38 First Aid

A. Rajkala

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1.  INTRODUCTION

 

The initial assistance or treatment given to a casualty for any injury or sudden illness before the arrival of an ambulance, doctor, or other qualified persons is called ‘first aid’,. The notion of ‘first’ itself signifies that the casualty is likely to be in need of ‘secondary aid’.

 

2.  LEARNING OBJECTIVES

 

After completion of this module the student will be able to

 

  • Identify the emergency situation
  • Understand the roles and responsibilities of first aider
  • Act as a first aider in any place

Illness, accidents and other emergencies to guests and staffs unfortunately occur from time to time in any establishment. Under the Health and Safety (First Aid) Regulation Act 1982, the employer must provide first aid equipment, facilities and personnel and must inform his/her employees of the first aid arrangements made. First- aid personnel should be available at all times and the staffs should know who they are.

 

3.  THE FIRST-AID BOX

 

First aid boxes are required to be kept and made available to all members of staff in certain areas of the establishment. The boxes must be checked regularly to ensure that they do not contain less than the minimum required by law. A minimum variety of certain types of supplies should be ensured at all times. A 171/2 inch x 10 inch x 61/2 inch dirt –proof box is ideal.A more comprehensive stock of materialsis usually kept in the housekeeping department.

 

The first-aid box must at least contain the following items.

 

  •   A first-aid box
  • Antiseptic cream-useful for cuts and grazes
  • Savlon or Dettol antiseptic solution-2 bottles.
  • Antihistamine lotion – can be rubbed on bites, stings and sunburn
  • Calamine lotion – a medicated liquid containing zinc carbonate, this has a soothing effect on painful sunburn. It can also relieve itching caused by minor insect bites and stings in the absence of an allergy.
  • Antacid tablets, magnesium trisilicate, or sodium bicarbonate-gives relief from mild indigestion and heartburn, a burning sensation caused by stomach acid irritating the gullet.
  • Anti-diarrheal tables-these are used to relieve diarrhea by slowing down bowel movements.
  • Paracetamol-used for relieving pain and lowering a high temperature
  • Aspirin-used for relieving pain and lowering a high temperature. Its use should be restricted, however, as it may irritate the stomach lining and has the potential to cause internal bleeding in susceptible people.
  • Kaolin clay-used to relieve diarrhea by slowing down bowel movements.
  • Methyl salicylate ointment-to rub into a strained or bruised muscle. It will also ease spasms and pain.
  • Chloromycetin eye ointment -2 tubes. This can be used in case of bacterial infections of the eye, such as bacterial conjunctivitis.
  • Soframycin skin ointment-2 tubes. This can be used in case of bacterial infections of the skin and in burns too.
  • Travel sickness tablets-these can be taken before a journey or as directed on the label.
  • Oil of cloves-for an aching tooth, used to provide temporary relief.
  • Clinical thermometer-can be used either orally or under the arm. It should be cleaned with antiseptic liquid after each use, even for the same patient.
  • Sterilized white absorbent gauze (28X8 inches) -1 packet. This dressing can be used dry, with no cream or ointment, to dress a minor wound.
  • Sterilized dressing (No.18) – 12 packets; for use on fingers
  • Sterilized dressing (No.24)-12 packets, for use on hands and feet.
  • Large sterilized dressing (No.20) – 12 packets; for use on other body parts.
  • Sterilized cottonwool (25g)-6 packets; can be used to pad a dressing or to clean an injury with soap and hot water.
  • Crepe bandage-6 packets; may be needed to bandage a sprained or strained joint such as a wrist or knee.
  • Adhesive plaster (larger)-can be used on minorwounds or to secure a dressing.
  • Adhesive dressing strip-for cuts and small wounds.
  • Open weave bandages-6 packets; to protect wounds from dirt and from friction against clothing.
  • Roller bandages –various sizes, 18 packets, can be used to secure dressings, to apply pressure to control bleeding and to give support to sprains or strains.
  • Unbleached triangular bandag-12 packets; a type of bandage that makes a sling to support an injured wrist or elbow.
  • Eye pad- for placing on the eye in case of an eye injury.
  • Tweezers-to remove splinters from the skin. They should be used in good light.
  • Dressing scissors-to use when cutting away dressings or bandages. The blunt-ended blade should be kept next to the skin.
  • Safety pins-1 packet of 10; to be used for fixing bandages or slings in place.
  • Pad and pencil for writing – 1 each.

