Chapter 7.docx

Other First Aid Emergencies Chapter 7 Other first aid emergencies Diabetes Diabetes is a condition in which there is either not enough insulin in the blood or there is enough insulin but the cells cannot use the insulin properly. Insulin is a hormone produced in the pancreas that regulates the amoun...

Other First Aid Emergencies Chapter 7 Other first aid emergencies Diabetes Diabetes is a condition in which there is either not enough insulin in the blood or there is enough insulin but the cells cannot use the insulin properly. Insulin is a hormone produced in the pancreas that regulates the amount of glucose in the blood. With diabetes, sugar builds up in the blood and the cells don't get the energy they need or the blood sugar levels can go abnormally low. A person with diabetes may take medication by mouth or injection, and carefully controls what they eat (the source of energy) and their level of exercise (the use of energy). A diabetic emergency occurs when there is too much or too little insulin in the blood. Hypoglycemia-not enough sugar, too much insulin Hyperglycemia-too much sugar, not enough insulin First aid for diabetic emergencies The aim of first aid in a diabetic emergency is to keep the casualty's condition from getting worse while you get medical help. Perform a scene survey, then do a primary survey. If the casualty is conscious, ask what is wrong. A diabetic casualty may have glucose tablets for treating hypoglycemia. Help them take their tablets if they are able to respond and swallow; repeat if symptoms persist after 10 minutes. If glucose tablets are not available, use other types of dietary sugars (in order of preference): glucose candy (e.g. Mentos), sucrose candy (e.g. Skittles), jelly beans, orange juice, fructose (e.g. fruit leather), and whole milk. Give ongoing casualty care. Send for medical help Seizures and convulsions A seizure is caused by abnormal electrical activity in the brain. In a partial seizure, only part of the brain is affected. The person may experience a tingling or twitching in one area of the body. In a generalized seizure, the whole brain is affected and the person loses consciousness and may have convulsions. A convulsion is an abnormal muscle contraction, or series of muscle contractions, that the person cannot control. Epilepsy is a disorder of the nervous system characterized by seizures. Many people with seizure disorders like epilepsy take medication to control the condition. Other causes of seizures include: Head or brain injury Stroke Brain infection Drug overdose A high fever in infants and children With epilepsy, the person may know that a seizure is about to occur because of a brief sensation they experience, called an aura. The aura, which may be a hallucinated sound, smell, or a feeling of movement in the body, is often felt just before a seizure. A typical generalized seizure has two phases: The "tonic" phase involves a sudden loss of consciousness causing the person to fall. The person's body becomes rigid for up to a minute during which the face and neck may turn bluish. In the "clonic" phase, convulsions occur, breathing is noisy, frothy saliva may appear around the mouth and the teeth may grind. A major seizure can come on very suddenly, but seldom lasts longer than a few minutes. When the seizure is over, the muscles gradually relax and the person regains consciousness. After the seizure, the person may not remember what happened. They may appear dazed and confused, and feel exhausted and sleepy. Signs and symptoms of a generalized seizure A sudden cry, stiffening of the body and loss of consciousness causing the person to fall Noisy breathing and frothy saliva at the mouth The body jerks Breathing may stop or be irregular for a minute-the casualty may turn blue Loss of bladder and bowel control First aid for a seizure or convulsion First aid for a seizure aims to protect the casualty from injury during convulsions and to keep the airway open while the casualty is unconscious. Perform a scene survey. Make the area safe-clear away objects that could cause injury. Clear onlookers away to ensure the casualty's privacy. During convulsions: Do not restrict the casualty's movements. Protect them from lnJUry. Carefully loosen tight clothing, especially around the neck. Place something soft under the head. Do not try to put anything in the mouth, between the teeth or to hold the tongue. Perform a primary survey after convulsions are finished. Place the unconscious casualty into the recovery position and clear any fluids from the mouth or nose. Do a secondary survey to see if the casualty was injured during the seizure; give first aid for any injuries. Give ongoing casualty care, monitoring breathing, keeping the casualty warm and allowing them to rest. Don't give the casualty any liquids during or immediately after a seizure Call for medical help if: The casualty is unconscious for more than five minutes, or has a second major seizure within a few minutes This is the person's first seizure or the cause of the seizure is unknown (ask the casualty when they regain consciousness) Fever emergency in an infant or child A rapid rise in temperature to 40°C (104°F) or higher can cause convulsions in infants and children. A fever emergency is when the temperature, taken in the armpit (or follow manufacture directions on digital thermometer), is: 38° C (100.5° F) or higher for an infant 40° C (104° F) or higher for a child First aid for a fever emergency in an infant or child Perform a scene survey, then do a primary survey. Call a doctor immediately and follow their advice. If the doctor can't be reached give acetaminophen (e.g. Tempra® or Tylenol®) or children's ibuprofen (not ASA) according to the directions on the label. This should bring down the child's temperature. Encourage the fully conscious child to drink clear fluids. If the temperature doesn't go down, sponge the child with lukewarm water for about 20 minutes, their temperature will go down quickly if the wet skin is exposed to air. Dry and dress the child in comfortable but not overly warm clothing. Monitor the child's temperature and repeat steps 3 to 5, as necessary, until medical help is reached. If the child has a convulsion: Do not restrain the child, but protect them from injury Loosen constrictive clothing When the convulsions stop, perform a primary