First Aid - Basic Principles

                                  First Aid

                                                  

First Aid Definition:

Initial care given to an injured or sick person to sustain life or to minimize deformity, before professional medical care is available is called First Aid.

Basic Facts:

 First Aid can be performed by anybody-non expert or a trained person.

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      The person who provides the first aid should look after his safety first.

Whatever be the cause of injury or illness, the basic principles of First Aid are the same.

A definitive diagnosis is not needed for the initiation of the First aid.

             Never be Panic when you face an unexpected situation.

The most important First Aid is Common Sense!

Aims of First Aid:

To preserve life: the important aim of First Aid is to save a life.

To Minimize Deformity: Second aim of First Aid is to prevent further injury. 

Like- keeping the patient away from harmful environment, applying bandage to stop a bleed and the ideal position of evacuation from the scene of event etc.

To Promote Recovery: If the First aid is given within the first hour following Injury or Trauma the chance of recovery is more. Hence this hour is called Golden Hour! ( Remember the Golden hour is the first hour following injury and not the time of arrival at a hospital!)

Remember, the difference between your doing something and doing nothing could be someone's life.                     

 Cardiopulmonary Resuscitation  

  

Normal Heart Rate is 72/minute

Normal Respiratory Rate is 16-20/minute

Cardiopulmonary resuscitation (CPR) is a lifesaving procedure useful in emergencies like heart attack, drowning, or trauma in which a person’s  breathing or heartbeat has stopped.

Anybody can begin CPR with chest compressions. This is called  Hands-Only CPR.

Most people who experience cardiac arrest at home, work or in a public location die because they don't receive immediate CPR from someone on the scene.

Remember, the difference between your doing something and doing nothing could be someone's life.

The American Heart Association recommends deep presses on the chest of an adult cardiac arrest victim until help arrives, works just as well as standard CPR .

Remember CPR can double a person's chances of survival!

Hands-only CPR is simpler and easier to remember.

How to Give Hands-Only CPR?

Give chest compressions at the centre of the chest at a rate of about 100 per minute. Continue till the arrival of the medical team.

If you're well trained and confident in your ability, start CPR with 30 chest compressions with two Rescue breaths.( Standard CPR)

The above advice applies to adults, children and infants needing CPR.

CPR can keep oxygenated blood flowing to the brain and other vital organs until more definitive medical treatment can restore a normal heart rhythm.

When the heart stops, the lack of oxygenated blood can cause brain damage in only a few minutes. A person may die within eight to 10 minutes.

Before starting CPR, check:

Is the person conscious or unconscious?

If the person appears unconscious, tap or shake his or her shoulder and ask loudly, "Are you OK?"

If the person doesn't respond begin CPR first but do not forget to call for the help.

ABC of Standard CPR

Airway: Clear the airway

Clean the airway to remove any dirt or secretions.

Slightly tilt the head and lift the chin and pull the tongue out so that it stays in the mouth and not obstructing the throat.

An ‘Oropharyngeal Airway’  if available can be used to keep the tongue forward.

   

If the person can utter his name properly, that means his airway is intact

1. 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. Beware of possible cervical spine injury while tilting the head!

2.Check for normal breathing, taking no more than five or 10 seconds. Look for chest movement, listen for normal breath sounds, and feel for the person's breath on your cheek and ear.

If the person isn't breathing normally begin mouth-to-mouth breathing.

If you believe the person is unconscious from a heart attack skip mouth-to-mouth rescue breathing and continue chest compressions.

Breathing: Breathe for the person

            

Rescue breathing can be mouth-to-mouth breathing or mouth-to-nose breathing if the mouth is seriously injured or can't be opened.

Step 1. Pinch the nostrils shut for mouth-to-mouth breathing and cover the person's mouth with yours, making a seal. One can place a hand kerchief over the victim’s mouth. (Better way of giving artificial respiration is by using a Face mask and an Ambu bag.)

Step 2.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 Jaw thrust, chin-lift manoeuvre and then give the second breath. Use the strength of your cheeks to deliver gentle puffs of air (instead of deep breaths from your lungs)

Step 3.Resume chest compressions at a rate of about 100 compressions a minute to restore circulation. 30 chest compressions followed by two rescue breaths is considered as one cycle CPR

Step 4. Continue CPR until there are signs of breathing movement or emergency medical personnel take over.

Circulation: Restore blood circulation with chest compressions

1.Put the person on his or her back on a firm surface.

2.Kneel next to the person's neck and shoulders.

