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medical emergency. Proper first aid can save a victim's life, especially if the victim is bleeding heavily, has stopped breathing, or has been poisoned. First aid also can prevent the development of additional medical problems that might result from an injury or illness. The person on the scene who has the best knowledge of first aid should administer emergency treatment. The treatment should be continued until professional medical help is available. First aid also involves reassuring a victim, relieving the pain, and moving the victim, if necessary, to a hospital or clinic. This article describes some basic first-aid techniques for common medical emergencies. People interested in taking a first-aid training course should contact their local chapter of the American Red Cross.
General Rules for First Aid
Analyze the situation quickly and decide whether you can help the victim. If you decide to treat the victim, begin at once. But if you are confused or unsure of yourself, do not attempt to give treatment. In many cases, the wrong treatment causes more damage than no treatment at all. For professional help in giving first aid, call a hospital, an emergency medical service, the fire department, or the police. The general steps to take in any situation requiring first aid include the following: (1) call a local emergency medical service or a physician for assistance, (2) provide urgent care for lifethreatening emergencies, (3) examine the victim for injuries, and (4) treat the victim for shock. Call for Assistance. Send someone else to call for a doctor, an ambulance, or other help while you care for the victim. If you are alone with the victim, you must decide when you can safely leave to call for assistance. Always treat the victim for any life-threatening conditions before leaving to summon aid. When telephoning for help, be ready to describe the nature of the victim's illness or injury, the first aid measures you have taken, and the exact location of the victim. Also be prepared to write down any instructions a physician may give you. Repeat the instructions and ask questions to clarify orders you do not understand. If you decide to take the victim to a hospital emergency room, first telephone the hospital to say you are coming. The hospital staff will then be better prepared to treat the victim's particular problems. Every home should have a list of emergency phone numbers posted on or near the telephone. However, if such numbers are not available, the operator can assist you in contacting the proper person or emergency unit. Provide Urgent Care. Certain medical emergencies require immediate care to save the victim's life. If the victim is bleeding severely, has been poisoned, or has stopped breathing, treatment must begin at once. A delay of even a few minutes can be fatal in these cases. The treatments for these emergencies are discussed in this article in the sections on First aid for bleeding, Treatment for poisoning, and Restoring breathing. Do not move a victim who may have a broken bone, internal injuries, or damage to the neck or spine, unless absolutely necessary to prevent further injury. If the victim is lying down, keep the person in that position. Do not allow the victim to get up and walk about. Never give food or liquid to a person who may need surgery.
If the victim is unconscious, turn the head to one side to help prevent the person from choking on blood, saliva, or vomit. But do not move the head of a person who may have a broken neck or a spinal injury. Never pour a liquid into the mouth of an unconscious person. Make certain that the victim has an open airway. The airway consists of the nose, mouth, and upper throat. These passages must remain open in order for the victim to breathe. For information on keeping the airway open, see the section of this article on Giving artificial respiration. Examine the Victim for injuries only after treating the person for any life-threatening emergencies. Then treat the individual injuries. The victim may suffer from diabetes, heart trouble, or some other disease that can cause sudden illness. Many persons with such medical problems carry a medical tag or card. The tag or card lists instructions for care that should be followed exactly. If you must examine the victim's identification papers to look for a medical card, you should do so in the presence of a witness, if possible. Make the victim comfortable, but handle the person as little as possible. If necessary, shade the victim from the sun or cover the victim to prevent chilling. Loosen the person's clothing. But do not pull on the victim's belt, because this pressure could damage an injured spine. Remain calm and reassure the victim. Explain what has happened and what is being done. Ask any spectators to stand back. Treat for Shock. Shock results from the body's failure to circulate blood properly. Any serious injury or illness can cause a victim to suffer from shock. Shock most often occurs after an injury that causes blood loss, when there is a probability of heart attack, or during overwhelming infection. When a person is in shock, the blood fails to supply enough oxygen and food to the brain and other organs. The most serious form of shock may result in death. A victim in shock may appear fearful, light-headed, confused, weak, and extremely thirsty. In some cases, the victim may feel nauseous. The skin appears pale and feels cold and damp. The pulse is rapid and breathing is quick and shallow or deep and irregular. It is best to treat a seriously injured person for shock even if these signs are not present. The treatment will help prevent a person from going into shock. To treat shock, place the victim on his or her back, with the legs raised slightly. If the victim has trouble breathing in this position, place the person in a half-sitting, half-lying position. Warm the victim by placing blankets over and under the body.