survey. Give ongoing care; place the child into the best recovery position for their age. Do not give ASA (e.g. Aspirin®) to children or adolescents because it may cause Reye's syndrome, a life-threatening condition. Do not use cold water when sponging the child-this may cause more serious problems. Only use lukewarm water. Opioid Overdose Opioids are a class of drug that affect the opioid receptors in the brain and produce a morphine-like effect. Frequently prescribed for pain relief, they can also be used for suppressing diarrhea and coughs. Common examples of opioids include morphine, hydrocodone, oxycodone, codeine, and fentanyl. These drugs are marketed under names such as Vicodin®, OxyContin®and Percocet®. Side effects, which are magnified when too much of the drug is taken, include: Nausea Constipation Respiratory depression Sedation Euphoria Opioids are a common drug of abuse among recreational users due to their euphoric side effects. Fentanyl use has emerged as a public health crisis in many jurisdictions. It is 100 times more potent than morphine and has a very rapid onset, which has made it a leading cause of fatal overdoses among recreational drug users. Fentanyl is commonly used in Emergency Medicine for rapid, effective pain control. Even small amounts of fentanyl can lead to severe reactions when misused. Fentanyl is a white, tastelless drug and has no smell, meaning it cannot be detected when it is mixed with other drugs. In Canada, fentanyl is being mixed (" cut") into many street drugs to increase their potency. The most common drugs being cut with fentanyl are heroin and cocaine. Another problem facing Canada is the proliferation of counterfeit pills on the black market that have been mixed with fentanyl, the most common being Oxycontin®. Prescriptions should be filled only at a pharmacy to ensure safety. In 2017, Health Canada found 3,987 people died from opioid overdose across the country. Of those, 72 percent were related to fentanyl. Carfentanyl is an even more potent and deadly opioid, which has been found in Canada's recreational drug supply. Carfentanyl is 100 times more powerful than fentanyl and used in veterinary medicine. A single grain of Carfentanyl, the size of a grain of salt, can cause a fatal overdose. Risk Factors Potentially anyone can be at risk of an opioid overdose, though some populations are at higher risk. Recreational drug users - either seeking a greater high, or unknowingly using fentanyl that has been cut into their regular drugs to increase potency. Youth - either knowingly when experimenting with drugs; or unknowingly when fentanyl is used as a cutting agent. Pain sufferers - when prescriptions run out or medication tolerance develops, some resort to street drugs to manage pain and addiction. Elderly- medication error may result in inappropriately high doses. Signs and Symptoms of a Suspected Opioid Overdose An opioid overdose will display some or all of the following signs and symptoms: A scene survey or history of the incident indicating potential drug use Excessive drowsiness or loss of consciousness Slow or absent breathing Cool, sweaty skin that is pale or bluish (cyanosis)Cyanosis Gurgling or snoring sounds Constricted pupils ("pinpoint pupils") Naloxone Naloxone (or Narcan®) is an opioid inhibitor. It binds to the same receptors in the brain that would normally bind opioids and blocks the opioids from binding and taking effect. Naloxone is available as a nasal spray or as an injection. If you are in contact with an at-risk group, you are encouraged to have a naloxone kit available and ensure it is properly maintained and not expired. Most provinces provide naloxone kits free. Visit your pharmacy or local addiction clinic to obtain a naloxone kit. First Aid for a Suspected Opioid Overdose First aid for an opioid overdose is a combination of rescue breathing and administration of naloxone (if trained and available). Rescue breathing is the same as breaths delivered during CPR, except without chest compressions. Deliver one breath every 5 seconds ensuring the chest rises. If you suspect the casualty is having an overdose, follow these first aid steps: Perform a scene survey. Make sure the area is safe for you to be in - be aware of risks from people in the area as well as drug paraphernalia. Use SAVE ME to remember the steps: S - Stimulate. Shake, shout, and activate EMS A - Airway. Open the airway V - Ventilate. Deliver one breath every 5 seconds ensuring the chest rises E - Evaluate. Are these steps helping? M - Medication. Prepare and deliver a dose of naloxone if available and you are trained. E - Evaluate. Did the naloxone help? You should see improvement within 2-3 minutes. If a casualty is not breathing, begin CPR. Rescue breaths are delivered to assist a casualty having an overdose if they are breathing on their own, but at a lower rate. Check local protocols if naloxone is delivered before or after rescue breaths/CPR have been started. When possible, have another rescuer perform rescue breaths while you prepare and deliver a dose of naloxone. If there is no improvement after 2 to 3 minutes, deliver a second dose of naloxone. Caution: Naloxone reverses the effects of an opioid overdose, which may cause the casualty to become aggressive or combative; or cause a seizure, vomiting, and a fast heart rate. Ensure your safety and be prepared to assist with these other conditions if they happen. Environmental Emergencies Environmental emergencies are a group of injuries and illnesses that arise due to extreme temperatures and/or prolonged exposure. The body does not function well when it is too hot or too cold These emergencies encompass heat-related illnesses such as heat exhaustion and heat stroke; as well as cold-related emergencies such as hypothermia and frostbite. In all environmental emergencies, the focus is to return the casualty's body temperature to a normal range. Cold-related injuries Core body temperature drops when the body loses more heat than it produces. In an outdoor emergency, heat loss by conduction and convection (wet and wind) are often the main contributors to hypothermia. The body has a number of ways to minimize heat loss and keep the body core warm. One of the first things the body does when it is losing heat is start shivering. If the body keeps getting colder, the blood vessels in the arms, legs and at the skin