First Aide
First aid is an important skill.
By performing simple procedures and following certain guidelines, it may be possible to save lives by giving basic treatment until professional medical help arrives.
Remember, too, that practice makes perfect. Go on a local first aid course.
In an emergency there's no time to read instructions. If you've memorised some of the basic procedures, it will help you react quickly and efficiently.
Breathing difficulties
If someone stops breathing, see if the person replies if talked to or touched on the shoulder.
WARNING!
This advice is a general guideline for use in an emergency.
It's not intended to replace professional classes in first aid and resuscitation.
If not, call for help – and immediately begin first aid. Send bystanders for help.
But if you're alone, perform basic life support for one minute before going for help.
· Place the person on his or her back on the floor.
· Tilt the head, so that the chin is pointing upwards. Do this by placing the fingertips under the jawbone, then lift gently while pressing down softly on the person's forehead. This is done to make sure the tongue is not blocking the throat.
· Keep holding the head in this way while checking for breathing. Look if the chest is rising and falling, or place your ear next to their mouth to listen for breathing and feel breath on your cheek. Only check for 10 seconds.
· If there's normal breathing, hold the head as described above until help arrives. If there's no breathing or gasping breaths, start basic life support.
How to give basic life support
In adults, the problem is usually the heart rather than the lungs – so cardiac compressions come first and rescue breaths second.
Do not waste time checking for a pulse, if the patient is not responding.
· Place the heel of your hand in the middle of the chest above the breasts. The heel of your hand should now be positioned on the middle of the lower half of the breastbone (not over the ribs or stomach).
· Now place the heel of your other hand on top of the first. Keep your fingers off the chest, by locking them together. Your pressure should be applied through the heels of the hands only.
· Keep your elbows straight, and bring your body weight over your hands to make it easier to press down.
· Press down firmly and quickly to achieve a downwards movement of 4 to 5cm, then relax and repeat the compression.
· Do this at a rate of about 100 times a minute (which is fast and hard work – you can help your timing and counting by saying out loud 'one and two and three and four ...' etc)
· Do this 30 times.
· Now open the airway by positioning the head with the chin pointing upward.
· Pinch the nostrils shut with two fingers to prevent leakage of air.
· Take a normal breath, and seal your own mouth over the person's mouth, making sure there's a good seal.
· Breathe slowly into the person's mouth – it should take about two seconds to adequately inflate the chest.
· Do this twice.
· Check to see if the chest rises as you breathe into the patient's mouth.
· If it does, enough air is being blown in.
· If there's resistance, try to hold the head back further and lift the chin again.
· Continue with 30 chest compression, then two rescue breaths – and only stop if the victim starts to breath.
Do not stop for any other reason, until someone else can take over from you.
Change the person doing the resuscitation every couple of minutes, without any interruption to compressions.
If there are two rescuers: one can do breaths and the other compressions, still at a ratio of 30 compressions, then two breaths.
Bleeding
With all types of bleeding, it's important to stop the flow of blood as quickly as possible.
Small cuts
Small cuts in the veins stop bleeding and clot within a few minutes. The area should then be washed, and a plaster placed gently on top.
Deeper cuts
Deeper cuts in the veins produce dark blood that seeps out slowly and steadily. It can be stopped by gentle pressure on the wound with a sterile or clean cloth, followed by the application of a clean or sterile bandage.
Often, these wounds need sewing or gluing, and almost all need a careful clean, so medical treatment will be necessary after first aid.
Arterial bleeding
WARNING!
Arterial bleeding must always be treated by a doctor.
Bleeding from an artery can cause death within a few minutes – so urgent first aid is essential.
This type of bleeding pulsates and squirts blood, as the pulse beats. The blood is often a light red colour.
To stop bleeding from an artery:
· apply hard pressure on the wound, and keep this up until the patient receives medical treatment
· press with a sterile cloth or just use your hand, if nothing else is available
· put a bandage on the wound if possible. If the blood soaks through the bandages, press harder until the bleeding stops
· do not remove the soaked bandages, but place another on top if necessary
· do not attempt to clean the wound.
The person must be made to lie down, preferably with their head lower than the rest of their body. This will ensure that enough oxygen gets to the brain.
If possible, position the wounded area higher than the rest of their body – so that the bleeding, will be reduced.
Nosebleeds
Nosebleeds occur when one of the small blood vessels in the mucous membranes of the nose bursts. Blood may also run into the stomach and then be vomited up.
Do not bend the head backwards or lie down, because this increases blood pressure in the head and so increases the bleeding.
To limit the bleeding:
· pinch the nostrils shut with the index and middle finger for 10 minutes. This way, the vein is compressed, which is often enough to stem the flow
· while the nostrils are shut, the person must breathe through their mouth
· if the bleeding continues, it's important to contact a doctor.