3.Place the heel of one hand over the centre of the person's chest, between the nipples. Place your other hand on top of the first hand. Keep your elbows straight and position your shoulders directly above your hands.

4.Use your upper body weight (not just your arms) as you push straight down on (compress) the chest at least 2 inches (approximately 5 centimetres). Push hard at a rate of about 100 compressions a minute.

5. Continue chest compressions and rescue breathing until there are signs of chest movement or until emergency medical personnel take over.

This action should be taken only for adults who unexpectedly collapse, stop breathing and are unresponsive. Most likely that the person is having cardiac arrest.

Hands only CPR -100 Chest compressions/minute

Standard CPR-30 chest compressions followed by two rescue breaths

Choking- First Aid

Choking occurs when a foreign object becomes lodged in the throat or windpipe, blocking the flow of air. In adults, a piece of food often is the culprit. Young children often swallow small objects. As choking cuts off oxygen to the brain, administer first aid as quickly as possible.

Choking is common during feasts or Bada Khana in which people take alcohol and meat together!  

The universal sign for choking is hands held in front of  throat.

       

Also look for these indications: Inability to talk, difficulty breathing or noisy breathing, inability to cough forcefully, skin, lips and nails turning blue or dusky, loss of consciousness etc

In case of choking Remember "Five-and-Five" approach to delivering first aid:

"Five-and-Five" approach

First, deliver five back blows between the person's shoulder blades over the back of chest with your hand.

Then give 5 abdominal thrusts. Perform five abdominal thrusts (also known as the Heimlich manoeuvre).

Alternate between 5 blows over the back of chest and 5 thrusts until the blockage is dislodged.

How to perform abdominal thrusts (Heimlich manoeuvre)?

Stand behind the person. Wrap your arms around the waist. Bend the person forward slightly. Make a fist with one hand. Position it slightly above the person's navel. Grasp the fist with the other hand. Press hard into the abdomen with a quick, upward thrust - as if trying to lift the person up. Perform a total of 5 abdominal thrusts, if needed. If the blockage still isn't dislodged, repeat the five-and-five cycle.

If the person becomes unconscious, perform standard CPR with chest compressions and rescue breaths.

How to perform Heimlich manoeuvre on yourself?

First, if you're alone and choking call for help if possible. Then perform abdominal thrusts to dislodge the item. Place a fist slightly above your navel. Grasp your fist with the other hand and bend over a hard surface like a half wall or chair. Press your fist inward and upward.

Injury / Wounds –First Aid

1.Stop the bleeding. Apply firm pressure with a clean cloth or bandage.

2.Clean the wound ideally with Normal Saline or clean water

3.Apply an antiseptic cream.

4.Cover the wound with bandages to keep the wound clean and keep harmful bacteria out.

Use Pressure Points to Stop Severe Bleeding

If bleeding does not stop by the application of direct pressure over the wound, apply firm pressure over the pressure points. Pressure point is an area where an artery can be pressed against an underlying bone so as to stop the flow of blood.

Brachial Pressure Point-Middle of the Cubital fossa inner to Biceps tendon. 

Femoral Pressure Point-At the center of the groin ( Mid Inguinal Point)

Routine use of tourniquet is not recommended except in near total amputation of a limb with uncontrollable haemorrhage. Make sure that tourniquet is applied as close to the major injury.

Puncture wound

A puncture wound doesn't usually cause excessive bleeding. Often the wound seems to close almost instantly. But this doesn't mean treatment isn't necessary. A puncture wound, such as from stepping on a nail, can be dangerous because of the risk of infection.

Gunshot Wound

1.Call for emergency medical assistance.

2. Make sure you are safe.

3. Also make sure that everyone's firearm is pointed away from any other person(s), cleared of ammunition, safe and secured.

4. Do not move the victim unless you must do so to keep him safe or to access care

5. Act quickly. Time is your enemy in treating the victim. Victims who reach medical facilities during the "Golden Hour" have a much better likelihood of surviving.

6. Always look for an exit wound. Check the victim as thoroughly as possible for other wounds that you may be unaware of. Pay special attention to the armpit, buttocks or other difficult-to-see areas.

7. Avoid completely undressing the victim before emergency help arrives as this may advance shock or Hypothermia

Blast Injury

Injury occurs from being struck by material thrown by the blast and

from being thrown by the blast.

Injuries to hollow organs, including the lungs, caused by the shock wave from the blast leading to life-threatening breathing emergencies.

First aid for a blast injury affecting breathing

If person is injured because of a blast you should suspect a head or spinal injury therefore, prevent any movement.

Make sure the casualty is rested in a semi-sitting position if there is no suspected head or spinal injury.