surface get smaller. This keeps the blood in the core, where it is warmest. If heat loss continues, the body processes get slower, including thinking, muscular action and the senses. Shivering will become uncontrollable and then will slow down and eventually stop. The muscles get stiff and movements become jerky. Thinking is confused, speech difficult and the senses dulled. The heart and breathing rates slow down and the person eventually loses consciousness. At this point, the condition is very serious. The heartbeat becomes unsteady and faint, and finally the heart stops. When the heart stops beating, the person is considered dead. However, when body tissues are cold, they aren't damaged as easily by a lack of oxygen. For this reason, there is often a chance of resuscitating a hypothermic person who doesn't show any signs of life. This means that as long as you aren't putting yourself or others at risk, you should continue your rescue efforts to get a hypothermic casualty to medical help. Hypothermia The normal temperature of the body's core is 37° C (98.6° F). If the body core temperature drops more than two degrees, the body's tissues cannot function properly. This state of generalized cooling is called hypothermia. Hypothermia, often referred to as exposure, kills many Canadians each year-but it is a condition that can be detected and corrected by a first aider if recognized early. Anyone can become hypothermic, but the following groups are especially prone: Elderly people-they often have poor circulation, less ability to sense the cold, and may be on medication that promotes heat loss Babies-have less ability to recover from mild and moderate hypothermia because they lose heat more quickly and their bodies don't control body heat as well People who are already weakened due to illness, injury, lack of food, fatigue or through the use of alcohol or drugs Teenagers-they often under-dress for the weather condition Signs of hypothermia Sign Mild Moderate Severe Pulse Normal Slow and weak Weak, irregular or absent Breathing Normal Slow and shallow Slow or absent Appearance Shivering, slurred speech Shivering violently, clumsy, stumbling, pupils dilated, skin bluish Shivering has stopped Mental state Conscious but withdrawn or disinterested Confused, sleepy irrational Unconscious Signs of hypothermia There are three stages of hypothermia: mild, moderate and severe, but it may be hard to tell exactly when one stage ends and another begins. Body temperatures are not listed here because the first aider has no practical way to take the temperature of the body's core. The key to successful first aid for hypothermia is recognizing the casualty's condition as soon as possible, and preventing hypothermia from getting worse. Hypothermia is the obvious thing to look for on a cold winter day, but it is less obvious when the temperature is above zero. Be on the lookout for hypothermia whenever the temperature is below 200 C, the weather is windy, wet or both, or the casualty is in one of the groups at risk for hypothermia. Don't forget yourself-as soon as you begin to shiver, think "I've got to prevent further heat loss." If you don't, hypothermia will soon affect your mind, and you won't be able to think clearly enough to take the right actions. First aid for hypothermia First aid for hypothermia aims to prevent further heat loss and get medical help. Perform a scene survey and a primary survey. Take measures to prevent further heat loss: Move the casualty out of the cold environment. If you cannot move indoors, protect the casualty from the wind. Cover exposed skin with suitable clothing or covers. If you are in a shelter and have a dry change of clothes, gently replace wet clothes with dry ones. If you are not sheltered, put the dry clothes over the wet clothes. If you don't have dry clothes, press as much water out of the wet clothes as possible and wrap the casualty with something windproof. Insulate the casualty from cold objects-have them sit on a rolled-up jacket or lie on a blanket. Give the casualty warm sweet drinks if they are conscious. Give ongoing casualty care, get medical help. Immersion hypothermia Immersion hypothermia refers to hypothermia caused by being in cold water. A person loses heat 25-30 times faster in water than in air of the same temperature. Immersion hypothermia can happen very quickly if a person falls into cold water. Suspect hypothermia whenever someone falls into water by mistake even in the summer. Immersion hypothermia can also happen more slowly, for instance while swimming or scuba diving in a lake. In these cases, hypothermia creeps up on the casualty, and may not be suspected right away. Do the following when a hypothermic casualty is in the water: Tell the casualty not to take off any clothing-clothes helps keep heat in. Tell the casualty to move as little as possible-moving around causes more heat loss (by convection). When taking a casualty out of the water, keep them in a horizontal position, and handle them as gently as possible. Give first aid for hypothermia to prevent further heat loss, and get medical help. If you are the casualty, use the "heat escape lessening position" (HELP) to preserve body heat. Rewarming a casualty There are two types of rewarming: passive rewarming and active rewarming. Passive rewarming means preventing further heat loss and letting the casualty's body rewarm itself; this usually works well for mild and moderate hypothermia. Active rewarming means adding heat to the casualty's body to warm it up. Active rewarming can cause complications and should only be done at a hospital-but active rewarming is what a casualty in severe hypothermia needs. This is why in severe hypothermia, the first aid is to prevent further heat loss and get medical help. In mild hypothermia, you can give the fully conscious casualty something warm and sweet to drink. The sweetened drink will provide energy to the muscles and help the body to continue shivering. Don't give a casualty in moderate hypothermia anything to drink. Their muscles for swallowing may not work well and they could choke, you should actively rewarm the casualty only if you are far from medical aid. Do this by placing the casualty near a heat source and placing containers of warm, but not hot, water in contact with the skin (neck, armpits, groin). Prevent further heat loss and get