance so that proper support of the bone and strong painkillers can be given. The casualty must not eat or drink as they may need an operation. They shouldn�t smoke or walk around as they are at risk of fainting and causing more injuries. The casualty may need to be treated for shock � ask the audience to recall how to do this (lie down, elevate legs if possible, keep warm, keep talking to casualty etc.).

27. 4. DISLOCATIONS

28. What is a dislocation? A dislocation occurs when the two bone ends come apart It is usually due to an impact to the joint Due to the forces involved, fractures may occur with dislocations Dislocations affect joints � they occur when the two ends of the bone that normally meet at the joint are displaced away from each other, usually by an impact to the joint. This means the bones cannot move against each other so the joint is immobilised. The ligaments and other structures around the joint may also be damaged. The x-ray here shows a dislocated finger joint.Dislocations affect joints � they occur when the two ends of the bone that normally meet at the joint are displaced away from each other, usually by an impact to the joint. This means the bones cannot move against each other so the joint is immobilised. The ligaments and other structures around the joint may also be damaged. The x-ray here shows a dislocated finger joint.

29. Recognising a dislocation How would you recognise a dislocation? History of injury � impact to a joint Crunching noise heard Deformity of the joint Swelling and redness Lots of pain Inability to move the joint Signs of a nearby fracture The key recognition features of a dislocation include a history of injury involving impact to a joint and immediate pain afterwards, e.g. a rugby tackle; a crunching noise or sensation as the joint dislocates; an obvious deformity of the joint, e.g. a bulge from a bone�s head; swelling and redness to the joint; the casualty will be in significant pain; an inability to move the joint, due to the pain and because the bones cannot touch; and possibly signs of a fracture of a nearby bone of this has occurred.The key recognition features of a dislocation include a history of injury involving impact to a joint and immediate pain afterwards, e.g. a rugby tackle; a crunching noise or sensation as the joint dislocates; an obvious deformity of the joint, e.g. a bulge from a bone�s head; swelling and redness to the joint; the casualty will be in significant pain; an inability to move the joint, due to the pain and because the bones cannot touch; and possibly signs of a fracture of a nearby bone of this has occurred.

30. How to treat a dislocation Keep the joint still and supported � use a sling or padding if necessary Never try to put the bones back into the normal position: Without x-ray can�t be sure it�s a dislocation May cause more damage It�s cruel without painkillers! A dislocated joint should be kept still, to prevent the bones moving further out of line and causing damage and pain. The joint can be supported with a sling or padding. As a first aider you must never try to put the bones back into position (or �reducing� the dislocation) � without an X-ray or medical experience you can�t be sure it�s a dislocation, you may cause more damage e.g. if a fracture is present and you pull it out of line, and most importantly it is cruel to the casualty to attempt this without painkillers!A dislocated joint should be kept still, to prevent the bones moving further out of line and causing damage and pain. The joint can be supported with a sling or padding. As a first aider you must never try to put the bones back into position (or �reducing� the dislocation) � without an X-ray or medical experience you can�t be sure it�s a dislocation, you may cause more damage e.g. if a fracture is present and you pull it out of line, and most importantly it is cruel to the casualty to attempt this without painkillers!

31. How to treat a dislocation The casualty needs to go to hospital as soon as possible Don�t let the casualty eat or drink, smoke or walk about Treat for shock if necessary Otherwise the treatment is as for a fracture � an ambulance is needed to transport the casualty to hospital. They must not be allowed to eat or drink as an operation may be required, or smoke or walk about as they could faint. Due to the amounts of pain involved, shock is common with dislocations so may be needed to be treated.Otherwise the treatment is as for a fracture � an ambulance is needed to transport the casualty to hospital. They must not be allowed to eat or drink as an operation may be required, or smoke or walk about as they could faint. Due to the amounts of pain involved, shock is common with dislocations so may be needed to be treated.

