First Aid

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What is First Aid?

First aid is emer­gency treat­ment for ill­ness or in­jury while wait­ing for med­i­cal help. At one time or an­other al­most ev­ery­one is called upon to ren­der first aid. Un­less he or she has taken a course on the sub­ject, there is usu­ally con­fu­sion and doubt as to what should be done. Statis­tics show that in most cases it is bet­ter for the per­son un­trained in first aid to do too lit­tle than too much. This is par­tic­u­larly true in ur­ban and sub­ur­ban ar­eas where med­i­cal help can eas­ily be ob­tained. If it is not pos­si­ble to reach a doc­tor, po­lice or fire­men are bet­ter equipped to give first aid than are the unini­ti­ated. It is ad­vis­able for at least one mem­ber of the fam­ily to take a First Aid course, and it is a ne­ces­sity for each house­hold to have a good emer­gency med­i­cal man­ual and a first-aid kit. Con­sult your lo­cal Red Cross for First Aid in­struc­tions, and ask your physi­cian to ad­vise you which of the many med­i­cal man­u­als to buy. This book­let is de­signed to be used only as a quick ref­er­ence dur­ing an emer­gency. There­fore it con­tains only the ba­si­clife sup­port tech­niques. Al­ways keep in mind that first aid does not re­place the doc­tor but merely at­tempts to keep the vic­tim alive and in the best con­di­tion pos­si­ble un­til med­i­cal aid ar­rives. Tele­phone op­er­a­tors usu­ally know how to ob­tain help in the quick­est way. Dial O and tell the op­er­a­tor that it’s an emer­gency. Be sure the op­er­a­tor has your right ad­dress. But to be pre­pared, one should have a list of emer­gency tele­phone num­bers handy.

The First Aid Kit

You can buy a pre-as­sem­bled com­mer­cial kit, or you can put to­gether your own kit. You should have also one for your car. If you go hik­ing or camp­ing, spe­cial snakebite kits are avail­able. A ba­sic kit should con­tain:* First-aid man­ual • Small box of ab­sorbent cot­ton • Box of ad­he­sive strip ban­dages, as­sorted sizes (such as BandAids or Cu­rads) • Rolls of ad­he­sive tape, ½”, 1”, 2” wide • Rolls of gauze ban­dage, 1”,2”, 3” wide • Box of cot­ton-tipped swabs • Large tri­an­gu­lar ban­dages • Small boxes of gauze pads, 3X3-inch, 2X4-inch • Ster­ile eye pads • Wood arm splint • Sturdy cloth 2” wide and 20” long for tourni­quet • Wood tongue de­pres­sors • Tweez­ers • Ban­dage scis­sors (sharp scis­sors with rounded ends) • Pa­per cups • Mea­sur­ing cup • Mea­sur­ing spoons • Ther­mome­ter • Small bot­tle of 70% al­co­hol (to be used as a dis­in­fec­tant) • Am­mo­nia in­halant (in case of faint­ing) • Tube of an­tibi­otic oint­ment • Tube of an­tibi­otic eye oint­ment • Box of salt tablets (in case of heat ex­haus­tion) • Calamine lo­tion • Hy­dro­gen per­ox­ide • Pe­tro­leum jelly • Oil of cloves (in case of mi­nor toothache) • Safety pins • Sharp nee­dles (must be ster­il­ized be­fore re­mov­ing splin­ters)

Life­sav­ing Mea­sures

There are four ba­sic life-threat­en­ing con­di­tions in which cor­rect and im­me­di­ate first-aid pro­ce­dures are in the true sense a ques­tion of life and death. They are: im­paired breath­ing, heart fail­ure, se­vere bleed­ing and shock, Sec­onds count in the recog­ni­tion and cor­rec­tion of these con­di­tions. Emer­gency treat­ment should be given in this or­der, as nec­es­sary: 1. Clear the air pas­sage. 2. Re­store breath­ing and heart­beat. 3. Stop bleed­ing. 4. Ad­min­is­ter treat­ment for shock. Do not move an in­jured per­son un­til you have a clear idea of the in­jury and have ap­plied first aid, un­less the vic­tim is ex­posed to fur­ther dan­ger at the ac­ci­dent site. If the in­jury is se­ri­ous, if it oc­curred in an area where the vic­tim can re­main safely, and if med­i­cal aid is read­ily ob­tain­able, it is some­times best not even to at­tempt to move the per­son, but to em­ploy such emer­gency care as is pos­si­ble at the site un­til more highly qual­i­fied emer­gency per­son­nel ar­rive.