medical help as soon as possible. Cautions in first aid for hypothermia Handle the casualty very gently and keep them horizontal if possible. Cold affects the electrical impulses that make the heartbeat. As a result, the hypothermic casualty's heart beat is very delicate. The heart can stop with rough handling of the casualty. Don't give the casualty any alcohol, coffee, or other drinks with caffeine, or let them smoke -these can increase heat loss. Don't rub the casualty's body to improve circulation-this will cause cold blood to flow back to the body core and cool the body further. Frostbite Frostbite refers to the freezing of tissues when exposed to temperatures below zero. It is a progressive injury with two stages: superficial frostbite and deep frostbite. Stages of frostbite and their signs and symptoms Stage Superficial frostbite Description The full thickness of the skin is frozen. Signs & symptoms White, waxy­ looking skin Skin is firm to touch, but tissue underneath is soft May feel pain at first, followed by numbness involving an entire hand Skin feels cold and or foot. hard There is no feeling in the area First aid for superficial frostbite Gradually rewarm the frostbitten part with body heat. Cover frostbitten toes, ears, etc. with warm hands. Warm up frostbitten fingers by placing them in a warm area of the body like the armpit. Take measures to prevent these areas from freezing again­ either stop the activity or dress more appropriately. First aid for deep frostbite Deep frostbite needs medical help as soon as possible. Prevent further heat loss from the frozen part and the rest of the body. Handle the frozen tissue gently to prevent tissue damage. Get medical help. If the feet or legs are frozen, transport using a rescue carry or stretcher if possible. If medical help is not available, you are in a safe, warm place and there is no danger of the part refreezing, then thaw the frozen part: Gently remove the clothing from the affected part. Find a container that is large enough to hold the entire frozen part and fill this with water that feels warm when you put your elbow in it (about 40° C). Remove any jewellery and put the whole frozen part in the water. Keep adding warm water to keep the water in the container at a constant temperature. Keep the part in the water until it is pink or does not improve any more- this can take up to 40 minutes, and may be painful. Gently dry the affected part. Put sterile dressings over wounds and between fingers or toes. Keep the part elevated and warm. Do not break any blisters that form A deeply frostbitten extremity will be very painful as it defrosts. There will be swelling and perhaps tissue loss. For that reason it is best done at a medical facility. If the casualty must walk out or be transported, do not thaw the frozen part-there will be less tissue damage and pain if the part is left frozen. Make sure the rest of the body is well protected from the cold and the casualty has plenty of food and water during the journey to safety. Cautions in first aid for frostbite Do not rub the area-the tiny ice crystals in the tissues may cause more tissue damage. Do not rub snow on the area-this maycause further freezing and tissue damage from the rubbing. Do not apply direct heat; this may rewarm the area too quickly. Trench Foot Trench Foot (immersion foot) is a condition caused by prolonged exposure to cold, but not freezing temperatures, usually along with wet conditions. Named from the First World War troops who stood and fought for long periods from waterlogged trenches. Trench Foot has been identified more recently at events where poor foot hygiene may be present: Multi-day music festivals Long-distance or multi-day races Hiking in cooler, wet conditions Prolonged work in cool and wet conditions Signs and Symptoms of trench foot Numbness or burning pain Discoloured skin that turns pale and swelling Leg cramps Development of blisters or ulcers after 2 to 7 days Odour in later stages due to dead tissue (necrosis) First Aid for trench foot The first aid for trench foot requires medical intervention and usually involves debridement of the wounds. Steps to take to prevent trench foot from setting in include: Keep feet dry - change socks and footwear when wet Keep feet warm - temperatures of 16° Celsius or lower increase the risk of trench foot Wash feet regularly and allow them to air-dry Avoid sleeping with socks on, particularly if they are wet or dirty Use heat packs to help rewarm cold feet that are showing early symptoms Frozen state When the temperature is below zero, it is possible to discover someone who is completely frozen-this is a frozen state. Recognize a frozen state when: The casualty is found in a cold location and is unresponsive The joints of the jaw and neck are rigid when you try to open the airway The skin and deeper tissues are cold and cannot be depressed The entire body moves as a solid unit If the casualty is in a frozen state, do not attempt first aid for the ABCs. Transport the casualty to medical help if this doesn't pose a risk to the rescuers. Otherwise, get yourself to safety and advise the police of the location of the frozen person. Heat-related injuries Prolonged exposure to extreme heat or heavy exertion in a hot environment can cause heat illnesses. Factors that can contribute heat-related illnesses include the age of the casualty, their level of fitness, health condition, medications or other drugs, and occupation. Heat cramps Heat cramps are painful muscle cramps, usually in the legs and abdomen, caused by losing too much water and electrolytes through sweating. Heat cramps are usually caused by heavy exercise or physical work in a hot environment. The casualty will complain of cramps and show signs of excessive sweating, though in a dry environment, the casualty may not seem to be sweating because the sweat evaporates so quickly. First aid for heat cramps Place the casualty at rest in a cool place. Give the conscious casualty water or drinks with electrolytes and carbohydrates, as much as they want. Gentle massage can provide relief for cramps If the cramps don't go away, get medical help. Heat exhaustion Heat exhaustion is more serious than heat cramps. The casualty has lost a lot of fluids through sweating. Circulation is affected as the blood flows away from the major organs and pools in the blood vessels just