If the person frequently suffers sudden, intense nosebleeds – they should also consult a doctor.
Choking
Choking happens when the passage through the windpipe is blocked. This usually occurs when food that hasn't been thoroughly chewed gets stuck.
If someone looks like they're choking, ask them if they're able to talk.
A person who is genuinely choking can usually only communicate with hand movements, and may place their hand against their throat. In such a case they will definitely need help, so summon assistance for them.
Provided the person is conscious and talking, you should not interfere. Encourage them to cough. However, be prepared to do so, if the obstruction appears to become complete or markedly worse.
If the person is conscious, but struggling to breath, stand behind them and lean their head slightly forward.
Using a flat palm, strike them forcefully between the shoulder blades, in the hope they will cough up (and out) the item causing choking. Repeat up to five times. If unsuccessful, proceed to the Heimlich manoeuvre:
The Heimlich manoeuvre
· Stand behind the person, who is choking.
· Place your arms around their waist, and bend them well forward.
· Clench your fist, and place it right above the person's navel (belly button).
· Place your other hand on top, then thrust both hands backwards into the stomach with a hard, upward movement.
· Repeat this until the object stuck in the throat is expelled through their mouth.
If you need to carry out this manoeuvre on yourself, place a clenched hand above your navel (belly button) and your other hand on top. Then thrust your fist hard into your stomach.
Repeat this until the object stuck in the throat is expelled through the mouth.
Shock
Shock occurs when too little blood circulates to the brain.
This means that the brain is not receiving enough oxygen, which leads to a feeling of faintness, disorientation and dizziness.
Shock may occur:
· after an accident involving loss of blood
· after a serious infection, with loss of fluids
· after a serious burn
· after other accidents that cause loss of fluids or blood
· as part of an allergic reaction (anaphylaxis).
When there is not enough blood in the blood vessels, the blood pressure drops and too little oxygen is circulated to the brain.
When this occurs a person may:
· go pale
· turn sweaty, clammy and cold
· become dizzy
· become anxious or restless
· have a weak, fast pulse
· have low blood pressure
· have slow, weak breathing
· lose consciousness
· become anxious or restless.
What to do if someone is in shock?
· The person must lie on their back – preferably with their feet raised – to ensure enough blood gets to the brain.
· Make sure the person is warm, comfortable and covered by a blanket if possible.
· Do not give them anything to drink because they could run a risk of choking.
· If the person vomits or bleeds from the mouth, he or she must be placed on their side to prevent choking.
· Call for an ambulance. A person in shock must always be treated by a doctor.
Burns: information on first, second and third degree burns and how to treat them
Burns are skin damage and deeper tissue caused by contact with fire, heat, electricity, radiation, or caustic chemicals. Find out which burns need treatment by health professionals.
What are burns?
Burns are damage to skin and deeper tissue caused by contact with fire, heat, electricity, radiation, or caustic chemicals.
Burns are classified according to the depth and extent of the skin damage, in the following way.
· First-degree burns: the skin is red, painful and very sensitive to touch. The damaged skin may be slightly moist from leakage of the fluid in the deeper layers of the skin.
· Second-degree burns: the damage is deeper and blisters usually appear on the skin. The skin is still painful and sensitive.
· Third-degree burns: the tissues in all layers of the skin are dead. Usually there are no blisters. The burned surface can appear normal, white, black (charred), or bright red from blood in the bottom of the wound. Damage to the sensory nerves in the skin can mean that third-degree burns may be quite painless as the burned skin lacks sensation to touch. A skin graft is usually necessary for significant areas of third-degree burns.
First aid for burns
The first thing to do is to limit the extent of the damage, and prevent the burn from becoming worse.
· Taking care that you do not put yourself at risk from the cause of the burns, move the person away from the danger area. Smother flames with a blanket or douse the person with water but beware of electricity or caustic chemicals.
· Remove clothing or jewellery from the burned area but don't try to peel back any clothing that is stuck to the skin.
· The burnt area must be cooled by being placed under tepid running water. The water should not be unpleasantly cold.
· Keep the damaged area under running water for at least one hour, or longer if the pain has not stopped. Up to four hours of this treatment can be beneficial. However, in severe burns it is more important to get the person to hospital for treatment, so don't let this delay calling the ambulance.
· Meanwhile keep the person warm a lot of heat can be lost from large burns so put a blanket or clothing around the non-injured areas.
· First-degree burns, eg mild sunburn, may not require this treatment although it may help to soothe discomfort.
· Put cling film or a plastic bag over the burn before moving the person to hospital, but don't wrap the cling film tightly round a limb.