Im­paired Breath­ing

The causes of im­paired breath­ing could be: (a) Suf­fo­ca­tion; (b) Elec­tri­cal shock ; (c) Gas poi­son­ing ; (d) Drown­ing ; (e) Heart fail­ure. The symp­toms are eas­ily rec­og­niz­able: The chest or ab­domen does not rise and fall; air can­not be felt ex­it­ing from the nose or mouth. Ac­tions to take: If a pa­tient stops breath­ing you must as­sist him im­me­di­ately. The sit­u­a­tion will dic­tate the method to be used. The res­pi­ra­tory fail­ure can be caused by block­age of the air pas­sages by for­eign mat­ter such as wa­ter

(drown­ing), mud, food par­ti­cles etc. In an un­con­scious pa­tient in the supine po­si­tion (ly­ing on the back), the tongue may drop back and block the throat. The car­dio­vas­cu­lar sys­tem may fail to cir­cu­late red blood cells, which can be caused by heart fail­ure. Re­gard­less of the cause, how­ever, im­me­di­ate steps must be taken to clear the air­way. When the air­way is cleared, if spon­ta­neous breath­ing does not re­sume, ar­ti­fi­cial re­s­pi­ra­tion must be ap­plied im­me­di­ately. There are two meth­ods of ar­ti­fi­cial re­s­pi­ra­tion; mouth- to-mouth or mouth-to-nose re­sus­ci­ta­tion and a man­ual method. The man­ual method is not rec­om­mended ex­cept when the res­cuer is un­able to per­form mouth-to-mouth or mouth-to-nose re­sus­ci­ta­tion; for ex­am­ple, when mas­sive fa­cial in­juries ab­so­lutely pre­vent it. In cases of heart fail­ure, mouth-to-mouth re­sus­ci­ta­tion in com­bi­na­tion with car­diac com­pres­sions should be ad­min­is­tered. How­ever, the car­diac com­pres­sions should be ex­e­cuted only by a per­son with spe­cial train­ing in this method.

AR­TI­FI­CIAL RE­S­PI­RA­TION FOR ADULTS Mouth-to-Mouth (-Nose) Tech­nique

1. Place the pa­tient on his back. If it is nec­es­sary to roll the vic­tim over, try to roll him over as a sin­gle unit, keep­ing the back and neck straight to avoid ag­gra­va­tion of any spinal in­jury. 2. Loosen all tight cloth­ing. 3. Clear the up­per air­way by run­ning your fin­gers be­hind his lower teeth and over the back of his tongue. Re­move den­tures or for­eign ma­te­rial. 4. Turn his head face up. Tilt the head back so that the neck is stretched and the chin is up. 5. Ad­just the lower jaw so that it juts out. This po­si­tion­ing moves the base of the tongue away from the back of the throat, thus clear­ing or en­larg­ing the air pas­sage to the lungs. 6. Seal the air­way opening (ei­ther the nose or the mouth) that is not be­ing used. The seal must be se­cure to keep air from leak­ing dur­ing in­fla­tion. Pinch the nos­trils shut with your free fin­gers (if you use mouth-to-mouth re­sus­ci­ta­tion) or seal the mouth by plac­ing two fin­gers length­wise over the pa­tient’s lips (if you use mouth-to-nose re­sus­ci­ta­tion). 7. Take a deep breath. Open your mouth wide and make an air­tight seal around the pa­tient’s mouth or nose by plac­ing your mouth over his mouth or nose. Breathe into the vic­tim’s mouth or nose un­til his chest rises. 8. Breathe into the pa­tient a to­tal of four times as quickly as pos­si­ble. If you feel or hear no air ex­change, retilt his head and try again. If you still feel no air ex­change, again sweep the mouth of for­eign ob­jects and breathe again into the vic­tim. If you still have no air ex­change, turn the vic­tim on his side and slap him on the back be­tween the shoul­der blades. This should free any­thing block­ing the throat. Again sweep his mouth to re­move for­eign mat­ter. (If none of the above steps clear the air pas­sage, re­peat the blows to the back and retilt the head.) 9. Re­peat breath­ing. Re­move mouth each time to al­low air to es­cape. If the ex­ha­la­tion is noisy, el­e­vate his jaw fur­ther.