below the skin. Signs and symptoms of heat exhaustion Excessive sweating and dilated pupils Casualty may complain of dizziness, blurred vision, headache or cramps Signs of shock, including: cold, clammy skin; weak, rapid pulse; rapid, shallow breathing; vomiting and unconsciousness Dry mouth and thirst (signs of dehydration) Irritability or aggressive behaviour First aid for heat exhaustion First aid for heat exhaustion combines the first aid for heat cramps with the first aid for shock. If the casualty is conscious: Give the conscious casualty water or drinks with electrolytes and carbohydrates; if the casualty vomits, don't give anything by mouth and get medical help right away Place them at rest on their back in a cool place Remove excessive clothing and loosen tight clothing at the neck and waist Apply cool wet towels or cold packs to the body core, around the head, and under the arms If the casualty is unconscious: Place them in the recovery position Get medical help right away Give ongoing casualty care until medical help takes over. Heatstroke (hyperthermia or sunstroke) Heatstroke is a life-threatening condition where the body's temperature rises far above normal. It is caused by prolonged exposure in a hot, humid, and perhaps poorly ventilated environment. In classic heatstroke, the body's temperature control mechanism fails; sweating stops and the body temperature rises rapidly. In exertional heatstroke, the body temperature rises rapidly due to heavy physical exertion in high humidity and temperature, even though sweating continues. Elderly people and those in poor health are more likely to suffer from heatstroke. Without immediate first aid heatstroke can result in permanent brain damage or death. Signs and symptoms of heatstroke Body temperature rapidly rises to 40°C or higher-the casualty is hot to the touch The pulse is rapid and full but gets weaker in later stages Breathing is noisy Skin is flushed, hot and dry in classic heatstroke, and flushed, hot and sweaty in exertional heatstroke Casualty is restless and may complain of headache, fatigue, dizziness and nausea Vomiting, convulsions, unconsciousness may occur You can tell the difference between heat exhaustion and heatstroke by the condition of the skin. In heat exhaustion, the skin is moist and cold. In heatstroke, the skin is hot, flushed and may be dry or wet. First aid for heatstroke Perform a scene survey and a primary survey. Lowering body temperature is the most urgent first aid for heatstroke. Move the casualty to a cool, shaded place. Cool the casualty-remove outer clothing and immerse the casualty in cool water up to the chin-watch them closely. If this is not possible: Cover them with wet sheets and fan the sheets to increase cooling. Sponge the casualty with cool water, Place cold packs in the armpits, neck and groin areas. When their body feels cool to touch, cover with a dry sheet. Put the conscious casualty into the shock position and the unconscious casualty into the recovery position. If their temperature begins to rise again, repeat the cooling process. Give ongoing casualty care until handover to medical help. Lightning injuries Electrical storms occur throughout most of Canada. Although the chance of being struck by lightning is very low, there are many injuries and deaths each year from lightning strikes. Give first aid at the scene of a lightning strike as you would any other emergency scene, keeping the following in mind: A person struck by lightning does not hold an electrical charge, you can touch the casualty without fear of electric shock The casualty has probably been thrown-suspect a head or spinal injury Lightning does strike the same place twice-assess the risk of another strike, and move to a safer location if needed If more than one person is injured, the principles of multiple casualty management are reversed-give first aid to unresponsive non-breathing casualties first since the casualties still breathing are on the road to recovery Advise all casualties of a lightning strike to seek medical help to ensure a full evaluation of any injuries Poisoning A poison is any substance that can cause illness or death when absorbed by the body. There are poisonous substances all around us. Poisonous consumer products have poison symbols on their labels, but there are many other poisonous substances that don't carry warnings. Examples include alcohol, some common household plants, contaminated food, and medications when not taken as prescribed. Many substances that are not harmful in small amounts may be poisonous in large amounts. Poisons are classified according to how they enter the body: Swallowed poisons-through the mouth Inhaled poisons-through the lungs Absorbed poisons-through the skin and mucous membranes Injected poisons-through a hollow needle or needle-like device (e.g. a snake's fangs) An important part of the first aid for poisoning is telephoning your local or provincial poison information centre for advice on what to do. Before calling, the first aider must quickly gather as much information about the incident as possible. Use the history of the scene and the signs and symptoms of the casualty to gather the information you'll need to answer the questions asked by the poison information centre. History of the scene You need to know four basic facts to give appropriate first aid for po1son1ng: What poison was taken-container labels should identify the poison; otherwise, save vomit and give it to medical help for analysis. What was taken will often tell you How the poison entered the body-first aid may differ for poisons taken by mouth, absorbed through the skin, injected into the blood or breathed into the lungs. How much poison was taken-estimate the quantity that may have been taken based on what you see or are told­ the number of pills originally in the container, the amount of chemical in the bottle, etc. Estimate the size/age of the casualty, the smaller the person the more dangerous the dosage. When the poison was taken-the length of time the poison has been in the body will help determine the first aid and medical care needed Signs and symptoms of poisoning If the history does not reveal what poison was taken, or by what means it was taken, signs and symptoms may be helpful in answering these questions. Signs and symptoms depend on the method of poisoning, however signs and