ISPA-Education
CEU Course
A Guide for the Professional’s Office in Learning CPR,
Safety and First Aid
2 CEU Credits
Brief Description
This course will discuss the basic elements of CPR and First Aid that can be utilized to
respond to a variety of emergency and non-emergency situations. The comprehensive
approach to this course will discuss the basics of CPR and First Aid ranging from the
supplies needed to furnish a First Aid Kit for the office to the appropriate response for
common yet life threatening situations. This course is designed to provide basic
knowledge on CPR and First Aid for those who have not previously taken a course. It
will also assist with refreshing the knowledge one has gained from a CPR and First Aid
course, as many workplaces only require recertification every two years.
Key Learning Objectives
1. Identify the key components needed in a basic First Aid Kit to ensure the appropriate
supplies are readily available when responding to a nonemergency or emergency
situation.
2. Identify how to effectively respond to a choking victim whether it is a infant, child,
adult, or pregnant or obese victim.
3. Identify the appropriate time to call 9-1-1 and the information that should be relayed
to the operator.
4. Learn the components of CPR and how to effectively assess the steps to performing
CPR on an infant, child, or adult.
5. Learn and identify common nonemergency and emergency conditions and how to
appropriately respond.
Assessment Techniques
Upon completion of the course, a set of multiple choice, short answer, and fill in the
blank assessment questions are provided. In addition, a print out will be available to you
regarding the key components of CPR and First Aid to display in the office setting.
Note: This course will not certify you in CPR and First Aid. This course is strictly
intended to provide you with basic knowledge and/or refresh your understanding of the
appropriate response to nonemergency and emergency situations that can arise. It can be
used as a refresher course and reference course that can and should be reviewed often
for basic office safety and between required recertification in CPR and First Aid.
Introduction
In this course I will start out with discussing the basic elements of a well-furnished First
Aid Kit that all professional offices should have on hand to respond to the needs of their
employees and clientele. In addition, discuss how to respond using First Aid and CPR for
any situation that may compromise an individual’s health and safety. I am a
baccalaureate prepared registered nurse and have been certified in CPR and First Aid for
six years by completing the required coursework and training needed to respond as a
healthcare professional. Online education offers an outstanding medium to present course
content that has practical application, discusses personal choices and can provide
Continuing Education Unit (CEU) credit. To further enhance your skills in CPR and First
Aid and receive certification in these skills, I have provided links to allow you the
opportunity for certification through the American Red Cross and American Heart
Association.
In this course, you will be challenged to consider how to effectively respond to
emergency situation that may arise amongst co-workers and client population you work
with on a daily basis. In addition, maximize your effectiveness in these skills as a
professional.
Compiling a Well-Furnished First Aid Kit for your Office
There are several items that should be in a First Aid Kit to ensure your ability to respond
to a variety of situations. It is important that you check and restock your First Aid Kit
frequently, once a month or after each use of the supplies in the kit, to ensure necessary
means are always available. It is often beneficial to create a checklist of the items needed
in the kit as well as a minimum quantity of items that should always be on hand. A
designated employee should be responsible for ensuring these supplies are available at
specific intervals. A list is available for printing and should be kept in or near the First
Aid Kit. It is also important that all employees are aware of the location of the First Aid
Kit to ensure ease in accessing the supplies. The following should be in a First Aid Kit at
all times:
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Adhesive Tape (one or two rolls)
Aluminum finger splint (one or two)
Antibiotic ointment, i.e. Neosporin (one tube)
Antiseptic towelettes (10)
Bandages (Ace wraps, Band-aids) in a variety of sizes
Instant cold packs (one to two)
Cotton balls or cotton-tipped swabs (10 or more)
Disposable gloves (two pairs of small, medium, and large)
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Gauze pads (three to four) and roller gauze (one roll)
Plastic bags for disposal of contaminated items (two to three)
Hydrogen peroxide (one bottle)
Scissors (one to two pairs) and tweezers (one)
Thermometer (one) with disposable sleeves (one box)
Barrier device for CPR (one for infant, child, and adult depending on the age of
clientele and employees)
Sterile eye wash, i.e. saline solution (one bottle)
Eye goggles (one to two)
First Aid manual (which is available for print out)
Instant hand sanitizer (one to two bottles)
Flash light (one), have extra batteries on hand (one to two boxes)
Emergency contact information (local emergency services, poison control)
Medications
 Tylenol
 Aspirin for chest pain (never give to children)
 Antihistamines (Benadryl)
 Calamine lotion
Note: The supplies listed are a general list that should ensure effective response to a
variety of situations. Additional supplies may be necessary depending on the industry in
which you are employed and the client population in which you serve.
