First Aid, Emergency & Disaster NSG PDF

CHAPTER ONE INTRODUCTION HISTORY OF FIRST AID First aid is the provision of initial care for an illness or injury. It is usually performed by non- experts, but trained personnel t...

CHAPTER ONE INTRODUCTION HISTORY OF FIRST AID First aid is the provision of initial care for an illness or injury. It is usually performed by non- experts, but trained personnel to a sick or injured person until definitive medical treatment can be accessed. The instances of recorded first aid were provided by religious knights, such as the Knights Hospitaller, formed in the 11th century, providing care to pilgrims and knights; and training other knights in how to treat common battlefield injuries. The practice of first aid fell largely in to disuse during the High Middle Ages, and organized societies were not seen again until in 1859 when Jean-Henri Dunant organized local villagers to help victims of the Battle of Solferino, including the provision of first aid. Four years later, four nations met in Geneva and formed the organization which has grown into the Red Cross, with a key stated aim of "aid to sick and wounded soldiers in the field". This was followed by the formation of St. John Ambulance in 1877, based on the principles of the Knights Hospitaller, to teach first aid, and numerous other organization joined them with the term first aid first coined in 1878 as civilian ambulance services spread as a combination of "first treatment" and "national aid" in large railway centres and mining districts as well as with police forces. It was Shepherd who first used the English term "first aid for the injured" First aid training began to spread through the empire through organizations such as St. John, often starting, as in the UK, with high risk activities such as ports and railways. Many developments in first aid and many other medical techniques have been driven by wars, such as in the case of the American Civil War, which prompted Clara Barton to organize the American Red Cross. Today, there are several groups that promote first aid, such as the military and the Scouting movement. New techniques and equipment have helped make today’s first aid simple and effective. Ghana Red Cross society was founded by Dr. Selwy and Clarke in 1929; the period Korle-bu was opened. There was need for maternal and child welfare services. Ghana Red Cross a branch 1 of British Red Cross Society in 1932. In 1958 it became a full independent member at the league of Red Cross Society and thereafter. Finally, it was recognized officially in 1958 as Ghana Red Cross Society. GENERAL PRINCIPLES OF FIRST AID First aid can be defined as the immediate, temporary treatment carried out in cases of emergency, sudden illness or accident prior to the arrival of a medical personnel or transportation of the patient to hospital. It is usually performed by non-expert, but trained personnel to a sick or injured person until definitive medical treatment can be accessed. Certain self-limiting illnesses or minor injuries may not require further medical care past the first aid intervention. It generally consists of a series of simple and in some cases, potentially life-saving techniques that an individual can be trained to perform with minimal equipment. AIMS OF FIRST AID To save life: This is done by making sure that the airway is patent and that breathing and heart beat are maintained or restored to its normal way. Also bleeding should be controlled and the casualty treated for shock. To relieve pain: Pain is a symptom that accompanies every injury, illness or disease. It may be slight or severe and when allowed to persist it can retard recovery and lead to death. Pain can be relieved by providing comfort such as pillows, immobilization of fracture, cold or hot compresses. To prevent complications: This is done by providing and using proper materials and simple methods of treatment which are immediately available. The first aider should also try to prevent the condition from becoming worse by doing the right thing at the right time, following the sequence of first thing first. 2  OBJECTIVES OF FIRST AID 1. To help the medical team: The first aider can help the medical team by doing the right thing and giving detailed information about the accident or illness and the first aid given to the victim. 2. To promote improvement: This is achieved by handling the victim gently, carefully and giving appropriate care without any disturbance. The first thing should be done firstly and no attempt should be made to do more than necessary. 3. To make adequate use of limited resources to help a victim out of a life threatening situation. 4. To employ effective and appropriate basic life saving techniques during emergencies. 5. To provide physical, psychological or emotional support and comfort. 