First Aid for Troop 402, BSA
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What Is First Aid?
First aid is the initial care of the injured or sick. It is the care administered
by a concerned person as soon as possible after an accident or illness.
It is this prompt care and attention that sometimes means the difference
between life and death, or between a full or partial recovery. |
First aid has limitations - not everybody is a doctor - but it is an
essential and vital part of the total medical concept. FIRST AID SAVES
LIVES! ...ask any ambulance officer or doctor who works in the emergency
medical field.
Immediate Action
It is important that any action taken by the first aid provider is done
as quickly as possible. Quick action is necessary to preserve life and
limb. A casualty who is not breathing effectively, or is bleeding copiously,
requires immediate intervention, and if quick effective first aid is provided,
then the casualty's chances of recovery are improved immeasurably. It should
be remembered though that any action undertaken is to be deliberate, and
panic by the first aid provider and bystanders will not be beneficial to
the casualty. Try to remain calm and think your actions through. |
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Will I Harm The Casualty?
It is unlikely that the casualty being treated by a trained first aid provider
will come to any additional harm, provided that the care and treatment
is rendered in accordance with the provider's level of training. Many horror
stories abound of well meaning first aiders causing irreversible spinal
injuries to their casualties, but these are usually just that -- stories!
If first aid is administered quickly, effectively, and with due care,
then the casualty will not suffer any additional harm. In most states,
the legal system takes a benevolent view towards first aid providers. Provided
that any care and treatment was undertaken for the good of the casualty,
that no deliberate harm was caused, and that the incident was handled as
if by
a reasonable person, then the first aid provider should have
no fear of litigation.
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How Do I Get Help?
To get expert medical assistance, call an ambulance on 911 (emergency
number) in metropolitan areas, and the local emergency numbers in the front
of the directory when in rural areas. If you are attending a casualty,
get a bystander to telephone for help - if you are on your own, then you
may have to leave the casualty momentarily to make a call. It's common
sense, the decision is yours! |
Medic Alert
Some individuals suffer from certain medical conditions that may cause
them to present with serious signs and symptoms at any time. As a form
of assistance and notification, these people may wear a form of medical
identification, usually a special bracelet, or less commonly, a necklace.
These devices are commonly referred to as Medic Alert bracelets. They are
stamped with the person's identity, the relevant medical condition, and
other details which may include allergies, drugs required, or specialized
medical contact. Medical conditions that may be notified vary from specific
heart diseases, to diabetes, epilepsy, asthma, and serious allergies. |
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DRABC!
DRABC is the prime consideration for everyone involved in the care and
treatment of casualties. Experienced first aid providers, ambulance crews,
nurses and medical specialists, are all-aware of the importance of:
Danger,
Response,
Airway,
Breathing and
Circulation.
Danger
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to yourself: don't put yourself in danger!
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to others: don't allow bystanders to be exposed to danger!
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to the casualty: remove the danger from the casualty, or the casualty from
the danger!
Response
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use the 'shake and shout' method!
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is the casualty alert?
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is the casualty drowsy or confused?
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is the casualty unconscious, but reacting?
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is the casualty unconscious with no reaction?
Airway
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is the airway open and clear?
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is there noisy breathing?
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are there potential obstructions such as blood?
Breathing
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look to see if the chest rises!
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listen for the sound of breathing!
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feel, by putting your hand on the diaphragm!
Circulation
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is there a neck pulse?
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is it strong?
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is it regular?
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is there major blood loss?
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If the casualty is conscious, then treat the injuries or illness according
to the signs and symptoms.
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If the casualty is unconscious, and breathing spontaneously, place him
or her in the stable side position, then treat any injuries.
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If the casualty is unconscious, and not breathing, then commence CPR.
Control of External Bleeding
Blood consists of red cells (erythrocytes), which convey oxygen throughout
the body; white cells (leukocytes), which fight introduced infection; platelets
(thrombocytes), which assist in the clotting process; and plasma, the fluid
portion of blood. There are between six and seven quarts of blood in the
average adult body.
Blood is moved around the body under pressure by the cardiovascular
system - the heart and blood vessels. Without an adequate blood volume
and pressure, the human body soon collapses. Bleeding, or hemorrhage, poses
a threat by causing both the volume and the pressure of the blood within
the body to decrease through blood loss.
External Bleeding
External bleeding is usually associated with wounds, those injuries that
are caused by cutting, perforating or tearing the skin. Serious wounds
involve damage to blood vessels. As arteries carry oxygenated blood from
the heart, damage to a vessel is characterized by bright red blood which
'spurts' with each heartbeat. Damage to veins appears as a darker red flow.