First Aid for Bleeding
Severe hemorrhage (bleeding) can cause death within minutes. Bleeding from most small wounds stops by itself in a short time, after the blood begins to clot (thicken). But clotting alone cannot stop the flow of blood from large wounds. When treating a bleeding victim, you should attempt to stop the bleeding, protect the victim from further injury, and prevent shock. As with any situation involving first aid, medical assistance should be called for immediately. Emergency treatments for severe bleeding include such techniques as (1) direct pressure on the wound and (2) pressure on arteries carrying blood to the wound. Direct Pressure. The most effective way of controlling heavy bleeding is to press directly on the wound itself. If possible, have the victim lie down and elevate the bleeding part above the rest of the body. Then place a sterile dressing over the wound and press firmly on it with your hand. If you do not have a sterile dressing, use a clean handkerchief, towel, or other cloth folded to make a pad. If no cloth is available, press your hand directly on the wound while someone else obtains the necessary material. Apply constant pressure to the wound for about 10 to 15 minutes, or until professional help arrives.
If the victim bleeds through the first dressing, add another on top of it and apply firmer pressure. Do not remove the first dressing. After the hemorrhage has stopped, secure the dressing with a bandage. Pressure on Arteries. Sometimes, direct pressure and elevation fail to stop severe bleeding. If such bleeding is from an arm or leg, you may be able to stop it by applying pressure to the artery that supplies blood to the injured limb. The illustrations in this article on How to control bleeding show the points at which pressure should be applied to these arteries. Pressure on arteries should be used in addition to--not instead of--direct pressure and elevation.
Treatment for Poisoning
There are four ways in which a victim may become poisoned. The poison may be swallowed, inhaled, injected, or absorbed through the skin. If a poison victim is unconscious, having difficulty breathing, or having seizures, call for an ambulance immediately. If necessary, perform artificial respiration. If the victim has become poisoned by injection, keep the affected area lower than the level of the heart to slow the spread of the poison. If a person has been poisoned by taking a drug, keep the person's breathing passage open. Quickly try to identify the drug, and then immediately call a physician or emergency medical service for help. Swallowed Poisons. A person who has swallowed a poisonous substance may die within minutes if not treated. The first step in treating the victim is to identify the poison. Identification of the poison helps determine the proper procedure for treating the victim. Immediately call a poison control center or a physician for advice. If the victim has swallowed a commercial product, take the container to the phone when you make the call so that you can provide information about the product. The poison control center or physician will tell you what to do. Do not put anything in the victim's mouth unless you have been told to do so by medical professionals. The poison control center or physician may advise you to make the victim vomit. The most reliable way of making a person vomit is to use a drug called syrup of ipecac. To induce vomiting, give 1 tablespoon (15 milliliters) of syrup of ipecac mixed in half a glass of water. Afterward, have the victim drink as much water as possible. Keep the victim moving about, because activity promotes vomiting. If vomiting does not occur within 15 to 20 minutes, administer another dose of syrup of ipecac. Do not repeat a third time. When a victim vomits, lay the person on his or her side. This position will help keep the airway open and will prevent the victim from inhaling the poisoned vomit into the lungs. Catch the vomit in a pan so that it can be examined by a physician. Inhaled Poisons. If the victim has inhaled a poison, such as carbon monoxide or chlorine gas, move the person to fresh air immediately. Open all windows and doors to ventilate the area. Then call a poison control center or a physician for advice. Injected Poisons include those transmitted by insect stings or bites and snakebite. information on the treatment of snakebite, see the section on Snakebite in this article. To treat a spider bite, apply cold compresses to the affected area. soothing lotion, such as calamine lotion, to the area. For
Afterward, apply a
When a tick bites a person, the tick often adheres to the skin or scalp. Remove the tick at once. Pull the tick out steadily and firmly, not suddenly. Do not use your bare hands. Use a
glove, a piece of plastic wrap or paper, or even a leaf. If you have tweezers, grasp the tick's mouthparts as close to the skin as possible. Do not attempt to remove the tick by burning it off, by coating it with petroleum jelly, or by putting oil on it. Clean the bite area with soap and water. Save the tick in a small, sealed container for possible identification. If a rash or flulike symptoms develop within the next several weeks, contact your physician. When a bee stings a person, the insect's stinger remains in the wound. The person should scrape the stinger off immediately, taking care not to pinch or squeeze the sting. This action reduces the amount of poison that enters the wound. A victim may experience a severe allergic reaction to a bite or sting. You should either call a physician for advice or take the victim to the nearest location that provides emergency medical treatment. Poisons on the Skin. Poisons can be absorbed through the skin as a result of contact with poisonous plants or chemical substances, such as insecticides. If a victim's skin has been exposed to a poison, remove all contaminated clothing and flush the skin with water for about 10 minutes. Afterward, wash the affected area with soap and water and then rinse it. Wear protective gloves to avoid exposing yourself to the poison.
