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First Aid

 

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    What Is First Aid?

    First aid is the initial care of the injured or sick. It is the care administered by a concerned person as soon as possible after an accident or illness. It is this prompt care and attention that sometimes means the difference between life and death, or between a full or partial recovery.


    First aid has limitations - not everybody is a doctor - but it is an essential and vital part of the total medical concept. FIRST AID SAVES LIVES! ...ask any ambulance officer or doctor who works in the emergency medical field.

     

    Immediate Action

    It is important that any action taken by the first aid provider is done as quickly as possible. Quick action is necessary to preserve life and limb. A casualty who is not breathing effectively, or is bleeding copiously, requires immediate intervention, and if quick effective first aid is provided, then the casualty's chances of recovery are improved immeasurably. It should be remembered though that any action undertaken is to be deliberate, and panic by the first aid provider and bystanders will not be beneficial to the casualty. Try to remain calm and think your actions through.

     


    Will I Harm The Casualty?

    It is unlikely that the casualty being treated by a trained first aid provider will come to any additional harm, provided that the care and treatment is rendered in accordance with the provider's level of training. Many horror stories abound of well meaning first aiders causing irreversible spinal injuries to their casualties, but these are usually just that -- stories!

    If first aid is administered quickly, effectively, and with due care, then the casualty will not suffer any additional harm. In most states, the legal system takes a benevolent view towards first aid providers. Provided that any care and treatment was undertaken for the good of the casualty, that no deliberate harm was caused, and that the incident was handled as if by a reasonable person, then the first aid provider should have no fear of litigation.


     

     

    How Do I Get Help?

    To get expert medical assistance, call an ambulance on 911 (emergency number) in metropolitan areas, and the local emergency numbers in the front of the directory when in rural areas. If you are attending a casualty, get a bystander to telephone for help - if you are on your own, then you may have to leave the casualty momentarily to make a call. It's common sense, the decision is yours!


    DRABC!

    DRABC is the prime consideration for everyone involved in the care and treatment of casualties. Experienced first aid providers, ambulance crews, nurses and medical specialists, are all-aware of the importance of:
    Danger,
    Response,
    Airway,
    Breathing and
    Circulation.

    Danger
    • to yourself: don't put yourself in danger!
    • to others: don't allow bystanders to be exposed to danger!
    • to the casualty: remove the danger from the casualty, or the casualty from the danger!
    Response
    • use the 'shake and shout' method!
    • is the casualty alert?
    • is the casualty drowsy or confused?
    • is the casualty unconscious, but reacting?
    • is the casualty unconscious with no reaction?
    Airway
    • is the airway open and clear?
    • is there noisy breathing?
    • are there potential obstructions such as blood?
    Breathing
    • look to see if the chest rises!
    • listen for the sound of breathing!
    • feel, by putting your hand on the diaphragm!
    Circulation
    • is there a neck pulse?
    • is it strong?
    • is it regular?
    • is there major blood loss?

     

    • If the casualty is conscious, then treat the injuries or illness according to the signs and symptoms.
    • If the casualty is unconscious, and breathing spontaneously, place him or her in the stable side position, then treat any injuries.
    • If the casualty is unconscious, and not breathing, then commence CPR.



    Control of External Bleeding

    Blood consists of red cells (erythrocytes), which convey oxygen throughout the body; white cells (leukocytes), which fight introduced infection; platelets (thrombocytes), which assist in the clotting process; and plasma, the fluid portion of blood. There are between six and seven quarts of blood in the average adult body.

    Blood is moved around the body under pressure by the cardiovascular system - the heart and blood vessels. Without an adequate blood volume and pressure, the human body soon collapses. Bleeding, or hemorrhage, poses a threat by causing both the volume and the pressure of the blood within the body to decrease through blood loss.

    External Bleeding

    External bleeding is usually associated with wounds, those injuries that are caused by cutting, perforating or tearing the skin. Serious wounds involve damage to blood vessels. As arteries carry oxygenated blood from the heart, damage to a vessel is characterized by bright red blood which 'spurts' with each heartbeat. Damage to veins appears as a darker red flow. Capillary damage is associated with wounds close to the skin and is of a bright red 'ooze' from below the surface.