It is also beneficial to have an employee list all their allergies, whether it is environmental
or drug allergies. I might suggest that this list be kept in the first aid kit itself and in the
personnel files.
When to Dial 9-1-1
Whenever you are uncertain how to respond to a situation in which an individuals health
and safety is compromised, call 9-1-1. However, NEVER leave a victim alone. Easy
access to means of communication should be readily available in all areas of the office
setting. When someone is with you, instruct him or her to dial 9-1-1 immediately. If you
are alone dial 9-1-1 before beginning CPR (soon to be discussed) on an adult OR perform
1 minute of CPR and then dial 9-1-1 with a child.
When calling 9-1-1, or local emergency services, provide the operator with the following
information:
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Your location
A number where you can reached
Details on the type of emergency
The victims current condition and/or conditions in which you found the victim
Remember! It is crucial that you have emergency contact information readily available
and displayed throughout the office or work setting.
First Aid for Choking Victims (Adult or Child)
In ANY situation in which a victims health or safety is compromised the first step is
ALWAYS to assess the situation.
Assess whether the victim can cough or talk by asking, “Are you choking?” If the victim
signals yes, either by shaking their head yes or clutching their hand to their throat (which
is the universal sign for choking), perform the Heimlich maneuver (discussed next) until
the object is expelled.
Other signs that indicate choking include:
 Difficulty breathing or gasping for air
 Inability to talk or cough
 Loss of consciousness or cyanotic skin (bluish coloration which typically occurs
as a late sign of impaired oxygenation)
The Heimlich maneuver
First, position yourself behind the victim. Perform five back blows to determine if the
object can be expelled. Using the palm of you hand firmly strike between the victim’s
shoulder blades, a maximum of five (5) times. This may be enough to dislodge the object.
If this is not effective, create a fist with your dominant hand and wrap it around the
victim’s torso just above the naval. Take your non-dominant hand and wrap it around the
fist. Position your hands slightly above the victim’s navel and just below their rib cage.
Have them lean forward slightly or if the victim is not able to follow commands, push the
torso forward slightly. With your fist, press firmly into the abdomen with quick, upward
thrusts. It is crucial that you determine that they are choking before performing the
Heimlich maneuver, as it can be detrimental to internal organs. Perform five abdominal
thrusts. If the object is not expelled from the victim’s airway repeat these steps until the
object is expelled or the victim becomes unresponsive. If the victim becomes
unresponsive, lower him or her to the ground away from danger and call 9-1-1 and begin
CPR. Exception: if the victim is a child perform one minute of CPR then call 9-1-1.
NEVER leave the victim alone!
If the victim is pregnant or obese, a chest thrust may be substituted for the abdominal
thrust. First, as with any emergency situation, assess if they are choking (as discussed
above). Then, perform five back blows to attempt to dislodge the object. If unsuccessful,
wrap you arms around the victims chest and place one hand just below the breastbone
and above the lowest rib. Perform the same steps as discussed above. You may need to
have the victim sit down if they are taller then you and proper placement of your hands is
unattainable. Perform the chest thrust five times and if the object does not dislodge,
repeat the steps. If the victim becomes unresponsive, call 9-1-1 and begin CPR.
If the victim is an infant (less then 1 year of age), again assess first. Determine if the
infant can cough or cry or observe for other signs of choking (discussed above). Once it
is determined that the infant is choking, assume a seated position. Securely hold the
infant face down on your forearm, which should be resting on your knee and secure their
head and neck with one arm while ensuring you are not further obstructing the airway.
Perform five gentle, yet firm, back blows using the same mechanism discussed above. If
the object is not expelled, turn the infant on their back. Support their back with your
forearm and support the infant’s head and neck with one hand. Place two fingers just
below the infant’s breastbone and perform five quick chest compressions, only pressing
1/3 to ½ the depth of their chest. If the object still fails to dislodge, turn the infant face
down and repeat the back blows. Continue to repeat this cycle of five back blows and five
chest compression until the object is expelled or the infant becomes unresponsive. If the
infant becomes unresponsive, initiate one minute of CPR and then call 9-1-1. NEVER
leave the infant alone!
Important Fact
Abdominal thrusts may cause complications, such as damage to internal organs. A victim
who has received abdominal thrusts should be examined immediately by a healthcare
provider to ensure that life-threatening complications do not arise (Hazinski, Gonzales,
and O’Neill, 2006).
The Basics of Cardiopulmonary Resuscitation (CPR)
How you respond to an emergency situation is determined by your training and comfort
level. Remember, doing something is ALWAYS better then not doing anything, even if
your knowledge and skills are not 100% (Mayo Clinic Staff, 2010).
Time is Critical!
For an unconscious victim who is not breathing, it takes very few minutes for brain
damage to occur and approximately eight to 10 minutes before death can occur (Mayo
Clinic Staff, 2010).