symptoms common to most poisonings include: Change in the level of consciousness Difficulty breathing (usually shallow and rapid) Change in the heart rate Burned tissue at the route of entry Chest pain Other signs and symptoms related to the method of poisoning include: Swallowed poisons usually cause nausea, abdominal cramps, diarrhea and vomiting. They may discolour the lips, cause burns in or around the mouth or leave an odour on the breath Poisons absorbed through the skin may cause a reddening of the skin, blisters, swelling and burns Poisons injected through the skin usually irritate the point of entry Inhaled poisons may cause coughing, chest pain and difficulty breathing Note that some poisonous gases (i.e. carbon monoxide) are colourless and odourless. They are not to be easily detectable. Exercise extra caution if inhaled poisoning is suspected. General first aid for poisoning Perform a scene survey. Do a primary survey. Gather any information about the suspected poison. If the casualty is responsive, call the poison information centre in your region and follow their advice. If the casualty is unresponsive or having a seizure, call for medical help. If the casualty is unresponsive but breathing, place in the recovery position. Give ongoing casualty care until medical help takes over. First aid for swallowed poisons If CPR is required, check the area around the mouth for poisonous residue and wipe clear. Always use a barrier device for added protection. Perform a scene survey and a primary survey. Do not dilute a poison that has been swallowed (do not give fluids) unless told to do so by the Poison Information Centre. If the casualty is conscious, wipe poisonous or corrosive residue from the casualty's face and rinse or wipe out the mouth. Never induce vomiting except on the advice of the Poison Information Centre-many poisons will cause more damage when vomited. First aid for inhaled poisons Perform a scene survey and a primary survey. Assess hazards with particular attention to the possible presence of a poisonous gas or vapour. Ensure your safety; it may be best to wait for professional rescuers. Move the person to fresh air and away from the source of the poison. If breathing is not present begin CPR. If the poison could affect you while giving first aid, use a face mask or shield with a one-way valve. If the casualty vomits, keep the airway open by clearing out the mouth and putting the casualty into the recovery position. If the casualty goes into convulsions, prevent them from injuring themself. Give ongoing casualty care. Get medical help. First aid for absorbed poisons Most poisons absorbed by the skin cause irritation at the place of contact, but don't affect the rest of the body. The irritation, called contact dermatitis, includes redness, itching and blisters. Some chemicals, however, do affect the rest of the body when absorbed by the skin, and these can cause life-threatening emergencies. Perform a scene survey and a primary survey. Flush the affected area with large amounts of cool water; if the poisonous substance is a powder, brush off excessive amounts with a dry cloth before flushing. Remove any clothing that has been in contact with the poison. Don't touch the clothing until it has been thoroughly washed. Wash the affected skin thoroughly with soap and water. Give ongoing casualty care until medical help takes over. First aid for injected poisons Follow the general first aid for poisoning. Injected poisons should be contained near the injection site. Delay the circulation of the poison throughout the body by placing the casualty at rest and keeping the affected limb below heart level. If you have been pricked with a needle with possible transmissible disease contamination, then the site of the needle-stick injury should be vigorously scrubbed with Iodine or similar disinfectant. Get medical attention. Emergency childbirth and miscarriage Emergency childbirth occurs when a child is born at an unplanned time or at an unplanned place. This may happen when there is a sudden, premature delivery or when the mother cannot get to the hospital for a full-term delivery. An average pregnancy is 40 weeks. If the baby is born before the 37th week, it is considered premature. Miscarriage is the loss of the fetus before the 20th week of pregnancy. Pregnancy and childbirth A baby is born in a three-stage process called labour. It can be hard to tell when labour has started, but it has probably begun when one of the following happens: The uterus contracts at regular intervals of ten to twenty minutes, with contractions getting increasingly stronger and closer together Amniotic fluid comes out of the vagina, which means the amniotic sac has broken-this maybe called the "water breaking." There may be a trickle or a rush of flu id Blood and mucus come from the vagina-this "bloody show" means that the mucus plug that had sealed the cervix has come out because the cervix has started to open Stage 1: Early labour-opening of the cervix The first stage of labour, called early labour, can take up to eighteen hours for a first child, but may be much shorter for the second or subsequent children. Usually there is enough time to get the mother to a medical facility. Early labour involves muscular contractions that may begin as an aching feeling in the lower back. As contractions get stronger, they feel like cramps in the lower abdomen. Contractions cause the cervix to open, or dilate. The cervix has to dilate until the opening is about 10 cm across before the fetus can be pushed down the birth canal, which is the second stage of labour. Stage 2: Birth of the baby The second stage of labour usually takes about one hour. It begins when the cervix is fully dilated and the contractions start to push the fetus out of the uterus and through the vagina. When the baby's head is close to the vaginal opening, the mother may feel a tremendous urge to push the fetus out. Usually, the fetus' head is born first, then one shoulder, then the other shoulder, and then the rest of the body is pushed out quite quickly. This second stage of labour ends when the baby is born. The baby will still be connected to the mother by the umbilical cord attached to the placenta, still in the uterus. Stage 3: Delivery of the placenta The third stage of labour is the delivery of the placenta after the baby is born. The uterus