32. First Aid in Common Emergency Conditions.pptx

First aid

1. First Aid in Common Emergency Conditions First Aid(s) are immediate preventive and therapeutic measures taken to help an accident victim or a person with acute emergencies The measures depend on the nature of the injury or disease Early assessment of emergencies is very important for taking a prompt action

2. Common Emergency Conditions and Diseases High Fever Low Blood Sugar Minor Injuries Fractures Fainting Bleeding Shock Stroke Bites Burns Choking Seizures Road Traffic Accidents Poisoning Drowning Foreign Bodies

3. High Fever Also known as pyrexia P erson’s temperature in mouth is over 37.7°C (99.9°F), is high fever U sually common medical sign of underlying condition or an infection Causes I nfection: streptococcal throat, flu etc. Heat stroke Over-exposure of skin to sunlight Prolonged strenuous exercise Silicosis Amphetamine abuse Alcohol withdrawal

4. Signs and Symptoms of High Fever Feeling cold when nobody else is shivering Lack of appetite Pallor Dehydration Headache and bodyache Lethargy and depression Sleepiness Sweating, hot flushed skin Irritability, confusion, delirium and convulsions Assessment of high fever in patients especially in children is clinically very important to prevent from developing convulsions

5. First Aid for High Fever Infants and toddlers 0-3 months: R ectal temperature of 100.4 ° F ( 38 ° C ) or higher Refer, even if child does not have any other signs or symptoms R ectal temperature up to 102 ° F ( 38.9 ° C) Encourage to take rest and drink plenty of fluids Refer, if child seems unusually irritable, lethargic or uncomfortable Above 6 months up to 3 years: R ectal temperature up to 102 ° F ( 38.9 ° C ). Give acetaminophen Refer, if fever does not respond to medication within one day 5 Do not give aspirin to an infant or toddler

6. First Aid for High Fever Above 3 to 17 years Oral temperature up to 102 °F (38.9 ° C),g ive Ibuprofen Encourage to rest and drink plenty of fluid Refer if fever, does not respond to medication or lasts longer than one day is accompanied with headache, stiff neck, shortness of breath or other unusual signs and symptoms 18 years and above Oral temperature up to 102 °F (38.9 ° C),give Acetaminophen or Ibuprofen or Aspirin Refer If fever, does not respond to medication consistently 103 ° F (39.4 ° C) or higher, or lasts longer than 3 days is accompanied by severe headache, stiff neck, shortness of breath, or other unusual signs or symptoms

7. Low Blood Sugar Also known as hypoglycemia Common medical emergency, associated with over dose of insulin intake or inadequate caloric intake Signs and Symptoms Irritability Confusion Tremors Blurring of vision Coma Seizures Tachycardia Hypotension Cold and clammy skin Diaphoresis

8. First Aid for Low Blood Sugar Note: It is difficult to differentiate whether patient has hypoglycemia or hyperglycemia. It medically advisable to treat patient initially as a case of hypoglycemia

9. Minor Injuries Injuries are trauma or damage to any part of the body Minor injuries includes: Cuts and wounds Sprains and strains Minor fractures Joint dislocations Superficial minor burns Insect stings Animal bites

10. First Aid for cuts and wound If wound is dirty, w ash thoroughly with soap and water and a pply firm pressure for around 5 minutes to stop bleeding Elevate wound, above the level of heart if possible Clean the affected area with antiseptic lotion and keep it dry Use sterile dressing Administer a dose of Tetanus Toxide injection Give anti-inflammatory analgesic such as tablet Lyzer D at once Give antibiotic, Amoxicillin 500 mg , 6 hourly for 5 days(if needed)

11. First A id for Sprains, strains, fractures and joint d islocations Give immediate care, i.e., RICE R : Rest the injured part I : Ice the area C : Compress with a bandage E : Elevate the injured part

12. First Aid for burns Run the burnt part under cold water or apply an ice pack Clean and bandage the burned area to avoid infection Apply Soframycin ointment and cover with Vaseline gauze Take off the dressing after 1 week Give Amoxicillin capsule 500 mg 8 hourly for 5 days in case of scalds

