1.

INTRODUCTION

WHAT IS FIRST AID ?

First Aid is the immediate care of the ill or injured before treatment can be given by a medical professional.

Aims of First Aid :

- To assess the situation. - To recognize the problem. - To provide immediate care. - To preserve Life. - To prevent worsening of injury. - To promote recovery. - To arrange transfer to a hospital, or for doctors advice.

INTRODUCTION

What will you learn on the course ?

You will learn the essential skills to deal with accidents, emergencies and sudden illness, which are commonly seen in day to day life. Note: First Aid measures are not meant to replace the medical professional care and treatment, but only to provide temporary support until professional medical help arrives.

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2.

FIRST AID KIT

CONTENTS OF FIRST AID KIT

Scissors Charcoal Tablets Tweezers Thermometer Disposable Gloves Adhesive Tape Safety Pins Antiseptic Wipes Gauze Pad Cotton Wool Triangular Bandage Antiseptic Cream Essential Medicine Dressings Crepe Bandages

First Aid Kit

Scissors
For cutting dressings/ bandages

Tweezers
To pull out stings

FIRST AID KIT

Charcoal Tablets
To be taken for ingested drug poisoning

Thermometer
For measuring temperature either under the tongue/armpit

Disposable Gloves
For Protection from contamination

Antiseptic Wipes
To clean wound

Triangular Bandage
Used for immobilisation of fractures and to cover wounds

Dressings
To cover wounds

Adhesive Tape
To tape ends of dressings/bandages

Gauze Pad
To cover wounds

Antiseptic Cream

Crepe Bandage
For bandaging wound

Safety Pins
To pin bandages

Cotton
To clean wounds

Essential Medicine

3.

WHAT TO DO FIRST ?

GENERAL EMERGENCY GUIDELINES Assess the Situation :

Check scene safety. Take control of your feelings - don't act impulsively. Decide whether to call for emergency help or not. Call for help (REMEMBER EACH SECOND COUNTS).

Controlling Your Feelings :

Remain calm and communicate a calm, supportive attitude to the ill or injured Individual. Try to project a confident attitude to the casualty, explaining what you are doing. Never leave an ill or injured individual unattended. Have someone else call for help in the form of Medical help/Ambulance depending on the seriousness. Do not allow unnecessary crowding of area by onlookers. If trained and if necessary, institute CPR or Rescue Breathing. Do not become involved in using treatment methods beyond your skill. When in doubt, call for help.

WHAT TO DO FIRST ?

When To Call ?
In an emergency, making the right phone call can mean the difference between life and death. Call emergency medical services closest to you if the victim

Has no pulse. Is unconscious or semi-conscious. Is showing signs of shock. Has a spinal injury. Has a head injury. Has multiple fractures. Is bleeding severely. Can not be moved easily. Has an injury or illness that is life threatening.

Has breathing problem. Burns (serious or covering large area). Poisoning. Seizures (more than one convulsion). Serious limb injury or amputation. Foreign body in throat.

Universal Precautions :

For Handling Blood/Body Fluids : - It is important to prevent infections from spreading from one person to another, through contact with infectious materials in routine and emergency situations. - Use protective barriers and infection control techniques in all the following situations: 1. When caring for bleeding injuries or handling other body fluids. 2. Body fluids include blood, drainage from cuts, skin lesions, urine, faeces, vomits, nasal discharge and saliva. 3. Avoid direct contact with body fluids. Use disposable gloves for cleaning cuts and scrapes or any injuries/bleeding wounds. 4. If skin contact occurs, hands and all other affected skin should be washed with soap and running water as soon as possible.

Being Prepared :

When you call for help, be prepared to give your name, the location, and the details of emergency. Know the route to the nearest hospital emergency room if possible.

What to tell the doctor or ambulance staff ?

What has happened. Whatever symptoms or signs & nature of injuries. Where is the victim. The phone number and address of your location.

For Rescue Breathing : - If it is necessary to perform rescue breathing, a one-way mask or other infection control barrier (handkerchief) should be used. However, rescue breathing should not be delayed while such a device is being located.

Prior to Treatment : - Wash hands with soap and water or rinse with an antiseptic solution, if available. - If available, gloves should always be worn. - Take care not to touch any unclean object when wearing gloves or once hands are washed. - If possible, use a protective cover over clothing.

During Treatment : - Use a face shield or mask with a one-way-valve or filter, if available, when doing active resuscitation, alternatively, use a handkerchief. - Use only clean bandages and dressings. - Avoid contact with body fluids. - Avoid treating more than one casualty without washing hands and changing gloves.

After Treatment : - Clean up both casualty and yourself. - Clean up the immediate vicinity. - Dispose of dressings, bandages, sharps, gloves and soiled clothing safely and correctly. - Wash hands with soap and water thoroughly, even if gloves were used. - Waste materials can be placed inside a plastic bag, which is then placed inside another plastic bag and tied securely. - Clean the spills.

Clean up : Spills of blood and body fluids : - Spills of blood and body fluids should be cleaned up immediately with a disinfectant cleaner. - Wear gloves. - Mop up spill with absorbent material. - Wash the area well, using 1:10 water/bleach solution or appropriate disinfectant. - Dispose of gloves, soiled towels, and other waste in sealed plastic bags and place in garbage, as already indicated.

Hand Washing Procedure : - Wash hands vigorously with soap under a stream of running water for at least 10 seconds. Ensure that hands are washed thoroughly between fingers and under nails. - Rinse hands well with running water and thoroughly dry with paper towels. - Even if gloves are used, hands should be washed after removal of gloves. - In case of handling more than one casualty, change gloves and wash hands in between the care of each casualty.

Gloves : - Gloves should be worn when direct care may involve contact with any type of body fluid, as explained above. - Disposable single-use, waterproof gloves (e.g., latex or vinyl) should be used. - Do not reuse gloves.

Disposal of Infectious Waste : - All used or contaminated supplies (e.g., gloves and other barriers, sanitary napkins, bandages) except syringes, needles, and other sharp implements should be placed into a plastic bag and sealed. This bag can be thrown into the garbage out of reach of children or animals. - Body waste (e.g., urine, vomits, feces) should be disposed of in the toilet. If body fluids (e.g., urine, vomits) are spilled, the body fluids should be covered with an absorbent sanitary material, gently swept up, and discarded in plastic bags.

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4.1

HEADACHE

Most headaches are minor and can be treated with a pain reliever. However, it is important to note that sometimes, headaches ....can be caused by serious underlying problems. If a headache is severe, gets worse despite medication or has accompanying symptoms such as fever, stiff neck, vomiting, confusion, medical help should be sought immediately. Migraine headaches usually start from one side, and may be associated with nausea/vomiting.

Causes
Commonly caused by exhaustion, eye strain, nervous tension, emotional upset or stress. Migraine headaches are very common and often caused by 'triggers' such as exposure to bright light or after eating certain foods.

COMMON CONDITIONS

First Aid :
a. Make the affected person sit down or lie down comfortably in a quiet place. (Fig. 4.1.1) b. Give 2 tablets of Paracetamol if the person is an adult. Give Syrup Paracetamol as per recommended dose to children. c. Apply cold compress on the forehead. (Fig. 4.1.2) d. If associated with any of the above-mentioned symptoms, or unrelieved, consult a doctor.

(Fig. 4.1.1)

(Fig. 4.1.2)

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4.2

STOMACH PAIN

4.3

GASTROENTERITIS

Any pain in the abdominal area is commonly referred to as stomach pain. The abdomen is an anatomical area that is bounded by the lower margin of the ribs above, the pelvic bone below, and the flanks on each side. The pain can be caused by a variety of conditions. Many organs are found within the abdominal cavity. Sometimes the pain is directly related to a specific organ such as the bladder or ovary. Usually, the pain originates in the digestive system. For example, the pain can be caused by appendicitis, diarrheal cramping, or food poisoning. The pain could be continuous or intermittent (colicky). Abdominal pain can range from mild stomach ache to severe acute pain. It may be accompanied by symptoms such as belching, vomiting or loose motions. The common causes are food poisoning, appendicitis, indigestion or may be associated with other serious underlying problem. In females, a gynaecological or obstetric cause may also be relevant.

Gastroenteritis is an inflammation of the stomach / intestines. Common causes are :

Infections from Viruses. Food or water contaminated by bacteria or parasites. Allergic reactions to certain food.

Signs and symptoms include :

Nausea or vomiting. Diarrhoea. Abdominal cramps. Indigestion, burning sensation in upper part of abdomen and bloating. Fever may accompany any these symptoms.