Capillary damage is associated with wounds close to the skin and is of
a bright red 'ooze' from below the surface.
Types Of Wounds
Incision is the type of wound made by
'slicing' with a sharp knife or sharp piece of metal.
Laceration is a deep wound with
associated loss of tissue - the type of wound barbed wire would cause.
Abrasion is a wound where the skin
layers have been scraped off.
Puncture wounds are perforations,
and may be due to anything from a corkscrew to a bullet.
Amputation is the loss of a digit
or limb by trauma.
Care should be taken to obtain medical advice for prevention of tetanus
Treatment
Incisions
And Lacerations
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DRABC
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Quickly check the wound for foreign matter
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Immediately apply pressure to stop any bleeding
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Apply non-adherent pad or dressing
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Apply a firm roller bandage
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Rest and elevate injured limb if injuries permit
Abrasions
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Inspect the wound for foreign matter ·
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Swab with a diluted antiseptic solution ·
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Cover with a light, dry dressing if necessary
Puncture
Wound
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DRABC ·
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Inspect the wound - do not remove any penetrating object ·
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Apply pressure to stop any bleeding ·
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Apply non-adherent pad or dressing ·
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Apply a firm roller bandage ·
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Rest and elevate injured limb if injuries permit
Amputation
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DRABC ·
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Apply immediate pressure to stop any bleeding ·
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Apply a large pad or dressing to the wound ·
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Treat for shock ·
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Rest and elevate injured limb if possible ·
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Collect amputated part - keep dry, do not wash or clean ·
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Seal the amputated part in plastic bag or wrap in similar waterproof material
·
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Place in iced water - do not allow the part to come in direct contact with
ice ·
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Remember - if the initial dressing doesn't stop the bleeding, put another
over the top - don't remove a dressing once it is in place! · Ensure
the amputated part travels to hospital with the casualty
Nosebleed
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Pinch fleshy part of the nose ·
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Lean slightly forward - Remain so for approximately ten minutes ·
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Do not blow or pick nose for several hours ·
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If bleeding persists, obtain medical aid
Cardio-Pulmonary Resuscitation
Cardio-Pulmonary Resuscitation (CPR) is the singularly
most effective form of active resuscitation available, and is used universally
by trained first aid providers and medical personnel. The technique is
used to resuscitate casualties in cardiac arrest. While expired air resuscitation
is the method by which oxygen is provided to the casualty, external cardiac
compressions, when applied correctly, duplicate the heart's mechanical
function of pumping the oxygenated blood around the body. This combination
of techniques is the principle of CPR. Effective CPR can sustain a casualty
until more expert definitive medical treatment is available and it is vital
that CPR is initiated immediately on contact with the casualty.
A particularly important aspect of CPR is that the rescuer's hands are
positioned correctly in relation to the casualty's heart. For the rescuer
to locate the correct position for the hands, two fingers should be placed
over the casualty's xyphoid process, the small 'bump' at the base of the
sternum. A hand is then placed centrally on the chest, above the two fingers.
This position should then approximate the location of the heart. The second
hand is placed over the first, and the fingers entwined for stability,
or alternatively, the second hand grips the wrist of the first hand. The
chest is compressed 1 1/2 -2 inches.
Hand position for a child is on a point centrally located on the lower
1/2 of the sternum. Compressions are performed at a depth of 1- 1 1/4 inch
using the heel of one hand only, the pressure is modified so as not to
cause damage to the ribcage. An infant's heart is located by placing two
fingers centrally on the lower 1/2 of the sternum. Compressions are then
performed by pressing with the fingers 1/2 - 3/4 inch deep, the pressure
is modified to reflect the fragility of the child's chest.
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CPR can be performed by a single rescuer, or by two rescuers. As two-person
CPR requires a degree of synchronized technique, it is usually more effective
for first aid providers to perform individual CPR, and change operators
after ten minutes or so.
Indications For CPR
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unconsciousness
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collapse
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cyanosis (blue color)
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pupils fixed and dilated
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absent respiration
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absent pulse
Procedure For One-Person
CPR
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begin immediately
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check for DANGER
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check for response, shake and shout
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check and clear airway
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tilt head back to open airway
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look, listen and feel for breathing
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give two breaths
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assess the rise and fall of the diaphram
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check for carotid (neck) pulse (15 seconds)
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kneel beside casualty's chest
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locate heart on lower half of chest
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place hands centrally over heart, fingers entwined
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lean over casualty, arms straight, elbows locked
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commence 15 compressions, with even pressure until resistance is felt
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compressions - rate of 60-80 per minute, children and infants 80-100 per
minute
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tilt head back to open airway
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give two breaths
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relocate heart
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15 compressions
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repeat cycle for 1 minute
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check carotid (neck) pulse (15 seconds)
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continue cycles and recheck pulse every minute
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Procedure For Two-Person
CPR
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one rescuer positions close to the casualty's head and delivers breaths
·
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the other positions on the opposite side of the body beside the chest and
performs compressions
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initial two breaths
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15 compressions
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2 breaths delivered on completion of the 15th compression
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continue cycle for 1 minute
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check carotid (neck) pulse (15 seconds)
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continue cycles and recheck pulse every minute
As air is forced under pressure into the casualty, and pressure is exerted
by compressions, the risk of causing the casualty to vomit is very real.