13. First A id for Insect stings and Animal bites Apply pressure with a clean bandage or towel to stop bleeding Clean and scrap the area to remove carefully the wings of insect Give immediately a dose of Tetanus Toxoid Apply antihistamine ointment to reduce itching, swelling and pain Treat the sting or bite according to type of insect or animal

14. Fractures Fracture is an injury that causes break in the bone Correct first aid is important to reduce the amount of tissues damage, bleeding, pain and shock Causes Direct force A blow that breaks the bone at the point of impact Indirect force B one breaks at some distance from the point of impact e.g . F all on an outstretched hand results in a fracture of collar bone Abnormal muscular contraction A sudden contraction of a muscle may result in fracture e.g . Elderly person snapping knee cap after tripping and trying to prevent fall

15. Types of Fracture Closed: Skin is unbroken and blood is lost into tissues Open: A wound leads to be fracture or bone protrudes through the skin Spiral fractures: Caused by twisting of bones

16. Types of Fracture Transverse fractures: Horizontal breaks directly across the bone caused by repetitive and damaging motion Greenstick fractures: Caused by sudden force and characterized by splinter of top layer of bone Comminuted fractures: Bone shatters into fragments

17. Signs and Symptoms of Fracture The break may have been felt or heard Pain at or near the site of injury Difficult or impossible normal movement of limb Deformity, abnormal twist or shortening of limb Tenderness at the site of fracture, when gentle pressure applied Swelling over and around the fracture Bruising at the site of fracture Crepitation: Coarse grating sound if one end of bone moves against other

18. First Aid for Fracture Place patient in a comfortable position with injured part well supported Immobilize the injured part with a splint or bandage Treat for shock but do not give any drink to the patient Stop any bleeding by applying a pad and bandage Use bandaging fairly firm to prevent movement of fractured ends Always tie knots on the smooth side

19. Fainting Also called as syncope is a t emporary loss of consciousness caused due to lack of oxygen in the brain It is characterized by: Rapid onset Short duration Spontaneous recovery C auses are: Prolonged standing Sitting for long periods followed by suddenly standing Being in hot and/or crowded places may precipitate an episode

20. Signs and Symptoms of Fainting

21. First Aid for Fainting Whenever a person fainting, immediately proceed as follows: Make the person to lie flat at least for 15 minutes or sit if light headedness present Open the airway and assess for breathing Raise the person’s legs above the level of his/her heart Loosen any restrictive clothing around the neck or waist Check for breathing and heart rate again if person remains unconscious Call ambulance and refer the person quickly to hospital

22. Bleeding Loss of blood from blood vessels due to cut, torn or damaged accidentally or due to disease External hemorrhage : Bleeding is visible to naked eye due to various injuries, like scrapes, cuts, puncture wounds, open fractures or amputations Internal hemorrhage: Bleeding is not visible to the naked eye as blood loss from vessels take place in chest or abdominal cavity or inside the skull

23. Types of Bleeding Type Characteristics Arterial bleeding Blood is bright red in color It spurts at each contraction Flow is pulsatile Venous bleeding Blood is dark red in color It does not spurt Flow is steady Capillary bleeding Blood is red in color It does not spurt It has slow but even flow

24. Signs and Symptoms of Bleeding Internal bleeding: History of sufficient injury Wounds that penetrated skull/ chest or abdomen History of medical condition which may cause internal bleeding (ulcer) Pain and tenderness around the affected area Symptoms and signs of shock Blood may appear from body orifices Fracture of bones External bleeding: Evidence of external blood loss S/S of shock: Patient complains of thirst Blurring of vision, fainting and giddiness Face and lips become pale Skin feels cold and clammy Pulse becomes faster, weaker Restlessness Breathing becomes shallower Unconsciousness

25. First Aid for Bleeding Control bleeding with direct pressure Cover wound with sterile dressing or clean cloth Press firmly until bleeding stops N o broken bone suspected, elevate wound higher than level of heart Do not move limb if it is broken Refer the patient to the hospital if: Patient has symptoms of shock Cut is longer than about 1/3 inch (3/4 cm) Bleeding doesn't stop on its own or within several minutes after pressure applied Symptoms of nerve or tendon injury, such as loss of sensation, movement or numbness Scrape is deep or has dirt and particles that are difficult to remove