6. To prepare the casualty for hospital treatment: This is done by keeping the wound as clean as possible so as to prevent infection. The best sort of treatment given by the first aider would make it possible for the casualty to be rushed to the theatre for immediate surgical operation or to be admitted on the ward for further medical care and necessary investigations. 7. Transport: The casualty should be transported as soon as possible to the hospital immediately after. No time should be wasted. In doing this, use any means of transport available e.g. by car, stretcher, human carriage or any means available. QUALITIES OF THE FIRST AIDER A first aider is any person who has been trained in first aid and has been awarded a certificate to give first aid safely. He/she should possess some basic qualities among which are; 3 Intelligence: the first aider must be intelligent and must have the necessary knowledge which is acquired from lectures, text books, magazines, periodicals and practical experiences. He must be both mentally and physically sound. Efficiency: the first aider must be efficient in the practical world which is an important factor of first aid treatment. He must have the ability to practice carefully what he has been taught, and what experience has shown to be proper. This involves the use of common sense. Organizational ability: the first aider must have the ability to organize his work methodically and be able to approach each case according to individual demand. Self confidence, sympathy and tact: the first aider must be a person who commands self confidence, he must have sympathy and tactful enough so that he does not easily get annoyed when faced with simple or multiple injuries. He must have good understanding of the casualty as an individual and be tactful in handling the victim and relatives, friends or standers by. Resourcefulness: resourcefulness, adaptability and good sense of judgment. This implies that the first aider must not stick rigidly to laid down rules in all cases. He must think fast and use his own initiatives and discretion when face with difficult situation. He must also be able to improvise the use of appliances which are not readily available suitable method when necessary. He should be able to put to use his common sense and the ability of a good leader. Approachable: a relaxed and cheerful countenance is reassuring and gives the casualty a sense of hope, acceptance and security. First aiders should handle casualties and care for them the way they want to be treated. A friendly approach can tremendously allay anxiety, inspires confidence and enable the first aider to gain the cooperation of the casualty and bystanders. RULES OF FIRST AID TREATMENT 1. Remove the victim from danger or remove further danger from the victim. 2. Treat the most urgent condition first and in order of precedence. These are; apparent cessation of breathing, severe bleeding and shock. 3. Unconscious victim should be place in the prone position or lying on their side or if not possible, lying in the recumbent position with the head turn to one side. 4  4. Unconscious victims should not be giving anything by mouth. This holds good for victims who are bleeding or vomiting. 5. Alcoholic stimulants should not be given as these have transient effect and subsequent depressive effect on the vital centers. 6. Reassure victim by word of mouth to allay anxiety, inspire hope and gain cooperation 7. Medical aid should be sought by writing message rather than verbally. 8. Organize unskilled onlookers or supervisors to help in any way possible. 9. Control bystanders and onlookers and prevent them exciting the patient. 10. Handle victim properly. If there is a suspected fracture, support the limb or part most carefully. Do not lift victim unless there are sufficient helpers. If cloths have to be removed e.g. jacket or trousers cut them carefully at the seams. This means they can be stitch again if necessary. Always remove garment from the uninjured part first; this enables the garment to be slipped off the injured part. 11. A sensible assessment of the situation is essential, especially if a decision is to be made regarding the need for medical aid or the transportation of the patient to hospital. THE SCOPE OF FIRST AID This consist of four components 1. Assessing the situation 2. Diagnosing what is wrong with the casualty 3. Giving immediate and appropriate treatment and 4. Disposing the casualty to the hospital or home depending on the seriousness of the condition. 