    Types Of Wounds

    Incision is the type of wound made by 'slicing' with a sharp knife or sharp piece of metal.
    Laceration is a deep wound with associated loss of tissue - the type of wound barbed wire would cause.
    Abrasion is a wound where the skin layers have been scraped off.
    Puncture wounds are perforations, and may be due to anything from a corkscrew to a bullet.
    Amputation is the loss of a digit or limb by trauma.
    Care should be taken to obtain medical advice for prevention of tetanus Treatment

     

    Incisions And Lacerations

    • DRABC
    • Quickly check the wound for foreign matter
    • Immediately apply pressure to stop any bleeding
    • Apply non-adherent pad or dressing
    • Apply a firm roller bandage
    • Rest and elevate injured limb if injuries permit
    Abrasions
    • Inspect the wound for foreign matter ·
    • Swab with a diluted antiseptic solution ·
    • Cover with a light, dry dressing if necessary
    Puncture Wound
    • DRABC ·
    • Inspect the wound - do not remove any penetrating object ·
    • Apply pressure to stop any bleeding ·
    • Apply non-adherent pad or dressing ·
    • Apply a firm roller bandage ·
    • Rest and elevate injured limb if injuries permit
    Amputation
    • DRABC ·
    • Apply immediate pressure to stop any bleeding ·
    • Apply a large pad or dressing to the wound ·
    • Treat for shock ·
    • Rest and elevate injured limb if possible ·
    • Collect amputated part - keep dry, do not wash or clean ·
    • Seal the amputated part in plastic bag or wrap in similar waterproof material ·
    • Place in iced water - do not allow the part to come in direct contact with ice ·

     

    Remember - if the initial dressing doesn't stop the bleeding, put another over the top - don't remove a dressing once it is in place! · Ensure the amputated part travels to hospital with the casualty

    Nosebleed
    • Pinch fleshy part of the nose ·
    • Lean slightly forward - Remain so for approximately ten minutes ·
    • Do not blow or pick nose for several hours ·
    • If bleeding persists, obtain medical aid


    Cardio-Pulmonary Resuscitation

     Cardio-Pulmonary Resuscitation (CPR) is the singularly most effective form of active resuscitation available, and is used universally by trained first aid providers and medical personnel. The technique is used to resuscitate casualties in cardiac arrest. While expired air resuscitation is the method by which oxygen is provided to the casualty, external cardiac compressions, when applied correctly, duplicate the heart's mechanical function of pumping the oxygenated blood around the body. This combination of techniques is the principle of CPR. Effective CPR can sustain a casualty until more expert definitive medical treatment is available and it is vital that CPR is initiated immediately on contact with the casualty.

    A particularly important aspect of CPR is that the rescuer's hands are positioned correctly in relation to the casualty's heart. For the rescuer to locate the correct position for the hands, two fingers should be placed over the casualty's xyphoid process, the small 'bump' at the base of the sternum. A hand is then placed centrally on the chest, above the two fingers. This position should then approximate the location of the heart. The second hand is placed over the first, and the fingers entwined for stability, or alternatively, the second hand grips the wrist of the first hand. The chest is compressed 1 1/2 -2 inches.

    Hand position for a child is on a point centrally located on the lower 1/2 of the sternum. Compressions are performed at a depth of 1- 1 1/4 inch using the heel of one hand only, the pressure is modified so as not to cause damage to the ribcage. An infant's heart is located by placing two fingers centrally on the lower 1/2 of the sternum. Compressions are then performed by pressing with the fingers 1/2 - 3/4 inch deep, the pressure is modified to reflect the fragility of the child's chest.

     

     

    CPR can be performed by a single rescuer, or by two rescuers. As two-person CPR requires a degree of synchronized technique, it is usually more effective for first aid providers to perform individual CPR, and change operators after ten minutes or so.

     

    Indications For CPR

    • unconsciousness
    • collapse
    • cyanosis (blue color)
    • pupils fixed and dilated
    • absent respiration
    • absent pulse
    Procedure For One-Person CPR

     

    • begin immediately
    • check for DANGER
    • check for response, shake and shout
    • check and clear airway
    • tilt head back to open airway
    • look, listen and feel for breathing
    • give two breaths
    • assess the rise and fall of the diaphram
    • check for carotid (neck) pulse (15 seconds)
    • kneel beside casualty's chest
    • locate heart on lower half of chest
    • place hands centrally over heart, fingers entwined
    • lean over casualty, arms straight, elbows locked
    • commence 15 compressions, with even pressure until resistance is felt
    • compressions - rate of 60-80 per minute, children and infants 80-100 per minute
    • tilt head back to open airway
    • give two breaths
    • relocate heart
    • 15 compressions
    • repeat cycle for 1 minute
    • check carotid (neck) pulse (15 seconds)
    • continue cycles and recheck pulse every minute

     