Treatment :
Make the person lie or sit down in a comfortable position. (Fig. 4.2.1) If he has vomiting, do not give anything to eat or drink. Seek medical help.

Treatment :

Ask the person to rest and not exert (Fig. 4.3.1). Provide plenty of fluids in sips, to prevent dehydration, such as ORS (oral rehydration solution)/ lemon water with salt. (Fig. 4.3.2). May consider giving an anti diarrhoeal or anti vomiting medicine. Avoid giving heavy or oily food. Seek medical attention if symptoms are severe, or there is accompanying fever.

(Fig. 4.3.1)

(Fig. 4.2.1)

(Fig. 4.3.2)

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4.4

DEHYDRATION

Dehydration can be caused by heat-related condition such as heat exhaustion or heat stroke, as well as a side effect of diarrhea, vomiting and fever. Children and persons over the age of 60 are particularly susceptible to dehydration.

Treatment for dehydration

If caught early, dehydration can often be treated at home under a physician's guidance. In children, directions for giving food and fluids will differ according to the cause of the dehydration, so it is important to consult a pediatrician. In cases of mild dehydration, simple rehydration is recommended by drinking fluids. Many drinks are available, such as electral (ORS), lemon juice etc. that effectively restore body fluids, electrolytes and salt balance. For moderate and severe dehydration, intravenous fluids may be required, so medical help should be sought early. Cases of serious dehydration should be treated as a medical emergency.

What causes dehydration ?

Under normal conditions, we usually replace all lost body water (through sweat, tears, urine and stool) by drinking fluids and eating foods that contain water. When a person becomes ill due to fever, diarrhea, or vomiting or if an individual is overexposed to the sun, the body loses water content and essential body salts such as sodium, potassium, calcium bicarbonate and phosphate and goes into a water and electrolyte deficit.

What are the symptoms of dehydration ?

The following are the most common symptoms of dehydration, although each individual may experience symptoms differently. Symptoms may include: 1. Thirst 2. Less-frequent urination 3. Dry skin 4. Fatigue 5. Light-headedness 6. Dizziness 7. Confusion 8. Dry mouth and tongue 9. Increased heart rate and breathing In children, additional symptoms may include :

*ORS / Electral Composition Ingredient Sodium Chloride Trisodium Citrate Dehydrate Potassium Chloride Glucose Water Quantity 3.5 gm 2.9 gm 1.5 gm 20 gm 1 ltr.

Dry mouth Sunken abdomen, eyes or cheeks High fever Listlessness Irritability Skin that does not flatten when pinched and released

*If home made ORS Ingredient Table Salt Sugar Water Quantity 5 gm 20 gm 1 ltr.

* Solution should be made fresh daily and used within 24 hours

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4.5

FEVER

Body temperature higher than the normal (>99.5 degrees F). Usually fever is caused by infection.

Contact the physician immediately in case of : - Seizures - Feeling sleepy or dull - Irregular breathing - Stiff neck - Confusion - Rashes - Ear pain - Persistent sore throat - Vomiting - Diarrhoea - Painful and burning urination

Fever may be caused by :

A bacterial or a viral infection. The body becoming overheated at play or in the sun.
0

Temperature above 104 F can be dangerous as it may trigger fits in children and infants.

Recognition :
Signs that may indicate fever may include: - Flushed face - Hot, dry skin May also have any of following:

Chills and Shivering Headache Bodyache Respiratory symptoms such as sore throat, cough or running nose Loose stools Nausea & vomiting
(Fig. 4.5.1)

Treatment :

Make the casualty comfortable in a cool room. Advise to take rest. An adult can be given Paracetamol tablets. Give lots of fluids to drink (Preferably electrolyte solution if available). A child can be given the recommended dose of Paracetamol syrup. Seek Medical opinion.

(Fig. 4.5.2)

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4.6

FAINTING

4.7

HEAT DISORDERS

Fainting occurs when the supply to brain is inadequate for a short time. This causes loss of consciousness. The loss of consciousness is usually for a brief time. Fainting may be due to normal physiological causes, or may be caused by an underlying medical disorder.

HEAT EXHAUSTION
Heat exhaustion is a milder form of heat-related illness that can develop after several days of exposure to high temperatures and inadequate or unbalanced replacement of fluids. Those most prone to heat exhaustion are elderly people, people with high blood pressure and people working or exercising in a hot environment.

Common Causes :
- Standing for long hours (Fig. 4.6.1) - Sudden change in position - Injury - An unpleasant sight - Emotional upset

Signs of heat exhaustion include :

Pale skin and face Excessive sweating Muscle cramps Exhaustion Weakness Headache/Dizziness Nausea or vomiting Fainting

How to Recognize :
- Weakness - Giddiness - Blurred vision - Sweating - Cold and clammy skin - Slow & Weak pulse
(Fig. 4.6.1)

The skin may be cool and moist. The pulse rate will be fast and weak, and breathing will be fast and shallow. If heat exhaustion is untreated, it may progress to heat stroke.

What to do ?
Cooling measures that may be effective include:

Treatment :
- Make the casualty lie down on the back. - Make sure the legs are elevated above the heart level. (Fig. 4.6.2) - Open the windows for fresh air and loosen the tight Clothing. - Look for any injury that may have occurred during fall and treat accordingly. - Seek medical assistance.

Cool, non-alcoholic beverages Rest in a cool place preferably air conditioned room Cool shower or bath Loosen the clothing and if possible provide lightweight clothing

Seek medical attention if symptoms worsen or last longer than 1 hour.

HEAT STROKE
(Fig. 4.6.2)

What is heat stroke ?

Heat stroke is the most severe form of heat illness and is a life-threatening emergency. It is the result of long, extreme exposure to the sun, in which a person does not sweat enough to lower body temperature. The elderly, infants, persons who work outdoors and those on certain types of medications are most susceptible to heat stroke. It is a condition that develops rapidly and requires immediate medical treatment.

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What causes heat stroke ?

Our bodies produce a tremendous amount of internal heat and we normally cool ourselves by sweating and radiating heat through the skin. However, in certain circumstances, such as extreme heat, high humidity or vigorous activity in the hot sun, this cooling system may begin to fail, allowing heat to build up to dangerous levels.

HEAT CRAMPS
Heat cramps usually affect people who sweat a lot during strenuous activity. This sweating depletes the body's salt and moisture. The low salt level in the muscles causes painful cramps. Heat cramps may also be a symptom of heat exhaustion.

Recognizing heat cramps

Heat cramps are muscle pains or spasms - usually in the abdomen, arms, or legs - that may occur in association with strenuous activity. If you have heart problems or are on a low sodium diet, get medical attention for heat cramps.

What are the symptoms of heat stroke ?

The following are the most common symptoms of heat stroke, although each individual may experience symptoms differently. Symptoms may include:

What to do ?
If medical attention is not necessary, take these steps:

Headache Dizziness Disorientation, agitation or confusion Sluggishness or fatigue Seizure Hot, dry skin that is flushed but not sweaty A high body temperature Loss of consciousness Rapid heart beat

The casualty should stop all activity, and sit quietly in a cool place. The casualty should be advised to drink clear juice / electral (ORS) or a sports beverage. Advise casualty to not return to strenuous activity for a few hours after the cramps subside because further exertion may lead to heat exhaustion or heat stroke. Seek medical attention for heat cramps if they do not subside in 1 hour.

What to do ?
It is important for the person to be treated immediately as heat stroke can cause permanent damage or death. The immediate first aid measures are:

Get the person indoors or into a shady area. Remove clothing and gently apply cool water using damp sheets of by spraying cold water to the skin followed by fanning to stimulate sweating. Apply ice packs to the groin and armpits. Have the person lie down in a cool area with their feet slightly elevated. Continue cooling until the body feels cold to touch. Seek medical help immediately.

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4.8

BLEEDING

4.9

WOUND AND DRESSINGS

Bleeding may be from an ARTERY, a blood vessel which carries oxygen-rich blood from the heart throughout the body. Bleeding may be from a VEIN, which carries blood back to the heart to be oxygenated or bleeding may be from a CAPILLARY, which are tiny blood vessels.

WOUNDS
Injuries causing wounds are very commonly encountered. Injuries that cause a break in the skin or underlying soft tissue are known as a wound. These may be large or small and can be on any part of the body.

How to recognize :
- Arterial bleeding is bright red and spurts out from a wound, (severe form of bleeding). This requires immediate attention as large amounts of blood loss can occur quickly, if uncontrolled. - Blood that oozes out slowly and is darker red in colour indicates venous bleeding (Milder form of bleeding). Venus bleeding is easier to control than Arterial bleeding. Capillary bleeding is usually slow, oozing in nature.