10. This pro­ce­dure should be re­peated twelve times per minute. Use deep breaths. As the vic­tim be­gins to breathe, main­tain head tilt.

Back Pres­sure Arm Lift Method

If it is im­pos­si­ble be­cause of se­vere fa­cial in­juries to ad­min­is­ter mouth-to-mouth or mouth-to-nose re­sus­ci­ta­tion try the fol­low­ing: 1. Place the vic­tim face down, af­ter first hav­ing cleared his mouth. Bend his el­bows and place his hands one upon the other at eye level un­der his head. Turn the vic­tim’s head to one side, mak­ing sure the chin juts out. 2. Kneel at the vic­tim’s head. Place your hand on his back so that palms lie just below an imag­i­nary line be­tween his armpits. 3. Rock for­ward un­til your arms are ver­ti­cal and the weight of your body ex­erts steady pres­sure on your hands. 4. Rock back, grasp­ing vic­tim’s el­bows, and draw vic­tim’s arms up to­ward you un­til you feel re­sis­tance at the shoul­ders. 5. Lower vic­tim’s arms to the ground. Re­peat about twelve times per minute (ev­ery 5 sec­onds). Keep check­ing to see if the mouth is clear, the air­way is open, and the heart is beat­ing. Note, In both meth­ods of ar­ti­fi­cial re­s­pi­ra­tion, con­tinue your ef­forts un­til the vic­tim breathes nor­mally or a doc­tor pro­nounces him dead, or a more qual­i­fied per­son takes charge, or you are phys­i­cally un­able to con­tinue. If the pa­tient must be moved, con­tinue ar­ti­fi­cial ven­ti­la­tion.

AR­TI­FI­CIAL RE­S­PI­RA­TION FOR CHIL­DREN AND IN­FANTS

The method is sim­i­lar with slight mod­i­fi­ca­tions. 1. Clear mouth with fin­ger. 2. Place child on his back. 3. Lift jaw so it juts out as with adults. 4. Place your mouth over both mouth and nose of the child to make an air­tight seal. 5. Gen­tly blow puffs of air, about twenty per minute. Oth­er­wise the pro­ce­dure is the same with one ex­cep­tion: in­stead of the slaps be­tween the shoul­der blades to re­move for­eign mat­ter, hold the in­fant by the an­kles up­side down and give sev­eral sharp pats be­tween the shoul­der blades to free the air pas­sage.

Chok­ing

The Cause: In most cases food par­ti­cles or bones caught in the wind­pipe in­stead of go­ing into the esoph­a­gus. The symp­toms: The vic­tim gasps for breath or has vi­o­lent fits of cough­ing; quickly turns pale then blue, and can­not talk. Ac­tions to take: If the vic­tim is still able to cough, don’t in­ter­fere. It is quite pos­si­ble that he will cough up the for­eign ob­ject. If any of the other symp­toms oc­cur, open the vic­tim’s mouth and grasp the

for­eign ob­ject with your in­dex and mid­dle fin­ger, try­ing to re­move it. If you can’t reach the ob­struc­tion with your fin­gers, use the fol­low­ing method: 1. Stand be­hind the chock­ing vic­tim, with your arms around him, thumb side of your fist against his stom­ach, just above the navel and below the ribcage. 2. Grasp your fist with your other hand and make four quick up­ward thrusts. This will force air out of the lungs and may ex­pel the ob­struc­tion. Re­peat this pro­ce­dure if nec­es­sary.