 

4.  First-aid Procedures-

 

The procedures for some common accidents and illnesses are discussed here.

 

4.1 Asphyxia/suffocation This may be due to exposure to a poisonous gas or due to something smothering or choking the victim. Try to find the cause of suffocation and remove it. Turn off any escaping gas. Open the windows or take the victim out into the open. In the case of choking, remove the obstruction from the victim’s nose or mouth. In all cases, give artificial respiration if breathing has stopped, using the mouth-to-mouth or ‘kiss of life’ method (see artificial respiration)

4.2 Asthma During an attack of asthma, the person has difficulty in breathing and there is a feeling of suffocation. A person who has chronic asthma would have been prescribed the use of an inhaler and other medication during an attack. These medications should be administered to the patient and he/she should be reassured until better.

4.3 Burns and scalds Burns may be caused by dry heat or by hot fat or oil. For minor burns on the limbs, immediately hold the injury under cold running water for five minutes. A small burn needs no further treatment. It should simply be left exposed to air. Do not apply any oil or ointment to the burn and do not prick or remove blisters.

 

Large and deep burns (covering more than 3 sq inches) need medical attention. If possible, relieve pain by immersing the area in cold water or applying cold wet cloths. Wrap to cover the injury with a clean cloth and a light bandage. Treat the victim for shock while waiting for medical help. If the victim can be moved, it is best to take him/her to the hospital.

 

In case of chemical burns on a large area of the body, especially that caused by a strong acid or alkali, put the victim under cold running water, a showers if possible.

 

In case of fire burns, if the victim’s clothing is on fire, smother the flames in a rug or blanket. Afterwards, lay the person flat. Remove any smouldering clothing if it is not adhering to the skin. Otherwise, dampen the smouldering garments with cold water but do not press the wet cloth against the patient’s skin. If possible, remove any jewellery, watch, socks or shoes near the burned area before the tissues have time to swell. Cover the burns with a clean cloth, which can be held in position with a light bandage. While waiting for medical help, treat for shock by keeping the patient quiet and covering him/her lightly with a blanket. Scalds are caused by moist heat, from hot liquid or steam. In case of scalds, remove any very hot clothing from the skin immediately and pour plenty of cold water over the burned area.

 

4.4 Choking The usual response of the victim while choking is violent coughing, because food or some foreign body is caught in the windpipe. If the coughing does not clear the blockage, get the victim to bend over and give him/her a hard slap between the shoulder blades. If this does not dislodge the object, put the victim face down on a table or chair, with the head and chest hanging downwards, and administer another hard slap in the same place. Another method is to make the victim stand facing the back of a chair and push the backrest against the casualty’s stomach with force. Repeat a few times. In the case of a small child, hold him/her upside down and slap on the back. If this is not successful, get medical aid immediately.

 

4.5 Concussion Caused by a blow on the head, concussion may render the casualty unconscious. If on discussing the incident later, loss of memory of the accident is evident, then concussion should be suspected. The person should be treated for shock and taken to the hospital.

 

4.6 Convulsions or fits Convulsions may occur in babies and children during teething ora very high fever. The child typically holds his/her breath, becomes rigid, and often goes purple in the face. He / she should be kept warm by covering with a blanket or being placed into a warm bath with someone in attendance. Meanwhile, a doctor should be called. A person, child or adult, who falls to the ground with violent movements of the arms and legs may be having an epileptic fit; an epileptic fit can also take the shape of a person suddenly becoming ‘spaced out’. Move furniture and other obstacles out of the way to reduce the risk of injury if the convulsion is a violent one. Try to slip a knotted handkerchief between the persons’s teeth, never a hard spoon or similar. In the case of absence of seizure (becoming ‘spaced out’), simply sit with the person until he/she returns to normalcy; do not attempt to shake them awake or similar. On regaining consciousness, the epileptic may be dazed and should be prevented from wandering off in this state.