Begin artificial respiration as soon as possible for any victim whose breathing has stopped. Two or three minutes without breathing can cause permanent brain damage, and six minutes can be fatal. Signs of breath stoppage include the lack of regular chest movements and a blue color in lips, tongue, or fingernails. Removing the Cause of Breathing Failure. The steps you take before administering artificial respiration depend on why the victim's breathing has stopped. For example, if the victim's airway is blocked, you must remove the obstruction before beginning artificial respiration. Electric shock also can cause respiratory failure. In cases of electric shock, free the victim from contact with the current before attempting artificial respiration. Turn off the current if possible. Do not touch the victim with your bare hands or with a wet or metal object until the contact has been broken. If you cannot turn off the current, free the victim from contact by using a dry stick, rope, or cloth. Be sure to stand on a dry surface that will not conduct electricity. Respiratory failure can also result from breathing air that lacks sufficient oxygen. Such air may be present in storage bins, poorly ventilated mines, and closed vaults. Breathing also may stop because the victim has inhaled large quantities of carbon-monoxide, a substance that interferes with the blood's ability to carry oxygen. In any of these cases, move the victim into fresh air before beginning artificial respiration. Giving Artificial Respiration. The most efficient method of artificial respiration is mouth-tomouth resuscitation. To administer mouth-to-mouth resuscitation, place the victim on his or her back, on a firm surface if possible. Kneel down near the head and, using your fingers or a handkerchief, quickly remove such objects as dentures, food, or vomit from the mouth. Place one of your hands under the victim's chin and the other on the forehead. Tilt the victim's head back by lifting with the hand under the chin and pressing down with the one on the forehead. This position--with the chin pointing upward and the neck arched--opens the airway. To treat an infant or small child, take a breath and place your mouth over both the mouth and nose. Blow gently into the child's mouth and nose. Then remove your mouth and listen for air to flow back out of the child's lungs. Take a breath and blow again. Repeat this procedure every three seconds.
If the victim is an older child or an adult, pinch the nostrils shut with the hand you have placed on the forehead. Take a deep breath, cover the mouth tightly with your own, and blow hard enough to make the chest rise. Then remove your mouth and listen for the return air flow. Repeat this procedure every five seconds. If the victim's mouth is too large for you to make a tight seal over it with your own, or if the victim has suffered a severe mouth injury, use mouth-to-nose resuscitation. Maintain the head-tilt position, and use the hand under the victim's chin to hold the mouth tightly shut. Then blow into the victim's nose. If the victim's chest does not rise when you blow in, check the mouth again to be sure that there is nothing in it. Also make certain that the head is tilted back far enough and that the lower jaw is pulled upward. If you still cannot make the victim's chest expand, it may mean that an object is blocking the airway. The recommended technique for removing an object from the throat is the Heimlich maneuver. This technique is described in the Choking section of this article. After the object has been forced out of the throat, continue artificial respiration until the victim starts to breathe or until professional help arrives.