Rescuers must be alert at all times to avoid the airway becoming soiled
by vomitus. Upon detection of vomitus in the casualty's mouth, roll him/her
into the stable side position, clear the airway, and when clear, roll casualty
back and resume CPR. CPR is to be continued once begun until either the
casualty is revived, the rescuer is relieved by expert medical aid, or
until the rescuer is too exhausted to continue.
Should the casualty regain his/her vital signs, put him/her into the
stable side position and observe closely, as often the casualty lapses
back into cardiac arrest.
Poisoning
Poisons are substances that if inhaled, ingested, absorbed or injected,
harm the structures or functions of the body. Some types of poisons may
act immediately on the body, others may act more slowly. Some poisons,
such as cyanide, are so toxic they only require a minute amount to be harmful,
while others, such as garden sprays, are cumulative and require exposure
over a long period to achieve the same level of toxicity. Many are carcinogenic,
and cause fatal cancers some years after exposure. Whatever the substance,
remember that prevention is better than cure! |
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Always ensure that poisonous substances are kept only if really necessary,
that pills and medications are locked away in a childproof cupboard. Substances
must never be decanted into attractive containers such as soft drink bottles.
All substances must be labelled and understood before use. Prescription
medications are used only by the person prescribed, and that all poisons
and medications are disposed of correctly.
The wide varieties of poisonous substances present with a similarly
wide variety of signs and symptoms. The list below is not exhaustive, but
casualties may present with all, or at least some, of them.
Signs And Symptoms
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obtain a history, look for empty bottles, containers, sometimes suicide
notes
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pale, cool, clammy skin
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rapid, weak (sometimes erratic) pulse
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nausea and/or vomiting
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cyanosis (blue color)
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burns around the mouth
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blurred vision
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ringing in the ears
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smell of fumes or odors
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stomach pains or cramps
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drowsiness, which may lead to unconsciousness
Care And Treatment
Urgent ambulance transport is essential. In middle Tennessee, the Poison
Control Center number is (615) 936-2034 (or see your local phone book,
check inside of the front cover) .
Heart Conditions
The HEART is a muscular pump, approximately the same size as its owner's
fist. Its function is to pump oxygen-rich blood from the around the lungs
to various parts of the body, and to pump the de-oxygenated blood from
the tissues back to the lungs to take on more oxygen. The mechanical pumping
action of the heart is driven by a complex electrical activity. Due to
factors such as sedentary life-style, poor diet and advanced age, and chronic
disease, the heart is sometimes compromised, and serious cardiac conditions
develop. The four major conditions are;
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Angina
Angina Pectoris (literally 'pain in the chest') is a condition due to
constriction of the blood vessels supplying the heart muscle with blood.
Angina sufferers are aware of their condition, and take medication to relieve
the symptoms. Medication is usually in the form of tablets, or spray, taken
under the tongue.
Signs And Symptoms
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pale, cool skin
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chest pain or discomfort, usually after exertion, a heavy meal or stress
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lethargy
Care And Treatment
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position of comfort, usually sitting supported
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rest
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assist with medication
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reassurance
It is important to realize that angina should be relieved by medication.
If after three tablets the pain does not diminish then the condition should
be considered a heart attack.
Heart
Attack
Heart Attack is also known as a Coronary Occlusion. A heart attack can
occur at any time, at any age, though certain people are at greater risk
due to factors such as hereditary influence, lack of exercise, smoking,
poor diet, and other negative contributions. The onset of heart attack
is usually due to the acute constriction, complete blockage, of a cardiac
blood vessel. Urgent medical attention is vital. |
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Signs And Symptoms
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'crushing', or 'vice-like' pain in the chest, sometimes also in the jaw
and arm
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pale, cold skin
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sweating
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rapid, or irregular, weak pulse
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rapid, shallow respiration
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partial collapse
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nausea and/or vomiting
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may feel the need to pass a bowel motion
Care And Treatment
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DRABC
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urgent ambulance transport
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position of comfort, usually sitting
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complete rest
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reassurance
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discourage visit to the toilet
If the casualty collapses and appears to become unconscious be prepared
to provide resuscitation as this is a sign of impending cardiac arrest.