Components of CPR
1. Chest Compressions
2. Mouth-to-mouth rescue breathing
The very first step in any emergency situation is to ASSESS. First, assess the scene in
which you found the victim to ensure safety for yourself and the victim. If danger to
yourself or the victim is foreseen, move yourself and the victim to safety immediately! If
the victim is unconscious, firmly pat the bottom of the victim’s foot or shake him or her
and loudly ask, “Are you OK?” Exception: If a neck or spinal cord injury is suspected do
NOT move or shake the victim unless in immediate danger. If the victim does not
respond and other people are near by, have someone call for emergency assistance
immediately and initiate CPR.
When performing CPR, remember ABC.
 Airway
 Breathing
 Circulation
Airway
Carefully position the victim on their back on a firm surface and kneel next to the
victim’s shoulders on the side where your dominant hand is facing the victim’s head and
your non-dominant hand is facing his or her torso. Open the victim’s airway using the
head-tilt, chin-lift. To perform the head-tilt, chin-lift complete the following steps:
 Tilt the victim’s head back and place the palm of your hand on his or her
forehead.
 With the other hand, gently lift the chin forward to assist in opening the airway.
Exception: If a neck or spinal cord injury is suspected, do not tilt the head back. Instead,
position yourself behind the victim’s head and position your hands on both sides of the
victim’s jaw. Gently push the jaw forward to open the airway.
 Look inside the victim’s mouth for the presence of a foreign object. If present, do
not attempt to remove the object as it may cause the object to become pushed
further into the airway. Instead, perform chest compressions (soon to be
discussed) until the object is expelled.
If you believe that the victim is unconscious due to a heart attack, skip the rescue breaths
(discussed under breathing) and begin chest compressions (discussed under circulation).
Breathing
Next, look, listen, and feel to assess for normal breathing. Do this by performing the
following steps:
 With the victim’s head still tilted back, place your ear over the victim’s mouth
and look for the rise and fall of the victim’s chest.
 Simultaneously, listen for breath sounds from his or her nose or mouth and feel
for the victim’s breath on your cheek.
 Do not take more then five to 10 seconds to complete this step.
 Note: If any of these are present, call for help and do not initiate CPR.
If breathing is not felt, give one rescue breath by following the steps below and look,
listen, and feel for normal breathing.
To give rescue breaths, first pinch the victim’s nose closed with your thumb and index
finger with your other hand still on the victim’s forehead. If a barrier device (usually a
plastic covering) is available, cover the victim’s mouth with the barrier device and secure
the device with one hand to create a seal. If there is not a barrier device available, cover
the victim’s mouth with your mouth and give one rescue breath.
To create an airtight seal:
 Place the barrier device over the victim’s mouth using the bridge of the nose as a
landmark. Make sure the victim’s head remains tilted back to maintain an open
airway.
 Once the barrier device is positioned over the victim’s nose and mouth, create a
“C” shape with your thumb and index finger on your dominant hand. Place the
index finger on the border of the mask on the side of the nose opposite to the side
you are on and the thumb on the border of the mask on the side of the nose closest
to you. Use your non-dominant thumb and index finger to pinch the border of
barrier device against the chin. Press firmly against the mask.
Give a rescue breath (one second duration) and watch for the rise and fall of the chest to
determine if the breath was effective. If the chest does not rise, perform the head-tilt,
chin-lift maneuver again to re-establish and open airway and repeat the steps above.
Circulation
Assess the carotid pulse (just below the victim’s jaw on the neck) with two fingers for
five to 10 seconds. Recheck every two seconds during the delivery of CPR. If no pulse is
felt or cyanosis (bluish color of lips) is present, begin chest compressions. To perform
chest compressions:
 Place the palm of the dominant hand over the victim’s chest between over the
sternum, between the nipples. Place the non-dominant hand over the hand
positioned on the victim’s chest. Intertwine your fingers and keep your elbows
straight with your shoulders directly above your hands.
 Push straight down using your upper body weight pushing hard and fast. Push
down 1 ½ to two inches the width of the victim’s chest for an adult and 1/3 to ½
the width of the victim’s chest for a child or infant. Perform compressions at the
rate of 100 compressions a minute. This is very quick and it is beneficial to count
out loud as you as performing compressions. Take a minute now to establish this
rate by timing yourself for one minute and counting to 100. This well help you
determine if you need to adjust the rate.
 After delivery of 30 compressions, give two rescue breaths and return to
compressions.
 One cycle of CPR is classified as 30 compressions to two rescue breaths (30:2)
ratio. Perform five cycles of CPR. If someone is with you, designate one person to
give rescue breaths and the other person will perform chest compressions.