32. 5. CONCUSSION

34. What is a Concussion The brain is free to move a little within the skull, and can thus be 'shaken'�by a blow to the head; shaking =�concussion Concussion produces widespread but temporary disturbance�of�normal brain activity Not usually associated with any lasting damage to the brain Impaired consciousness - only for a short time (few minutes) and is followed by a�full recovery

35. Recognition Brief period of impaired consciousness following a blow to the head There may also be�: Dizziness or nausea on recovery Loss of memory of events at the time of, or immediately preceding, the injury Mild, generalised headache

36. Treatment Check level of response -�AVPU Regularly monitor and record vital signs When the casualty has recovered, place them in the care of a responsible person Advise the casualty to obtain medical aid if they develop symptoms such as headache, vomiting, confusion, drowsiness or double/blurred vision Check level of response -�AVPU Regularly monitor and record vital signs - level of response, breathing and pulse Even if the casualty appears to recover fully, watch them for any deterioration in their level of response When the casualty has recovered, place them in the care of a responsible person. If a casualty has been injured on the sports field, never allow them to 'play on' without first obtaining medical advice Advise the casualty to go to hospital, if following a blow to the head they develop symptoms such as headache, vomiting, confusion, drowsiness or double vision. Warning:�if the casualty does not recover fully,�or�if there is a deteriorating level of response after an initial recovery�dial 999�for an ambulance. A casualty who has been concussed should be�monitored�and advised to obtain medical aid if symptoms such as�headache�or�blurred vision�develop later. Check level of response -�AVPU Regularly monitor and record vital signs - level of response, breathing and pulse Even if the casualty appears to recover fully, watch them for any deterioration in their level of response When the casualty has recovered, place them in the care of a responsible person. If a casualty has been injured on the sports field, never allow them to 'play on' without first obtaining medical advice Advise the casualty to go to hospital, if following a blow to the head they develop symptoms such as headache, vomiting, confusion, drowsiness or double vision. Warning:�if the casualty does not recover fully,�or�if there is a deteriorating level of response after an initial recovery�dial 999�for an ambulance. A casualty who has been concussed should be�monitored�and advised to obtain medical aid if symptoms such as�headache�or�blurred vision�develop later.

37. If the casualty does not recover fully,�or�if there is a deteriorating level of response after an initial recovery� - dial 999�for an ambulance

38. 6. HEAT EXHUASTION

39. What is Heat Exhaustion? Caused by a�loss of salt and water�from the body Excessively high body temperature ? sweats profusely ?�dehydration These effects coupled with the drug�s effect (e.g. ecstasy) on the temperature regulating centre of the brain can lead to heatstroke and even cause death Caused by a�loss of salt and water�from the body, usually through�excessive sweating. It develops�gradually�and it usually happens to people who are not acclimatised to hot humid conditions or people that are�unwell, especially those with illnesses that�cause vomiting and diarrhoea. They are more susceptible than others to developing heat exhaustion. A dangerous and common cause of heat exhaustion is the�excessively high body temperature�and other physical changes that result from certain drugs taken for pleasure, such as�ecstasy. The user�sweats profusely, due to prolonged over activity then�dehydrationdevelops leading to heat exhaustion. These effects coupled with the drug�s effect of the temperature regulating centre of the brain can lead to heatstroke and even cause death. Caused by a�loss of salt and water�from the body, usually through�excessive sweating. It develops�gradually�and it usually happens to people who are not acclimatised to hot humid conditions or people that are�unwell, especially those with illnesses that�cause vomiting and diarrhoea. They are more susceptible than others to developing heat exhaustion. A dangerous and common cause of heat exhaustion is the�excessively high body temperature�and other physical changes that result from certain drugs taken for pleasure, such as�ecstasy. The user�sweats profusely, due to prolonged over activity then�dehydrationdevelops leading to heat exhaustion. These effects coupled with the drug�s effect of the temperature regulating centre of the brain can lead to heatstroke and even cause death.

40. Recognition Headache Dizziness and confusion Loss of appetite Nausea Sweating with pale clammy skin Cramps in the arms, legs and the abdominal wall Rapid, weakening pulse Rapid, shallow breathing

41. Treatment Replace any lost�body fluids and salt and to�cool the casualty down Help the casualty to a cool place Lie down with their legs raised Give them plenty of water Follow if possible with a weak salt solution -�one teaspoon of salt per litre of water, assist the casualty to drink it

42. Even if the casualty recovers quickly, ensure that they see a doctor If the casualty�s responses deteriorate place them into the recovery position and call for an ambulance Monitor and record any vital signs � the level of response, the pulse and breathing rate Be prepared to give rescue breaths and chest compressions if necessary