 

4.7 Cuts and abrasions These may be caused in many ways and may sometimes get infected if not treated properly. The wound should be cleaned with warm water and antiseptic solution and then covered with a clean dressing. In case of bleeding, pressure should be applied on the wound if it is free of foreign particles such as glass or metal. For deep cuts and excessive bleeding, the person should be treated for shock and, if necessary, taken to a hospital.

 

4.8 Dislocation When a joint is dislocated, the casualty is unable to move its in the usual way. There may be a swelling and numbness beyond the point where the dislocation has occurred. Do not attempt to replace the bone in its proper place. Keep the parts as still as possible till medical help and arrives.

 

4.9 Diabetes This is a disorder in which a person’s body is not able to regulate the uptake of available sugar, as a result of which excess sugar may appear in the blood and urine. Many diabetics whose sugar level are difficult to control depend on insulin and a controlled diet. When such a person eats insufficient food, there is an imbalance due to the insulin administered, and the person may become hypoglycaemic. In hypoglycaemia, the patient starts to perspire and becomes nervous or irritable. If hypoglycaemia is not controlled, the person may go into a diabetic shock, resulting in coma. At the first sign of hypoglycaemia, the diabetic should be given two lumps of sugar, a piece of chocolate, or a glucose drink. If the patient does not respond, he/she should be taken to the hospital immediately.

 

4.10 Electric Shock If the victim is still in contact with the electrical equipment, he/she should not be touched until the electric current has been switched off. It may be necessary to try to drag the appliances away from the victim by pulling the insulating wire leading to it. If this is not possible, separate the victim from the electrical source using a non-conducting object, such as a dry wooden stick. If the casualty’s heart does not seem to be beating, give the breastbone in the centre of the chest a sharp thump. If the victim is not breathing, start mouth-to-mouth artificial respiration at once and continue until medical aid arrives. If the victim is breathing but unconscious, place him/her in the recovery position. Treat for burns and shock.

 

4.11 Eye Injuries If rapid blinking fails to dislodge a speck of dust fallen into the eye, lift the lid of the affected eye by the lashes and try to remove the object with the corner of a clean handkerchief. However, do not attempt to remove anything from the cornea, which is the transparent, domed front of the eyeball. If the object is embedded in the eyeball or cannot be seen, cover the eye with a gauze pad held lightly in place with a plaster and immediately transport to the hospital.

 

If any acid or other corrosive agents have come into contact with the eye, they should be washed out immediately. Both the eyes with cold water-if possible, keeping it under running water for 10-15 minutes to ensure that all the acid is washed out. Take the casualty to the hospital immediately.

 

4.12 Fainting Fainting may be caused by a sudden reduction in blood flow or oxygen to the head. It may be the result of a slowing down of the heartbeat from shock, anxiety, or even hormonal changes in early pregnancy. If someone feels faint, get the person to lie down with the feet raised above the level of the head. Avoid crowding- in, so as to get plenty of air and then treat for shock.

 

4.13 Heart attack it is due to cloting of blood in the heart and manifests itself by acute chest pain, breathlessness and feeling faint. The patient should be propped up and made to sit on a chiarand on no account moved till the ambulance or doctor arrives.

 

4.14 Poisoning may result from swallowing, inhaling or injecting poisonous substances. In most cases when poison has been taken by mouth, the patient should be made to vomit by swallowing warm water with salt or mustard in it and prevented from sleeping till the doctor or ambulance arrives. if the position is known to be corrosive, then vomiting should be avoided and the patient should be taken to hospital as soon as possible.

 

4.15 Foreign body in the eye, may be grit, glass, etc causing pain. The injured should not be allowed to rub but bathed with the aid of an eyebath and nose blown thoroughly. If the object can be seen, if possible try to remove it with the corner of a clean hand kerchief. If not removed and the eye is painful, the patient should be taken to the doctor/ hospital.

 

5.ARTIFICIAL RESPIRATION- The most important technique to know for first aid includes administering CPR and the Holger Neilsen method of artificial respiration.