 If after five cycles of CPR, the victim has not regained consciousness continue to
perform CPR until the emergency medical team arrives or you are no longer
physically able to effectively perform CPR.
 If you are with another person, have the individual who was giving rescue breaths
perform chest compressions and vice versa. CPR is an extremely arduous task! It
is very important to conserve energy by alternating the roles of giving rescue
breaths and chest compressions.
 If the victim has not regained consciousness after five cycles of CPR, attach an
Automated External Defibrillator --AED (if available) and deliver a rescue shock
if advised by the device (discussed below).
Automated External Defibrillator (AED)
Every office should have an AED in a designed area, which is universally known by all
employees. In addition, it should be noticeably marked and placed in an area that can be
easily accessed. AED provides an individual with detailed instructions on how to operate
the device. If you are uncomfortable using an AED, a 9-1-1 operator can instruct you on
the appropriate steps to operating the device.
Attach the pads that are provided in the AED to the victim. Remove the paper protector
on the pads (there is an adhesive side which should be placed on the victim and a nonadhesive side to attach the wires). Most AED’s have diagrams to demonstrate proper
placement of the pads. Place one pad below the left nipple, and the other pad above the
right nipple. If the victim has a hairy chest, attach the sticky side of the AED pad to the
victim’s chest and quickly remove it. Then place a new pad on the chest in the designated
locations. Most AEDs will have at least two sets of pads. Again, it is important to
routinely check the AED devices to ensure proper equipment is available for an
emergency situation.
When using an AED on a child (one to eight years of age), use pediatric pads if
available. Place one pad in the middle of the child’s chest, between the nipples. Place the
second pad on the child’s back between the shoulder blades. NEVER use an AED on an
infant (younger then one year of age).
After the pads are attached continue to follow the AED’s prompts. It will instruct to press
analyze and avoid touching the victim. The AED will analyze the victim’s heart rate and
determine if a shock is advised. If advised, loudly announce “Everyone clear?” Press the
shock button once you have determined that no one is touching the victim. After the
shock is administered, the AED will prompt you to deliver another shock or begin CPR.
Each AED will provide you with prompts on how to effectively deliver a rescue shock.
CPR on a Child (one year of age to puberty)
The steps to CPR are the same on a child as an adult. However, there are a few
differences that you should understand.
 If you are alone, perform five cycles of CPR (approximately one minute duration
if the rate of compressions is 100/min) before calling 9-1-1 or using an AED.
 For chest compressions, use the palm of ONE hand and only press 1/3 to ½ the
width of the child’s chest.
 Provide more gentle rescue breaths then you would on an adult. If you gave
rescue breaths to a child as you would for an adult, you may hyperventilate the
child, which can cause concurrent lung tissue damage.
 If two rescuers are available, provide 15 compressions to every two breaths. If
you are alone provide 30 chest compressions to every two breaths as you would
for an adult.
CPR on an Infant (younger then one year of age)
The steps to CPR are the same on an infant as an adult. However, there are a few
differences that you should understand.
 During the assessment process, never shake the infant to determine
consciousness. Instead, stroke the infant’s arms or legs and watch for a response.
 For rescue breaths, provide gentle breaths are you would for a child to provide
hyperventilation and concurrent lung tissue damage.
 For chest compressions, place two fingers of your dominant hand just below the
infant’s breastbone. Only compress the infant’s chest 1/3 to ½ the width of his or
her chest. Perform compressions at the same rate as a child or adult (100
compression per minute).
 If two rescuers are available, provide 15 compressions to every two breaths. If
you are alone provide 30 chest compressions to every two breaths as you would
for an adult or child.
I understand that this is a ton of information and seems like a lot of numbers to keep
straight. What has helped to me remember the numbers for chest compressions to breaths
ratio, the rate and depth of compressions, is to draw a chart as a visible aid for
comprehension. Also, making note cards to review may help.
Critical Points to Remember for CPR
Quality CPR improves the victim’s chance of survival. The following are critical points
to understand:
 Push hard and fast. Speed equivalent to 100 compressions per minutes. It is
beneficial to time yourself while practicing compressions to familiarize yourself
with the correct rate.
 Allow the chest to fully recoil between each compression
 Minimize irruptions while providing chest compressions. Interruptions should be
minimized to less than 10 seconds.
 Avoid hyperventilation, especially on a child or infant
(Hazinski et al, 2006)
What to do in Specific Emergency and Non-Emergency
Situations
Emergency and non-emergency situations can arise at any time, in any place, and to
someone at any age. Therefore, it is crucial that you understand and are able to identify
the symptoms of conditions that compromise an individual’s health and safety in order to
promptly and effectively respond.