Monitor breathing and if ineffective, give assisted breathing. If breathing stops, give Artificial Respiration.

Precautions:

Wear all protective clothing (hats, gloves, goggles, etc.)

Make use of Shelters

Varicose Vein Bleed

Apply pressure bandage and keep the limb elevated to stop bleeding from

the varicose veins.

Head Injury- First Aid

The features of Head Injury in an adult are: - External Bleeding, Internal Bleeding from Ear or Nose, Cerebro Spinal Fluid leakage from the nose or ears, Severe headache, Change in level of consciousness, Black-and-blue discoloration below the eyes or behind the ears, Cessation of breathing, Confusion, Loss of balance, Weakness or an inability to use an arm or leg, Unequal pupil size, Slurred speech, Seizures, Vomiting etc.

The features of Head Injury in children are: - Any of the signs or symptoms for adults, Persistent crying, Refusal to eat, Bulging in the soft spot on the front of the head (infants).

Keep the person still. Keep the head slightly lower down than the chest so that if at all the person vomits the vomitus should not obstruct the airway.

Avoid moving the person's neck. If the person is wearing a helmet, don't remove it.

Stop any bleeding. Apply firm pressure to the wound with sterile gauze or a clean cloth.

Watch for changes in breathing and alertness. If the person shows no signs of circulation begin CPR.

Things to Remember

External Bleeding-Apply Pressure Bandage to stop external bleeding.

Internal Bleeding or CSF Leak-Do not try to stop it with packing.

Head to be Tilted to one side-so that the vomitus may not obstruct the air way. 

Do not pull out an impacted foreign body-it can do more harm.

Spinal Injury- First Aid

           

 Assume a person has a spinal injury if:1)There's evidence of a head injury with an ongoing change in the person's level of consciousness, 2)The person complains of severe pain in his or her neck or back,3)The person is not moving his neck, 4)An injury has exerted substantial force on the back or head, 5)The person complains of weakness, numbness or paralysis or lacks control of his or her limbs, bladder or bowels, 6)The neck or back is twisted or positioned oddly

If injury to spine is suspected, keep the person still. Place heavy towels on both sides of the neck or hold the head and neck to prevent movement.

Provide as much first aid as possible without moving the person's head or neck. If the person shows no signs of circulation begin CPR, but do not tilt the head back to open the airway. Use your fingers to gently grasp the jaw and lift it forward. If the person has no pulse, begin chest compressions.

If the person is wearing a helmet, remove it carefully to with the help of another person stabilizing the head and neck together. You need at least one other person to move him. With one of you at the head and another along the side of the injured person, work together to keep the person's head, neck and back aligned while rolling the person onto one side.

Log roll the victim with the help of another person on a Hard Stretcher or Spine Board. Otherwise permanent paralysis or respiratory arrest can occur.

Syncope/ Shock - First Aid

Lie down the patient on a flat surface. Lift both feet together so that the blood supply of the brain is increased.

Don’t be panic.

Make the patient lie down on a flat surface.

Lift both feet together so that the blood supply of the brain is increased.

Make sure about the good aeration of the room

Epistaxis/ Nose Bleed- First Aid

Nosebleeds are common. It can be due to a local cause like a hit on nose or as a part of head injury.

If the nose bleed is a part of head injury the person may show other features of head injury like loss of consciousness, vomiting or seizures. In the absence of these, one should think of a local cause.

Epistaxis due to a local cause:-Sit upright and lean forward. Pinch the nose. Using thumb and index finger. Breathe through your mouth. Continue to pinch for five to 10 minutes. Pinching exerts pressure to the bleeding point on the nasal septum and often stops the flow of blood.

To prevent re-bleeding, don't pick or blow your nose and don't bend down for several hours after the bleeding episode. During this time remember to keep your head higher than the level of your heart.

Nasal pack with sterile gauze or an inflatable latex balloon to put pressure on the blood vessel and stop the bleeding.

Ask if the person is taking any drugs like anti coagulants, such as aspirin or warfarin or anti hypertensives.

Check the blood pressure. High blood pressure is one cause of epistaxis in adult.

The commonest cause of nose bleed in a child is Nose Picking or keeping the finger inside the nose quite often.

Do not try to stop a nose bleed if it is as a part of Head Injury (Internal Bleeding)

Face Injury- First Aid

In serious face injury obstruction of the air way is a major complication. Hence maintenance of air way is an important aspect in the first aid. Oro pharyngeal air way can be kept for a patent airway.  Even in the absence of this one can ensure a patent airway by keeping the tongue forward.