    Procedure For Two-Person CPR

    • one rescuer positions close to the casualty's head and delivers breaths ·
    • the other positions on the opposite side of the body beside the chest and performs compressions
    • initial two breaths
    • 15 compressions
    • 2 breaths delivered on completion of the 15th compression
    • continue cycle for 1 minute
    • check carotid (neck) pulse (15 seconds)
    • continue cycles and recheck pulse every minute

    As air is forced under pressure into the casualty, and pressure is exerted by compressions, the risk of causing the casualty to vomit is very real. Rescuers must be alert at all times to avoid the airway becoming soiled by vomitus. Upon detection of vomitus in the casualty's mouth, roll him/her into the stable side position, clear the airway, and when clear, roll casualty back and resume CPR. CPR is to be continued once begun until either the casualty is revived, the rescuer is relieved by expert medical aid, or until the rescuer is too exhausted to continue.

    Should the casualty regain his/her vital signs, put him/her into the stable side position and observe closely, as often the casualty lapses back into cardiac arrest.


     Poisoning

    Poisons are substances that if inhaled, ingested, absorbed or injected, harm the structures or functions of the body. Some types of poisons may act immediately on the body, others may act more slowly. Some poisons, such as cyanide, are so toxic they only require a minute amount to be harmful, while others, such as garden sprays, are cumulative and require exposure over a long period to achieve the same level of toxicity. Many are carcinogenic, and cause fatal cancers some years after exposure. Whatever the substance, remember that prevention is better than cure!

     

    Always ensure that poisonous substances are kept only if really necessary, that pills and medications are locked away in a childproof cupboard. Substances must never be decanted into attractive containers such as soft drink bottles. All substances must be labelled and understood before use. Prescription medications are used only by the person prescribed, and that all poisons and medications are disposed of correctly.

    The wide varieties of poisonous substances present with a similarly wide variety of signs and symptoms. The list below is not exhaustive, but casualties may present with all, or at least some, of them.

    Signs And Symptoms
    • obtain a history, look for empty bottles, containers, sometimes suicide notes
    • pale, cool, clammy skin
    • rapid, weak (sometimes erratic) pulse
    • nausea and/or vomiting
    • cyanosis (blue color)
    • burns around the mouth
    • blurred vision
    • ringing in the ears
    • smell of fumes or odors
    • stomach pains or cramps
    • drowsiness, which may lead to unconsciousness
    Care and Treatment

    Urgent ambulance transport is essential. In middle Tennessee, the Poison Control Center number is (615) 936-2034 (or see your local phone book, check inside of the front cover) .


     Heart Conditions

    The HEART is a muscular pump, approximately the same size as its owner's fist. Its function is to pump oxygen-rich blood from the around the lungs to various parts of the body, and to pump the de-oxygenated blood from the tissues back to the lungs to take on more oxygen. The mechanical pumping action of the heart is driven by a complex electrical activity. Due to factors such as sedentary life-style, poor diet and advanced age, and chronic disease, the heart is sometimes compromised, and serious cardiac conditions develop. The four major conditions are;

     

    Angina

    Angina Pectoris (literally 'pain in the chest') is a condition due to constriction of the blood vessels supplying the heart muscle with blood. Angina sufferers are aware of their condition, and take medication to relieve the symptoms. Medication is usually in the form of tablets, or spray, taken under the tongue.

    Signs And Symptoms
    • pale, cool skin
    • chest pain or discomfort, usually after exertion, a heavy meal or stress
    • lethargy
    Care And Treatment
    • position of comfort, usually sitting supported
    • rest
    • assist with medication
    • reassurance

    It is important to realize that angina should be relieved by medication. If after three tablets the pain does not diminish then the condition should be considered a heart attack.

     Heart Attack

    Heart Attack is also known as a Coronary Occlusion. A heart attack can occur at any time, at any age, though certain people are at greater risk due to factors such as hereditary influence, lack of exercise, smoking, poor diet, and other negative contributions. The onset of heart attack is usually due to the acute constriction, complete blockage, of a cardiac blood vessel. Urgent medical attention is vital.

     

    Signs And Symptoms

    • 'crushing', or 'vice-like' pain in the chest, sometimes also in the jaw and arm
    • pale, cold skin
    • sweating
    • rapid, or irregular, weak pulse
    • rapid, shallow respiration
    • partial collapse
    • nausea and/or vomiting
    • may feel the need to pass a bowel motion
    Care And Treatment
    • DRABC
    • urgent ambulance transport
    • position of comfort, usually sitting
    • complete rest
    • reassurance
    • discourage visit to the toilet

    If the casualty collapses and appears to become unconscious be prepared to provide resuscitation as this is a sign of impending cardiac arrest.