 

5.1 CPR

 

This procedure is carried out upon a person whose respiration has ceased. A constant supply of oxygen is vital for the brain and if breathing stops, blood oxygen levels will be affected as all tissues get oxygen through blood circulation.

 

The heart acts as a pump and maintains circulation in the body. If the heart also stops then it will lead to death unless proper action is taken at the correct time. The flow of oxygenated blood to the brain in such case is rapidly restored by means of artificial ventilation and chest compression. This dual technique is called cardio-pulmonary resuscitation or CPR.

 

In case only breathing has stopped, the techniques for chest compression to stimulate cardiac function can be left out and only artificial respiration is to be concentrated on.

 

5.2 ABC of artificial respiration The ABCs of artificial respiration are as follows:

  •  A for Airway: Clear airway.
  • B for Breathing: Restore breathing,
  • C for Circulation: Restore circulation

    5.2.1 Clearing the airway An unconscious casualty’s airway may be blocked, making breathing difficult and noisy. The main reason for this is that muscular control in the throat is lost, which allows the tongue to sag back and block the throat. Follow the steps given below to clear the airway:

 

5.2.1.1 Remove the obstructing object or substance form the mouth with your fingers, using your first finger as a hook to dislodge it.

 

5.2.1.2 Extend the neck to open the airway. Place one hand under the nape of the neck, place the other hand on the forehead, and tilt the head back. Lift the chin up gently without closing the mouth.

 

5.2.1.3 Check if breathing has been restored. If not, start mouth to-mouth resuscitation.

 

5.2.2 Restoring breathing This is done by administering mouth-to-mouth respiration. Put your face close to the casualty’s mouth and look, listen, and feel for breathing for five seconds, before taking any further action. If the heart is beating, it will generate a pulse in the neck (the carotid pulse)where the main arteries pass up to the head. Slide your fingers back towards you along the victim’s throat till it sits in the gap between the Adam’s apple and the strap muscle, feel for the carotid pulse.

 

Restore breathing by giving mouth-to-mouth resuscitation. To start mouth –to-mouth artificial respiration:

 

5.2.2.1 Pinch and compress the nose to close the nostrils.

 

5.2.2.2 Take a deep breath

 

5.2.2.3 Place your mouth around the victim’s mouth, making an airtight seal and quickly breathe into the victim’s mouth four times.

 

5.2.2.4 Re-fill your lungs by inhaling deeply after this step. Fill the victim’s chest with air once every 5 seconds.

 

5.2.2.5 Watch the victim’s chest movement for rise and fall of chest.

 

5.2.2.6 Allow the patient to exhale.

 

If the chest does not rise, check that:

 

  • The head is tilted sufficiently far back
  • You have a firm seal around the casualty’s mouth
  • You have closed the nostrils completely
  • The airway is not obstructed by vomit, blood, or a foreign body.

 

In case of mouth-to-nose ventilation, where mouth injuries make a good seal impossible or a harmful substance has been ingested through the mouth, the following methods is followed:

 

1. With the casualty’s mouth closed, form a tight seal with your lips around the casualty’s nose and blow in.

2. Open the mouth to let the breath out.

3. Continue to repeat the procedure mentioned in the first point

5.3 Restoring circulation This is achieved by external cardiac compression. The procedure, also known as external cardiac massage, can be carried out by one individual or two.

  • Place the victim on a hard surface.
  • Kneel at the victim’s side
  • Locate the xiphoid process (see’Key Terms’)
  • Measure 1-2 inches above the xiphoid process. Place the heel of one hand at this point on the sternum. Place the other hand on top of it. Interlock fingers to keep them off the victim’s ribs.
  •  Keep elbows straight and lean forward, making full use of your body weight to deliver a downward compression upon the breastbone. Apply steady, smooth pressure to depress the victim’s sternum by 11/2-2 inches.
  • Release pressure completely, but do not let your hands leave the victim’s chest or you may lose the correct hand position.
  • Repeat

 

If there are two individuals to perform first-aid, the other person should continue with artificial respiration in the meantime. If there is only one person, perform cardio-pulmonary resuscitation (CPR) for 1 minute as follows:

 

1  After 15 chest compressions, give 2 quick lung inflations by mouth-to-mouth breathing, and then 2 more inflations if the carotid pulse is still absent.