Neck Injury- First Aid

  

A strong suspicion is needed to rule out cervical spine injury. Immobilization is the key principle.

A penetrating injury in the neck can become fatal without obvious bleeding.

Tying a bandage around the neck should not be done as it may do more harm.

Chest Injury- First Aid

Chest Injury can be of two types-Penetrating/ Non Penetrating. Penetrating injury can be as a result of Gun Shot Wound or stab injury.

Bleeding from a non penetrating injury can be dealt with pressure bandage.

But if a penetrating wound in the chest is suspected (person will complain of chest pain and breathing difficulty), that wound should be dressed using a broad pad. Air tight plaster must be applied over that. This is to prevent entry of atmospheric air in to the chest cavity. This can result in Tension Pneumothorax.

  

The most comfortable posture for a person with chest injury is sitting posture.

Hence ideal position of carrying a person with chest injury will be sitting position.

In case of Gun Shot Wounds, search for an exit wound at the back.

Abdominal Injury- First Aid

Apply dry, sterile dressing to all open wounds.

Never pull out an impacted knife or metal piece. Stabilize penetrating object.

    

Never attempt to put the intestines back at the site of event!

    

Place a clean saline soaked cloth over it and transport the patient to the nearest hospital.

Never give water or food for the patient. Feeding of such patient can worsen the condition.

Ideal position of carrying a person with Abdominal Injury will be supporting his back of chest and folding the knee, so that the abdominal area gets relaxed.

Making the person lie can cause more discomfort for the patient.

Look for an exit wound at the back in case of Gun Shot Wounds.

Fracture ( Broken Bone) - First Aid

Signs of Fracture: Even gentle pressure or movement causes pain. The limb or joint appears deformed. The bone has pierced the skin. In fracture femur, the leg and foot turns outward abnormally.

First Aid

Don't move the person except if necessary to avoid further injury. Take these actions immediately while waiting for medical help:

Stop any bleeding. Apply pressure to the wound with a sterile bandage, a clean cloth or a clean piece of clothing.

Immobilize the injured area. Don't try to realign the bone or push a bone that's sticking out back in.

If you've been trained in how to splint and professional help isn't readily available, apply a splint to the area above and below the fracture sites.

Padding the splints can help reduce discomfort. Apply ice packs to limit swelling and help relieve pain until emergency personnel arrive.

Don't apply ice directly to the skin — wrap the ice in a towel, piece of cloth or some other material.

Treat for shock. If the person feels faint or is breathing in short, rapid breaths lay the person down with the head slightly lower than the trunk and, if possible, elevate the legs.

                                                                                                                                 

Burns-First Aid

  

Put off the fire and shift the victim to safe place.

Hold the burned area under cool (not cold) running water for 10 or 15 minutes or until the pain subsides. Or immerse the burn in cool water or cool it with cold compresses. Don't put ice directly over the burn.

Cover the burn with a sterile gauze bandage. Don't use fluffy cotton, or other material that may get lint in the wound.

Putting ice directly on a burn can cause a person's body to become too cold and cause further damage to the wound.

Don't apply egg whites, butter or ointments to the burn. This could cause infection.

Don't break blisters. Broken blisters are more vulnerable to infection.

Don't remove burned clothing. However, do make sure the victim is no longer in contact with the hot object.

Don't immerse large severe burns in cold water. Doing so could cause a drop in body temperature (hypothermia) and deterioration of blood pressure and circulation (shock).

If there is no breathing or other sign of circulation, begin CPR.

Elevate the burned body part or parts.

Cover the area of the burn. Use a cool, moist, sterile bandage; clean, moist cloth; or moist cloth towels.

Make the patient drink water as much as possible.

Chemical Burns- First Aid

1. Remove the chemical by first brushing any remaining dry chemical and then rinsing the chemical off the skin surface with cool, gently running water for 10 to 20 minutes or more'

2. Remove clothing or jewellery that has been contaminated by the chemical.

3. Wrap the burned area loosely with a dry, sterile dressing (if available) or a clean cloth.

4. Rewash the burned area for several more minutes if the person experiences increased burning after the initial washing.

Chemical Splash in the Eye

Flush the eye with water. Use clean, lukewarm tap water for at least 20 minutes, and use whichever of these approaches is quickest:

Get into the shower Hold the affected eye or eyes open.

Don't rub the eye — this may cause further damage. Don't put anything except water or saline rinse in the eye, and don't use any eye drops. If available wear sun glasses to protect from the sunlight.