· Do not put any creams on the burn at this stage, but you can give the person simple pain relief such as paracetamol.
Which burns need treatment by health professionals?
· Burns that are bigger than the palm of the hand.
· Burns on the face, neck, hands, and in the groin.
· All chemical and electrical burns (electrical burns can look surprisingly minor while causing a lot of damage, and chemical burns may need specific treatment for the chemical that caused them).
· All third-degree burns.
· Most second-degree burns.
Remember that it can be difficult to distinguish between second- and third-degree burns, so always have a nurse or doctor check all but the most minor burns.
Any person who is showing other signs of being unwell, such as being cold and clammy, in distress, or who has other injuries.
The elderly and the young (over 65 and under 5) should always have burns checked by a professional
· If possible, keep pouring water over the burn on the way to the doctor, or use clean, soaking wet towels.
· Do not lance the blisters yourself.
· Never apply an ointment to burns or try other folk remedies – water is the only thing that should be used. Do not use butter or lard on burns!
· If the burn is exposed and you are worried that it may get dirty, or if it causes discomfort as clothing brushes over it, it can be loosely covered with cling film or a clean plastic bag (over and arm or leg for example) Alternatively , cover it with a clean dry non-adherent dressing held in place with a simple bandage. Do not put any lotions or creams on it.
· Do not forget to have a tetanus injection if you have not had a booster within the last 10 years.
What complications can occur?
· When skin is burned, it loses its ability to protect, which increases the risk of infection. So it is important that the damaged area be thoroughly cleansed within the first six hours and that the area is kept clean while it is healing.
If, after a few days, there are signs of an infection – ie the skin is becoming increasingly red, hot, and swollen, and the victim experiences a throbbing pain or feels generally unwell or has a fever – contact a doctor or your practice nurse.
· Severe burns can cause scarring.
· In cases of extensive severe burns, the body may lose large quantities of fluid. This can disturb the blood circulation and cause problems with the body's salt balance. As a result the person may go into 'shock' with a low blood pressure and rapid pulse. Such injuries should be assessed at your local Accident and Emergency department.
· Heat exhaustion and heatstroke can also occur if the body temperature rises too high (for example, after excessive exposure to hot sun, often with sunburn). Watch out for extreme tiredness, rapid pulse, headache, and confusion. Help the person to cool down in the shade, with tepid water to drink and get urgent medical help if you are worried.
Cardiopulmonary resuscitation (CPR): First aid
Cardiopulmonary resuscitation (CPR) is a lifesaving technique useful in many emergencies, including heart attack or near drowning, in which someone's breathing or heartbeat has stopped. The American Heart Association recommends that everyone — untrained bystanders and medical personnel alike — begin CPR with chest compressions.
It's far better to do something than to do nothing at all if you're fearful that your knowledge or abilities aren't 100 percent complete. Remember, the difference between your doing something and doing nothing could be someone's life.
Here's advice from the American Heart Association:
· Untrained. If you're not trained in CPR, then provide hands-only CPR. That means uninterrupted chest compressions of 100 to 120 a minute until paramedics arrive (described in more detail below). You don't need to try rescue breathing.
· Trained and ready to go. If you're well-trained and confident in your ability, begin with chest compressions instead of first checking the airway and doing rescue breathing. Start CPR with 30 chest compressions before checking the airway and giving rescue breaths.
· Trained but rusty. If you've previously received CPR training but you're not confident in your abilities, then just do chest compressions at a rate of 100 to 120 a minute. (Details described below.)
The above advice applies to adults, children and infants needing CPR, but not newborns.
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.
To learn CPR properly, take an accredited first-aid training course, including CPR and how to use an automated external defibrillator (AED). If you are untrained and have immediate access to a phone, call 911 before beginning CPR. The dispatcher can instruct you in the proper procedures until help arrives.
Before you begin
Before starting CPR, check:
· Is the environment safe for the person?
· 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 and two people are available, one should call 911 or the local emergency number and one should begin CPR. If you are alone and have immediate access to a telephone, call 911 before beginning CPR — unless you think the person has become unresponsive because of suffocation (such as from drowning). In this special case, begin CPR for one minute and then call 911 or the local emergency number.
· If an AED is immediately available, deliver one shock if instructed by the device, then begin CPR.
Remember to spell C-A-B
The American Heart Association uses the acronym of CAB — compressions, airway, breathing — to help people remember the order to perform the steps of CPR.
Compressions: Restore blood circulation
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 center 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 centimeters) but not greater than 2.4 inches (approximately 6 centimeters). Push hard at a rate of 100 to 120 compressions a minute.