Other First-Aid Procedures
Animal Bites or Stings. Bites made by nonpoisonous animals can result in serious infections and diseases if left untreated. Wash the area of the bite thoroughly with soap and water. Rinse the wound and cover it with a gauze dressing. Call a physician. If possible, the animal should be kept under observation by a veterinarian to determine if it has rabies. Bites by poisonous animals include those of some spiders, insects, and snakes. Such bites require medical attention. For information regarding such treatment, see the sections in this article on Injected poisons and Snakebite. Burns. The first-aid treatment of burns depends on the severity of the injury. Burns are classified, in order of increasing severity, as first-, second-, or third-degree. First-degree burns produce a reddening of the top layer of skin. Second-degree burns damage deeper skin layers. These burns give the injured skin a red or spotted appearance and cause blisters. Third-degree burns destroy tissues in the deepest layer of skin. The injury has a white or charred appearance. To treat first- and second-degree burns, apply dressings soaked in iced, sterile solution to the injured area for about 20 or 30 minutes. Then dress the injured area with sterile bandages. Victims suffering first- or second-degree burns on the face or over an area larger than the size of the hand should receive professional medical attention. A person who receives third-degree burns should not be treated at home. The person should instead be treated by a physician immediately. Large burns may be wrapped in a clean sheet or towel, or in plastic bags or kitchen wrap. Plastic bags or wrap should never be placed over the face. Clothing stuck to the wound should not be pulled away. In treating any kind of burn, do not open blisters, and do not smear the injury with petroleum ointment, butter, or any greasy substance. If the victim has suffered burns around the face or has been exposed to smoke, watch for respiratory difficulties. If the victim has trouble breathing, give artificial respiration. Severe burns cause much pain and a loss of body fluids and may send the victim into shock. In such cases, take the first-aid measures to prevent or treat shock. Chemical burns should be flushed with large amounts of water. Use a hose, shower, or bucket. Wash the injury for at least 10 minutes. Remove any clothing that has been covered
by the chemical and cover the burn with a sterile dressing. Take the victim to a physician immediately. Sunburn, in most cases, is a first-degree burn. Extremely deep sunburn may cause seconddegree burns, with blistering. Do not open any blisters. Apply cool compresses to relieve pain. Consult a physician in cases of severe sunburn. Choking occurs when food or some other object blocks the trachea (windpipe). A person who is choking cannot breathe or speak. After a short time, the victim's skin turns blue and he or she collapses. If the object is not removed in 4 to 6 minutes, death can occur. An effective way to remove an object blocking the windpipe is a technique called the Heimlich maneuver. To perform this maneuver, stand behind the victim and place your arms around the victim's waist. Make a fist and place it so that the thumb is against the victim's abdomen, slightly above the navel and below the ribcage. Grasp your fist with your other hand and then press your fist into the victim's abdomen with a quick upward thrust. This thrusting action forces air out of the victim's lungs and blows the object from the trachea. If the victim has collapsed or is too large for you to support or place your arms around, lay the person on his or her back. Then face the victim and kneel straddling the hips. Place one of your hands over the other, with the heel of the bottom hand on the victim's abdomen, slightly above the navel and below the ribcage. Then press your hands into the victim's abdomen with a quick upward thrust. When applying the Heimlich maneuver, be careful not to apply pressure on the victim's ribs. Such pressure may break the ribs of a child or an adult. Concussion is a head injury that results from a violent blow or shock. If the injury has knocked the victim unconscious, place the victim flat on his or her back, taking care not to move the neck. Give artificial respiration if the breathing stops. Get medical assistance as soon as possible. Victims of a violent head blow might not lose consciousness at the time of the injury. However, they should be watched closely for the next 12 to 24 hours. They may develop delayed symptoms that should be treated by a physician. Such delayed symptoms include loss of consciousness, repeated vomiting, severe headache, pale appearance, weakness in the arms or legs, unsteady walking, convulsions, unusual