Take the chemical container or the name of the chemical with you to the emergency department.

Electric Shock- First Aid

The danger from an electrical shock depends on the type of current, how high the voltage is, how the current traveled through the body, the person's overall health and how quickly the person is treated.

Call your local emergency number immediately if any of these signs or symptoms occurs:

Cardiac arrest, Heart rhythm problems (arrhythmias), Breathlessness, Muscle pain and contractions, Burns, Seizures. Numbness (Neurologic deficit), Unconsciousness.

While waiting for medical help, follow these steps:

Look first. Don't touch. The person may still be in contact with the electrical source. Touching the person may pass the current through you.

Turn off the source of electricity, if possible. If not, move the source away from you and the person, using a dry, non conducting object made of cardboard, plastic or wood.

Check for signs of circulation (breathing, coughing or movement). If absent, begin cardiopulmonary resuscitation (CPR) immediately.

Lay the person down and, if possible, position the head slightly lower than the trunk with the legs elevated.

Caution!

Don't touch the person with your bare hands if he or she is still in contact with the electrical current.

Don't get near high-voltage wires until the power is turned off. Stay at least 20 feet away — farther if wires are jumping and sparking.

Heat Stroke- First Aid

Heatstroke often results from exercise or heavy work in hot environments combined with inadequate fluid intake.

Young children, older adults, people who are obese and people born with an impaired ability to sweat are at high risk of heatstroke.

What makes heatstroke severe and potentially life-threatening is that the body's normal mechanisms for dealing with heat stress, such as sweating and temperature control, become inadequate.

The main sign of heatstroke is a markedly elevated body temperature — generally greater than 104 F (40 C) — with changes in mental status ranging from personality changes to confusion and coma.

Other signs and symptoms are:- dry and hot Skin, Tachycardia, Rapid and shallow breathing, Elevated or lowered blood pressure, Cessation of sweating, Irritability, confusion or unconsciousness, Feeling dizzy or lightheaded, Headache, Nausea, Fainting, which may be the first sign in older adults.

First aid measures for heatstroke:

Move the person out of the sun and into a shady or air-conditioned space. Cool the person by covering with damp sheets or by spraying with cool water. Direct air onto the person with a fan or newspaper.

Have the person drink cool water or other non alcoholic beverage without caffeine.

To prevent Heat stroke drink enough water and eat more salt during summer exercises.

Hypothermia- First Aid

When exposed to cold temperatures, hypothermia, can result.

Wet or inadequate clothing, falling into cold water and even not covering your head during cold weather can increase your chances of hypothermia.

Signs and symptoms of hypothermia include: Shivering, Slurred speech, Abnormally slow breathing, Cold, Pale skin, Loss of coordination ,Fatigue, lethargy or apathy, Confusion or memory loss, Bright red, cold skin (infants).

First Aid measures of Hypothermia:

Move the person out of the cold. If going indoors isn't possible, protect the person from the wind, cover the head, and insulate the individual from the cold ground.

Remove wet clothing. Replace wet things with a warm, dry covering.

Don't apply direct heat. Don't use hot water, a heating pad or a heating lamp to warm the person.

 Instead, apply warm compresses to the centre of the body — head, neck, chest and groin. Don't attempt to warm the arms and legs.

Heat applied to the arms and legs forces cold blood back toward the heart, lungs and brain, causing the core body temperature to drop. This can be fatal.

Don't give the person alcohol. Offer warm non alcoholic drinks, unless the person is vomiting.

Don't massage or rub the person. Handle people with hypothermia gently because their skin may be frostbitten, and rubbing frostbitten tissue can cause severe damage.

Snake Bite

Do’s

Make sure the victim and others are a safe distance away from the snake and try to memorize its appearance.

Keep the victim calm. Give him enough courage and confidence. Take control of the situation without becoming panic. Reassure him about the recovery.

Immobilize the bitten arm or leg and prevent any movement of the victim as far as possible to block the poison from spreading throughout the body.

Never let the victim run. Only allow him to walk if absolutely unavoidable.

Remove the wrist watch, ring, bangles and jewellery that may become constrictive if the limb becomes oedematous.

Cleanse the wound and cover it with a clean, dry dressing.

In case of neurological bites (All elapid's and hydrophilic: Cobras, King Cobras, Kraits, Coral snakes and Sea Snakes), pressure immobilization (Sutherland method - with Long crepe or other stretchy bandage (5 - 10 cm wide, several rolls) and splint to be applied immediately to the bitten limb, starting at the digits and working up to the groin or arm pit.

Take the victim to hospital as soon as possible.