43. 7. BLISTERS

44. Leave well alone�if it�s unbroken If it�s broken or likely to be damaged, cover with a�dry, non-adhesive dressing�that extends well beyond the edges of the blister Do not break or cover a blister with any creams or lotions

46. This is caused by friction damaging the skin You can prevent this by�covering nipples with plasters�or�petroleum jelly� If they bleed,�wash and dry carefully�and cover with a plaster, but do not use waterproof plasters Sometimes, nipple bleeding may be due to more serious problems. If in doubt, consult your doctor Sometimes, nipple bleeding may be due to more serious problems. If in doubt, consult your doctor

47. First Aid Aerobics!

48. Scenario 1 Shelley, instead of being on duty, was actually playing football. However, the opponents were vicious and studded her, resulting in a massive cut across her shin that bled profusely 3 seconds to get into the position that you would put Shelley in� Correct answer is A. B describes a dislocation. C describes a strain. D describes a simple soft tissue injury or bruise.Correct answer is A. B describes a dislocation. C describes a strain. D describes a simple soft tissue injury or bruise.

49. Position for shock Lie down and raise legs

50. Vlad was silly enough to run he marathon in his new trainers and ended up with 6 blisters on his feet � they were unbroken 3 seconds to do whatever you do for unbroken blisters� Scenario 2

51. Unbroken blisters Leave well alone! i.e. do nothing

52. Mit has tried to play rugby as a new hobby. Unfortunately, 2 minutes into the game, he has collided with a muc sturdier Jaimie and sustains a collar bone fracture (closed) 5 seconds: on your piece of blank paper, write down how you would treat this Scenario 3

53. Elevation Sling

54. Scenario 4 You are called at the ice rink because your vice chair, Sara who has never been ice skating before, has slipped on the ice and fallen. She put her left arm out as she landed She is now complaining of severe pain in her upper arm and cannot move her shoulder or elbow There is a tender swelling halfway between her shoulder and elbow

55. What type of injury do you think this is and from your first aid bag, get out the appropriate object for the treatment Bonus point if you can attempt to treat yourself as if you have the injury

56. Fracture of humerus (upper arm) Arm Sling

57. Scenario 4/5 As you get Sara to the first aid post in a wheelchair, she complains of feeling sick and faint. What do you do? 3 seconds to get into position

58. Treat for shock � lie down and raise legs

59. Scenario 6 You are on duty at the London 2011 Marathon but then you see our member support officer, Chris, limping towards you with redness and swelling at the knee 3 seconds to get out the most appropriate equipment to treat this from your first aid kit

60. Ice pack (RICE)

61. Scenario 7 After you have sent Chris away, our Social Sec Dhanya suddenly appears before you complaining of headache, dizziness, cramps and wanting to throw up Upon further questioning, you found out that she actually thinks she is in Solomon Islands taking a dive She is sweating with pale clammy skin with rapid, weakening pulse and rapid, shallow breathing

62. 5 seconds to write down: What is your priority after moving her to an appropriate place AND also get into the correct positioning

63. Rehydrate (replace lost fluids) Lie down and raise legs� AGAIN!

64. Scenario 8 For our LINKS social, we went bowling but due to her technique, Sarah threw the bowling ball onto Tom�s head 10 seconds to write down what you are worried about and how you would check the seriousness of the harm caused

65. Concussion AVPU

66. Scenario 9 While Dushy was doing aerobics in the LINKS store-cupboard, a full-body Annie fell on him on he crashed against the shelf. When Sav came to investigate what has happened, he was Dushy crying on the floor with a bone sticking out from his leg� What would you do if you were Sav? N.B. You cannot just walk again and lock the doors behind you

67. You have 8 seconds to get out TWO things that you would use from the stores to save Dushy�s life�

68. Dressing and Sterile Saline Cover any bone ends to reduce chance of infection

69. Scenario 10 On a sunny morning, you saw the 65 year old Jaimie Henry running vigorously along the riverside � suddenly clutches his chest and collapses On examination his face was grey and sweaty Unresponsive

70. What do you think is wrong with him and what position will you put him in?

71. The �W� Position Heart Attack