26. Important Instructions for taking c are of bleeding If bleeding does not slow after 5 min, lie down the victim and continue direct pressure on wound and apply pressure between wound and heart For wounds on arms, press on brachial artery : Use your fingers to apply pressure to inner side of victim’s upper arm, between elbow and shoulder, in groove between muscles For wounds on legs, press on femoral artery in groin : Use heel of hand to apply pressure at middle of crease where thigh meets groin Once bleeding controlled, secure original dressings with bandage Observe for shock Do not give food or drink 26

27. Shock Condition of severe depression of body’s vital functions following an injury, hemorrhage, severe pain or emotional Young, aged, weak, anemic persons develop shock quickly when suffering from shock producing conditions Causes: Abdominal injuries Profuse bleeding Severe burns Fractures (especially when severe and when improperly handled) Severe wounds Chest injuries Skull injuries

28. Types of Shock

29. Signs and Symptoms of Shock Primary shock Secondary shock Pallor of face and lips Beads of sweat on forehead Clamminess of skin Cold hands and feet Shallow breathing Rapid and feeble pulse Pallor of face and lips Beads of sweat on forehead Clamminess of skin Cold hands and feet Shallow breathing Rapid and feeble pulse Vomiting Restlessness Vacant expression Unconsciousness (later stage)

30. First Aid for Shock Lay the patient down on a stretcher or a bed Raise foot of stretcher or bed about 25 cm of ground Keep the patient warm by covering him/her with the blanket. If available, use a hot water bottle Stop any bleeding Give the patient hot tea with plenty of sugar if conscious Splint fractures and cover wounds before sending patient to PHC Transfer the patient immediately to PHC or hospital

31. Stroke Also called as brain attack Occurs when blood flow to an area in the brain is cut off Due to decreased oxygen and glucose, brain cells die If not treated early, results in permanent brain damage or death

32. Types of stroke Ischemic stroke Accounts 80% of all strokes Clots can form in blood vessels of brain or leading to brain , or blood vessels elsewhere in body and then travel to brain T oo much plaque (fatty deposits and cholesterol) also clogs brain’s blood vessels Hemorrhagic stroke Occurs when a blood vessel in brain breaks or ruptures Oozing out of blood in the brain tissue leads to brain cells damage High blood pressure and brain aneurysms are primary cause

33. Signs and Symptoms of Stroke Common s/s S udden weakness or numbness of face, arm or leg on one side of body Loss of vision or dimming in one or both eyes Loss of speech, difficulty in talking Sudden, severe headache of unknown cause Fainting or unstable walking along with light headedness, dizziness and confusion Sudden loss of long-term or short-term memory s/s related to cause In cerebral thrombosis symptoms occur gradually, sometimes fading and progressing over several days In cerebral embolism, symptoms come on quickly S troke caused by subarachnoid hemorrhage signaled by sudden onset of headache, nausea, vomiting, confusion and seizures

34. Prevention and First Aid for Stroke Treatment: Follow quickly the steps of emergency treatment: Keep patient lying down on his/her side Keep head high, turned on side to prevent aspiration of vomit Keep patient quiet and cover lightly with blanket Observe for signs and symptoms shock and treat it Shift the patient quickly to hospital Prevention Aware public that up to 50% of all strokes are preventable R isk factors are : blood pressure, dyslipidemia, obesity stress, smoking, alcohol etc Practice healthy lifestyle pattern: healthy food, exercise, adequate sleep and rest and recreation

35. Bites Wounds caused by piercing or stinging of the flesh of a person by an animal, insect or by another person

36. Signs and symptoms of Insect Bite - Bees/wasps/bed bug/hornet stings/jelly fish Sharp pain at the site of sting Swelling around the affected area with central reddened puncture point Sting may be there in the wound If the person is prone to allergies, may go into shock Stings in the mouth and throat may cause swelling leading to asphyxia

37. First Aid for Insect Bite - Bees/wasps/bed bug / hornet stings/jelly fish Treatment The insects have sting which is left at the site of puncture has to be removed to prevent the person from danger Removal of sting If sting has been left embedded in the skin hold tweezers as near to the skin as possible grasp the sting and remove it Do not squeeze the poison sac because this will force the remaining poison into the skin