Heart
Failure
When the heart is unable to perform its proper function, and causes
blood and fluid to congest around the lungs and in the body, the condition
is called Heart Failure. It is typified by the casualty finding it difficult
to breathe, and swelling of the ankles and legs as fluid pools in the extremities.
Signs And Symptoms
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pale, cold, clammy skin
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chest discomfort, difficulty breathing
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'bubbly', gasping breaths
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frothy sputum
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swelling of the extremities, especially the ankles, which may show 'dimples'
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partial collapse
Care And Treatment
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DRABC
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position of comfort, usually sitting supported
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allow legs to hang, do not elevate
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urgent ambulance transport
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reassurance
Cardiac
Arrest
When the heart ceases to function, then the casualty is said to be in
Cardiac Arrest. Whether the heart is at a complete standstill, or whether
it is vibrating in some fatal rhythm, it is no longer doing its task. The
condition may be due to heart attack, heart failure, electrocution, drowning,
trauma or other medical condition - first aid treatment is the same: ATTEMPT
RESUSCITATION!
Signs And Symptoms
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pale, cool skin
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no pulse
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usually no respiration, though there may be irregular, 'gasping' breaths
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pupils fixed and dilated
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cyanosis (blue color)
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may be loss of bladder/bowel control
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evidence of vomitus
Care And Treatment
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immediate CPR
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urgent medical assistance
Burns and Scalds
Burns are caused by contact with flame, hot objects, chemicals, electrocution,
radiated heat, or frozen surfaces. Scalds are caused by contact with boiling
fluids or steam. The results of either injury are disfigurement, scarring
and severe pain. As with most potentially serious injuries, prevention
is better than cure.
Burns are classified as either: Superficial reddening of the skin, frequently
with blisters; or Deep destruction of tissue and nerves, leaving a whitish
or blackened area surrounded by superficial burns. The severity of burns
is dependent on certain factors such as; the age of the casualty, the depth
of the burns, the part of the body burnt, and the area affected. The burnt
body area of a casualty is assessed as a 'percentage', and is arrived at
by reference to The Rule Of Nines.
Eleven areas of the body are designated each worth 9%, eg. arm = 9%,
etc. The percentages are added, and the total given as the percentage of
the total body area burnt. This is particularly important information to
pass on to the ambulance service, as they may act on this information to
arrange urgent specialist assistance, such as a helicopter for evacuation
to a large city hospital's burns unit.
Treatment
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DRABC
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cool with water
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10 minutes for heat burns
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20 minutes for chemical burns (e.g., lye)
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30 minutes for bitumen burns (e.g., fuel oil, gasoline)
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cover with a clean, non-adherent dressing
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urgent ambulance transport if the burn is severe
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treat for shock if the burn is severe ensure that chemicals are flushed
from the skin, pay special attention to eyes
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Do Not Over cool and cause shivering
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Do Not use creams or ointments unless prescribed
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Do Not attempt to remove material adhering to the burn
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Do Not prick blisters
Burns to the face inevitably have an effect on the casualty's breathing,
and these effects may take some time to appear. It is important that any
casualty who has inhaled smoke, fumes or superheated air, or has been burnt
on the face, should seek medical aid as soon as possible after the incident.
REMEMBER - Severe burns can lead to shock and massive infection if not
treated properly!
Choking
Choking is due to the lodgement of a foreign object in the casualty's
airway (trachea). In some instances, the object lodges at the epiglottis
- the entry to the airway - but does not actually enter the trachea. Both
cases cause initial coughing, the body's reflex action to dislodge the
object. If an object is firmly lodged in the airway, coughing at least
keeps it high in the trachea, though may not expel it. Coughing with an
object at the entrance to the airway, however, will generally cause it
to be expelled.
Should you encounter a person with an apparent obstruction who is Coughing
Effectively, Do Not Slap him or her on the back. If the obstruction is
at the entrance to the trachea, then reactions to the slaps may cause the
person to inhale the object and cause complete obstruction. If a casualty
initially coughs to no effect, and appears to be in increasing distress,
then the object may be totally obstructing the airway.
Signs And Symptoms
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absence of breathing
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agitation and distress - grabbing the throat
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cyanosis (blue color)
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eventual collapse
Care And Treatment
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Strike sharply on the back four times
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Use abdominal thrusts four times
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If victim is unconscious, use abdominal thrusts from straddling the victim.
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Use CPR if necessary
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