First Aid Tips

FIRST AID TIPS

BASIC PROCEDURES FOR FIRST AID

When a person is injured or ill, someone must take charge, send for a doctor, and apply first aid. The person taking charge must make a rapid but effective examination to determine the nature of the injuries.

Do not move the 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 to attempt to move the person, but to employ such emergency care as is possible at the place until more highly qualified emergency personnel arrive.

When making an initial survey, a first aider will consider what witnesses to the accident tell him about the accident, what he observes about the victim, what the victim tells him.

The first aider must not assume that the obvious injuries are the only ones present, because less noticeable injuries may also have occurred. Look for the causes of the injury, this may provide a clue to the extent of physical damage.

While there are several conditions that can be considered life-threatening, respiratory arrest and severe bleeding require attention first.

In all actions taken during the initial survey, the first aider should be especially careful not to move the victim any more than necessary to support life. Any unnecessary movement or rough handling should be avoided because it might aggravate undetected fractures or spinal injuries.

Once respiratory arrest and severe bleeding have been alleviated, attention should be focused on other injuries-open chest or abdominal wounds should be sealed, open fractures immobilized, burns covered and less serious bleeding wounds dressed. Again, remember to handle the victim carefully.

Once the obvious injuries have been treated, the secondary survey can be made to detect less easily noticed injuries that can be aggravated by mishandling. If a victim with a spinal injury is mishandled, he could suffer spinal damage, leading to paralysis. Also a closed fracture can become an open fracture if not immobilized. The secondary survey is a head to toe examination. Start by examining the victim's head, then neck, trunk, and extremities, looking for any type of abnormalities such as swelling, discoloration, lumps, and tenderness that might indicate an unseen injury.

FIRST AID PROCEDURES FOR LIFE-THREATENING CONDITIONS

This section outlines the first aid measures that should be used when life-threatening conditions exist. These conditions include: impaired breathing, heart failure, severe bleeding, and shock. Obviously, of first and paramount concern is immediate 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.

IMPAIRED BREATHING

Causes

1. Suffocation
2. Gas Poisoning
3. Electrical shock
4. Drowning
5. Heart failure

Signs/Symptoms

1. The chest or abdomen does not rise and fall.
2. Air cannot be felt exiting from the nose or mouth.

First Aid Treatment

There are several methods of artificial ventilation. Mouth-to-mouth is the most effective. Use the mouth-to-nose method if the victim has a severe jaw fracture or mouth wound, or has his jaws tightly closed. Simply breathe into his nose instead of his mouth.

Use back pressure method only when mouth-to-mouth cannot be used: For example, if the victim has severe facial injuries, is trapped or pinned face down, or when you are in a toxic environment and both you and the victim are wearing masks that do not contain a resuscitation device.

Move Fast

Seconds count when a person is not breathing. Start artificial ventilation at once. Don't take time to move the victim unless the accident site remains unsafe.

MOUTH-TO-MOUTH (NOSE) TECHNIQUE

1. Position victim 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. This is to avoid aggravation of any possible spinal injury.
2. Kneeling at the victim's side, tilt victim's head back so chin is pointing up by placing one hand under the neck and the other hand on the forehead.
3. Quickly glance in victim's mouth for any obstruction (e.g., food. tobacco, blood, dentures). If an obvious obstruction is present, carefully turn the victim on his side, tilt his head down, and sweep his mouth out with your fingers. When mouth is clear, move the victim onto his back again and tilt his head back.
4. Check for breathing by bending over the victim, placing your ear close to victim's mouth and nose. For at least five seconds listen and feel for air exchange and look for chest movements.
5. If no breathing is present, pinch the nose closed with the hand that is resting on the forehead, form an air-tight seal by placing your mouth over the victim's mouth, and breathe into the victim's mouth until his chest rises. (If using the mouth-to-nose method, seal the victim's mouth with your hands and breathe in through his nose.)
6. Breathe into the patient for a total of four times as quickly as possible. If you hear no air exchange, re-tilt his head and try again. If you still feel no air exchange, again sweep the mouth of foreign objects (step 3), and breathe into the victim again. If you still have no air exchange, turn victim on side and slap the victim in the back between his shoulder blades. Again sweep his mouth to remove foreign matter. (Note: If none of the above steps clear the air passage, repeat blows to the back and tilt the head.)
7. Repeat breathing. Remove mouth each time to allow air to escape. Repeat 12 times per minute for an adult -- 20 times for a small child or an infant. Use deep breaths for an adult, less for a child, and gentle puffs of cheeks for infants. As the victim begins to breathe, maintain head tilt. If it is impossible to do mouth-to-mouth or mouth-to-nose, use the following:

BACK PRESSURE ARM LIFT METHOD

1. Place victim face down. Clean mouth. Bend his elbows and place his hands one upon the other at eye level under victim's head. Turn his head to one side, making sure the chin juts out. This method will be done on a five-beat count.
2. Kneel at victim's head. Place your hands on victim's back so palms lie just below an imaginary line between armpits. (COUNT 1)
3. Rock forward until arms are vertical and the weight of your body exerts steady pressure on your hands. (COUNT 2)
4. Rock back grasping victim's elbows (COUNT 3) and draw victim's arms up toward you until you feel resistance at the shoulders. (COUNT 4)
5. Lower victim's arms to the ground. (Count 5) Repeat about 12 times per minute (every 5 seconds). Keep checking to see if mouth is clean, airway open, and heart is beating. If heart is not beating, begin external cardiac compression (circulatory failure).

Don't Stop

Continue artificial ventilation until victim breathes normally, a doctor pronounces him dead, a more qualified person takes charge, or you are physically unable to continue. If he must be moved, continue artificial ventilation.

FOREIGN OBJECTS IN THE THROAT

Signs/Symptoms

1. The victim gasps for breath
2. Has violent fits of coughing
3. Quickly turns pale and then blue
4. Cannot talk or breathe

First Aid Treatment

1. Open victim's mouth and grasp foreign object with fingers (index and middle), trying to remove obstruction.
2. Place head lower than body or roll victim on his side and slap him on the back.
3. If these methods do not work, try this third method:
• Rescuer stands behind the choking victim with arms around the victim just above the navel and below the rib cage.
• Lean the victim forward at the waist with his head and arms hanging down.
• The rescuer grasps his wrist then exerts sudden strong pressure against the victim's abdomen. This will force air out of the lungs and may expel the obstruction.

CIRCULATORY FAILURE

Causes

1. Heart attack
2. Impaired breathing
3. Shock
4. Electrical shock

Signs/Symptoms

1. No breathing
2. No pulse

First Aid Treatment

Don't waste time! Cardiac arrest (heart stops beating) means certain death if CPR (cardiopulmonary resuscitation) is not attempted.

If you have been trained in CPR:

1. CHECK FOR RESPONSE - Gently shake the victim and shout, "Are you OK?"
2. CHECK AIRWAY - Open the victim's airway by tilting his head back. (Victim should be on his back.)
3. CHECK BREATHING - For at least 5 seconds listen and feel for air exchange and look for chest movements.
4. IF NOT BREATHING - Give four quick, full breaths using the mouth-to-mouth technique.
5. CHECK PULSE - After giving four quick breaths, check the pulse using the carotid artery in the neck. To find the carotid artery, locate the voice box and slide two fingers into the groove between the voice box and the large neck muscle. Press firmly but gently to feel for the pulse and hold for at least 5 seconds. If a pulse is not present, begin cardiac compressions immediately.
6. CARDIAC COMPRESSIONS - Kneel at the victim's side near his chest. (Victim should be on a hard, flat surface.) To determine the pressure point for cardiac compressions, locate the bony tip of the breastbone (sternum) with your ring finger and place the two fingers just above that point. Place the heel of one hand adjacent to your fingers and the second hand on top of the first.
   
• Position your shoulders directly over victim's breastbone and press downward, keeping arms straight. Depress the sternum 1 1/2 to 2 inches for an adult. The time spent depressing and releasing the sternum should be equal.
  
