First Aid and Emergency Nursing Notes: CPR 2025, Burns, Poisoning, Snake Bite and Triage

These first aid and emergency nursing notes summarise what CHO, ANM, staff nurse and AIIMS NORCET exams ask about emergency care: CPR as per the current AHA guidelines, choking, bleeding, shock, burns, fractures, poisoning, snake bite, drowning, heat stroke, triage, disaster management and emergency drugs. Every section focuses on the steps and numbers that appear in MCQs.

Emergency questions are increasingly scenario based, so pair these notes with our medical-surgical nursing notes and the pharmacology nursing notes for drug details.

First aid and emergency nursing notes: exam scope

In CHO and ANM papers first aid is usually a separate section, because these workers are the first contact for emergencies in the community. In NORCET and nursing officer exams, emergency care appears through medical-surgical, critical care and pharmacology questions. The most repeated areas are CPR numbers, burns calculations, poisoning antidotes, snake bite first aid and triage colours.

Principles of first aid

• Aims (the 3 Ps): preserve life, prevent the condition from worsening, promote recovery.
• Check the scene is safe for you, the casualty and bystanders before acting.
• Primary survey: Danger, Response, Send for help, Airway, Breathing, Circulation (compressions), Defibrillation.
• Call for emergency help early. In India, 108 is the emergency ambulance number and 112 is the integrated emergency number.
• The Glasgow Coma Scale ranges from 3 to 15 (eye 4, verbal 5, motor 6). A score of 8 or less usually means the airway needs protection.

CPR: adult, child and infant

The American Heart Association released updated CPR guidelines in October 2025. The core sequence remains C-A-B (compressions, airway, breathing) with high-quality compressions as the priority.

Component	Adult	Child (1 year to puberty)	Infant (under 1 year)
Pulse check (10 seconds or less)	Carotid	Carotid or femoral	Brachial
Compression rate	100 to 120 per minute	100 to 120 per minute	100 to 120 per minute
Compression depth	At least 5 cm, not more than 6 cm	At least one-third of chest depth, about 5 cm	At least one-third of chest depth, about 4 cm
Hand position	Two hands, lower half of sternum	One or two hands, lower half of sternum	Heel of one hand or two-thumb encircling technique, just below the nipple line
Compression to ventilation, 1 rescuer	30:2	30:2	30:2
Compression to ventilation, 2 rescuers	30:2	15:2	15:2

• The 2025 AHA update no longer recommends the two-finger technique for infant compressions; use the heel of one hand or two-thumb encircling.
• Allow full chest recoil, keep pauses under 10 seconds, and switch compressors about every 2 minutes.
• Give each breath over about 1 second with visible chest rise. With an advanced airway in adults, give 1 breath every 6 seconds with continuous compressions.
• Use an AED as soon as available. Shockable rhythms are ventricular fibrillation and pulseless ventricular tachycardia; asystole and PEA are not shockable.
• Untrained bystanders should give hands-only (compression-only) CPR.

Choking (foreign body airway obstruction)

• The universal sign is clutching the throat. If the person can cough forcefully, encourage coughing and do not interfere.
• Adults and children (severe obstruction): the 2025 AHA guidelines recommend cycles of 5 back blows followed by 5 abdominal thrusts until the object comes out or the person becomes unresponsive.
• Infants: alternate 5 back blows and 5 chest thrusts (with the heel of one hand). Abdominal thrusts are not used in infants.
• Use chest thrusts instead of abdominal thrusts in late pregnancy and in people who are very obese.
• If the person becomes unresponsive, start CPR. Look in the mouth before giving breaths and remove a visible object; never do a blind finger sweep.

Bleeding control

• Direct pressure on the wound is the first and most effective step. Add more dressings over soaked ones rather than removing them.
• For life-threatening limb bleeding not controlled by direct pressure, apply a tourniquet about 5 to 7 cm above the wound (not over a joint) and note the time of application.
• Do not remove embedded objects; pad around them.
• Nosebleed (epistaxis): sit the person upright, leaning forward, and pinch the soft part of the nose for about 10 to 15 minutes. Do not tilt the head back.

Shock

Type	Cause	Example
Hypovolaemic	Loss of blood or fluid	Trauma, severe diarrhoea, burns
Cardiogenic	Pump failure	Acute myocardial infarction
Distributive	Vasodilation	Septic, anaphylactic, neurogenic shock
Obstructive	Blocked circulation	Tension pneumothorax, cardiac tamponade, massive pulmonary embolism

• Signs: rapid weak pulse, low blood pressure, cold clammy skin, restlessness, reduced urine output. Neurogenic shock typically shows bradycardia with warm skin.
• First aid: lay the person flat, keep them warm, give nothing by mouth, and arrange urgent transfer. Raising the legs may help if there is no injury to the legs, pelvis or spine.
• Anaphylaxis: adrenaline 1:1000 (1 mg/ml) intramuscularly into the outer thigh, 0.5 mg for adults or 0.01 mg/kg in children (maximum 0.5 mg); repeat after 5 to 15 minutes if needed.