Wounds may be of the following types :

Open Wound: The skin surface has been broken. Closed Wound: The skin surface is unbroken but underlying tissues have been damaged.

Types of closed wounds :

Bruise: Damage to tissues beneath the skin. When the damage is minor, the wound is called a bruise (contusion).

How to control bleeding :

1. Apply pressure directly over the wound by placing sterile gauze, dressing or a clean handkerchief on the bleeding point. (Fig. 4.8.1) 2. Apply pressure by fingers or by hand. 3. Once pressure is applied, keep it in place. If dressings become soaked with blood, apply new dressings over the old dressings. The less a bleeding wound is disturbed, the easier it will be to stop the bleeding! 4. Apply continuous pressure by putting more gauze on top of the previous one if it is soaked. NEVER THROW AWAY SOAKED GAUZE. 5. Support and elevate the bleeding part above heart level and treat the shock. 6. Once the bleeding stops, do not try to remove the cloth that is against the open wound as it could disturb the blood clotting and restart the bleeding. 7. Cover and bandage the wound before transporting to the hospital.

Ecchymosis
When the tissue has extensive damage, blood and fluid collect under the skin causing discoloration (ecchymosis), swelling (edema), and pain. First aid consists of applying ice or cold packs to reduce swelling and relieve discomfort.

Hematomas
Are caused by severe blunt injury with extensive soft tissue damage and collection of large amounts of blood below the skin. Large hematomas, may be associated with injuries such as broken bones, especially if deformity is present. First aid consists of applying ice or cold packs to reduce swelling and relieve pain, direct pressure (manual compression) to help control internal bleeding, splinting, and elevation. When large areas of bruising are present, shock may develop.

Types of open wounds :

In open soft tissue injuries, the protective layer of the skin has been damaged:

Abrasions
Abrasions are caused when the skin is rubbed or scraped off. Abrasions easily can become infected, because of contamination with dirt and germs. There is normally very little bleeding or oozing of clear fluid.

(Fig. 4.8.1)

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Amputations
Amputations (traumatic) are the removal of the a body part such as fingers, toes, hands, or ears from the body. Bleeding is heavy and normally requires a tourniquet, to control the blood flow. There are three types of amputation : 1. Complete - Body part is completely torn off (severed). 2. Partial - More than 50% of the body part is torn off. 3. De-gloving - Skin and tissue are torn away from body part.

What to do ?
First aid treatment for all wounds consists of controlling the flow of blood, treating for shock, and preventing infection. When providing first aid to casualty with multiple injuries, treat the wounds that appear to be life threatening first. Since most of the body is covered by clothing, carefully examine the entire body for bleeding. When necessary, tear or cut clothing away from the wound because excessive movement of the injured part will cause pain and additional damage.

Bleeding
After establishing an adequate open airway, the main concern will be to control bleeding, by direct pressure and elevation. Indirect pressure and the use of a tourniquet should be used only if direct pressure and elevation do not control the bleeding. A protective covering (dressing) that is properly applied should adequately control the bleeding. In cases of severe bleeding, additional dressing over the first one may be required.

Immediate Action :
- Establish and maintain the Airway, Breathing, and Circulation (ABC). - Request Medical Assistance immediately. - Control bleeding with direct pressure, elevation, indirect pressure, or tourniquet only as a last resort, do not remove or loosen a tourniquet once it has been applied. - Apply dressing to the stump. - Treat for shock.

Shock
Shock may be severe in a casualty who has lost a large amount of blood or suffered a serious injury. In case of no pulse proceed to keep a check and maintain ABC.

How to bandage a wound during first aid :

- Proper dressing and bandaging a wound will aid in the healing process and help prevent infection and scarring. - Protect yourself. Scrub your hands thoroughly with soap and disinfected water and put on latex gloves if available, to prevent the spread of infectious disease. - Clean the wound with water/antiseptic solution and carefully remove any excess debris. - Remove any jewelry, such as rings or watches that might impair circulation. - Apply antibiotic cream to the inside of the material you are using as the dressing. - Cover the wound with the dressing. The dressing should extend beyond the wound by about inch so that it covers the wound completely and allows room to affix the dressing to uninjured skin. - Cut four strips of tape and affix them to the dressing and skin on all four sides of the dressing. The purpose of the bandage is to help keep the dressing in place, and it shouldn't be too loose (able to move around) or too tight (impairing circulation).

Incisions
Incisions, commonly called cuts, are wounds made by sharp cutting instruments such as knives or broken glass. Incisions tend to bleed freely because the blood vessels may be cut. The wound edges are smooth.

Lacerations
Lacerations are wounds that are torn, rather than cut. They have ragged, irregular edges and torn tissue underneath.

Punctures
Punctures are caused by objects that enter the skin while leaving a surface opening. Wounds made by nails, needles and bullets are normally punctures. Small puncture wounds usually do not bleed freely; however, large puncture wounds may cause severe internal bleeding.

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4.10

NOSE BLEED

The nose is a part of the body that is very rich in blood vessels (vascular) and is situated in a vulnerable position on the face. As a result, any trauma to the face can cause bleeding. The bleeding may be profuse, or minor. Nosebleeds can occur spontaneously also. This is common in dry climates, or during the winter months when the air is dry and warm from household heaters. People are more susceptible to bleeding if they are taking medications, which prevent normal blood clotting.

Do's and Don'ts to control nose bleed :

- Avoid forceful blowing of the nose or putting anything into it. - Do not strain during bowel movements. - Try to keep the head higher than the level of the heart. - Do not strain or bend down to lift anything heavy. - Do not smoke. - No hot liquids for at least 24 hours. - Give cold liquids / Ice creams.

Causes :
- Trauma to the nose (nose picking, foreign bodies, forceful nose blowing). - Drying of the nasal membranes. - Tumors, of the nose or sinuses. - High Blood pressure. - Inflammation of the nose or sinuses and cold. - Foreign objects in the nose, or other nasal obstruction.

Recognition :
- Bleeding from one or both nostrils. - Frequent swallowing. - Flow at the back of the nose and throat.

First Aid :
- Calm the patient.
(Fig. 4.10.1)

- The patient should sit with the upper part of the body tilted forward and the mouth open so that he/she can spit out the blood instead of swallowing. - Pinch all the soft parts of the nose together between the thumb and index finger. - Hold the nose pinched for at least 8-10 minutes (timed by the clock). - Repeat as necessary until the bleeding stops. - Apply ice (crushed in a plastic bag or washcloth) to the base of the nose. - Seek medical help.

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4.11

ASTHMA

4.12

BURNS AND SCALDS

People with asthma have hypersensitive airways. Their airways become narrow, causing wheezing, cough and difficulty in breathing due to various triggers.

Triggers are :
- Anxiety and emotional distress - Cold air - Allergies - Dust & Smoke - Vigorous exercise - Certain food, food additives and preservatives

The severity of a burn depends upon its size, depth and location. Burns are most severe when located on the face, neck, hands, feet and genitals. Also, when burns affect large parts of the body, they cause severe fluid loss and infection, and can be life threatening. Burns result in pain, infection and shock. They are also more serious when the victims are very young or very old.

Burns can cause damage to the body tissues by :

- Dry Heat-Flames, Lighted Cigarettes, Hot Iron - Moist Heat (scalds) - Boiling Water or Hot Oil - Cold - Liquid Nitrogen - Chemical - Acids or Alkali - Electrical Burns - Electricity or Lightning - Radiation - Sun Rays or Laser To distinguish a minor burn from a serious burn, the 1st step is to determine the degree and the extent of damage. Burns are classified (Fig. 4.11.1)

Recognition :
- Casualty prefers to be in a sitting position (Fig. 4.11.1). - In a sudden attack, the patient has difficulty breathing and there may be a whistling sound (wheeze) when breathing out. There may be accompanying cough. - The patient may be anxious, distressed and sweating. - In severe cases, there may be blueness of the lips, hands and feet and exhaustion and possible loss of consciousness. - In severe cases, the patient is unable to speak because of difficulty in breathing.

According to the depth a) b) 1st Degree Burn 2nd Degree Burn Redness Swelling & Pain (such as mild sunburn) Blisters, Redness Very painful Associated with loss of fluid through the damaged skin are the most painful because nerve ending are usually intact, despite severe tissue damage Deepest Skin is charred and waxy Fat, muscle, even bone may be affected Extremely painful or relatively painless.