38. First Aid for Insect Bite - Bees/wasps/bed bug / hornet stings/jelly fish Local treatment Neutralized bee venom by application of ammonia, soda Neutralizes wasp venom by application of vinegar or lemon juice For jelly-fish stings, apply Calamine lotion Apply cold compress and spirit at the site of sting Give Tab.Ibugesic to relieve pain and swelling Give antihistamine (Tab. Avil) for allergy Treatment for insect stings inside the mouth or throat To reduce swelling, give ice to suck Rinse mouth with cold water or solution of water and bicarbonate of soda If breathing becomes difficult, shift the patient immediately to hospital

39. Signs and symptoms of Insect Bite (Scorpion/Spider Sting) Itching and swelling at effected site (such as eye may be closed due to swelling) Burning pain and increased sensation or numbness near the site of bite Restlessness, lacrimation, salivation Nausea, vomiting Profuse sweating, 4 - 6 hours after bite 39

40. Treatment of Insect Bite (Scorpion/Spider Sting) Examine the site of sting If sting is on extremity, apply a tourniquet proximal to the site of sting and release it every 5 -10 mnts for a few seconds to prevent gangrene formation Apply ice packs on the region to slow down the absorption of poison Apply cold compress or fresh potassium permanganate solution on wound Give Tab. Ibugesic to relieve pain and swelling Give antihistamine (Tab. Avil) for allergy Look for the signs of shock, particularly in children Refer immediately if patient does not recover or show symptoms of shock 40

41. Snake Bite An injury caused by the bite of a snake, especially a venomous snake M ost people die from fear and venom is not the point of consideration

42. Signs and symptoms of snake bites Local signs and symptoms Bleeding, numbness at the site of bite Swelling and burning pain at the site of bite Signs of poisoning Drowsiness Dimness of vision Difficulty in breathing and speech Area becomes bluish purple after bite in 12 hrs Dribbling of saliva, paralysis Convulsions, coma The punctured wound produced by the fangs of snake will be clearly visible

43. Assessment of patient with Snake Bite Site may show one or more punctures, a small abrasion and perhaps a linear laceration In non-poisonous snakes bite semi circular row of teeth marks may be seen Local swelling appearing within few minutes after bite is a sign of poisonous snake bite Respiratory symptoms Paralysis 43

44. Treatment for Snake Bite Lay the patient down and reassure him/her Do not make patient to walk Tie immediately a piece of cloth or tourniquet tightly above the bite to prevent venous blood return. Loosen it every 10 mnts for few seconds If case seen within one hour of bite: T ake a scalpel and make 4 - 6 cuts 1 cm deep over the area of bite Squeeze the part hard so that the blood flows out of cuts Wash cuts gently with normal saline or antiseptic lotion Apply a clean dressing Immobilize the affected limb Apply icepacks on the wound Treat shock Shift patient to hospital immediately

45. Dog Bite If a person is bitten by a dog, it should be taken seriously Wounds following a dog bite are potentially infected because of dirt and germs The patient will report the following complaints: History of bite Discomfort , pain at the site of bite Dog bite may cause fatal medical condition i.e. fear of water called hydrophobia The dog should be watched for 10 days If dog is healthy after this period then, no danger of rabies

46. Signs and symptoms of Rabies Headache, nausea and vomiting Agitation, confusion and hallucination Difficulty in swallowing Foaming at mouth Respiratory paralysis D ifficulty in drinking water

47. Treatment for Dog Bite If dog is known to patient and behaves normally: Wash wound well with soap and flush with running water by syringe Apply antiseptic lotion such as Betadine Bandage wound with sterile dressing Give a dose of Tetanus Toxoid Give anti-inflammatory analgesic such as Tab. Lyzer D Give antibiotic Cap. Amoxicillin 500 mg, 8 hourly for 5 days Tell the patient to watch the dog for 10 days for the abnormal behaviour If dog is not known to patient : Give above and refer to doctor immediately for anti-rabies vaccine S ame treatment applies to bites or scratches of other animals

48. First Aid for Dog Bite Tell the patient to watch the dog for 10 days for the abnormal behavior: If the dog no longer eats If the dog no longer barks Shivers, becomes aggressive, barks at those it knows Has convulsions and saliva dribble from it’s mouth If the dog has died or was killed, send the carcass to the nearest veterinary dispensary for investigation If the dog is not known to the patient: Refer the patient to doctor immediately for anti-rabies vaccine