2. Continue CPR by alternating lung inflations with chest depressions for a minute or until the victim is breathing on his/her own and a pulse is found.

 

A minute of CPR delivers 60 chest compressions (15 at a time multiplied by 4 times) and 8 long inflations (2 at time multiplied by 4 times). To sun up, the main steps of cardio-pulmonary resuscitation are as follows:

 

1.Clear airway

2.Breatheinto victim’s mouth four times quickly

3.Compress chest 15 times

4. Give 2 quick lung inflations

5.Alternate 15 chest compressions with 2 quick lung inflations

6.In a minute, the victim should revive.

 

5.3 Hoiger Nielsen method of artificial respiration

 

In this method of administering artificial respiration, the patient is turned face downwards with the head turned to one side, kneeling at the patient’s head and placing both your hands over the shoulder blades. Pressure should be exerted here by slowly rocking forward. For an adult, the pressure of weight may be about 13.6kg. The patients’ arms are raised by the elbow to expand the chest and release the pressure by means of rocking backwards. The process is repeated until the doctor or an ambulance arrives. Each phase of expansion and compression should last about 21/2 seconds, the complete cycle being repeated 12 times per minute.

 

5.3.1 The recovery position

 

If any person is unconscious he/ she should be placed in the recovery position. This way of positioning the patient prevents the tongue from blocking the throat. Because the head is slightly lower than the rest of the body, it will allow fluids to drain from the mouth, thus reducing the risk of the casualty inhaling stomach acids or saliva. The head, neck, and back are kept in a straight line, while the bent limbs keep the body propped in a secure and comfortable position. If you must leave an unconscious casualty unattended, he or she can safely be left in the recovery position while you get help. Before turning a casualty on the side, remove his or her spectacles (if worn) and remove any bulky objects from the pockets.

 

A person is placed in the recovery position by following this procedure

  • Kneeling beside the casualty, open the airway by tilting the head back and lifting the chin. Straighten the legs. Draw the arm nearest to you so that it is at right angles to the body, with elbow bent and the plan facing up.
  • Bring the arm furthest from you across the chest and hold the hand, palm outwards, against the casualty’s nearer check.
  • With your other hand, grasp the thigh furthest from you across the chest and pull the knee up, keeping the foot flat on the ground.
  • Tilt the head back to make sure the airway remains open. Adjust the hand under the cheek, if necessary, so that the head stays in this tilted position.
  • Adjust the upper leg, if necessary, so that both the hip and the knee are bent at right angles.
  • Call an ambulance immediately. Check for breath and pulse frequently while waiting for the doctor.

6.  CHARACTERISTIC OF A FIRST AIDER

  • Must be a good observant
  • Resourceful; – use to the best of what ever is at hand to prevent further damage
  • Tactful.to handle the situation
  • Dexterous; – handling a causality without causing unnecessary pain and use appliances efficiently, quickly and neatly
  • Explicit- to give clear instructions to the causality and for the by standers how best to assist him
  • Persevering – that she/or may continue his efforts, though not at first successful, until relieved by a superior medical authority, or if death of the causality is undoubted
  • Discriminating: – that she/he may decide which of several causalities and injuries should be treated first and where modification of the correct treatment as the result of Common sense, may be necessary.
  • Sympathetic: – that she/he may give real comfort and encouragement to the suffering, always remembering the first principles of humanity.

 

SUMMARY

 

“Without proper action at proper time, danger awaits us with a bigger face.” We must act on time when a person is injured. We must take care of the person the way it is meant. Otherwise, a valuable life might be lost. We need to understand how precious lives of people are and what importance first-aid carries in saving these precious lives.

 

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WEBLINKS:
  • www.gaymidlands.org
  • ners.unair.ac.id
  • www.resus.org.uk
  • www.ncbi.nlm.nih.gov
  • www.education.gov.mt
  • www.nou.edu.ng