Car­diac Ar­rest

The causes: In­suf­fi­cient oxy­gen sup­ply to the heart or the brain, block­age of blood ves­sels of the heart, heart dis­ease, em­bolism (for­eign par­ti­cles in the blood­stream), or over­dose of cer­tain drugs. Res­pi­ra­tory ar­rest is the most com­mon cause of car­diac ar­rest. The heart stops within min­utes af­ter breath­ing ceases. The symp­toms: No breath­ing, no pulse, un­con­scious­ness, di­lated pupils of the eyes, limp body, and flac­cid skin. Ac­tion to take: 1. Roll the vic­tim on his back. 2. Loosen all tight cloth­ing. 3. Check the air­way and re­move any ob­struc­tion. 4. Hyper­ex­tend the neck and lift the lower jaw for mouth-to-mouth ar­ti­fi­cial re­s­pi­ra­tion. 5. Give the pa­tient five quick puffs of air by mouth-to­mouth. *6. Place the heel of your hand on the lower half of the breast­bone and press down un­til the breast­bone is de­pressed about 2 inches. Re­peat the com­pres­sion about 15 times, about once per sec­ond. (To de­ter­mine the pres­sure point for car­diac com­pres­sions, lo­cate the bony tip of the breast­bone with your ring fin­ger and place two fin­gers just above that point.) 7. Re­turn to mouth-to-mouth ar­ti­fi­cial re­s­pi­ra­tion and give the vic­tim two res­pi­ra­tions. 8. Re­peat this 15-¬2 cy­cle un­til help ar­rives or the pa­tient is pro­nounced dead. 9. If help is avail­able, one per­son should give the car­diac com­pres­sions and the other should give mouth-to-mouth ar­ti­fi­cial re­s­pi­ra­tion. The ra­tio with two op­er­a­tors should be five com­pres­sions to one ar­ti­fi­cial re­s­pi­ra­tion. The com­pres­sions should not be in­ter­rupted, even for res­pi­ra­tions. When re­s­pi­ra­tion is be­ing ap­plied, the com­pres­sions must be stopped only mo­men­tar­ily. 10. The car­diac com­pres­sions should equal about

60 per minute, the res­pi­ra­tions about 12 per minute.

Se­vere Bleed­ing

Acute hem­or­rhage is a rapid loss of blood from the blood ves­sels. In the event of an acute se­vere hem­or­rhage (loss of at least 2 pints of blood) an emer­gency is present. If the bleed­ing is not stopped, the pa­tient will die. 1. Ar­te­rial Bleed­ing The symp­toms: Spurt­ing blood, bright red in color. The blood leaves the heart through the ar­ter­ies un­der pres­sure. If an artery is opened, blood will spurt out force­fully. With each beat of the heart there will be a cor­re­spond­ing spurt of blood. The larger the artery, the more rapid the blood loss. 2. Ve­nous bleed­ing The symp­toms: Con­tin­u­ous flow of blood, dark red in color. Blood flow­ing through the veins is un­der less pres­sure than in the ar­ter­ies. How­ever, a break in a vein will al­low blood to flow out of it. The rate of blood loss de­pends upon the size of the opened vein. 3. Cap­il­lary bleed­ing The symp­toms: Blood ooz­ing from a wound. The blood loss is usu­ally not se­ri­ous, as the bleed­ing is lim­ited. Ac­tions to take: Con­trol of hem­or­rhage is pri­mar­ily me­chan­i­cal and con­sists of clos­ing off the opened blood ves­sel. 1. Di­rect pres­sure: Cover the wound with the clean­est cloth im­me­di­ately avail­able or with your bare hand, and ap­ply di­rect pres­sure on the wound. Most bleed­ing can be stooped this way. 2. Dig­i­tal pres­sure (in case of ar­te­rial bleed­ing and if di­rect pres­sure does not do the trick). Ap­ply your fin­gers to the ap­pro­pri­ate pres­sure point - a point where the main artery sup­ply­ing blood to the wound is lo­cated (see di­a­gram). The three pres­sure points