Note the time of the bite and the progression of any visible symptoms.

Give the doctor a brief and correct description of the bite and symptoms.

Don’ts

Do NOT waste time with trying to get any elaborate first aid.

Never try to suck out the venom.

Don't cut the wound further to let out blood or to remove the venom. Never tamper with the site of the bit, as bite marks may give a clue  about the type of snake.

Don't give the victim coffee or alcohol.

Do not tie a tourniquet or use ice.

Don't try to capture the snake, but try to remember its colour and shape so you can describe it, which will help in the treatment.

Never go to traditional healers or try home remedies. Anti snake venom serum is the only proven cure for venomous snakebites.

All the above actions often cause more damage than good.

Pressure immobilization (Sutherland method)

The pressure-immobilisation first aid technique was developed in the 1970's by Professor Struan Sutherland. Its purpose is to retard the movement of venom from the bite site into the circulation, thus "buying time" for the patient to reach medical care.

Research with snake venom has shown that very little venom reaches the blood stream if firm pressure is applied over the bitten area and the limb is immobilised.

Pressure-immobilisation was initially developed to treat snakebite, but it is also applicable to bites and stings by some other venomous creatures.

How to give Pressure-immobilisation?

Step1. Apply a broad pressure bandage or elastocrepe bandage from below upwards and over the bite site as soon as possible. Do not remove trousers, as this will help the venom to enter into the bloodstream.

      

The bandage should be as tight as you would apply to a sprained ankle. The patient should avoid any unnecessary movements.

Step2.Extend the bandages as high as possible (ideally up to the groin or in the case of arm, up to the armpit).

Step3. Apply a splint to, immobilize the adjacent joints.

Step4.Bind the splint firmly to the limb as possible. Walking should be restricted.

In cases of bites on the hand and forearm : apply elastocrepe bandage up to the axilla, use a splint to the elbow and use a cuff and collar sling. 

How to Prevent Snakebite? (Prevention is always better than cure! )

To reduce your risk of snakebite, avoid touching any snake. Instead, back away slowly. Most snakes avoid people if possible and bite only when threatened or surprised.

• Take care when clearing vegetation, or dry leaves in your garden.

• Supervise kids in the outdoors, especially in a green neighborhood.

• Use torch /flashlight at night and keep wearing shoes.

• Check shoes before wearing them.

• Watch your step while walking and see the area before you sit!

• Keep your backyard free of junk and make sure your solid waste is managed properly.

• If you see a snake, do nothing. Let it go.

• Do not try to pick it up or kill it.

• If a snake has entered your premises, call professional snake rescuers.

Carbon Monoxide Poisoning- First Aid

1.Get the Person to Fresh Air

2.Move the person away from carbon monoxide area.

3.If the person is unconscious, check for injuries before moving.

4.Turn off carbon monoxide source if you can do so safely.

5. Begin CPR, if the person is not breathing normally.

6. Call for Help

7. Continue CPR until the person begins breathing or emergency help arrives.

8. Give Oxygen if facilities are available

Insect Bite

Signs and symptoms of an insect bite result from the injection of venom or other substances into body.

The venom causes pain and sometimes triggers an allergic reaction. Nausea, swelling of lips, breathlessness, abdominal pain, hypotension (shock).

Bites from bees, wasps are typically the most troublesome. Bites from mosquitoes, ticks, biting flies, ants, scorpions and some spiders also can cause reactions. Scorpion and ant bites can be very severe.

Move the victim to a safe area to avoid more stings. Remove the stinger, especially if it's stuck on the skin. This will prevent the release of more venom. Wash the area with soap and water. Apply a cold pack or cloth filled with ice to reduce pain and swelling.

Severe allergic reactions are manifested as Difficulty breathing, swelling of the lips or throat, Faintness, Dizziness, Confusion, Tachycardia, Nausea, cramps and vomiting.

Loosen tight clothing and cover the person with a blanket. Don't give anything to drink.

Turn the person on his or her side to prevent choking if there's vomiting or bleeding from the mouth.

Begin CPR if there are no signs of circulation, such as breathing, coughing or movement.

 Dog Bite /Animal Bite- First Aid

For minor wounds. If the bite barely breaks the skin and there's no danger of rabies, treat it as a minor wound.

Wash the wound thoroughly with soap and water.

Apply an antiseptic cream to prevent infection and cover the bite with a clean bandage.

For deep wounds. If the animal bite creates a deep puncture of the skin or the skin is badly torn and bleeding, apply pressure with a clean, dry cloth to stop the bleeding.