What to do ?
- Reassure the casualty. - Make the patient sit upright and lean forward. - Encourage casualty to take puff if he/she is on medication. Most asthmatics will be familiar with the use of inhalers and the dosages. (Fig. 4.11.2) - Loosen the garments and open the windows for fresh air. - Ask casualty to breathe slowly and deeply. - Seek professional help early.
(Fig. 4.11.2)

c)

3rd Degree Burn

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Management :
Remember 4 C's while managing burns : 1. Cool the burnt part by keeping it under running water for at least 10 minutes. Don't put ice on the burn. 2. Constrictors should be removed immediately like rings, bracelets etc before swelling occurs. (Fig. 4.12.1) 3. Cover the burnt part to prevent infection by using any clean cloth for example handkerchief. (Fig. 4.12.2) 4. Consult a Doctor immediately. General care for burns : 1. Smother the flames or move the victim away from danger. 2. Lay the casualty down on the floor. 3. Check the response, airway, breathing and pulse while managing the burn. Resuscitate the casualty if necessary. 4. Call for medical help immediately. 5. Look and treat for associated injuries or shock. 6. Cover all the wounds with clean dressing. Precautions : a. Do not touch or interfere with the burnt area. b. Do not apply toothpaste, hair cream, butter or any ointment. c. Do not cover with cotton. d. Do not remove clothes sticking to the burnt area. e. Do not break the blisters.
(Fig. 4.12.2) (Fig. 4.12.1)

CHEMICAL BURNS In case the burns are caused by chemicals, it is important to remove clothing on which chemicals have spilled and flush the affected area with copious amounts of water for 15 to 30 minutes. ELECTRICAL BURNS An electrical burn may appear minor, but the damage can extend deep into the tissues beneath the skin. Management : 1. Look first, don't touch. 2. Turn off the source of electricity if possible. 3. Assess breathing, check pulse. 4. Cover the affected area. 5. Call for help.

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4.13

BITES ANIMAL BITE

4.14

SNAKE BITE BITES

Domestic pets cause most animal bites. Bites from sharp & pointed teeth can cause superficial and deep wounds. Bites may also be caused by pet puppies, stray dogs/cats/monkeys. In these cases, there is immediate requirement to take treatment to protect from rabies. Medical advice should be taken immediately.

Snakes are commonly found in tropical climates. They can be poisonous or non poisonous. People who walk in jungles, camp, hike, picnic, or live in snake-inhabited areas should be aware of the potential dangers posed by venomous snakes.

Symptoms of poisonous Snake Bites :

While each individual may experience symptoms differently, the following are the most common symptoms of poisonous snake bites:

What to do ?

Calm and reassure the person. Wear latex gloves or wash hands thoroughly before attending to the wound. Wash hands afterwards as well.

Anxious look Fang marks in the skin and redness / swelling at the site of the bite Pain localized to site of bite Vision disorder - blurred or double vision Convulsions Fainting Dizziness / weakness Excessive sweating Loss of muscle coordination Nausea and vomiting Numbness and tingling Rapid pulse Difficulty in breathing
(Fig. 4.14.1)

Superficial Wound :

If the bite is not bleeding severely, wash the wound thoroughly with mild soap and running water for 3 to 5 minutes. Then, cover the bite with antibiotic ointment and a clean dressing.

Deep Wound :

If the bite is actively bleeding, apply direct pressure with a clean, dry cloth until the bleeding subsides. Once the bleeding stops, place clean dressing and apply bandage. Elevate the area of the bite. Seek medical advice immediately.

First Aid for Snake Bites :

- Reassure the casualty to stay calm. - Don't try to capture the snake. - Don't attempt to cut or suck the part to remove the venom. - Immobilize the bitten part. - Maintain the part below the level of the heart. - Wash the wound and dry it with clean cloth. - Lightly compress the limb above the wound. (Fig. 4.14.1) - Monitor Vital signs. - Rush to the nearest hospital.
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4.15

INSECT BITES AND STINGS

4.16

POISONING

Signs and symptom of an insect bite result from the injection of toxins & allergens into the skin. Mild to severe allergic reactions can rapidly develop including breathing difficulty, facial swelling and shock. Bites from wasps, bees, hornets and fire ants are usually painful rather than dangerous which can be relieved by first aid.

What is poisoning ?
A poison is any substance that is harmful to the body. Poisons may enter the body through the mouth, the lungs, or the skin. Substances that can commonly cause poisoning include a variety of medicines (overdose), household substances and industrial products. The poison may cause more serious effects if larger quantities are consumed, or if time elapses. Most poisoning occurs accidentally, and specially by due to accidental ingestion by children. The common agents are : Insecticides such as Baygon Cleaning Agents like Harpic that contain acids Kerosene (Fig. 4.16.1) Medicines kept at home: Painkillers, Sedatives (like calmpose ) (Fig. 4.16.2)

Treatment : For Mild Reactions :

1. Scrape or brush off the stinger with a straight edged object such as credit card or the back of a knife. 2. Try to pullout the sting if a tweezers is available. (Fig. 4.15.1) 3. To reduce pain and swelling, apply ice or cold pack. 4. Consult a doctor.

Signs and symptoms :

(Fig. 4.15.1)

The signs and symptoms of poisoning depend on the substance involved and on the amount of poison taken. One should look out for: Abdominal pain Breath that smells of the substance such as insecticide Nausea and/or vomiting Breathing difficulty Drowsiness / Falling level of consciousness Burning sensation in chest/stomach Blurred vision Sudden collapse Change of skin colour Burns around the mouth Behavioral changes Convulsions Diarrhoea Abnormally slow or fast pulse Abdominal pain

(Fig. 4.16.1)

(Fig. 4.16.2)

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Act Fast
It is important to act quickly. Action is the most important factor in first aid if poisoning is suspected. Before Calling for Help :

Look into the victim's mouth and remove all tablets, powder or any material that is present. Wear gloves. Examine the mouth for cuts, burns, swelling, unusual coloring or odor. Rinse and wipe out the mouth with a cloth. If individual is in no apparent life threatening distress, allow them to rest. Do not give any medication, food, or liquid until told to do so by poison center/doctor. If serious, perform ABC. Give Rescue Breathing (use a protective shield or handkerchief) or CPR. If necessary, treat for Shock. Calls for Help : Identify yourself and give your relationship to the patient. Give your phone number in case your call is disconnected. Follow the advice of the Poison Center / medical personnel. Provide medical personnel with: - All containers, food, drinking glasses, bottles, etc. found near the individual. - Container of known poison. - Any information known regarding prescription medicine the individual is taking. - Information on condition of casualty. Try to have the following information when you call : - What has been swallowed? - Time it was taken. - Exact Name of the substance or medicine. - How much was swallowed. (Number of pills, milligrams per pill)

Treatment : Move the casualty away from the poison to an area where fresh air is available. Check level of response, open the airway, check breathing and check pulse. Give CPR if required. Use a face shield. If conscious, reassure the casualty.

Poisonous Fumes or Gases : Immediately carry or drag the person to fresh air. Minimize your own and the casualty's exposure to the fumes. If the victim is not breathing, start artificial respiration immediately and continue it until the victim is breathing or help arrives. Send someone for help as quickly as possible. If individual cannot be moved, the room in which the gas/vapor exposure occurred should be ventilated with open windows, fans, etc.

Poisons on the Skin : Wear gloves, if not available, avoid directly touching the poison yourself. Wipe off any dry poisons and flood the affected area with large amounts of plain water for 5 to 10 minutes. Then wash the skin with soap and water for another 5 minutes and rinse. Remove and discard all affected clothing.

Poisons in the Eye : Pour water from a glass on the bridge of the patient's eye and allow water to flood the eye gently for 15 minutes. Use plain lukewarm water. Do not allow the victim to rub his/her eyes.

Swallowed Poisons/Medications : Ingested poisoning can occur from drug overdoses, medication errors, caustic and corrosive substances. If a potentially caustic or corrosive liquid chemical has been swallowed, have the individual rinse their mouth with water and spit it out several times before giving them 1/2 cup (only), of water to drink. This is the only situation in which an individual can have something to drink before calling for help at a poison center/medical professional.

How to produce vomiting ?

Remember : Never produce vomiting unless instructed to do so! This is especially important if the patient has swallowed petroleum products such as gasoline, cleaning fluids and lighter fluids. Ipecac is a plant extract that when swallowed causes vomiting. Vomiting will remove the poison from the stomach. There are very few instances where Ipecac would be recommended

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4.17

DRUNKENESS

by a doctor or Poison Center; - NEVER use Ipecac without the advice of a doctor or the Poison Control Center. Never produce vomiting if the patient : - Is drowsy or unconscious. - Is having convulsions (fits). - Has swallowed a strong corrosive such as acid. If this occurs, give liquids only.