Heart Attack (Myocardial Infarction, MI)
When you think of individual’s who have suffered from a heart attack, many tend to think
that only older, overweight individuals who lead a sedentary lifestyle and smoke are the
only individuals who this may happen to. However, that is not true. Yes, these factors do
increase the risk of a heart attack, but it can happen to anyone. Individuals in their 20’s
who are active and healthy have suffered from heart attacks. In addition, these individuals
may even be at higher risk for mortality, as the appropriate life saving measures may not
be implemented in a timely manner. Therefore, it is important to identify the symptoms
of a heart attack and provide a quick response to reduce the risk of death or life-long
morbidity.
If you notice any of the following symptoms, call 9-1-1 or local emergency services
immediately:
 Chest pain or discomfort lasting that is unrelieved by rest or nitroglycerin. Chest
discomfort is the most important sign of a heart attack, especially if it radiates to
the left arm or jaw.
 Increased perspiration or shortness of breath accompanied by weakness or fatigue
 Dizziness and fainting are likely to occur as well
If there is aspirin readily available, take one to two tablets with a full glass of water
(follow administration instructions on bottle) unless contraindicated due to a bleeding
disorder, aspirin allergies, and never give aspirin to a child.
If you are with a victim who has become unconscious and you believe it is due to a heart
attack, begin CPR immediately! Unless certified in CPR, skip the rescue breaths and
immediately begin chest compressions.
Stroke (Cerebrovascular Accident, CVA)
Again, a stroke can occur to any individual, of any age, at any time. If you notice any of
the following signs and symptoms of a stroke, immediately call 9-1-1 or local emergency
services.
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Sudden weakness or numbness dependent to one side of the body
Discombobulated, unorganized speech or thought processes
Drooping of one side of the face
Sudden, severe headache
If any of these symptoms arise, assist the individual to a sitting position on a chair nearby
or the floor if necessary to prevent further injury. Stay with the victim until the
emergency medical team arrives.
Anaphylaxis (Allergic Reaction)
Anaphylaxis can occur within minutes and can last up to several hours after exposure to
an allergy-causing substance. A wide range of substances can cause an anaphylactic
reaction including:
 Insect venom
 Pollen
 Latex
 Certain drugs and food
 From an unknown cause
(Mayo Clinic Staff, 2010)
Signs and symptoms of anaphylaxis include but are not limited to the following:
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Swelling
Itching
Hives or rash
Difficulty breathing, gasping for air
If an anaphylactic reaction is suspected, immediately call 9-1-1 or local medical services.
Look for special medications that the victim may have with them to treat the attack, such
as an inhaler or an EpiPen. Administer the drug as directed. If the individual has an
EpiPen or inhaler they are usually able to self-administer the medication. However, if you
find the victim unconscious or they are incapable of administering it on their own you
must administer the drug. If uncomfortable or unfamiliar with administering epinephrine,
stay on the line with the 9-1-1 operator to have them coach you through the
administration. With an EpiPen, it is usually administered by pressing an auto-injector
located at the top of the pen distal to the needle. Press the injector against a muscular area
on the victim’s body (thigh or upper arm) and hold it in place for at least 10 seconds to
ensure all the medication is administered. After administering the injection, massage the
injection site to increase the rate of absorption.
If the victim has a patent airway, administer antihistamines (ex: Benedryl) if available.
Remember, only administer if you are certain that the victim can swallow the medication
without choking. Anaphylactic reactions commonly cause the airway to swell making
swallowing a pill unattainable.
Loosen the victim’s clothing and have them lay in the Trendelenburg position (on their
back with their head lower then their feet). If vomiting is present, have the victim lay on
their side to prevent choking.
If the victim becomes unconscious, breathless, has an absent pulse, or signs of cyanosis
are observed, initiate CPR.
Seizures
In the instance of a seizure there are a few important do’s and don’ts to consider.
DO:
 Free the victim from potential hazardous objects
 Turn the victim to their side if possible, otherwise position them flat on their back
free from danger
 STAY WITH THE VICTIM AT ALL TIMES
 Loosen clothing
 Observe the victim closely, noting the onset of seizure activity, event in which the
seizure occurred, the duration of the seizure, and another other distinct activity it
can be reported to the healthcare provider.
 Call 9-1-1 or local emergency services:
o If you are not familiar with the victim’s medical history
o The seizure activity persists for longer than five minutes
o Another seizure occurs
DON’T
 Restrain the victim
 Place anything in the victim’s mouth
 Leave the victim
Fainting
If you or anyone you are with begin to feel faint, you should lie sit down on the closest
chair or the floor if necessary and place your head between your knees. If dizziness or
fainting is a recurrent issue, immediately contact your healthcare provider. Do not
attempt to drive and call 9-1-1 or local emergency services if you are alone as it may be
indicative of an underlying medical condition.