5. If you haven't been trained in CPR, continue chest compressions until there are signs of movement or until emergency medical personnel take over. If you have been trained in CPR, go on to checking the airway and rescue breathing.
Airway: Clear the airway
1. 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.
2. Check for normal breathing, taking no more than five or 10 seconds. Look for chest motion, listen for normal breath sounds, and feel for the person's breath on your cheek and ear. Gasping is not considered to be normal breathing. If the person isn't breathing normally and you are trained in CPR, begin mouth-to-mouth breathing. If you believe the person is unconscious from a heart attack and you haven't been trained in emergency procedures, skip mouth-to-mouth 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.
1. 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.
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 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.
3. Resume chest compressions to restore circulation.
4. If the person has not begun moving after five cycles (about two minutes) and an automated external defibrillator (AED) is available, apply it and follow the prompts. Administer one shock, then resume CPR — starting with chest compressions — for two more minutes before administering a second shock. If you're not trained to use an AED, a 911 or other emergency medical operator may be able to guide you in its use. If an AED isn't available, go to step 5 below.
5. Continue CPR until there are signs of movement or emergency medical personnel take over.
To perform CPR on a child
The procedure for giving CPR to a child age 1 through 8 is essentially the same as that for an adult. The American Heart Association also recommends the following to perform CPR on a child:
· If you're alone, perform five cycles of compressions and breaths on the child — this should take about two minutes — before calling 911 or your local emergency number or using an AED.
· Use two hands, or only one hand if the child is very small, to perform chest compressions. Press straight down on (compress) the chest about 2 inches (approximately 5 centimeters). If the child is an adolescent, push straight down on the chest at least 2 inches (approximately 5 centimeters) but not greater than 2.4 inches (approximately 6 centimeters).
· Breathe more gently.
· Use the same compression-breath rate as is used for adults: 30 compressions followed by two breaths. This is one cycle. Following the two breaths, immediately begin the next cycle of compressions and breaths. If there are two people conducting CPR, conduct 15 compressions followed by two breaths.
· After five cycles (about two minutes) of CPR, if there is no response and an AED is available, apply it and follow the prompts. Use pediatric pads if available, for children ages 1 through 8. If pediatric pads aren't available, use adult pads. Do not use an AED for children younger than age 1. Administer one shock, then resume CPR — starting with chest compressions — for two more minutes before administering a second shock. If you're not trained to use an AED, a 911 or other emergency medical operator may be able to guide you in its use.
Continue until the child moves or help arrives.
To perform CPR on a baby
Most cardiac arrests in babies occur from lack of oxygen, such as from drowning or choking. If you know the baby has an airway obstruction, perform first aid for choking. If you don't know why the baby isn't breathing, perform CPR.
To begin, examine the situation. Stroke the baby and watch for a response, such as movement, but don't shake the baby.
If there's no response, follow the CAB procedures below and time the call for help as follows:
· If you're the only rescuer and CPR is needed, do CPR for two minutes — about five cycles — before calling 911 or your local emergency number.
· If another person is available, have that person call for help immediately while you attend to the baby.
Compressions: Restore blood circulation
1. Place the baby on his or her back on a firm, flat surface, such as a table. The floor or ground also will do.
2. Imagine a horizontal line drawn between the baby's nipples. Place two fingers of one hand just below this line, in the center of the chest.
3. Gently compress the chest about 1.5 inches (about 4 centimeters).
4. Count aloud as you pump in a fairly rapid rhythm. You should pump at a rate of 100 to 120 compressions a minute.
Airway: Clear the airway
1. After 30 compressions, gently tip the head back by lifting the chin with one hand and pushing down on the forehead with the other hand.
2. In no more than 10 seconds, put your ear near the baby's mouth and check for breathing: Look for chest motion, listen for breath sounds, and feel for breath on your cheek and ear.
Breathing: Breathe for the baby
1. Cover the baby's mouth and nose with your mouth.
2. Prepare to give two rescue breaths. Use the strength of your cheeks to deliver gentle puffs of air (instead of deep breaths from your lungs) to slowly breathe into the baby's mouth one time, taking one second for the breath. Watch to see if the baby's chest rises. If it does, give a second rescue breath. If the chest does not rise, repeat the head-tilt, chin-lift maneuver and then give the second breath.
3. If the baby's chest still doesn't rise, examine the mouth to make sure no foreign material is inside. If an object is seen, sweep it out with your finger. If the airway seems blocked, perform first aid for a choking baby.
4. Give two breaths after every 30 chest compressions. If two people are conducting CPR, give two breaths after every 15 chest compressions.
5. Perform CPR for about two minutes before calling for help unless someone else can make the call while you attend to the baby.
6. Continue CPR until you see signs of life or until medical personnel arrive.