• If there is only one rescuer, compressions should be made at a rate of 80 per minute with 2 breaths (artificial ventilation) after each 15 compressions. Remember, after the two breaths, check your hand position on the sternum before resuming compressions.
  
• If there are two rescuers, they should be opposite sides of the victim. One rescuer should perform compressions at a rate of 60 per minute, while the second rescuer is interposing a breath (artificial ventilation) after every fifth compression. Compressions should not be interrupted to breathe for the victim.

CARDIOPULMONARY RESUSCITATION FOR INFANTS AND SMALL CHILDREN

1. Airway - be careful not to overextend the infant's head when tilting it back; it is so pliable that you may block breathing passage instead of opening it.
2. Breathing - you can cover both mouth and nose with your mouth and use less volume of air; give a breath every three seconds.
3. Circulation - In both infants and small children only one hand is used for compressions. For infants, use only the tips of the index and middle fingers to depress the mid-sternum 1/2 to 3/4 of an inch at a rate of 80 to 100 compressions per minute. For small children, use only the heel of the hand to depress the chest at mid-sternum and depress the mid-sternum 3/4 to 1 1/2 inches, depending on the size of the child. The rates should be every 80 to 100 compressions per minute.
   
• In both small children and infants, breaths should be interposed after every fifth chest compression.

BLEEDING

Signs/Symptoms

Blood coming from an artery, vein, or capillary:

a. Artery - spurting blood, bright red in color
b. Vein - continuous flow of blood, dark red in color
c. Capillary - blood oozing from a wound

First Aid Treatment

1. Cover wound with the cleanest cloth immediately available or your bare hand and apply direct pressure on the wound. Most bleeding can be stopped this way.
2. Elevate the arm or leg as you apply pressure, if there is no broken bone.
3. Digital pressure at a pressure point is used if it is necessary to control bleeding from an arterial wound (bright red blood spurting from it). Apply your fingers to the appropriate pressure point - a point where the main artery supplying the blood to the wound is located. Hold pressure point tightly for about 5 minutes or until bleeding stops. The three pressure points in the head and neck should only be used as a last resort if there is a skull fracture and direct pressure can't be used. If direct pressure can be used, it will stop bleeding on the head in about 95% of the injuries.
4. A tourniquet should be applied to an arm or leg 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 a fracture. Make sure it is applied tightly enough to stop bleeding completely.
• In the case of an improved tourniquet, the material should be wrapped twice around the extremity and halfknotted. Place a stick or similar object 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.
• Once the tourniquet is put in place, do not loosen it. Mark a "T" on the victim's forehead and get him to a medical facility as soon as possible. Only a doctor loosens or removes a tourniquet.
• 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

Signs/Symptoms

1. Cold and clammy skin
2. A weak and rapid pulse
3. Eyes dull and pupils enlarged
4. Possible thirst
5. Nausea and vomiting
6. Pain in affected area

First Aid Treatment

1. Treat victim for shock.
2. Anticipate that victim may vomit, give nothing by mouth
3. Get the victim to professional medical help as quickly and safely as possible.

SHOCK

Shock may accompany any serious injury: blood loss, breathing impairment, heart failure, burns.

Shock can kill-treat as soon as possible and continue until medical aid is available.\

Signs/Symptoms

1. Shallow breathing
2. Rapid and weak pulse
3. Nausea, collapse, vomiting
4. Shivering
5. Pale, moist skin
6. Mental confusion
7. Drooping eyelids, dilated pupils

First Aid Treatment

1. Establish and maintain an open airway.
2. Control bleeding.
3. Keep victim lying down.
Exception: Head and chest injuries, heart attack, stroke, sun stroke. If no spine injury, victim may be more comfortable and breathe better in a semi-reclining position. If in doubt, keep the victim lying flat.
4. Elevate the feet unless injury would be aggravated by this position.
5. Maintain normal body temperature. Place blankets under and over victim.
6. Give nothing by mouth, especially stimulants or alcoholic beverages.
7. Always treat for shock in all serious injuries and watch for it in minor injuries.