5 ASSESSING THE SITUATION The first aider should be calm and take charge of the situation. She should be confident to the casualty by talking to him, listening to him and reassure him or her. Ensure safety of the casualty and yourself and guide against further casualty arising. In the case of road traffic accident, instruct someone to control the traffic. In case of collapsing building or fire, move the casualty to safety. In case of gas and poisonous fumes, turn off the gas or move casualty to safety where fresh air is available. In the event of electrocution, switch off the current and take precaution against electric shock. Get others to help you by making use of bystanders. Keep them occupied, the more they are giving something to do the less they interfere with your work. Telephone for or send for the ambulance, police or other services. Keep back any crowd and assist if necessary with the actual treatment of the patient. When sending bystanders to telephone, make sure that they understand the message they send. Write it down if possible but in any case ask them to repeat the message before actually sending it. See that they report to you. DIAGNOSIS Diagnosis is the determination of the disease or injury causing or producing the signs and symptoms. In arriving at the diagnosis, the first aider is guided by; History of the case reports giving by a conscious casualty or by people present as to how the accident happened or how the illness started. Signs: this includes all the physical manifestations observed by the first aider. It is obtained by a complete examination of the casualty. Symptoms: this includes all that the casualty complains of i.e. all the details of the sensations obtained from the casualty. Use all your senses to obtain maximum information i.e. look, touch, listen, speak and smell. 6 OBSERVATION FOR THE PURPOSE OF DIAGNOSIS If the casualty is conscious, ask him if he has pain, where the pain is located and if there is pain examine the part carefully. Handle the injured part gently but firmly, make sure there are no further injuries to the casualty. If he thinks there is anything more then check tenderness and bleeding. Examine the casualty carefully in a regular and methodical manner by running your hands gently but firmly over all parts of the body. Start at the head and neck, then spine and trunk, the upper limbs and the lower limbs. Always compare the abnormal side to the normal side. The first aider only needs to remove enough of the casualty’s clothing to expose injuries and treat them. Check the breath, color of skin, nature of breathing and pulse and note its strength and reading. Also note the temperature of the body whether it is cold or hot to touch. If the casualty is unconscious the task is much more difficult and a thorough detailed examination is necessary as no symptoms are available to help. If breathing is present, note its level. If absent immediately commence artificial respiration. Examine overall under the casualty for dampness which may indicate bleeding or incontinence. Stop any serious bleeding before proceeding further with the examination bearing in mind the possibilities of internal bleeding. Establish the cause of the unconsciousness by examining the breathing and depth, pulse rate and its character. Look at the color of the face and determine the temperature, examine the pupil of the eyes, note their size, reaction to light and injuries to the eyeball. Carefully examine the head for any injuries as well as the ears, eyes, nose and the mouth for blood and other deformities. Take a look at the whole body for signs of injuries. If there are casualties with multiple assessments, one must receive priority treatment. Immediately place any unconscious casualty in the recovery position if you are working alone before you attend to other victims. Effect temporary control of continuous severe bleeding with the assistance of the casualty or bystanders if available. NB. The noiseless casualty is the most severely injured 7 GIVING IMMEDIATE AND APPROPRIATE TREATMENT After the above measures have been taken, the immediate and appropriate treatment should be given. In the cause of treatment, priority should be set, such as giving first thing first applying the correct method of treatment. Where breathing has ceased, artificial respiration should be immediately commenced to ensure that the casualty is receiving sufficient supply of oxygen. Secondly, if there is any severe bleeding it should be controlled to prevent the loss of this vital body fluid. Thirdly if the casualty is in shock or unconscious, warmth should be provided, the airway cleared and the feet slightly raised than the head to facilitate adequate supply of blood to the brain and other measures taken to prevent the casualty from further injury. DISPOSAL OF THE CASUALTY TO THE HOSPITAL OR HOME Immediately after treatment, the casualty should be removed as quickly as possible by any suitable means to the nearest hospital or the casualty sent home as the condition demands. If the casualty is sent to the hospital a brief and explicit note stating the extent of treatment given and any necessary information should accompany him to the hospital. In some cases it may be necessary for first aider himself to accompany the casualty to the hospital. A note should be sent to his relatives if the casualty is sent to the hospital or employer stating his where about. PRIMARY SURVEY In the event of an accident the first aider must be quick at taking decision and to seek priorities to lead him to the appropriate steps in treatment that should be given. In