Alcohol is the most widely used and abused drug today. Alcohol intoxication, also known as drunkenness, is so common that it fails to receive the attention and respect it deserves. Ethyl alcohol (ethanol) is the primary ingredient in wine, beer, and liquor. Ethanol is classified as a drug because it depresses the central nervous system, affecting physical and mental activities. Alcohol is addictive. What starts out as social drinking may, result in alcoholism? Alcohol affects the body in stages. First, there is a feeling of relaxation and well-being, followed by a gradual disruption of coordination, resulting in an inability to accurately and efficiently perform normal duties and activities. Continued drinking depresses body functions enough to cause difficulty breathing, loss of consciousness, coma, and death. Withdrawal from alcohol can result in delirium tremens (DTs), identified by anxiety, confusion, restless sleep, nausea, vomiting, depression, hallucinations, and seizures. Signs and symptoms of alcohol intoxication include: 1. Smell of alcohol on breath. 2. Staggering, loss of balance, and slurred speech. 3. Nausea, vomiting, and flushed face. These signs and symptoms may indicate an illness or injury (e.g. diabetes, head injury) other than alcohol abuse. If you suspect alcohol intoxication, do the following: 1. Sit or lay the casualty down, protecting him or her from further injury. 2. Establish and maintain the airway, breathing, and circulation (ABCs). 3. Observe closely, casualty may become unconscious. 4. Don't criticize but be firm. 5. Never leave an intoxicated person alone. 6. Request medical assistance as soon as possible.

Use of Activated Charcoal : Activated Charcoal

Activated charcoal is not recommended for home use. It is used to bind drugs and chemicals before they are absorbed into a person, but activated charcoal does not bind all drugs or chemicals and has some risk when given. Important: Only use it when told to do so by the Poison Center / doctor.

IMMEDIATE CARE OF A DRUNK PERSON :

1. Keep the person comfortable. 2. If the person is put in bed - make sure the person is lying on their side, not back. 3. If possible, assess whether the person is in a life threatening health crisis. If so, get help advisory and/or police. 4. If you put a person to bed, monitor their breathing. 5. Keep your distance. 6. Keep a check whether victim vomits and the level of unconsciousness.

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4.18

HYPERGLYCEMIA (HIGH BLOOD SUGAR)

4.19

HYPOGLYCEMIA (LOW BLOOD SUGAR)

Hyperglycemia is the condition when glucose levels in the blood are higher than normal range.

Defined as a lower blood sugar than the normal range.

Recognition :
- Drowsiness - Frequent Urination - Excessive thirst - Hot and dry skin - Rapid pulse

Causes :
1. Insulin or anti-diabetic medicine overdose 2. Insufficient food intake 3. Excessive Exercise 4. A missed meal

How to Recognize :
1. Weakness, trembling or shaking 2. Dizziness & hunger 3. Numbness around lips and fingers 4. Pallor 5. Sweating profusely 6. Rapid pulse 7. Altered mental status
(Fig. 4.19.1)

Treatment :
1. Make the casualty sit comfortably in a cool place. 2. Seek medical help immediately. (Fig. 4.18.1) 3. Give sugar free oral fluids.

Treatment :
1. Reassure the casualty & make him/her comfortable. (Fig. 4.19.1)
(Fig. 4.18.1)

2. Give oral fluids with glucose or a sweetened drink. (Fig. 4.19.2) 3. Repeat the drinks every 15 minutes until medical help arrives. 4. Loosen and remove excessive clothing.

(Fig. 4.19.2)

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4.20

FRACTURES, SPRAINS, STRAINS & DISLOCATIONS

Fractures, sprains, strains and dislocations may be hard for the non medical person to differentiate.

Management : Aims :
- Immobilization and support to the fractured part. - Minimizing the painful movements. 1. Reassure the casualty and ask not to move. 2. Check circulation and treat for shock. 3. Steady and support the fractured limb. 4. Keep the joints above and below the fractured part immobilized with splint (or any improvised item). Proper splinting may reduce pain. 5. To design a splint, use a rigid material such as wood, plastic or metal. 6. Fasten the splint to the limb with gauze, bandages, and strip of cloth, string or even a belt. 7. Tie bandages firmly. 8. Stop bleeding with direct pressure if possible. 9. If possible elevate the injured part. 10. Transport the casualty to the nearest hospital. 11. Check circulation, breathing, level of consciousness every 10 minutes.

Fracture means broken or cracked bones. Fractures can be caused by :

1. Direct force - Bones are broken at the point where severe force is applied. 2. Indirect force - Bones are broken away from the point where severe force is applied.

Types of fracture :
Closed Fracture : Skin is intact with broken bone. Open Fracture : Broken bone with open wound. Skin is broken with evident bleeding.

How to recognize ?
1. Immobility 2. Deformity 1. Look for pain 2. Look for tenderness 3. Look for Swelling 4. Look for Loss of function 5. Any unnatural movement 6. History of heavy blow or fall

First aid for strains, sprains, confusions, dislocations, or uncomplicated fractures. - R.I.C.E. (Rest, Ice, Compression, Elevation) Treatment.

Complication of fractures :
- Associated injuries may be present - Shock - Hypovolemic or Neurogenic

Rest : (Fig. 4.20.1)

Stop using injured part - Continued activity could cause further injury, delay healing, increase pain, and stimulate bleeding

(Fig. 4.20.1)

Use crutches to avoid bearing weight on injuries of the leg, knee, ankle, or foot Use splint for injuries of the arm, elbow, wrist, or hand

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4.21

COMMON SPORTS INJURIES

Ice :

Hastens healing time by reducing swelling around injury - Sudden cold contracts blood vessels - Helps stop internal bleeding from injured capillaries and blood vessels Keep damp or dry cloth between skin and ice pack Do not apply ice for longer than 15 to 20 minutes at a time - Apply at least 3 times throughout the day for 15 to 20 minutes

Most major sports injuries can be recognized by their signs and symptoms, and treatment can be provided as required. Head injuries, concussion, lacerations, soft tissue injuries and fractures, are recognizable and can be effectively treated by anyone trained in basic first aid. Certain other sports injuries are more common, and may require more specific first aid treatment. These are explained below:

Chest cramps (or 'stitch')

Usually caused by cramps of the muscles between the ribs, or the diaphragm high in the abdomen. Brought on by exertion, chest cramps are identified by sharp, spasmodic pain in the chest, difficulty in standing upright, and gasping respirations. A 'Stitch' will disappear with rest and concentration on deep breathing.

Compression :

Hastens healing time by reducing swelling around injury - Decreases seeping of fluid into injured area from adjacent tissue Use elasticized bandage, compression sleeve, or cloth - Wrap injured part firmly -- Do not impair blood supply --- Too tight compression may cause more swelling - Wrap over ice - Loosen the bandage if it gets too tight

Groin and testicle injuries

Caused by a blunt injury to the pelvic area. Causes severe pain in the area. The casualty will be unable to stand upright, and will 'guard' the injured area with his hands. The casualty should be placed on his back with knees slightly bent, and have an ice pack applied with caution to the injury site. Seek medical aid.

Muscle cramps
Caused by over-stretching muscles, or by abnormal muscle contraction. They may also be associated with loss of fluid due to excessive sweating. Will have pain, tenderness, loss of power and stiffening or spasms of the muscles. Muscles respond to rest, application of an ice pack, then subsequent gentle stretching. DO NOT massage the affected muscles. Other sports injuries should be treated as they present, and medical aid sought as a matter of course. If these injuries are in the form of sprains and strains, they may require support in the form of strapping or taping.

Elevation :

Elevate injured part above level of heart - Decreases swelling and pain - Use objects and pillows for props, Strains, Sprains

What to do ?

Rest to the injured part Pain killer (Analgesic)

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4.22

HEAD INJURIES

Any blow to the head can result in a head injury. Head injuries can cause damage to the :

Avoid unnecessary movements. Immobilize the neck, spine and head. (Fig. 4.22.2) Assess for consciousness and breathing. Give rescue breaths if not breathing. Assess the circulation, check pulse. Control bleeding if present. Reassure the casualty and keep warm and calm.
(Fig. 4.22.2)

Scalp : layer outside the skull bone. Skull : bony cage. Brain: a concussion, a contusion (the brain tissue is bruised), or a hematoma (blood collects in an area of the brain from a broken blood vessel).