Burns

Area (rule of nines, adult)	% body surface
Head and neck	9
Each upper limb	9
Front of trunk	18
Back of trunk	18
Each lower limb	18
Perineum	1

• In children the head is proportionally larger, so the Lund and Browder chart is more accurate. The patient’s palm with fingers is about 1% of body surface area.
• Parkland formula: 4 ml x body weight (kg) x % TBSA of Ringer lactate in 24 hours; give half in the first 8 hours from the time of the burn and the rest over the next 16 hours.
• Depth: superficial (red, painful, no blisters), partial thickness (blisters, very painful), full thickness (white or leathery, painless because nerve endings are destroyed).
• First aid: stop the burning, remove jewellery and non-stuck clothing, cool with cool running water for about 10 to 20 minutes, then cover loosely with clean cling film or a non-adherent dressing. Do not use ice, butter, toothpaste or oil, and do not burst blisters.
• Chemical burns: brush off dry powder, then irrigate with plenty of water. Electrical burns: switch off the source before touching the casualty, and watch for arrhythmias.
• Singed nasal hair, soot in the mouth and hoarseness suggest inhalation injury.

Fractures and splinting

• Types: closed, open (compound), greenstick (children), comminuted, impacted, pathological, stress fracture.
• Signs: pain, swelling, deformity, loss of function, abnormal movement and crepitus.
• First aid: immobilise in the position found, splint to include the joint above and below, cover open wounds with a sterile dressing and control bleeding. Never push protruding bone back.
• Use an arm sling for upper limb injuries; the Thomas splint is classically used for femur shaft fractures.
• Suspected spinal injury: keep the head and neck in line and move only by log rolling.
• Complications: compartment syndrome (pain out of proportion and on passive stretch is the earliest sign), fat embolism after long-bone fractures (breathlessness, confusion, petechial rash, usually within 24 to 72 hours).

Poisoning

• Priorities are airway, breathing, circulation, then identifying the poison. Keep the container or sample.
• Do not induce vomiting. Activated charcoal (about 1 g/kg) works best within 1 hour, but is not useful for corrosives, kerosene and other hydrocarbons, alcohols, iron or lithium.
• Kerosene and corrosive poisoning: no emesis and no gastric lavage, because of aspiration and perforation risk.
• Organophosphate poisoning causes excess secretions, pinpoint pupils, bradycardia and fasciculations. Give atropine until atropinisation (clear chest, heart rate above 80, systolic BP above 80, dry axillae), with pralidoxime as per protocol.
• Aluminium phosphide (celphos) has no specific antidote; care is supportive.

Poison	Antidote
Paracetamol	N-acetylcysteine
Opioids	Naloxone
Benzodiazepines	Flumazenil
Organophosphates	Atropine, pralidoxime
Heparin	Protamine sulphate
Warfarin	Vitamin K
Iron	Desferrioxamine
Methanol	Fomepizole or ethanol
Digoxin	Digoxin-specific antibody fragments
Magnesium sulphate toxicity	Calcium gluconate

Snake bite (Indian protocol basics)

• The Big Four: Indian cobra and common krait (neurotoxic), Russell’s viper and saw-scaled viper (haemotoxic).
• Krait bites often occur at night in people sleeping on the floor and may be painless.
• First aid (“Do it RIGHT”): Reassure, Immobilise the limb like a fracture, Get to hospital fast, Tell the doctor about symptoms.
• Do not apply a tight tourniquet, cut, suck, apply ice or use herbal remedies. Remove rings and tight items.
• The 20-minute whole blood clotting test (20WBCT) detects coagulopathy from viper bites.
• Polyvalent anti-snake venom (ASV) is given intravenously against the Big Four; keep adrenaline ready for reactions. A routine skin test dose is not recommended. Neostigmine with atropine is used for neurotoxic (especially cobra) envenomation.
• India launched the National Action Plan for Prevention and Control of Snakebite Envenoming in March 2024, and in November 2024 the Centre asked states to make snakebite a notifiable disease.

Drowning, heat stroke and other emergencies

• Drowning: the arrest is hypoxic, so early rescue breaths matter along with compressions. Do not try to drain water from the lungs or use abdominal thrusts. Take spinal precautions only if a diving or trauma injury is likely.
• Heat stroke: core temperature above 40 degrees C with confusion, seizures or coma. Cool immediately (cold water immersion is most effective for exertional heat stroke; otherwise evaporative cooling with water spray and fanning). Antipyretics do not help.
• Heat exhaustion: heavy sweating, weakness and normal mental status. Move to a cool place and give oral fluids with salt.
• Seizure: protect from injury, do not restrain or put anything in the mouth, turn to the recovery position afterwards. Seek help if the seizure lasts more than 5 minutes.
• Hypoglycaemia: oral glucose if conscious; intravenous dextrose if unconscious.