less than a minute you can check the victim for immediate life threatening conditions. This is called primary survey or “checking the ABCs” where A = Airway B = Breathing and C = Circulation A=AIRWAY 8 We can breathe only if the airway is patent (open). The airway may be blocked by something stuck in the throat or by an unresponsive victim’s own tongue. To make sure the tongue is not obstructing the airway in an unresponsive victim, position the victim’s head to open the airway. In a victim not suspected of having a neck injury, lift the chin and tilt the head back (head tilt- chin lift). If the victim may have a neck or spine injury, do not tilt the head back to open the airway. Instead only lift the jaw upward using both hands (jaw thrust) B=BREATHING After opening the airway you then check to see if the victim is breathing. Lean over with your ear close to the victim’s mouth and look at the victim’s chest to see if it rises and falls with breathing. Listen for any sounds of breathing and feel for breath on your cheek. If you do not notice any signs of breathing within 10 seconds, assume the victim is not breathing. Initiate rescue breathing and cardiopulmonary resuscitation at this point. C=CIRCULATION After checking for the victim’s airway and breathing, you next check for circulation. This means checking that the heart is beating and blood is moving round the body. If the victim’s heart has stopped or the victim is bleeding profusely,, there is a circulation problem and the victim can die. If the victim is moving, coughing, speaking or breathing, the heart is beating. Check for signs of circulation by scanning the body for signs of breathing, coughing, movement and normal skin condition. Lack of circulation may be indicated by bluish, pale skin color, cool skin temperature, and clammy skin. It is currently recommended that only health care workers or professional rescuers spend time checking for a victim’s pulse 9 Check for severe bleeding by quickly looking over the victim’s body for obvious blood. Control any severe bleeding with direct pressure. After checking the ABCs for immediate and life-threatening conditions try to find out more about what happened and the victim’s condition. Talk to a responsive victim, or ask bystanders about what they know or saw in a situation involving an unresponsive victim. Use the SAMPLE history format. S= signs and symptoms: what you can observe about the victim (signs)? Ask the victim how he or she feels (symptoms). A= allergies: ask the victim about any allergy to foods, medicines, insect stinks or other substance. Look for a medicine alert bracelet. M= Medications: ask the victim if he or she is taking any prescribed medications or over the counter products. P = previous problems: ask if he or she has had anything like this before or has any other illnesses. L = Last food or drink: ask the victim what and when he or she ate or drank anything. E = Events: ask the victim what happened and try to identify the events that lead to the current situation. The information from the SAMPLE history may help you give the right first aid. If the victim is unresponsive when help arrives, give any information gathered to the EMS professionals. It will help to give appropriate medical care. 10  CHAPTER TWO RESCUE BREATHING OR ARTIFICIAL RESPIRATION Respiratory emergency is one in which normal breathing stops or in which breathing is reduced so that oxygen intake is insufficient to support life. Artificial respiration also known as “RESUSCITATION” is a procedure for making air to flow into and out of a person’s lungs when his natural breathing is inadequate or ceases. Methods of rescue breathing include; mouth to barrier, mouth to mouth, mouth to nose and mouth to stoma. COMMON CAUSES OF RESPIRATORY FAILURE (PROBLEMS) i. Obstruction of the air way by tongue dropping back. ii. Aspiration iii. Compression of the neck iv. Respiratory disease v. Drowning vi. Strangulation vii. Electrical shock viii. Lung disease ix. Heart disease x. Circulatory collapse (shock) xi. Swallowing of corrosive poisons xii. Direct injury cause by a blow xiii. Swelling after burns of the face xiv. Inhalation of combustible gases, carbon monoxide etc. ARTIFICIAL RESPIRATION General Information  The average person may die within 4- 6 minutes if his/ her oxygen supply is cut off.  Recovery is usually rapid except in case of carbon monoxide poisoning, over dosage of drugs or electrical shock. In such cases, it is often necessary to continue artificial respiration for a long time.  