Signs and Symptoms of head injuries that alert the need for medical attention include :

Loss of consciousness, confusion, drowsiness Inability to move any part of the body or weakness in an arm or leg (Fig. 4.22.1) Bruise, cut on the scalp Severe headache Stiff neck Vomiting Blood or fluid that comes from the mouth, nose or ear Loss of vision, blurred or double vision, pupils of unequal size
(Fig. 4.22.1)

SPINAL INJURIES
Common causes are :

Accidents-Cars, Motorcycles Falls Diving mishaps - from diving into the water that is too shallow A hard blow to back while playing Gun shot wound that penetrates the head and neck

Treatment :

Do the scene survey for safety to self and the casualty. Call for the ambulance.

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4.23

EYE INJURIES

You can treat many minor eye irritations by flushing the eye, but more serious injuries should be shown immediately to the doctor.

Chemical burns :

Routine Irritations :
(Sand, dirt, and other foreign bodies on the eye surface)

Flood the eye with water immediately, using your fingers to keep the eye open as wide as possible. Hold the head under a tap or shower, or pour water gently into the eye from a container for at least fifteen minutes. Roll the eyeball as much as possible to wash out the eye. Do not use an eyecup, or bandage the eye. Seek medical help immediately.

Wash your hands thoroughly before touching the eyelids to examine or flush the eye. Do not touch, press, or rub the eye itself. Do not try to remove any foreign body except by flushing. Tilt the victim's head over a basin with the affected eye down and gently pull down the lower lid, encouraging the victim to open his or her eyes as wide as possible. For an infant or small child, it's helpful to have a second person hold the child's eyes open while you flush. Gently pour a steady stream of tap water from a jug across the eye. Flush for upto 15 minutes, checking the eye every 5 minutes to see if the foreign body has been flushed out. Consult a doctor.

Embedded Foreign Body - An object penetrates the globe of the eye :

Call for emergency medical help. Stabilize the embedded object in place & rush to doctor /call EMS.

Cuts of the eye and lid :

Seek medical help immediately. Do not attempt to wash out the eye or remove any object stuck in the eye. Never apply pressure to the injured eye or eyelid. The eye should not be rubbed.

Blunt injury (blow) to the eye :

Immediately apply an ice compress to the eye to reduce pain and swelling. Seek medical help immediately.

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4.24

ABDOMINAL INJURY

4.25

TOOTH INJURIES

Abdominal injuries are caused by blunt or penetrating trauma and can involve internal bleeding or the exposure of the internal organs to air. Whatever the cause of the injury the first aid provider should be alert for shock due to internal bleeding.

Blunt Trauma / Wound :

If the injury is either blunt trauma, e.g. a severe blow to the abdomen without any associated wound, or a penetrating injury, the first aid steps and approach will be the same.

When a tooth is knocked out, appropriate emergency medical and dental care is necessary. If a child is 7 or more it is likely to be a second or permanent tooth. A second or permanent tooth can often be saved if prompt action is taken, and the tooth is handled carefully. The delicate tissue covering the root must be protected to ensure successful re-implantation. If a child is 6 or less it is likely to be a baby or primary tooth. Baby teeth may become injured after a fall and turn grey in colour. Treatment is not always necessary, but it is best to have the dentist examine the child as soon as possible.

Signs and Symptoms :

Care and Treatment : When a baby or toddler injures gums or teeth :

Pale, cool, clammy skin There may be evidence of wound Rapid, weak pulse, shock Rapid, shallow breathing Abdominal rigidity 'Guarding' of abdomen will be rolled up for comfortable position if lying down

If there is bleeding, put cold water on a piece of gauze and apply pressure to the site. Offer the casualty an ice cube to suck, to reduce swelling call your dentist. He or she will probably want to see the child to assess the need for realignment, or removal of a very loose tooth.

If a permanent tooth is knocked out :

What to do ?

Hold the tooth by the crown (the top), not the root. Rinse the tooth immediately with saline solution or milk, avoid scrubbing material off it. If this is not possible, wrap in plastic cling wrap. If the casualty will cooperate, replace the tooth gently in its socket. Have the casualty bite down gently on a gauze pad to keep the tooth in place. If the tooth cannot be re-inserted, put it in milk which is a good preservative because its chemical make-up is compatible with teeth. If milk is not available, the tooth can be placed in the casualty's mouth between the teeth and cheek, if old enough not to swallow the tooth. If this is not possible, wrap in plastic cling wrap. Give the casualty a gauze pad or handkerchief to gently bite down on, which will help control bleeding and ease the pain. See a dentist right away, within 20 minutes if possible. Do not replace the tooth or place anything in the mouth of a drowsy or unconscious casualty.

Perform ABC. Carefully position individual on their back. If movement of the legs does not cause pain, place a pillow under knees to help relax the abdominal muscles. If movement of the legs causes pain, leave individual lying flat. Wear gloves. Control bleeding with a dressing.

Do not give food or drink. Do not give medication.

Stabilise any object in where it is, and pad around wound. Avoid removing or touching penetrating objects. Reassurance.

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4.26

STROKE

If the tooth can't be re-implanted, control bleeding by placing a gauze pad in the tooth socket, and then get the casualty to bite gently down on the pad. Avoid rinsing out the mouth because this can interfere with blood clotting. If the gums are bleeding, put cold water on a piece of gauze and push it between the lips and gums. Have the casualty hold pressure on the bleeding site.

Stroke / Brain Attack What is stroke ?

Stroke, also called a brain attack, happens when the arteries leading to the brain are blocked or rupture. When the brain does not receive the needed oxygen supply, the brain cells begin to die.

Reasons :
Clotting of blood or Arterial rupture. Warning signs and symptoms may include :

In some cases head and eye may deviate to one side. sudden weakness or numbness of the face, arm, or leg on one side of the body. (Fig. 4.26.1) Sudden difficulties with speech and understanding what others are saying. Sudden problems with vision - dimness or loss of vision, particularly in one eye Sudden dizziness. Sudden problems with walking.

(Fig. 4.26.1)

Another warning sign of stroke is called transient ischemic attack (TIA), also called a "mini-stroke." A TIA can cause many of the same symptoms as a stroke, but TIA symptoms generally only last for a few minutes. Call for immediate medical assistance if you suspect a person is experiencing a transient ischemic attack, as TIA may lead to stroke. Also call for immediate medical assistance is you suspect a person is experiencing a stroke.

Management :

Alert emergency medical services immediately. Check and monitor the victim's airway, breathing, and circulation using your CPR and First Aid skills. Ensure adequate ventilation & loosen tight clothing's if any. Lay the victim down with their head and shoulders slightly elevated. (Place pillows under the head and shoulders).This will reduce blood pressure on the brain.

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4.27

FITS

If the victim is unresponsive, but breathing place them on their left side with their chin extended. This serves as two purposes. It will assist in keeping the victim's airway open and allow vomit and secretions to drain from their mouth. Never give a suspected stroke victim anything to eat or drink. Their throat may be paralyzed restricting their ability to swallow. Encourage the victim not to move and reassure them that help is on the way to care for them. Keep the victim warm.

What is a fit ?
It is a violent involuntary contraction of muscles in the body. Reasons : - Brain damage due to various diseases. - Head injury. - Reduced oxygen supply to the brain. - Poisoning. - High fever in children. Signs and Symptoms : 1. Poor balancing and loss of coordination with staggering. 2. Disorientation and irritability. 3. Stiffness and rigidity. (Fig. 4.27.1) 4. Rolling of the eye to one side. 5. Clenched teeth with foaming at the mouth. 6. Incontinence of urine and loss of bowel control. 7. Unnatural limb movements. What to do ? 1. Make a clear surrounding around casualty. 2. Protect the casualty from injury. 3. Do not restrict the movement till fits stop. 4. Do not put anything in the casualty mouth. 5. Turn the casualty to a side to facilitate any secretions to drain out safely. 6. Manage if any injury occurred from seizures. 7. Do not disturb if the casualty falls asleep. 8. Check ABC continuously. 9. Seek medical aid.
(Fig. 4.27.2) (Fig. 4.27.1)

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4.28

SHOCK

Fits in Young Children : Fever is the most common cause for fits in infants and young children. Signs and Symptoms - Same as adult. Treatment : 1. Protect child from injury. 2. Keep the airway open and clear. Turn the child to one side. 3. Sponge the body with tap water if child feels hot. Do not overcool. (Fig. 4.27.2) 4. When convulsion stops, and the body temperature is reduced to normal, cover lightly. 5. Monitor child frequently and closely. 6. Reassure the parents. 7. Seek medical aid.