49. Burns Leading cause of accidental death Burns are caused by: Flame Hot liquids Hot surfaces Chemicals Radiations or electric current

50. Types of Burns

51. Determination of Burn Severity Severity of burns is determined by many factors such as : Depth of burn Percentage of body surface area (size of burns) Location Age Medical history Cause of burn

52. Depth of Burn Superficial or 1 st degree Skin is partially destroyed After burn, skin becomes red, extremely sensitive to the touch, wet and swollen Partial thickness or 2 nd degree Burn is deeper Blisters form and filled with clear, thick liquid Affected area is swollen and painful Full thickness or 3 rd degree Burns is deeper, affects muscles, bones, nerve endings etc. Difficult to determine depth of burn until several days after in jury

53. Rule of Nine method for calculating percentage of Burns Head and neck 9% Right upper extremity 9% Left upper extremity 9% Anterior trunk 18% Posterior trunk 18% Right lower extremity 18% Left lower extremity 18% Perineum 1%

54. First a id management for burn Major goals of first aid are: Stop burning Assess airway, breathing and circulation Begin cardiopulmonary resuscitation, if necessary Conserve body heat Minimise wound contamination Transport patient to nearby hospital

55. First aid management of burns For Thermal burns Remove person from the source and lie on the ground Log roll the person to extinguish the flames and cool wound quickly Douse burnt area with cool water within 10 minutes of injury Drink plenty of water and do not run Do not attempt to remove adherent clothing Remove jewellery from the burned area Do not attempt to remove adherent clothing F or Chemical b urn Brush off dry chemical and immediately rinse with a lot of clean cold water for 15 - 20 minutes Prolong contact with chemicals increase the burn severity

56. First aid management of burns For Electric burns Turn off source of electricity immediately Separate the person from electric current by using dry wool, rope, etc If underground or overhead electric wires are involved, contact electric utility company for assistance After disconnected from electric source, quickly assess cardiopulmonary function and start CPR immediately if necessary Do not apply ointment or cream to burnt area Refer patient to hospital immediately

57. Formulas for Calculating Fluid in Burns 57 Evan Formula First 24 hours Colloids -1 mg/kg/% Total Body Surface Area ( TBSA ) Physiologic saline solution – 1 mg/kg/% TBSA Non-electrolytes – 2000 ml of 5% dextrose in water or correspondingly less in children Second 24 hours 1/2 of amounts of colloids and electrolytes administered in first 24 hours

58. Formulas for Calculating Fluid in Burns 58 Brooke Formula First 24 hours Colloids (blood, dextrane or plasma) – 0.5 ml/kg/% TBSA Ringer’s lactate – 1.5 ml/kg/% TBSA Water replacement (dextrose in water) 200 ml for adults and in children less Second 24 hours Colloids and Ringer’s lactate- but ½ of amount given in first 24 hours Administer ½ of 24 hour total fluid in first 8 hours ¼ of 24 hour total fluid in second 8 hours ¼ of 24 hour total fluid in third 8 hours

59. Choking Also called as asphyxia Occurs due to obstruction in windpipe Causes Most common in children Piece of marble or coin or a button get struck in air passage In adults food may go down in the wrong way and lead to choking

60. First aid for Choking - for adults When victim is standing: Stand behind the victim and wrap his arms around the waist Gasp the fist with other hand Place thumb of fist against abdomen slightly above the navel and below rib cage Press fist into victim’s abdomen with a quick upward thrust Repeat several times till foreign body is expelled out When victim is sitting Stand behind the chair and performs same maneuver as mentioned above

61. First aid for Choking - f or adults When victim is lying: Turn him supine Facing the victim, kneel astride the victim’s legs With one hand on the top of other, place the heel of bottom hand over the abdomen between the naval and rib cage Press in the victims abdomen with a quick upward thrust Repeat it several times Before patient vomits, place him on his side and wipe to prevent asphyxia Following expulsion of foreign body give him artificial respiration if needed

62. First aid for Choking - I nfant Refer immediately to hospital if above measures fail Hold infant upside down by legs and slap his back hard three or four times If not successful, lay the infant prone with his head hanging downwards over the knee and give sharp slaps between shoulders If still not successful, induce vomiting by passing two fingers right to the back of throat