gets smaller and pushes the placenta out. This stage usually takes ten to twenty minutes. Labour is finished when the placenta is delivered. Emergency childbirth Your role as a first aider in emergency childbirth is to help the mother deliver the baby, to protect the mother and baby, and to save all parts of the placenta and amniotic sac until medical help takes over. If labour is in the second stage, the baby will be born quite soon. Recognize the second stage of labour by: Longer and stronger contractions, less than two minutes apart The mother's previous experience-if she says the baby is coming, believe her Bulging of the vaginal opening and seeing the baby's head (called crowning) The mother is straining and pushing down, and feels like she has to have a bowel movement If you see these signs, you will probably not have time to get the mother to medical help. Call medical help to the scene, if possible, and get ready to deliver the baby. Emergency delivery Locate someone to help you. Get the materials you will need to deliver the baby and the placenta. During the second stage of labour, when the baby will be born very soon, place the mother on her back with knees bent and head supported, unless she prefers another position. Cover her with sheets so you can easily lift them to check on the progress of labour. When you can see the baby's head, the mother can push with the contractions. Tell her to wait until the contraction peaks, then take a deep breath, put her chin on her chest and push down as hard and as long as she can, while she is holding her breath. She may be able to push like this twice for each contraction. Position yourself to watch for the baby. Usually the head is born first and if it comes out too quickly, the baby could be injured. As the head comes out, tell the mother to control her pushing. Support the baby as it is born, but be careful. A new-born baby has a very slippery whitish coating-handle the baby gently, firmly and carefully. Clear the baby's airway-all babies have fluid in the nose and throat. Hold the baby with the head lower than the body to help drainage. Most babies will cry right away. When they do, they become pink as they start breathing. If the baby doesn't start to breathe and remains pale and limp, try stimulating him. If the baby still doesn't breathe, start infant CPR. Once the baby is breathing, pat them dry with a towel, being careful not to remove the slippery coating. Wrap the baby in a dry towel or blanket to keep them warm. Check the umbilical cord. If the cord is still pulsating, keep the baby at the level of the vagina. If the cord has stopped pulsating, place the baby on their side in the mother's arms with the head low to assist drainage. Check the vagina for bleeding. If bleeding from the vagina is severe-act quickly. The umbilical cord must be tied because the baby's blood may be bleeding through the cord and out of the placenta. Tie the umbilical cord and keep the baby at the same level as the vagina. Wait for the placenta to be delivered. This usually happens within twenty minutes of the baby's birth, but don't be surprised if it takes longer. Gently massaging the mother's lower abdomen will quicken the delivery of the placenta. There may be some bleeding from the vagina after the delivery of the placenta. This is normal, and can usually be controlled by firmly massaging the uterus. The uterus can be felt as a hard, round mass in the lower abdomen. Massaging it every few minutes will help it to contract which helps control any bleeding. The baby's nursing at the mother's breast also helps to contract the uterus. Use sanitary pads to absorb any bleeding. Examine the skin between the anus and the vagina for lacerations and apply pressure with sterile dressings to any bleeding tears of the skin. Give ongoing casualty care to the mother and infant. Keep them warm and comfortable and transport them to medical help as soon as possible. Vaginal bleeding and miscarriage Miscarriage is the loss of the fetus before the 20th week of pregnancy. Most miscarriages happen because the fetus was not developing properly. The medical term for a miscarriage is spontaneous abortion. Signs and symptoms include: Vaginal bleeding that could be severe Signs of shock Cramp-like pains in the lower abdomen Aching in the lower back Passage of tissue First aid for miscarriage Your main concern in first aid for miscarriage is the shock caused by severe bleeding. The casualty may be very distressed. Perform a scene survey and a primary survey. Call for medical help. Give first aid for shock-place the woman on her back, or on her left side. Ensure privacy. Reassure her and give her emotional support. Keep any evidence of tissue and blood loss (bloody sheets, clothing, etc.). Send this with the woman to medical help for examination by the doctor. Give ongoing casualty care. Assault A casualty who has been assaulted may be feeling physically and emotionally distressed. In the case of sexual assault, there may be physical injuries along with emotional ones. There is potential for the casualty to go into severe emotional shock during or shortly after the attack. General first aid for assault Perform a scene survey including obtaining consent and ensuring the scene is safe for the first aider. This is potentially an emotional situation and the casualty may be feeling vulnerable. If you suspect an assault, try hard not to disturb evidence by removing, washing, or disposing of clothing. Call for medical help, stay with the casualty and offer reassurance until medical help arrives. Alcohol and Drug Considerations Drugs are defined as any substance that can produce a physical or mental effect on the body. They include alcohol, prescription drugs and illegal substances. The effects of drugs are wide-ranging and can be unpredictable. Dosages and combinations of drugs (including alcohol) will affect a casualty's condition. Be prepared for behaviour which can change quickly. First aid for a casualty on drugs or alcohol: Approach the casualty in a calm, professional, sympathetic manner and try to gain their confidence. Ask about the type and amount of the drug consumed, if possible. If the casualty has convulsions, vomiting or low or no level of consciousness, be sure to maintain an open airway and assess breathing. Give ongoing casualty care and get medical help. If present, check