Shock is an emergency condition when blood flow to vital organs (Brains, Heart, Kidney) is decreased.

Some causes for shock are :

- Heart Failure - Severe or sudden blood loss - Large drop in body fluids (a severe burn or severe vomiting and/or diarrhea) - Food poisoning - Exposure to extreme heat or cold for too long

Other things that lead to shock are :

- Fracture of a large bone - Severe allergic reaction - Severe Hypoglycemia - Excessive of alcohol - Drug overdose
(Fig. 4.28.1)

Signs and symptoms of shock :

- Weakness, trembling, restlessness - Confusion - Loss of consciousness (Fig. 4.28.1) - Pale or blue-colored lips, skin and/or fingernails - Cool and moist skin, sweating - Weak, but fast pulse - Rapid, shallow breathing - Nausea, vomiting - Extreme thirst
(Fig. 4.28.2)

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4.29

ANAPHYLACTIC SHOCK

What to do ?
- Activate Emergency Medical Services. - Lay the person down, face up. - Elevate the feet about 1 foot with a box or rolled blankets. This causes blood to flow from the legs to the vital organs in the body. Note : Do not raise the feet or lower the head if you suspect the person has a head, neck, back or leg injury. - Do not raise feet or move legs if hip or leg bones are broken. (Fig. 4.28.2) - Loosen tight clothing. Then, cover the person with a coat or blanket to prevent heat loss. - Monitor for breathing and pulse every 5 minutes. - Do not give any food or liquids unless person is recovered/alert. - Reassure the person. - If the person vomits, roll him or her on the side.

Common Causes :
Drug or Food allergies, Insect bites and Stings.

Recognition :
- Anxiety - Red, blotchy skin - Swelling of tongue and throat - Puffiness around eyes - Impaired breathing Wheezing may be present with gasping of air. - Signs of shock

Treatment :
1. Call for ambulance immediately. 2. Provide on as much information as possible. 3. Help the casualty to sit in a position that eases any breathing difficulties. 4. Monitor casualty and record vital signs (ABC)- Level of consciousness, pulse & breathing until help arrives. 5. Provide resuscitation if casualty collapses.

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4.30

ROAD TRAFFIC ACCIDENTS

Most modern vehicles are designed to withstand impacts of a certain force, and to provide protection to drivers and passengers. However, road traffic accidents are a common day occurrence and as a first aid provider, you may be required to provide help at the scene of a road traffic accident.

Access to the casualties :

Ensure that any vehicle involved is safe. Do not touch the vehicle unless you are certain. Beware of the vehicle being in contact with an electrical power source. If it is a new model vehicle (with electronic fuel injection), DO NOT turn off the ignition as this may cause a spark. If the engine is running, turn it off but leave the ignition on. If you attempt to gain entry, do not wrench open the door unless you know that it is not in contact with a casualty. Be careful of broken glass if you insert your head through a window. Make sure that you can gain effective entry beside and behind the casualty. Beware of sharp metal and broken glass.

Reaching the scene of accident :

Take care of your own safety and those of by standers. Approach the scene methodically, keep away from traffic, and ask someone to accompany you for help. Examine the scene - Is the vehicle stable; will it move or roll over? Is there spilt fuel? Is there any danger of fire? Are power poles involved? What about oncoming traffic? If a van or truck; is the load safe? Don't touch anything until you are sure that it is safe.

Attending to the casualties :

Perform a quick examination of the casualties : ABC, bleeding, burns, fractures, other injuries. Move the casualties with minor injuries away from the scene to a safe place. This will give you more space to attend to the more serious cases. Always try to have a responsible person to help you attend to serious casualties - it helps to have assistance and support.

After the initial quick assessment, call for police and ambulance. Provide information on location, number of casualties, estimated seriousness of injuries, and if road rescue is required for trapped casualties. Control the scene :
As you move to the scene, ask bystanders to move back. Ask a responsible person to slow down or redirect any oncoming traffic. Ask someone else to make sure that bystanders (especially children) don't become involved with passing traffic. Ask bystanders not to smoke near any damaged vehicles.

What to do ?
Treat any casualties in accordance with your training. DO NOT remove any seriously injured casualties from the vehicle unless fire, fear of further collision, airway protection, control of severe bleeding, or CPR are necessary. Wait for the ambulance to arrive. Provide what treatment and reassurance you can, keep the casualties warm with blankets if available, and periodically check on the 'walking wounded' who have been moved from the scene. Remember that SHOCK is a life-threatening condition, and is common after trauma sustained in a road traffic accident. Be ready to treat any signs and symptoms that indicate that a casualty is progressing into shock. Do not confuse shock with the adrenaline 'rush' associated with the 'fight or flight' mechanism which causes people involved to shiver, shake, cry and feel faint after an accident. This is not a serious condition, and others can look after them while you attend to the needy casualties. On arrival of the ambulance, give the crew what information you have and advise them of any treatment you have provided. Your intervention will be appreciated by all concerned - especially the casualties.

Assess the scene :

What are the initial impressions? How many casualties? Are they walking around? Unconscious? Talking? Any obviously dead? Any trapped? Ask bystanders for help. May require to do triage. Without adequate help do not become committed to resuscitation of a cardiac arrest victim at the expense of others who require urgent assistance.

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Transportation :
In an emergency, there are many ways to move a casualty to safety, ranging from one-person carries to stretchers. The casualty's condition and the immediacy of danger will dictate the appropriate method, but remember to give all necessary first aid before moving the casualty. At times it will be necessary to move the casualty immediately, without regard to the severity of the injuries. Remember, when you move a casualty, you are taking a calculated risk. You may cause further

injury or even death!

You are justified in taking such a risk only when it is evident that the casualty will die if not moved.

General Guidances :
1. Whenever possible, render first aid before transporting the casualty. Reduce the casualty's pain and make them as comfortable as possible. 2. Use a regular stretcher, with enough people to carry it, so that you will not drop the casualty. 3. Whenever possible, take the stretcher to the casualty, instead of carrying the casualty to the stretcher. 4. Fasten the casualty to the stretcher so that they don't slip, slide, or fall off. 5. Use blankets, clothing, or other material to pad the stretcher and protect the casualty from exposure. 6. Casualties should be lying on their back while being moved. In all cases, it is important to place the casualty in a position that will best protect them from further injury. 7. Always give a complete account of the situation before giving the casualty to other personnel. Include what caused the injury and what first aid procedures have been completed. Also, get the name of the casualty and the person whom you are turning them over to. This is one way of protecting yourself and at the same time ensuring that the patient will be in good hands.

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5.1

HEART ATTACK

Introduction Heart Attack

The death of heart tissue caused by a complete blockage in one of the arteries that supply blood to the heart (coronary arteries), leads to a heart attack. The Common symptoms of a heart attack are : - Chest pain or discomfort felt as pressure, squeezing or tightness - Pain radiating to the shoulder, the arm, upto the jaw and occasionally to the abdomen - Profuse sweating - Shortness of breath - Nausea or vomiting - Palpitations After a heart attack a person may either recover or develop one of the three complication: - Heart failure - Collapse and death - Heart rhythm disturbances At the time of collapse, the heart stops pumping blood and if nothing is done immediately to restart the heart, brain damage begins with in four minutes. The cardiopulmonary Resuscitation (CPR) and defibrillation are the only two preferred techniques which can keep the heart alive. CPR can be performed by any trained person & it is also useful to keep the heart beating in case of electrocution, drowning and other causes of collapse.

SPECIAL CONDITION

First Aid :

Seek Medical help immediately. Make the person lie down comfortably. Ask him to take deep breaths. Monitor his pulse. If feeble and thready, raise the foot end and treat as per shock guidelines. If no pulse, start CPR.

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5.2

ONE MAN ADULT CPR

Step 1 Assess :
- Call the victim loudly and ask by shaking his shoulders gently. Hello, Hello, are you Ok OR are you alright. (Fig. 5.2.1) - Avoid unwanted movements of the neck in the event of trauma to the neck and spine. - If there is no response, it means that the victim is unconscious either due to: 1. An obstructed Airway due to secretions or food or the tongue falling backward. 2. Not breathing. 3. The Heart has stopped beating.
(Fig. 5.2.1)

Step 3 Positioning :
- The victim should be made to lie on his / her back and on a flat and firm surface. This is the most suitable position to perform resuscitation. - Rescuer should straighten the legs and arms of the victim alongside the body. - If the victim is lying face down or on his side, turn on his /her back before starting any of these procedures. - If there is an obvious head and the neck injury or suspected head / neck injury, do take care of the head and back by supporting while repositioning, and all the movements should be as gentle as possible.