If you witness someone faint, position him or her on their back and place them in the
Trendelenburg position if possible. Assess the environment to ensure the victim’s and
your own safety. If the victim does not regain consciousness, call 9-1-1 or local
emergency services and follow the ABC’s of CPR.
Minor Skin Alterations
Minor skin alterations, such as small cuts and scrapes, typically do not require emergency
medical attention. However, it is very important that you have the knowledge and
understanding of how to effectively care for minor skin alterations to prevent infection. A
few key things to consider when caring for a minor skin alteration are:
 Stop the bleeding. For minor skin alterations, such as a paper cut, bleeding usually
subsides on its own. However, if it does not, apply pressure to the alteration with
a tissue or gauze pad. Apply pressure for three to five minutes or until bleeding
subsides.
 Cleanse the wound. Rinse the skin alteration under cool water and pat dry. You do
not need to use soap, as it may be irritating to the wound.
 Apply antiseptic ointment to the skin alteration. You can use a cotton-tipped swab
to do so. It is important to avoid applying too much ointment as it can irritate the
surrounding skin. Only apply enough to cover the alteration.
 Apply a band-aid. Though application of a band-aid seems to be a pretty straight
forward process, there a few things people often do not consider. Remember, the
goal is to prevent infection. Band-aids are considered sterile before you open the
protective wrapper. Once the wrap is open, you will notice one side of the bandaid has paper protecting the gauze pad and adhesive. On the paper side, there will
be two folds at the center that protect the gauze pad that will cover the wound.
Pinch the two folds and carefully pull them away from the center, avoiding
contamination of the gauze pad. Once the folds are pulled back and the gauze pad
is exposed to air, immediately cover the wound with the gauze pad. Once the
wound is covered, pull back the rest of the paper to uncover the remainder of the
adhesive. Easy enough right!
Continue to monitor the minor skin alteration daily. It is important to change the bandage
at least once a day or whenever the bandage appears soiled. Continue to keep the skin
alteration covered until a pink, beefy tissue covers the wound in which infection is no
longer a threat. Contact your healthcare provider if you notice signs of infection. The
acronym SWEEP can identify signs of infection.
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Swelling
Warmth
Erythema (redness)
Exudate (drainage, especially if an opaque color with a foul odor)
Pain (increasing in intensity)
Sprained Ligament
A sprain is characterized by any injury to a ligament (elastic-like bands that provide
connect bones and joints). The most common symptoms observed with a sprain are
considerable pain and swelling. If a sprained ligament is suspected, remembering the
acronym RICE will assist you to provide prompt and effective care.
 Rest the effected area. Avoid weight bearing or use of the sprained ligament.
Splinting or the use of crutches are effective methods to rest and protect the
sprained ligament.
 Ice. Apply ice to the effected area to reduce swelling and pain. Ice is effective
when applied immediately after injury has occurred. Cover the effected area with
a towel or cloth and apply ice. Keep ice on effected area for 15 to 20 minutes four
to five times daily for the first 48 hours after injury. NEVER apply ice directly to
your skin or keep ice on area for more then 20 minutes at a time as it may cause
tissue damage. Initially you want to reduce the swelling by using ice and after 48
hours or when swelling has subsided, heat may be applied. Apply same rule of
thumb (time on and off, do not directly apply to skin) for heat application as you
would for ice.
 Compress. Ace or elastic bandages can be used to effectively compress the
effected area. Compression also assists with reduce swelling. The longer swelling
is prevalent, the longer healing time may be. When applying a compression
bandage, monitor the area for numbness, redness, or increased pain, as the
bandage may be too tight. Periodically provide rest periods for the area by
removing the compression bandage. Some compression bandages can be left on
for athletics, training and/or occupational activities. Others may need to be
removed every 30 minutes. Make sure to read the instructions before applying the
compression bandage.
 Elevate the effected area to promote blood return and assist in reduction of
swelling. Whenever possible, elevate the effected area or extremity above the
heart.
Use of Non-steroidal anti-inflammatory analgesics (NSAIDs) such as Tylenol or
Ibuprofen can be used as an additional measure to reduce pain and inflammation. Avoid
to potent of an analgesic as it may mask the pain and impede your ability to prevent
further injury.
Sprains are usually resolved in two to three days with the RICE regimen. However, if
pain does not subside, it becomes more painful to apply weight to the effected area, or
you develop a fever (> 100 F), you should contact your healthcare provider, as damage to
the ligament may be more extensive then you thought.
Fractures
Fractured or broken bones are always considered a medical emergency. If a fracture is
suspected, call 9-1-1 or your local emergency services. While waiting for emergency
personnel to arrive, complete the following steps to prevent further injury or internal
damage. For care of a fracture, remember the acronym ACTION.