in the head and neck should be used only as a last re­sort if there is a skull frac­ture and di­rect pres­sure can­not be used. If di­rect pres­sure can be used, it will stop bleed­ing on the head in about 95 per­cent of in­juries. The pres­sure-point method is not rec­om­mended if pres­sure must be main­tained for a long pe­riod of time, but it may be use­ful tem­po­rar­ily un­til a pres­sure dress­ing can be ap­plied. 3. El­e­va­tion: If bleed­ing from a wound is only ve­nous or cap­il­lary, el­e­va­tion of the wound above the heart may slow the flow of blood. How­ever, el­e­va­tion is of no value in con­trol of ar­te­rial bleed­ing, and it may ag­gra­vate frac­tures. 4. Tourni­quet: Ap­ply­ing a tourni­quet to an arm or a leg should be done only as a last re­sort when all other meth­ods fail. A tourni­quet is ap­plied be­tween the wound and the point at which the limb is at­tached to the body, as close to the wound as pos­si­ble but never over a wound or frac­ture. Make sure it is ap­plied tightly enough to stop bleed­ing com­pletely. Although the tourni­quet will stop the bleed­ing by com­press­ing all the ves­sels, it is po­ten­tially dan­ger­ous, be­cause it de­prives the un­in­jured tis­sues of blood. Pa­tients who have tourni­quets ap­plied should be clearly iden­ti­fied with a “T” on the fore­head. Once ap­plied, a tourni­quet should never be loos­ened or re­moved ex­cept un­der the su­per­vi­sion of a doc­tor. In the case of an im­pro­vised tourni­quet, the ma­te­rial should be wrapped twice around the ex­trem­ity and half- knot­ted. Place a stick or some­thing sim­i­lar on the half-knot and tie a full knot. Twist the stick to tighten the tourni­quet only un­til the bleed­ing stops-no more. Se­cure the stick or level in place with the loose ends of the tourni­quet, an­other strip of cloth, or other im­pro­vised ma­te­rial. Note: A tourni­quet can be im­pro­vised from a strap, belt, hand­ker­chiefs, neck­tie, cra­vat ban­dage, etc. Never use wire, cord, or any­thing that will cut into the flesh. IN­TER­NAL BLEED­ING The symp­toms: Cold and clammy skin, weak and rapid pulse, eyes dull and pupils en­large, nau­sea and vom­it­ing, pain in the af­fected area, es­pe­cially the ab­domen and chest. Ac­tions to be taken: 1. Treat vic­tim for shock (see below). 2. An­tic­i­pate that vic­tim may vomit; there­fore give noth­ing by mouth. 3. Keep the pa­tient still to al­low max­i­mum flow of blood to vi­tal or­gans and pre­vent fur­ther in­ter­nal dam­age. 4. Get the pa­tient to pro­fes­sional med­i­cal help as quickly and safely as pos­si­ble.

Shock

The causes: Shock is a com­plex sub­ject, but ba­si­cally the causes may be : Loss of blood, breath­ing im­pair­ment, heart fail­ure, or burns. The most com­mon cause is hem­or­rhage, when blood es­capes from the vas­cu­lar sys­tem and con­se­quently does not reach the tis­sues. Shock can kill; treat as soon as pos­si­ble, and con­tinue un­til med­i­cal aid is avail­able. The symp­toms: Shal­low breath­ing, rapid and weak pulse, nau­sea, col­lapse, vom­it­ing, shiv­er­ing, pale and moist skin, men­tal con­fu­sion, droop­ing eye­lids. Ac­tions to take: 1. Es­tab­lish and main­tain an open air­way. 2. Stop the bleed­ing and in­sure that the pa­tient is breath­ing ad­e­quately. 3. Place the pa­tient on his back with his head down (by el­e­vat­ing the feet with a pil­low or blan­kets) to im­prove the flow of blood to the brain. Ex­cep­tions: head and chest in­juries, heart at­tack, stroke, sun­stroke. If there is no spine in­jury, the vic­tim may be more com­fort­able and breathe bet­ter in a semire­clin­ing po­si­tion. If in doubt, keep the vic­tim flat. 4. Make sure the pa­tient is com­fort­able and re­as­sure him. This can help to pre­vent wors­en­ing of the shock. 5. Main­tain normal body tem­per­a­ture. Place blan­kets un­der and over the vic­tim. 6. Give noth­ing by month, es­pe­cially stim­u­lants or al­co­holic bev­er­ages. 7. Al­ways treat for shock in cases of se­ri­ous in­juries, and watch for it in mi­nor ones.

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