Triage (START) and disaster management

START (Simple Triage and Rapid Treatment) sorts mass-casualty victims in under a minute each.

Tag colour	Category	START criteria
Green	Minor (walking wounded)	Able to walk
Red	Immediate	Respiration above 30 per minute, or radial pulse absent / capillary refill more than 2 seconds, or cannot follow simple commands
Yellow	Delayed	Cannot walk but breathing under 30, perfusion adequate and obeys commands
Black	Dead or expectant	Not breathing even after airway repositioning

• JumpSTART is the paediatric version.
• The disaster management cycle has four phases: mitigation, preparedness, response and recovery (rehabilitation and reconstruction).
• India’s Disaster Management Act 2005 created the National Disaster Management Authority (NDMA), chaired by the Prime Minister, and the National Disaster Response Force (NDRF).
• The Sendai Framework for Disaster Risk Reduction covers 2015 to 2030.
• Golden hour: the first hour after major trauma, when definitive care gives the best chance of survival. The concept is credited to R Adams Cowley.

Emergency drugs

Drug	Main emergency use
Adrenaline	Cardiac arrest (1 mg IV every 3 to 5 minutes), anaphylaxis (IM)
Amiodarone	Shock-refractory VF or pulseless VT (300 mg IV first dose, then 150 mg)
Atropine	Symptomatic bradycardia; organophosphate poisoning
Adenosine	Stable narrow-complex SVT (6 mg rapid IV push, then 12 mg)
Magnesium sulphate	Eclampsia, torsades de pointes, severe asthma
Calcium gluconate 10%	Hyperkalaemia, magnesium toxicity, hypocalcaemia
Dextrose 25% or 50%	Hypoglycaemia
Naloxone	Opioid overdose
Lorazepam, diazepam, midazolam	Status epilepticus
Nitroglycerin, aspirin	Suspected acute coronary syndrome

Quick revision points

1. CPR compression rate for all ages is 100 to 120 per minute.
2. Adult compression depth is 5 to 6 cm.
3. Two-rescuer CPR in children and infants uses 15:2.
4. Infant pulse is checked at the brachial artery.
5. The 2025 AHA update dropped the two-finger infant compression technique.
6. Infant choking: 5 back blows and 5 chest thrusts.
7. VF and pulseless VT are shockable; asystole and PEA are not.
8. Direct pressure is the first step for external bleeding.
9. Nosebleed: sit up, lean forward, pinch the soft nose.
10. Each adult lower limb is 18% in the rule of nines.
11. Parkland formula: 4 ml x kg x %TBSA, half in first 8 hours.
12. Full thickness burns are painless.
13. Splint the joint above and below a fracture.
14. Do not induce vomiting in kerosene or corrosive poisoning.
15. Paracetamol antidote is N-acetylcysteine.
16. Cobra and krait are neurotoxic; vipers are haemotoxic.
17. No tourniquet in snake bite first aid.
18. Red tag in START: RR above 30, CRT above 2 seconds or cannot obey commands.
19. Heat stroke: core temperature above 40 degrees C with CNS dysfunction.
20. Golden hour is the first hour after major trauma.

Practise these with timed scenario questions in the staff nurse test series or the CHO test series. Programme links such as the snakebite action plan also appear in our national health programmes notes, and basic life support skills connect with the fundamentals of nursing notes.

Frequently asked questions

Which CPR guidelines should I follow for nursing exams in 2026?

Follow the AHA guidelines released in October 2025. Core numbers (rate 100 to 120, adult depth 5 to 6 cm, 30:2 and 15:2 ratios) are unchanged, but infant technique and choking steps were updated.

Is first aid a separate subject in the CHO exam?

Many CHO papers include first aid and emergency care as a section within community health or general nursing. Check the subject list in the CHO exam pattern and syllabus.

What is the correct first aid for snake bite in India?

Reassure, immobilise the limb, get to hospital quickly and tell the doctor about symptoms. Avoid tourniquets, cutting, sucking and ice. ASV is given only in hospital.

How is burn fluid calculated?

Use the Parkland formula: 4 ml x weight in kg x % total body surface area burned, giving half in the first 8 hours from the time of injury and half over the next 16 hours.

What does START triage mean?

Simple Triage and Rapid Treatment. It uses walking ability, respiration, perfusion and mental status to tag victims green, yellow, red or black in mass-casualty incidents.