 Assess the area to ensure the victim and yourself are free from danger. If danger is
suspected immediately move to a safe area. If no danger is suspected, avoid
moving the victim.
 Compress to stop the bleeding. Bleeding may or may not be present. Bleeding
usually occurs if the bone has penetrated through the skin. Apply pressure with a
compression bandage, a towel, or article of clothing. Keep the area sterile if
possible, however in most emergency situations you may not have the supplies or
the proper environment to do so.
 Treat the fracture. While waiting for emergency personnel to arrive, the best way
to treat the fracture and prevent further injury is immobilize the effected area.
Splinting above and below the injured area is the most effective way to
immobilize the fracture. However, do not attempt to splint the fracture if it is a
neck or spinal cord injury or if you are not trained on how to effectively do so. If
a neck or spinal cord injury is suspected NEVER move the victim. If you have
not been trained on how to use a splint, try to keep the victim calm and instruct
the to avoid moving the fractured area.
 Ice the area. Same principles apply for fractures as for sprains.
 Observe for signs of worsening condition. Signs of worsening condition include
sudden loss of consciousness, hemorrhage, or shock. If the victim becomes
unconscious, apply the ABCs of CPR to stabilize the victim. If hemorrhaging
occurs, continue to apply pressure until emergency personnel arrive. Signs that
indicate shock are manifested by feelings of faintness, shortness of breath,
vomiting, or changes in pupil size (usually dialated). If these signs become
apparent, place the victim in the Trendelenburg (discussed above in CPR section)
position if possible.
 Never leave the victim alone!
Minor Head Injury
A concussion is the most common type of minor head injury. Individuals who engage in
contact sports are most susceptible to concussion and may not notice when a concussion
occurs. Some of the common signs of a concussion include headache, confusion, short
lapse of consciousness, and memory loss of the event in which the concussion occurred.
It is advised to contact a healthcare provider if a concussion is suspected to evaluate the
extent of damage that has occurred. If a child has a suspected head injury, always contact
the healthcare provider for further evaluation.
Some symptoms of a concussion may not occur until two weeks to two months after the
injury. These symptoms include, but are not limited to, sleep disturbances, irritability,
and altered concentration. If any symptoms arise that affect your ability to complete
activities of daily living (ADL’s) contact your healthcare provider.
Mayo Clinic Staff (2009) suggest that you seek medical advice if any of the following
symptoms arise as they may indicate a severe head injury:
 Prolonged headache or dizziness
 Vision or eye disturbances, including pupils are dilated or of unequal sizes
 Nausea or vomiting
 Impaired balance
 Prolonged memory loss
 Ringing in the ears
 Loss of smell or taste
(Mayo Clinic Staff, 2009)
 Drainage from the ears (bleeding or clear cerebrospinal fluid)
 Bruising around the eyes (Raccoon eyes)
Gastrointestinal (GI) Alterations
Gastrointestinal alterations can arise from a variety of sources that may be pathological in
origin or caused from an outside source (food poisoning, medication side effects,
bacteria). I will discuss some common GI alterations, effective care for each, and when to
seek medical advice.
Gastroenteritis
Gastroenteritis is inflammation of the stomach and intestines that can be caused by
contaminated food or water, viruses, and medication side effects. Symptoms of
gastroenteritis include nausea and vomiting, bloating, abdominal cramps and diarrhea that
persist for 24 hours to several weeks. Remember the acronym REST to effectively
manage gastroenteritis.
 Rest your stomach and intestines. Once symptoms of gastroenteritis are apparent,
avoid food and fluid for two to three hours to provide adequate rest.
 Ensure adequate hydration and nutrition.
o Hydration. After a brief period of no oral intake, it is important to avoid
the presence of dehydration. Vomiting and diarrhea are common causes of
dehydration. So to prevent further complications, make sure to ingest at
least seven to eight glasses of water daily. Sprite, Gatorade, and chicken
broth may be tried. If you are unable to tolerate fluids, you can try small,
frequent sips or ice chips. Also, monitor your urine output. The average
urine output should be between 800 – 1,200 mL per day or at least 30 mL
per hour. If you drink at least eight glasses of water a day, adequate output
is usually achieved. Also, monitor for urine with a strong or foul odor and
darker in color (normal is a yellow to light amber). Both of these factors
indicate dehydration. Dehydration is also manifested by lightheadedness,
persistent headaches, dry oral mucous membranes, sunken eye balls, and
little, infrequent urine output. If you are unable to ingest adequate fluids
and signs of dehydration are apparent, contact your healthcare provider.
o Nutrition. When nausea, vomiting, and diarrhea are present, ingesting food
generally feels like the last thing you want to do. However, to prevent
electrolyte imbalances from dehydration and inadequate dietary intake
following the BRAT diet will provide adequate supplementation until you
are feeling better. The BRAT diet stands for, Bananas, Rice, Applesauce,
and Toast. These food items are bland and low in fiber therefore gentle on
the GI tract. Once you are able to tolerate these food items, you may
gradually introduce your favorite foods back into your diet. Make sure to
avoid alcohol, caffeine, and dairy products.