behavior, difficulty in talking, pupils of unequal size, double vision, watery discharge from the ears or nose, and excessive drowsiness. Check the victim for alertness every 15 minutes immediately following the injury and awaken him or her every 3 hours during that night. If signs of a concussion appear, consult a physician. Convulsion and Epileptic Seizure. A person who is suffering a convulsion experiences violent, completely involuntary contractions of the muscles. Major convulsions, particularly those that are associated with epileptic seizures, also involve loss of consciousness. The victim falls to the ground. The muscles twitch and jerk, or they become rigid. Most attacks last a few minutes. Try to prevent the victim from being injured during the attack. Leave the victim in the position in which he or she falls, but move aside objects that the victim might strike during the seizure. Do not attempt to restrain the victim, and do not attempt to move the head. You may, however, loosen the victim's clothing. Put a folded handkerchief between the teeth to prevent the victim from biting the tongue. But be careful not to place your fingers in the victim's mouth because the person could bite them. After the attack, if there is no evidence
that the victim may have fallen or may have injured the spine, turn the victim's head to one side to prevent choking in case vomiting occurs. Eye Injury. If acids or alkalis have been splashed into the eye, immediately flush the eye with water. Flush continuously at least 10 minutes for acids and 20 minutes for alkalis. Use a continuous stream of water from a tap or a hose, or pour the water from a cup or other container. Flush the eye from the inside corner outward, to avoid washing the chemical into the other eye. Cover the eye with sterile gauze or a clean pad and take the victim to an eye doctor. Dust particles or other foreign objects can be removed from the eye by gently flushing with water. Or they can be removed with the corner of a clean handkerchief. However, do not wipe across the cornea (clear central part of the eye) with a handkerchief or any other material. Seriously injured victims should have the eyes examined at the emergency department of a hospital. Fainting is a brief, sudden period of unconsciousness. It occurs when blood pressure falls to the point where the brain does not receive enough oxygen. In most cases, fainting occurs when a person is standing. The victim falls to the ground while losing consciousness. Leave the victim lying down. Loosen the clothing and raise the feet slightly. Blood will flow back into the head, and the victim should regain consciousness promptly. Should the victim fail to do so, lay the person on his or her side and make certain the airway remains open. Call a physician. Just before fainting, a person may feel weak or numb. Other symptoms include nausea, light-headedness, blurred vision, pale appearance, sweating, or excessive yawning. A person experiencing these symptoms should lie down or sit with the head between the knees. If the victim has a heart or lung problem, fainting may be a serious condition related to the ailment. The conditions of such patients should be evaluated in a hospital's emergency department. Fractures and Dislocations. A fracture is a break in a bone. A dislocation occurs when the end of a bone is forced out of its normal position in a joint. Fractures and dislocations frequently result from automobile and sports accidents. Signs of fractures and dislocations include pain, an unusual position of a joint or bone, and tenderness and swelling around the injury. The victim may also experience a grating sensation, caused by fragments of broken bone rubbing together. The victim may be unable to use a hand or a foot. Keep the victim quiet and treat for shock. Whenever possible, do not move the person until expert help arrives. Improper handling of an injured bone or joint may seriously damage arteries, muscles, or nerves. It may also increase the severity of the fracture or dislocation. If you must move the victim before help arrives, apply a splint to the injured area. The splint prevents broken or dislocated bones from moving. You can make a splint from any material that will support the injured part without bending. For fractures of the arm or leg, the splint should be long enough to prevent movement of joints above and below the injury. Pad the splint surfaces that touch the body. Do not try to correct any deformities before splinting. Do not push bone fragments back into an open wound. Use strips of cloth to tie the splint above and below the point of injury. Do not tie the splint so tightly that it interferes with circulation. Blueness or swelling in fingers, for example, indicates that a splint has been tied too tightly to an arm.