63. Seizures (Fits) Intermittent episodes of brief and nearly undetectable long periods of vigorous shaking of the muscles affecting the part or whole of the body Usually accompanied by loss of consciousness Remember Fits can be distinguished from spasms, which are muscle contractions and do not particularly affect all muscles of the body as in a fit In both the patient has no control in starting or stopping the fit or spasm

64. Types of Fits Convulsive seizures Occur in infants and in young children Alarming sign for onset of any fever or illnesses such as whooping cough, viral respiratory tract infection, etc Epileptic Seizures Occurs in older children and adults Result of excessive and abnormal nerve cell activity in the cortex of the brain The fits in epilepsy come on long intervals and patient is either known to be epileptic or has had similar fits before

65. Signs and Symptoms of Seizure Generalised seizures A ll areas of brain (the cortex) are involved therefore referred to as grand mal seizures Signs and symptoms include: Patient suddenly utters a loud cry out and falls down Whole body becomes stiff for several seconds to a minute followed by rhythmic jerky movements of arms and legs Eye balls are rolled upwards Patient froths at the mouth and clenches teeth Patient goes to a deep sleep and appear blue May pass urine or stool without knowing it

66. Signs and Symptoms of Seizure Partial or focal seizures O nly part of the brain is involved h and of patient may show rhythmic or jerky movements Small repetitive movements such as picking at one’s clothes or smacking of lips P atient appears dazed or confused Absence or petit mal seizures C ommon in childhood Impairment of consciousness with person often staring blankly Repetitive blinking or other small movements may be present Seizures are brief, lasting only seconds Some patients have many of these in a day

67. First Aid for Seizure Convulsive seizures If child has fits or convulsion: Take history Check temperature for high fever, if present give cold sponge Keep the child on his side to prevent from aspirating the vomit Place a rolled cloth between the teeth to prevent biting the tongue Look child for signs of infection and neck stiffness Look child for teething symptoms Refer child immediately to hospital for investigation and treatment

68. First Aid for Seizure Epileptic seizures Make sure that patient is safe and protect him/her from danger Lie patient down and turn face on one side. Place a cushion under head Clear people from around patient to give sufficient fresh air Place a rolled cloth between teeth to prevent from biting tongue Do not try to restrain the patient during the fit Do not give water or anything by mouth during fit When seizure has stopped, clean secretions from mouth Check for breathing and make patient comfortable Look for any card indicating a history of epilepsy and prescription Give prescribed medicine and let the patient rest for a while Keep monitoring the person until the patient is fully recovered After the patient regains consciousness, give him a hot tea with sugar

69. Road Traffic Accidents (RTAs) According to WHO: RTAs is 8 th leading cause of death globally, by 2030 it is predicted to become 5 th leading cause of death > 2,31,000 people die due to RTAs in India every year Guidelines for handling RTAs: Casualties may have to be moved in order to save lives They should be moved immediately if: Casualty is unconscious Risk of spinal injury Severe internal bleeding Danger of further injury from fire Breathing and heart beat have stopped

70. First Aid for RTAs Immediate action Look for any indication of dangerous substances being present Call the emergency services immediately Do not pull casualties from vehicle Switch off the engines Instruct bystanders to setup warning triangles at least 200 meters away from accident site Immobilize the vehicle Look inside the vehicle for any small children Do not allow anyone to smoke near the vehicle

71. First Aid for RTAs Moving a Casualty: Casualty should be moved very carefully Immobilize the casualty Make sure that there are enough persons to support all parts of body Removal should be carried out in one continuous movement Removal of trapped casualty: If casualty is trapped under a vehicle and to be removed because of danger of fire, then try to move vehicle away from casualty first Mark exact position of casualty or vehicle before moving either because police needs this information I f victim is trapped in vehicle by impacted steering wheel, watch for unconsciousness, place them in open airway position till arrival of skilled help

72. Poisoning Poisons are harmful substances When sufficient doses are consumed either accidentally or for suicidal purpose, it may prove very dangerous or may kill a person Routes of Taking Poisons Eating or drinking poisonous substances by mouth Inhaling household or industrial gases, chemical vapors or fumes I njection into skin: bites from animals , insects, or by hypodermic syringes Absorption through skin by contact with poisonous sprays ( ex: pesticides)