Domestic pets cause most animal bites. Dogs are more likely to bite than cats. Cat bites, however, are more likely to cause infection because they are usually puncture wounds and can't be thoroughly cleaned.

 Bites from nonimmunized domestic animals and wild animals carry the risk of rabies. Rabies is more common in bats and foxes than in cats and dogs. Rabbits, squirrels and other rodents rarely carry rabies.

Children or adults exposed to bats, or who are sleeping and discover bats present, seek medical advice, even if they don't think they've been bitten. This is because bat bite marks are hard to see.

Human Bites- First Aid

   

Human bites can be as dangerous as or even more dangerous than animal bites because of the types of bacteria and viruses contained in the human mouth.

If someone cuts his knuckles on another person's teeth, as might happen in a fight, this is also considered a human bite.

If you sustain a human bite that breaks the skin:

1. Wash the wound thoroughly with soap and water.

2. Stop the bleeding by applying pressure with a clean, dry cloth.

3. Apply an antibiotic cream to prevent infection.

4. Apply a clean bandage. Cover the affected area with a non stick bandage.

5. Tetanus toxoid injection and antibiotic prophylaxis are indicated.

Such wounds can have a broken piece of tooth inside. Hence it is advised to take an X ray of the affected part.

Stroke- First Aid

A stroke occurs when there's bleeding into brain or when normal blood flow to brain is blocked.

 A stroke is a true emergency. The sooner treatment is given; the more likely it is that damage can be minimized. Every moment counts.

In the event of a possible stroke, use FAST to remember warning signs.

Face. Does the face droop on one side trying to smile?

Arms. Is one arm lower when trying to raise both arms?

Speech. Can a simple sentence be repeated? Is speech slurred or strange?

Time. During a stroke every minute counts. If you observe any of these signs, call your local emergency number immediately.

Other signs and symptoms of a stroke include:

Weakness or numbness on one side of your body including either leg, Dimness, blurring or loss of vision, particularly in one eye, Severe headache with no apparent cause, Unexplained dizziness, unsteadiness or a sudden fall, especially if accompanied by any of the other signs or symptoms.

First Aid to Stroke is to keep the air way patent and to prevent further harm because of the paralysis.

Risk factors for stroke include having high blood pressure, having had a previous stroke, smoking, having diabetes and having heart disease. The risk of stroke increases with age.

Poisoning- First Aid

Many conditions mimic the signs and symptoms of poisoning, including seizures, alcohol intoxication, strokes and insulin reactions. 

Look for Empty medication bottles or scattered pills at the scene.

Signs and symptoms of poisoning

Burns or redness around the mouth and lips, from drinking certain poisons

Breathe that smells like chemicals, such as kerosene or paint thinner

Burns, stains and odours on the person, on clothing.Vomiting, breathlessness, sleepiness, confusion or other unexpected signs

Drowsy or unconscious, Uncontrollably restless or agitated,Having seizures

What to do while waiting for help?

If the person has been exposed to poisonous fumes, such as carbon monoxide, get him or her into fresh air immediately.

If the person swallowed the poison, remove anything remaining in the mouth.

If the suspected poison is a household cleaner or other chemical, read the label and follow instructions for accidental poisoning.

If the poison spilled on the person's clothing, skin or eyes, remove the clothing. Flush the skin or eyes with cool or lukewarm water, such as by using a shower for 20 minutes or until help arrives.

Make sure the person is breathing. If not, start CPR and Rescue breathing.

Take the poison container (or any pill bottles) with you to the hospital.

What NOT to do Don't give ipecac syrup or do anything to induce vomiting.

Amputated Limb/ Finger

    

Calm the injured person. Keep the bleeding under control with pressure bandage. Elevate the injured arm.

If the injured person is unaware of the amputation, cover the amputation site with a cloth to protect the person from psychological trauma. They will be more equipped to learn of the amputation in a more stable environment.

If the finger is near by, collect it, but do not compromise the care of the victim to find the finger.

Remember, the person will survive without the finger if they receive prompt appropriate care. The finger will do nothing for them if they bleed to death!

Wrap the finger in a clean, slightly damp but not dripping wet paper towel.

If the victim is stable, rinse the finger if it is dirty, then place it in a plastic sealable bag.

Place the bag into another one filled with ice or cold water. Never place the finger directly on cold water or ice as this could cause frostbite in the finger and damage the tissue so that it can't be reattached.

Once the medical personnel arrive, give them the finger so it can be transported to the hospital and possibly reattached.

Mass Casualty Management- Triage

Triage is allocation of priority to a group of injured persons so as to get maximum benefit to maximum number of persons with the available resources.