Do not move a person who may have suffered a broken neck or other spinal injury. A person may receive such an injury by diving into shallow water, falling from a considerable height, or striking the head in an auto accident. Moving such an accident victim may cause permanent paralysis or death. Frostbite may occur when the skin is exposed to extreme cold. It most frequently affects the skin of the cheeks, chin, ears, fingers, nose, or toes. Frostbitten skin appears whitish and feels numb. It should be handled gently. Never massage frostbitten skin, and do not rub it with snow or bathe it in cold water. Warm the affected area with the heat of your hand or cover it with a heavy cloth until you can get the victim indoors. Thaw the affected skin by soaking it in lukewarm water. The temperature of this water should be between 102 and 105 degrees F. (39 and 41 degrees C). Keep the temperature in this range by adding more warm water as needed. Never use water hotter than 105 degrees F. (41 degrees C). If warm water is not available, wrap the frostbitten area with blankets. Obtain medical assistance as quickly as possible. If a victim of frostbite must be moved, protect the person from additional exposure. Never treat frostbite with heat from a stove or with a heating pad, hot water bottle, or heat lamp. Such treatment may produce temperatures that can damage frostbitten tissue. If frostbite blisters occur, do not break them. Bandage them to prevent infection. Heart Attack. Most heart attacks begin with a crushing tightness or intense pressure behind the sternum (breastbone). This pain may spread across the chest, affecting the arms, the neck, the jaw, or the pit of the stomach. In most cases, it lasts more than five minutes. The victim appears worried, has difficulty breathing, and may perspire heavily and experience feelings of weakness and nausea. He or she may vomit. Call a physician or summon an ambulance that has oxygen equipment. Stay calm and reassure the victim that help is on the way. The victim should not be picked up or allowed to move. Place him or her in the most comfortable sitting or half-sitting, half-lying position. Do not give the victim liquids without a doctor's orders. In severe heart attacks and serious accidents, the victim's heart may stop beating temporarily. An effective method of treatment in such cases is cardiopulmonary resuscitation, commonly called CPR. CPR consists of artificial respiration and artificial circulation of the blood. It should be performed only by someone trained in the technique. Heatstroke and Heat Exhaustion can occur when the body becomes overheated. Heatstroke is the more serious of the two conditions. A person suffering heatstroke feels hot but cannot sweat. The skin becomes hot, dry, and red. The body temperature rises so high that it can cause brain damage if not lowered quickly. Undress the victim. Either place the victim in a tub of cool water or apply cold, wet towels to the entire body. Get medical attention as quickly as possible. A person suffering heat exhaustion, also called heat prostration, displays many of the symptoms of shock. Such symptoms include faintness, headache, and nausea. The skin is cold, gray, and wet with perspiration. In most cases, the body temperature remains about normal. Treat the victim as if he or she were in shock. Place the victim on his or her back, with the legs raised slightly. If the victim has trouble breathing in this position, place the person in a half-sitting, half-lying position. Take the victim to a hospital, in an airconditioned vehicle if possible. Nosebleed. To control a nosebleed, have the victim sit up and lean forward. Then press the nostrils firmly together for 5 to 10 minutes. Consult a physician if the bleeding does not stop within 10 to 15 minutes.
Snakebite. The treatment of a snakebite depends on whether or not the snake is poisonous. If the snake is nonpoisonous, the bite should be washed thoroughly with soap and water. A person bitten by a poisonous snake requires medical attention. Most poisonous snakebites cause deep, burning pain along with swelling and discoloration. Within minutes the victim may begin to feel numb and have difficulty breathing. Call a physician or take the victim to a hospital. If possible, kill the snake and bring it along for identification. Keep the victim motionless and quiet, because activity increases the spread of the poison. Place the bitten portion of the body at a level below that of the heart. If the bite is on an arm or a leg, tie a band above the wound, between it and the heart. The band should be loose enough for you to slip your finger under it. Release the band for 90 seconds every 10 minutes to prevent damage from lack of circulation. For more information on emergency treatment of snakebite, see SNAKEBITE.
Transporting the Victim
Moving a seriously injured person to a medical facility requires great care. Rough or careless handling can make the victim's injuries even more serious. If a victim must be moved, call for an ambulance. If you must transport the victim yourself, be sure that you have thoroughly examined the person to determine the full extent of the injuries. All bleeding should be under control, and breathing should be satisfactory and comfortable. Treat the victim for shock and splint any fractures and dislocations. If the victim must be lifted, get someone to help you, in order to avoid rough handling. Whenever possible, use a stretcher to carry a seriously injured person. If a person may have suffered a back or neck injury, wait for professional help. Move such a victim only if it is necessary to save the person's life. Take great care not to bend or twist the body or neck. Carry the victim on a wide, hard surface, such as a lightweight door. During transport, drive safely. If possible, two persons should transport the victim. One can ensure that the victim's airway remains open and give comfort while the other drives. Compiled by Mr. Shahzad Shameem CONDITIONS REQUIRING FIRST AID Asphyxiation Fainting Poison Bee (Sting) Fracture Poison Ivy Bleeding Frostbite Rabies Blister Hemorrhage Shock Bruise Hyperthermia Snakebite Burn Hypothermia Stroke Dislocation Nosebleed Sunburn Drowning
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