73. Mechanism of a ction of Poison Swallowed poisons act directly on food passages resulting in vomiting, pain and diarrhea Corrosive poisons may severely burn lips, mouth, gullet and stomach thus causing intense pain Fumes and gases cause choking result in difficulty of breathing and unconsciousness Some poison work in blood stream, central nervous system and prevent breathing, heart action and other vital life process Some poisons act by displacing the oxygen in blood and preventing its distribution to tissues 73

74. Assessment of p atient with Poisoning A ssessment depends on nature of poison and method of entry into body It includes following: General information from patient or witness suggesting contact with a poison Check the container having poison or poisonous plant Observe patient for signs and symptoms Convulsions Signs and symptoms of asphyxia Vomiting B urns on lips and mouth after contact with corrosive poisons 74

75. Types of Poisoning 75

76. Types of Poisoning 76

77. First Aid for Poisoning Inform the police Collect information from patient or persons accompanying patient Preserve suspecting material like bottle containing pills or liquid If patient vomited, preserve vomited material If patient is conscious and no burns on lips or mouth then induce vomiting by giving fluid or milk and touching the fauces (inside the mouth) If lips or mouth shows signs of burn, cool them by giving water or milk If patient is unconscious but breathing normally, treat as for shock If breathing and heart beat stop begin resuscitation immediately If convulsions present manage it Shift patient immediately to hospital

78. Drowning R esult of complete immersion of nose, mouth in water or any other liquid Water enters the windpipe and lungs, clogging lungs completely which can lead to death due to suffocation and lack of oxygen Causes 2 nd leading cause of death in children< 14 years, are curious and attracted to water Alcohol consumption Suicidal attempt 78 Near drowning: An event in which a drowning victim can be resuscitated back to life

79. First Aid for Drowning Quickly assess breathing . If not breathing, immediately begin CPR as follows : Clear mouth of any material obstructing air entry, artificial teeth if any Lay the patient on his back on a firm surface Raise shoulders on a folded coat or in some other way Extend the head backwards to keep the air way clean Kneel down on both sides of patients head If necessary turn patients head to one side to clear out the mouth Grasp wrists and cross them over the lower part of chest Rock your body forward and press down on patient’s chests Release pressure with a sweeping movement - patient’s arms backward and outward Repeat steps (vii. to ix) rhythmically twelve times per minute in an adult Transfer to nearest PHC or hospital . Continue giving artificial respiration on the way 79

80. Foreign Bodies A foreign body is a substance that can enter in the skin, eye, ear, nose, throat, esophagus or stomach If not removed in time, can lead to complication or even cause death

81. First aid for foreign body under Skin If piercing object is large and embedded in skin: Dress wound gently Immobilize part with splint Give a dose of inj.TT Give a dose of inj. Voveran stat Refer patient immediately to hospital W ound is small and can deal at sub-centre Sit or lay the patient down Clean wound with boiled water Remove foreign body with sterile forceps Stop bleeding using direct pressure Apply antiseptic ointment and cover with clean dry dressing Give a dose of inj.TT Give Tab. Lyzer D for pain Give Cap Amoxicillin 500 mg, 8 hourly for 5 days Causes: Skin may be pierced by thorns, glass, iron pieces, needles etc.

82. Foreign body in the Eye Causes Wings of insects, dust and coal, metal particles from lathes, wood particles and loose eyelashes are common objects Signs and symptoms: Irritation or eye discomfort Tearing Blurred vision, light sensitivity Uncontrolled eyelid contractions Redness of conjunctiva (white of the eye) Swelling of the eyelid O bject may even cause scratch in eyeball’s transparent tissue (cornea) and eye may become infected with bacteria 82

83. First aid for foreign b ody in the Eye Restrict patient from rubbing eye. If child, tie his hands together Pull the lower lid down. If foreign body is floating remove it with narrow moist swab If foreign body is not visible, Hold the head of patient to one side with eyelids open. Flush eye(s) with clear water or saline solution for 15 mnts Ask the patient to keep the eye(s) open as blinking repeatedly may scratch the cornea If unsuccessful, pull upper lid forwards, push lower lid upwards and let go of both the lids. Try this 2 or 3 time If foreign body is embedded in eye , particularly in cornea , do not touch it If foreign bodies are penetrating apply a soft, sterile pad and light bandage and refer quickly to hospital When injury with corrosive acid, alkali or juices from plants are suspected, blinking eyelids under water a number of times. Then apply a soft pad and light bandage and refer