    

As per triage, when a mass casualty occurs we group the patients in to four categories as follows and a color coded disc is worn over the patient’s collar for the early identification during transport.

Priority 1-Life saving emergency-Red Disc

Priority 2-Limb saving emergency-Yellow Disc

Priority 3-Minor Wounds-Green Disc

Priority 4-Severely Injured-No scope of recovery-Blue Disc

Practical Exercises

1.How to check for Pulse- Radial/ Brachial /Carotid and Femoral

2.How to check for Respiration

3.How to give CPR

4.How to check for Spine Injury

6.How to make a modified stretcher

7.How to give a splinting

8.How to give Bandage

9.Evacuation Methods

10.Practice to give courage to the victim.

MCQs                                                                                           25 Marks

1. Who can give First Aid ?

A)    A Doctor                                           C) A Health Worker

B)    A Qualified person in First Aid        D) Anybody    

            

2. What is the normal Respiratory Rate per minute for an Adult?

A)    72                                           C) 16-20

B)    110                                         D) 98    

           

3. Standard CPR is

A) One Chest Compression, One Rescue Breathing

B) Two Chest Compressions, Two Rescue Breathing

C) Ten Chest Compressions, Two Rescue Breathing
D) Thirty Chest Compressions, Two Rescue Breathing

4. What is the  ABC of CPR?

A) Act, Beware, Care

B) Age, Basic, Care

C) Airway, Breathing, Circulation
D) Anybody, Basic, Care

5. What is the  first aid for Choking?

A) Back Blows and Abdominal Thrusts

B) Make the person lay down

C) Make the person sit

D) Apply Bandage

 6. What is the  ideal position for evacuation of a chest injury patient?

A) Lying

B) Walking

C) Standing

D) Sitting

7 . What is the  ideal position for evacuation of a head injury patient?

A) Lying

B) Leg down

C) Head tilted to one side

D) Sitting

8. A spine injury patient should be shifted by

A) Pulling the patient

B) Bending the spine

C) Lying in a Hard platform

D) Sitting

9. What is the  first aid for Syncope?

A) Leg lifting

B) Head rising

C) Bandaging

D) Injections

10. Which is Not correct for a chest injury patient?

A) Sitting position

B) Air Tight Bandaging

C) Broad Pads for Dressing

D) Small Pieces of cotton for Dressing

11. Which is the correct first aid for Abdominal injury?

A) Push the intestines back

B) Allowing the patient to drink

C) Apply  splints

D) Lying with knee bend position

12. Which is the correct first aid for Fracture?

A) Apply Ice Directly

B) Realign the bone

C) Apply  splints

D) Glucose Drip

13. Which is the correct first aid for Gun Shot Injury?

A) Apply pressure dressing

B) Remove the bullet from the wound

C) Shout at the patient

D) Give Blood Transfusion

  

14. Which is correct for Blast Injury?

A) Amputation of a part of Limb

B) Breathing Difficulty

C) Splinter Injury

D) All of the Above

15. Which is the correct First Aid for Burns?

A) Break the Blisters

B) Apply Ice Directly

C) Apply Egg white

D) Ask the patient to drink plenty of water

16. Which is the correct First Aid for Snake Bite?

A) Suck out the venom

B) Kill the snake first

C) Make the patient Run

D) Give Courage and do Pressure immobilisation

17. Which is the correct First Aid for Carbon Monoxide Poisoning?

A) Give Fresh Air

B) Apply Ice

C) Apply Splint

D) Pressure Bandage

18. Which is the correct First Aid for Dog Bite?

A) Kill the Dog

B) Give injections

C) Give Blood Transfusion

D) Wash the wound with Soap and water

19.What are the signs of Fracture

A) Pain

B) Deformity

C) Abnormal mobilty

D) All

20.What is the normal pulse rate per minute?

A) 16

B) 72

C) 120

D) 80

Write True or False

21.Nose bleed in a head injury patient should be stopped- True / False

22.Impacted foreign body like splinters, metal piece or bullet should be removed immediately as a first aid- True / False

23.Support a fractured limb gives relief to the patient- True / False

24.HIV spreads through contaminated blood- True / False

25.Smoking and alcohol are injurious to health- True / False

Answers.

1.   D

2.   C

3.   D

4.   C

5.   A

6.   D

7.   C

8.   C

9.   A

10. D

11. D

12. C

13. A

14. D

15. D

16. D

17. A

18. D

19. D

20. B

21. False

22. False

23. True

24.True

25.True