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First aid must be administered immediately to: restore breathing and heart-beat,
control bleeding, remove poisons, prevent further injury to the patient (for instance,
his removal from a room containing carbon monoxide or smoke).
In the case of an injured limb, get the sound limb out of the clothing first, and then
peel the clothes off the injured limb. If necessary, cut clothes to expose the injured
part.
The patient's pulse should be taken. If it cannot be felt at the wrist, it should be felt
at the carotid artery at the side of the neck. If there is no pulse, heart compression
and artificial respiration must be started. The patient should be treated for shock if
the pulse is weak and rapid, or the skin pale, cold, and possibly moist, with an
increased rate of shallow, irregular breathing. Remember that shock can be a
great danger to life, and its prevention is one of the main objectives of first aid.
The patient should be kept in the position that best provides relief from his injuries.
Usually this is a lying-down position, which increases circulation of the blood to the
head.
The patient should be observed for type of breathing and possible bleeding. If he is
not breathing, mouth-to-mouth or mouth-to-nose artificial respiration must be
given.
During this time, the patient, if conscious, should be reassured and told that all
possible help is being given. The rescuer should ask about the location of any
painful areas.
The patient should be kept in a lying-down position and moved only when
absolutely necessary. The general appearance of the patient should be observed,
including any signs and symptoms that may indicate a specific injury or illness.
The patient should not be moved if injuries of the neck or spine are suspected.
Fractures should be splinted before moving a patient. No attempt should be made
to set a fracture.
Note. Never consider anyone to be dead, until you and others agree that: no pulse
can be felt, and no sounds are heard when the examiner's ear is put to the chest;
breathing has stopped; the eyes are glazed and sunken; there is progressive
cooling of the body (this may not apply if the surrounding air temperature is close
to normal body temperature).
If you're trained in CPR and you've performed 30 chest compressions, open the person's airway
using the head-tilt, chin-lift maneuver. Put your palm on the person's forehead and gently tilt
the head back. Then with the other hand, gently lift the chin forward to open the airway.
With the airway open (using the head-tilt, chin-lift maneuver), pinch the nostrils shut for mouth-
to-mouth breathing and cover the person's mouth with yours, making a seal.
Prepare to give two rescue breaths. Give the first rescue breath — lasting one second — and
watch to see if the chest rises. If it does rise, give the second breath. If the chest doesn't rise,
repeat the head-tilt, chin-lift maneuver and then give the second breath. Thirty chest
compressions followed by two rescue breaths is considered one cycle. Be careful not to provide
too many breaths or to breathe with too much force.
2. STOP SEVERE BLEEDING.
For severe bleeding, take these first-aid steps and reassure the injured person.
Remove any clothing or debris on the wound. Don't remove large or deeply
embedded objects. Don't probe the wound or attempt to clean it yet. Your first job is
to stop the bleeding. Wear disposable protective gloves if available.
Stop the bleeding. Place a sterile bandage or clean cloth on the wound. Press the
bandage firmly with your palm to control bleeding. Apply constant pressure until the
bleeding stops. Maintain pressure by binding the wound with a thick bandage or a
piece of clean cloth. Don't put direct pressure on an eye injury or embedded object.
Secure the bandage with adhesive tape or continue to maintain pressure with your
hands. If possible, raise an injured limb above the level of the heart.
Help the injured person lie down. If possible, place the person on a rug or blanket to
prevent loss of body heat. Calmly reassure the injured person.
Don't remove the gauze or bandage. If the bleeding seeps through the gauze or
other cloth on the wound, add another bandage on top of it. And keep pressing
firmly on the area.
Clean Cut or Wound. Gently clean with soap and warm water. Try to rinse soap out
of wound to prevent irritation. Don’t use hydrogen peroxide or iodine, which can
damage tissue.
Protect the Wound. Apply antibiotic cream to reduce risk of infection and cover with
a sterile bandage.
3. Remove Poisons.
Prevent further injury to the patient (for instance, his removal from a room containing carbon
monoxide or smoke).
Cosmetics
Personal care items such as shampoo, body lotions and perfume
Cleaning solutions, including laundry detergent pods
Plants
Foreign bodies such as watch or button batteries
How you treat someone who may have been poisoned depends on:
Drowsy or unconscious
Having difficulty breathing or has stopped breathing
Uncontrollably restless or agitated
Having seizures
Known to have taken medications, or any other substance, intentionally or accidentally
overdosed (in these situations the poisoning typically involves larger amounts, often
along with alcohol).
Call Poison Help at 800-222-1222 in the United States or your regional poison
control center in the following situations:
Swallowed poison. Remove anything remaining in the person's mouth. If the suspected
poison is a household cleaner or other chemical, read the container's label and follow
instructions for accidental poisoning.
Poison on the skin. Remove any contaminated clothing using gloves. Rinse the skin for
15 to 20 minutes in a shower or with a hose.
Poison in the eye. Gently flush the eye with cool or lukewarm water for at least 15
minutes or until help arrives.
Inhaled poison. Get the person into fresh air as soon as possible.
If the person vomits, turn his or her head to the side to prevent choking.
Begin CPR if the person shows no signs of life, such as moving, breathing or coughing.
Call Poison Help at 800-222-1222 in the United States or your regional poison control for
additional instructions.
Have somebody gather pill bottles, packages or containers with labels, and any other
information about the poison to send along with the ambulance team.
Caution
Syrup of ipecac. Don't give syrup of ipecac or do anything to induce vomiting.
Expert groups, including the American Association of Poison Control Centers and
the American Academy of Pediatrics, no longer endorse using ipecac in children
or adults who have taken pills or other potentially poisonous substances. No
good evidence proves its effectiveness, and it often can do more harm than good.
If you still have old bottles of syrup of ipecac in your home, throw them away.
Button batteries. The small, flat batteries used in watches and other electronics
— particularly the larger, nickel-sized ones — are especially dangerous to small
children. A battery stuck in the esophagus can cause severe burns in as little as 2
hours.
If you suspect that a child has swallowed one of these batteries, immediately take
him or her for an emergency X-ray to determine its location. If the battery is in the
esophagus, it will have to be removed. If it has passed into the stomach, it's
usually safe to allow it to pass on through the intestinal tract.
Medicated patches. If you think a child got hold of medicated patches (adhesive
products for transdermal drug delivery), carefully inspect the child's skin and remove any
that are attached. Also check the roof of the mouth, where they can get stuck if the child
sucks on them.
make the casualty sit down in the normal sitting position but, if pain is
severe, place him in the half-sitting-up position, leaning over towards
the injured side;
transport him in this position to the ship’s hospital or his cabin;
treat pain;
do not put strapping around his chest;
keep him at rest in the position he finds most comfortable, either in
bed or sitting in a chair or on the floor (Figures 1.62, 1.63, 1.64).
Figures 1.62
Figures 1.63
Figures 1.64
Severe chest injuries
The ribs form a rigid cage which protects the heart and lungs. Severe force
may cause any one or a combination of the following injuries:
The fragments of a fractured rib are usually held in place by the muscles
between the ribs. After severe injury, a rib fragment may be driven inwards,
causing a tear in the covering of the lung with consequent leaking of blood or
air into the chest cavity. The lung on that side will then collapse and/or be
compressed, resulting in difficulty in breathing. There may be a blue/grey tinge
to the skin of the face and lips, and the casualty may cough up frothy blood-
stained sputum.