    Heart Failure

    When the heart is unable to perform its proper function, and causes blood and fluid to congest around the lungs and in the body, the condition is called Heart Failure. It is typified by the casualty finding it difficult to breathe, and swelling of the ankles and legs as fluid pools in the extremities.

    Signs And Symptoms
    • pale, cold, clammy skin
    • chest discomfort, difficulty breathing
    • 'bubbly', gasping breaths
    • frothy sputum
    • swelling of the extremities, especially the ankles, which may show 'dimples'
    • partial collapse
    Care And Treatment
    • DRABC
    • position of comfort, usually sitting supported
    • allow legs to hang, do not elevate
    • urgent ambulance transport
    • reassurance
    Cardiac Arrest

    When the heart ceases to function, then the casualty is said to be in Cardiac Arrest. Whether the heart is at a complete standstill, or whether it is vibrating in some fatal rhythm, it is no longer doing its task. The condition may be due to heart attack, heart failure, electrocution, drowning, trauma or other medical condition - first aid treatment is the same: ATTEMPT RESUSCITATION!

    Signs And Symptoms
    • pale, cool skin
    • no pulse
    • usually no respiration, though there may be irregular, 'gasping' breaths
    • pupils fixed and dilated
    • cyanosis (blue color)
    • may be loss of bladder/bowel control
    • evidence of vomitus
    Care And Treatment
    • immediate CPR
    • urgent medical assistance


    Burns and Scalds

    Burns are caused by contact with flame, hot objects, chemicals, electrocution, radiated heat, or frozen surfaces. Scalds are caused by contact with boiling fluids or steam. The results of either injury are disfigurement, scarring and severe pain. As with most potentially serious injuries, prevention is better than cure.

    Burns are classified as either: Superficial reddening of the skin, frequently with blisters; or Deep destruction of tissue and nerves, leaving a whitish or blackened area surrounded by superficial burns. The severity of burns is dependent on certain factors such as; the age of the casualty, the depth of the burns, the part of the body burnt, and the area affected. The burnt body area of a casualty is assessed as a 'percentage', and is arrived at by reference to The Rule Of Nines.

    Eleven areas of the body are designated each worth 9%, eg. arm = 9%, etc. The percentages are added, and the total given as the percentage of the total body area burnt. This is particularly important information to pass on to the ambulance service, as they may act on this information to arrange urgent specialist assistance, such as a helicopter for evacuation to a large city hospital's burns unit.

    Treatment
    • DRABC
    • cool with water
    • 10 minutes for heat burns
    • 20 minutes for chemical burns (e.g., lye)
    • 30 minutes for bitumen burns (e.g., fuel oil, gasoline)
    • cover with a clean, non-adherent dressing
    • urgent ambulance transport if the burn is severe
    • treat for shock if the burn is severe ensure that chemicals are flushed from the skin, pay special attention to eyes
    • Do Not Over cool and cause shivering
    • Do Not use creams or ointments unless prescribed
    • Do Not attempt to remove material adhering to the burn
    • Do Not prick blisters

    Burns to the face inevitably have an effect on the casualty's breathing, and these effects may take some time to appear. It is important that any casualty who has inhaled smoke, fumes or superheated air, or has been burnt on the face, should seek medical aid as soon as possible after the incident. REMEMBER - Severe burns can lead to shock and massive infection if not treated properly!


     Choking

    Choking is due to the lodgement of a foreign object in the casualty's airway (trachea). In some instances, the object lodges at the epiglottis - the entry to the airway - but does not actually enter the trachea. Both cases cause initial coughing, the body's reflex action to dislodge the object. If an object is firmly lodged in the airway, coughing at least keeps it high in the trachea, though may not expel it. Coughing with an object at the entrance to the airway, however, will generally cause it to be expelled.

    Should you encounter a person with an apparent obstruction who is Coughing Effectively, Do Not Slap him or her on the back. If the obstruction is at the entrance to the trachea, then reactions to the slaps may cause the person to inhale the object and cause complete obstruction. If a casualty initially coughs to no effect, and appears to be in increasing distress, then the object may be totally obstructing the airway.

    Signs And Symptoms
    • absence of breathing
    • agitation and distress - grabbing the throat
    • cyanosis (blue color)
    • eventual collapse
    Care And Treatment
    • Strike sharply on the back four times
    • Use abdominal thrusts four times
    • If victim is unconscious, use abdominal thrusts from straddling the victim.
    • Use CPR if necessary