with family members if they have been provided a medication to use in case of overdose. If available and the first aider is trained, assist with an antidote if appropriate. Mental Health Awareness Consider these factors and how they might affect someone: Critical incident or traumatic event Dementia in an older adult (Alzheimer disease, Lewy body disease or vascular dementia, neurocognitive disorder) Mood and psychiatric disorders (depression, anxiety, bipolar disorder, schizophrenia) The World Health Organization defines health as "a state of (complete) physical, mental and social well-being and not merely the absence of disease or infirmity" (WHO). Mental health issues can be related to the health of a whole person. There are symptoms of physical conditions that may mimic the symptoms of a mental health issue or crisis such as: Diabetic emergencies Drug reactions Environmental emergencies (heat and cold injuries) Head injuries Infections/fever Lack of oxygen Shock If you are concerned for a casualty's well-being, call 911. It is more important to focus on getting the appropriate help than trying to determine a cause of the emergency. The Mental Health Continuum shows the range of mental health. Those with mental health illness or mental health problems can move through this range, and with self-care, support or treatment, they can "get back to green". The focus is behaviours because loved ones or colleagues who are suffering will show certain behaviours. They can be directed to resources. This is not a tool for diagnosing someone. That is for mental health professionals. CARE - Responding to a Mental Health Issue or Crisis C- Call for help if the person is at risk of suicide If you think this is a life-threatening emergency call 911; this is a time to take action. If no risk of suicide, proceed to the next step A-Ask & Listen. Ask the casualty how they are feeling and listen to the person's responses. The casualty may try to tell you what they need, so listening and really hearing this person is important. R - Respond with options that may be available to them. Important: Provide options NOT ADVICE. Example of what a first-aider could say, "There is a mental health crisis line that has helped other people, would you like to call them together?" Or "Maybe we could call someone that you would like to talk to (that you trust or that could help) right now?" See the Resources section for more information. E - Encourage support in a variety of ways. What the person may be feeling is normal and other people have felt this way too. A first aider can tell someone that they are not alone and to seek help. Anxiety or Panic Attack A panic or anxiety attack is both a mental health as well as a physical health issue. An anxiety attack has similar signs and symptoms to a heart attack and a first aider might not be able to differentiate between them. The anxiety attack can be serious and if left untreated, can lead to a more serious physical condition. Therefore it is always recommended to call 911. Signs and symptoms of an anxiety attack may include some or all of the following: Hyperventilating (breathing too quickly) Chest pain or tightness Trembling and sweating Hyperventilation, tingling hands and feet Nausea or vomiting ""l;I' 1 ,i-i£i3 <Ii :i:: "1::1. '3 l i:ii '! REACTING INJURED <fl ·OuJ C OJ O'l '- OJ E Q) ""CJ ro +-' <fl.:;':-:::: '-...OcJ: +-' 0 E :::, :::, ·.C.-, u0.c.:t:: (tJ Cl) J:.(.t,J C Cl) :E Physically and socially active Performing well Limited or no alcohol/gambling De0'63sed social activity Procrastination Regular alcohol use/gam ing IM>idance Tardiness Decreased performance Alcohol/gamblingh to control Soul"J!:e:wwN.theworkingmind.ca 0 --0 N First aid for a panic attack: Call 911 immediately. Sit the casualty down in a comfortable position, preferably in a quiet area if possible. While waiting for medical help, and if the casualty or hyperventilating, attempt to control or slowdown the casualty's breathing. Examples that can help someone focus on their breathing include: Ask them to count to 4 while breathing in, and again count to 4 while breathing out. Ask them to breathe in through the nose and out through the mouth. Do not have the casualty breathe into a paper bag. This is not effective and can make the attack worse. Occupational Stress Injury Occupational stress refers to stress related to one's job. It can be related to added responsibilities or workload without corresponding supports, role conflict, and working hour changes. In more extreme cases, it can be related to harassment, bullying, and a toxic work environment. An occupational stress injury occurs when mild stressors have reached a point to create a crisis. Signs and Symptoms of Occupational Stress Injury Disruption in sleep patterns and fatigue Irritability Lack of interest in food Anxiety or panic, particularly relating to work Lack of interest in work Increased risk-taking at work Isolation from co-workers Aggressive behaviour Other first aid emergencies Steps to care for Occupational Stress Injuries As with many first aid situations, the best care is prevention. If you recognize some of the symptoms listed above, examine ways to reduce the occupational stressors in your life. Make use of available vacation and mental health days Set aside time each day and each week for personal interests (even 15 minutes a day can help) Talk with family and friends about your struggles at work Strive to get more sleep, exercise, and eat well Leave work at work - home is for family and personal time If you recognize a co-worker may be suffering from an occupational stress injury, employ the steps of C.A.R.E. Engage the resources of Human Resources, an Ombudsperson, or governmental agencies if needed (i.e. Ministry of Labour). Crisis Help and Other Mental Health Resources 9-1-1 or 2-1-1; Check your local directory if not available in your region Kids Help Phone 1-800-668-6868 (all ages 20 and under) Mental Health Helpline 1-866-531-2600 or Web Chat www. mentalhealthhelpline.ca www.suicideprevention.ca - This resource has listings for Mental Health Crisis and Suicide help by province Local Employee Assistance Programs Mental Health First Aid: A 2-day program by the Mental Health Commission of Canada. The Working Mind: A longitudinal program by the Mental Health Commission of Canada that focuses on resiliency in the workplace. 262