Step 4 Keep the airway open :

- In unconscious victim lying flat with his face upwards, it is important to prevent the tongue falling backward and blocking the airway. - The tongue falling backward can easily be prevented by head tilting backward and lifting the chin forward (Head tilt and chin lift). (Fig. 5.2.3) - You should aim to leave the victim's mouth slightly open when doing this procedure.
(Fig. 5.2.2) (Fig. 5.2.3)

Step 2 Call for help : (Fig. 5.2.2)

Immediately dial 105111 or 102 for the emergency medical service. Information to be given : - What is the status of person collapsed? - Where is the victim located? - Give your correct telephone number. If you have another help or person around, ask him / her to call the ambulance and give the above mentioned information to the

- Look into the mouth and check if there is any foreign body in the mouth such as broken teeth, dentures, meat piece or oral secretions. If visible try to clear, and be careful not to push it further into the mouth. - In case head / neck injury is suspected, do a gentle head tilt and chin lift (jaw thrust). Remember to keep the causality's mouth slightly open.

Step 5 Breathing - Look, Listen, Feel : (Fig. 5.2.4)

- Once the airway is open, maintain the head tilt chin lift position with your hands as described earlier, assess and check the breathing.
68 (Fig. 5.2.4)

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- Position your cheek close to victim's nose and mouth, look toward victims chest for 10 secs Look (for the chest wall to rise and fall) Listen (for the sounds of air escaping from the victim' mouth and nose).

Step 8 Locate the hand position :

1. Run the middle finger along the lower ribs. margins till margins merge with sternum breastbone. (Fig. 5.2.7) 2. Place the index finger next to your middle finger. (Fig. 5.2.8) 3. Place the heel of you plant next to index finger. (Fig. 5.2.9) 4. Place your other hand over the first hand and interlace your fingers of both hands. (Fig. 5.2.10) 5. This position is on the lower half of the sternum (breastbone). (Fig. 5.2.11) This is the correct hand position for chest compression. - Compressions below this landmark can cause damage to the liver in the upper abdomen. - Compressions too high on the chest are ineffective. - Compressions directly over the ribs can cause the fracture of the rib.
(Fig. 5.2.11) (Fig. 5.2.10) (Fig. 5.2.9) (Fig. 5.2.7) (Fig. 5.2.8)

Feel (for the air on your cheek escaping from the nose and mouth of the victim). Step 6 Breathing - Mouth to Mouth : (Fig. 5.2.5)
- If victim is found not breathing, begin mouth to mouth ventilation by pinching the nostril and sealing victims mouth by placing your mouth on top. - Maintain head tilt and chin lift throughout with the other hand. - Taking a deep breath and opening your mouth wide, blow into the victim's mouth until you see the chest rise. - Leave the nostrils immediately to let the victim exhale. - Give two rescue breaths initially.

(Fig. 5.2.5)

Step 7 Check for Circulation : (Fig. 5.2.6)

1. Check for carotid pulse by locating the adam's apple at the neck of the victim with the adam's second hand. Maintain head tilt and chin lift with first hand. 2. Slide the fingers of the second hand laterally on the side of the adam's apple until you reach the groove. Applying gentle pressure with finger tips, feel pulse for 10 seconds. - If the pulse is felt, the heart is beating
(Fig. 5.2.6)

Step 9 Begin - Chest Compressions :

1. By maintaining the position of hands on the chest wall, extend both the elbows and lock in position - 90o to the chest wall of the victim. 2. Use your body weight by leaning forward and compress the victim's chest wall by about 4 to 5 cm.

- Rescue breathing is given at the rate of one breath every 5 second or 12 breaths minute by counting 'blow' 3 one thousand 4 one thousand 3. If no pulse is felt, then begin external chest compression.

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Step 10 Ratio of chest compression to breaths :

While performing chest compressions you should be able to get heart rate of about 60 per minute. After every 15 chest compressions, 2 breaths are given. This rate is achieved by counting loudly while you are compressing the chest as follows :1 and 2 and 3 and 4 and 5 1 and 2 and 3 and 4 and 10 and and 2 and 3 and 4 and 15

THE RECOVERY POSITION : Step I

a) Tuck the arm on your side under the victim's thigh by keeping it straight and palm facing upwards. (Fig. 5.2.13) b) Bring the opposite arm across the victim's chest and place the hand over the victim's cheek. (Fig. 5.2.13), (Fig. 5.2.14) c) Bend the victim's far knee to 90 degree angle by using other hand. (Fig. 5.2.15)

Step 2
a) Place your palm on the top of victims palm, which is on cheek to maintain the position. Hold the victim's hip on the opposite side and roll him towards you unless victim is lying on his side. (Fig. 5.2.16)

Points to remember :
1. After every 15 compressions you should not take more than 4 to 7 seconds to deliver 2 ventilations. 2. Make sure to release pressure on the chest at the end of each compression. 3. Check Pulse after every 4 cycles of 15 compressions:2 ventilation which should be completed in one minute. 4. If the pulse has returned, check breathing. If not breathing perform rescue breathing. 5. If the pulse is still absent, continue CPR until the ambulance or medical team arrives. 6. If both pulse and breathing returns after successful CPR, turn the victim to the recovery position, but assess continuously for pulse and breathing every few minutes as these can stop again. 7. Never Perform CPR on a person with a pulse. 8. Use your CPR skills when you encounter a collapsed person.

Step 3
a) Make sure that the cheek of the victim is lying over the back of the palm. b) See that the other hand is lying free on the body side with palm facing upward. c) The leg should be flexed to knee at about 90 degree.

CPR CAN SAVE LIFE AND THE VICTIM GETS A CHANCE TO LIVE

(Fig. 5.2.12)

(Fig. 5.2.13)

(Fig. 5.2.14)

(Fig. 5.2.15) 72

(Fig. 5.2.16) 73

CHOKING

The Obstructed Airway

The Heimlich Maneuver :

1. Immediately take position behind the victim. (Standing or seated). 2. Put your arms around the victim's waist. (Fig. 5.2.18) 3. Locate the navel with one of the hand and place two finger above the navel using the other hand. 4. Place a closed fist with thumb inside, 2 fingers above the navel. 5. Put your other hand over your closed fist. 6. Give quick thrust inward and upward to the abdomen with both hands. 7. Each thrust should be separately and forcefully delivered. (Fig. 5.2.19) 8. Continue giving thrust until foreign body is expelled or the victim become unconscious. 9. For an unconscious victim, proceed as one man CPR.
(Fig. 5.2.18)

What do we do ?
Choking can result in unconsciousness and cardio-pulmonary arrest. It is often caused by foreign body lodged in the airway. The recognition and proper management of choking is of key importance to safety at homes, restaurants, and other public places.

Prevention : Adults :
- Cut food into small pieces. - Chew food slowly and thoroughly, especially if wearing dentures. - Avoid laughing and talking during eating food. - Avoid excessive intake of alcohol before and during meals.

Infants & Children :

- Keep marbles, beads and other small objects out of their reach. - Prevent them from walking, running or playing with food or toys in their mouth.

If the victim is obese or pregnant ( CHEST THRUSTS) :

1. Stand behind the Victim and encircle your arms around the chest. 2. Place the thumb side inside and make a fist. 3. Place the thumb side on the middle of the victim's breastbone and cover the fist with other hand. 4. Give thrusts in backward direction. Repeat the thrust until the foreign body is out or victim becomes unconscious. 5. For an unconscious victim continue as one man CPR.
(Fig. 5.2.17) (Fig. 5.2.19)

How can one recognize symptoms of choking ?

1. Victim clutches at his neck-universal sign for choking. (Fig. 5.2.17) 2. If not sure of choking, ask victim loudly Are you choking can you talk, can you breath, can you cough. 3. Ask victim to cough as hard as he can. 4. If the choking is getting worse, you will notice Victim's coughing is becoming weak and ineffective. - Victim is unable to speak. - Victim develops harsh noise while speaking. - Victim's face may become blue. This suggest that immediate assistance is needed to help the victim expel the obstructing foreign body from the upper air way. The technique is called Heimlich Maneuver.

Safety precautions while practicing CPR on manikin :

1. Wash hands before manikin contact. 2. Manikin's mouth and nose should be disinfected thoroughly in between participants, use alcohol swab. 3. Do not use lipstick on manikin. 4. Inform the training centre if you have : a) Rashes on your body or hands, mouth b) Hepatitis B -Positive c) An upper respiratory infection

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