84. Foreign b ody in the Ear Causes Solid objects (round or irregular such as: pea, beans) Insects such as: mosquito, fly, etc E xcessive wax formation can block the air passage Signs and symptoms Disturbance in hearing or dizziness Ear irritation or itching and ear ache Wriggling sensation in the ear due to presence of insect Swollen, red and hot ear 84

85. First aid for fo reign body in the Ear Ask patient whether he/she knows that something has gone into ear Assess patient for any signs and symptoms Enquire whether patient has had trouble with ear wax before If foreign body is an insect, fill the ear with glycerin or coconut or mustard oil or warm salt water If there is nothing floating up, leave it alone, do not meddle at all Refer patient to the hospital as soon as possible

86. First aid for foreign body in Nose Make the patient breathe through mouth Do not try to remove the foreign body If the patient is a child, tie his hands behind his back Refer the patient immediately to hospital 86

87. First a id for f oreign b ody in the Throat If large, irregular objects stuck in throat and if visible, these may be taken out by using fingers In a child, hold child’s head downward and tap on the back of neck and foreign body may fall out In the case of fish bones or thorn these may get lodged by piercing some part of the throat. K eep patient calm and refer to the hospital 87

88. F irst aid for foreign body in the Esophagus If a person has swallowed an object, encourage them to continue coughing If person’s condition worsens, breathing becomes difficult, t hen follow steps of First Aid Give 5 back blows (between shoulder blades with the heel of your heel) Give 5 abdominal thrusts (Heimlich manoeuver) Alternate between 5 back blows and 5 abdominal thrusts until the blockage is dislodged If person becomes unconscious, help them to the ground and begin CPR After attempted rescue breaths, check the mouth for an object and if visible remove it Do not perform a blind finger sweep

89. First aid for foreign body in the Esophagus Steps to perform Heimlich on other: Stand behind the person: Wrap your arms around the waist. Tip 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: Perform it if needed. If the blockage still is not dislodged, repeat the five-and-five cycle

90. First aid for foreign body in the Esophagus Steps to perform Heimlich maneuver on yourself: Place a fist slightly above your navel Grasp your fist with other hand and bend over a hard surface – a counter top or chair will do Push your fist inward and upward

91. Model Questions Discuss the first aid measures for treating high fever in infants and toddlers List down the immediate steps which you will take for managing a case with low blood sugar level List the signs of primary shock List the steps of first aid treatment that you will follow for taking care of a patient with snake bite at your level List signs and symptoms of generalized seizures Mention the steps of first aid treatment to be followed, if a patient has an epileptic fit What are the signs and symptoms of asphyxia Mention the steps to perform the Heimlich maneuver if someone else has aspirated a foreign body which is blocked in his/her throat or esophagus

92. References Brunner& Suddarth’s Text Book of Medical Surgical Nursing , 11th edition, vol.1, Wolter Kluwer publishers (India) Pvt .Ltd. New Delhi-19. 2009. 2431-2433. Black JM,Hawks JH, Medical Surgical Nursing- Clinical Management for Positive Outcomes, 7th edition, vol.2, Reed Elsevier India, Pvt .Ltd. New Delhi-65, 2007.p 1906-1907; 2503-2505. Gupta.LC and Gupta A .Management of General Injuries, Sports Injuries and Common Injuries : Manual Of First Aid. Ist edition. Japee Brothers Medical Publishers (P) Ltd. New Delhi-02 (India) 1995 p. 81-82 ;101-103; 254-258. First Aid to the Injured. St John Ambulance Association. 4th edition. Red Cross Road, New Delhi 1991. p 115-124. Antonio M. Gotto . The Cornell Illustrated Emergency Medicine &First Aid Guide. 1st edition. Life Line Press Regnery Publishing Company, Washington DC.2002 p.120-124,130-134,146, 155-157, 176-177, 184-186. Panwar PK : Medical Surgical Nursing. 4th edition. AITBS Medical Publishers, New Delhi -51 India. 2015 , p. 213- 214.

93. THANK YOU