 Sleep. Illness and dehydration can lead to weakness and fatigue. Make sure to get
an adequate amount of rest.
 Tylenol and other mild analgesics may be used for relief of discomfort.
Contact your healthcare provider if symptoms persist for two or more days, if you notice
blood in your stool, if you develop a fever (> 100 F), or if any changes in balance or
mental status occur.
Food Poisoning
Food poisoning may occur from ingestion of contaminated, undercooked, or expired food
or fluids. Some common symptoms of food poisoning include:





Nausea and vomiting
Diarrhea
Fever (>100 F)
Pallor (pale colored skin)
Abdominal pain and discomfort
If you develop food poisoning, the best treatment is rest and adequate fluids. As with
gastroenteritis and most GI alteration, it is crucial that you prevent dehydration. Also,
avoid the use of anti-diarrheal medications, such as Imodium, as you want to allow your
body to excrete the ingested toxins. Food poisoning can develop within hours of ingesting
contaminated food or fluids and can persists from days to weeks.
Contact your healthcare provider if you notice bloody stools, persistent vomiting and/or
diarrhea (> two to three days), uncontrolled fever, or dehydration occurs.
Appendicitis
Appendicitis occurs when the appendix becomes inflamed and filled with mucous from
the GI tract. It is important to understand the signs and symptoms of appendicitis to
prevent further inflammation and mucous accumulation that will essentially lead to
rupture of the appendix. Prompt medical attention and removal of the appendix
(appendectomy) before it ruptures will prevent complications such as peritonitis
(infection of the peritoneum) or sepsis (widespread infection). Signs and symptoms of
appendicitis are generally associated with the lower right quadrant of your abdomen and
include:
 Pain around the navel that shifts to the right lower quadrant of the abdomen (pain
increases as the appendix becomes more inflamed)
 Rebound tenderness of the right lower quadrant of the abdomen (when you push
in on the abdomen and quickly release, sharp pain occurs upon release)
 Nausea and Vomiting
 Fever
 Constipation
Assessment
This concludes the Continuing Education Course on CPR and First Aid. Below is a
comprehensive quiz on the information discussed throughout the course. The answer key
is available to score the quiz and further determine your level of comprehension. If you
are not currently certified in CPR and First Aid and the use of an AED, you can click on
the following links to search for hands-on classes near you. I hope you enjoyed the course
and feel confident in the knowledge you have acquired. Remember, doing something is
ALWAYS better then doing nothing at all.
American Red Cross
http://www.redcross.org/portal/site/en/menuitem.d8aaecf214c576bf971e4cfe43181aa0/?v
gnextoid=58d51a53f1c37110VgnVCM1000003481a10aRCRD&vgnextfmt=default
American Heart Association
http://www.americanheart.org/presenter.jhtml?identifier=1200000
Note: If the hyperlinks do not work on your computer, simply copy the link and paste it
in your browser’s address bar.
Assessment Quiz
1) Identify three ways to tell if someone is choking.
2) Compare and contrast the method for providing the Heimlich maneuver for
an adult, child, and infant.
3) What is the sequence for providing back blows and abdominal thrusts to a
choking victim?
4) After providing abdominal thrusts what is an important to inform the
victim?
5) What are the two components of CPR?
6) T/F: If someone becomes unconscious and you are not trained in CPR, you
should call 911 and wait with the victim until help arrives.
7) What do the ABCs of CPR stand for?
8) What needs to be assessed when you find an unconscious victim?
9) Compare and contrast the compression to breath ratio and compression rate
and depth on an adult, child, and infant.
10) T/F: AED’s should be used on all unresponsive victims regardless of their
age.
11) Identify the appropriate placement of AED pads on an adult and child.
References
Hazinski, M.F., Gonzales, L., & O’Neill, L. (Eds.). (2006). BLS for healthcare providers:
Student manual (2nd Edition). Dallas, Texas: American Heart Association.
Mayo Clinic Staff (2010). Anaphylaxis: First Aid. Retrieved from
http://www.mayoclinic.com.
Mayo Clinic Staff (2010). Cardiopulmonary Resuscitation (CPR): First Aid. Retrieved
from http://www.mayoclinic.com.
Mayo Clinic Staff (2009). Concussion. Retrieved from http://www.mayoclinic.com.