When a victim revives he/she should be treated for shock  A physician care is necessary during the recovery period  Artificial respiration should always be continued until: 11  - the victim begins to breathe by himself - He/she is pronounced dead by a doctor or he/she is dead beyond any doubt. MOUTH- TO- MOUTH ARTIFICIAL RESPIRATION (“kiss of life”) 1. Lay the patient flat on his or her back 2. Clear any obstruction from the mouth 3. Extend the patients head 4. For hygienic purposes a handkerchief or piece of tissue can be placed over the patient’s mouth, provided that it does not limit the flow of air into the lungs 5. The operator now holds the patient’s nose closed covers the patient’s mouth completely with his or her own mouth and blows quickly, deeply and sharply into the patient’s mouth. This air inflates the patient’s lungs. This can be seen by the rise of the chest wall. The operator now releases the hold on the patient’s nose and allows expiration to take place. The process should be continued for as long as is necessary. Individuals inspire approximately 16 times per minute. The operator should try to inflate the lungs 14 – 16 times per minute. If pulse cannot be felt, external cardiac massage can be started. Both procedures can be carried out simultaneously. The massage is applied by another first aider. The work of the two first aiders must be synchronized. CARDIOPULMONARY RESUSCITATION Cardiopulmonary resuscitation (CPR) is an emergency technique which combines rescue breathing and chest compression. Rescue breathing serves to get oxygen into the victim’s lungs whiles chest compressions is to pump oxygenated blood to vital organs. It is indicated in those victim’s who are unresponsive with no breathing or abnormal breathing, 12 CPR involves chest compressions at least 5 cm deep and at a rate of at least 100 compressions per minute in an effort to create artificial circulation by manually pumping blood through the heart STEPS INVOLVED IN CPR 1. When approaching a patient the rescuer should check that there are no hazards to him before proceeding to treat the victim. 2. Assess level of consciousness: shake victim’s shoulder and shout “are you ok?” if no response, call for help and activate the EMS system. 3. Assess and establish an airway (in less than 10 seconds): use head-tilt or jaw-thrust maneuver; determine whether air is being exchanged by looking to see whether the chest is moving, listening for whether air can be escaping during exhalation, and feeling whether air can be felt escaping during exhalation. 4. Initiate rescue breathing: maintain the head-tilt or jaw-thrust maneuver and pinch the victim’s nostrils; give two slow breaths using pocket mask or bag mask. 5. Assess circulation: palpate carotid pulse 6. Deliver external cardiac compressions: ensure that the victim is on a hard surface and in a supine position; place heel of hand over lower half of body of sternum, interlock hands and compress the chest 3.8 to 5cm (1.5 – 2 inches for an adult). 7. Maintain the ventilation/compression ratio: one or two rescuers – two breaths after every 15 compressions (rate of 100 per minute); reassess carotid pulse after first four cycles and then every few minutes. 8. Defibrillate using automated external defibrillator (AED); part of BLS for health care providers (if available). 9. Place victim in recovery position if pulse and respiration resumes; continue to monitor breathing regularly. 10. Terminate CPR indicated: return of cardiac rhythm and spontaneous respirations; rescuer exhaustion; physician ordered cessation. 13 NB: Artificial respiration + cardiac massage = CPR BACK BLOWS OR SLAPS This is basically the use of percussions to exert pressure behind the blockage in an attempt to dislodge the object causing airway obstruction. In most victims’s the vibration caused by the blows or slaps may be enough to move the object sufficient to provide temporally relieve. STEPS 4. With the heel of the hand, strike the casualty between the shoulder 1. Quickly rush to aid of a choking blades. victim and assess the level of consciousness 5. Keeping the casualty bent forward, encourage coughing after about five 2. If conscious and breathing, stand to blows. the side slightly behind the victim. 6. After each circle of back blows, 3. Supporting the chest with one hand, check to see if there is improvement. help the victim lean slightly forward. 14  Also check the mouth for any obvious article. 7. After three circles of back blows, if the airway is still not cleared, try Heimlich maneuver/abdominal thrusts. 15  HEIMLICH MANEUVER 1. Stand behind the person. Wrap your arms around the waist. 2. Make a fist with one hand and place your fist with thumb side in, just above the navel but below the person’s rib cage in the front. 3. Grasp the fist with the other hand. Keeping your arms off the person’s rib cage, give four quick inward and upward thrusts. 4. Repeat this several times (four to five times) until the object is coughed out or the person becomes unconscious. 5. If choking continues, seek medical help. 16  EMERGENCY CARE AND TRIAGE By definition, emergency care is care that must be rendered without delay. In a hospital ED, several patients with diverse health problems—some life-threatening, some not—may present to the ED simultaneously. One of the first principles of emergency care is triage. TRIAGE The word triage comes from the French word trier, meaning “to sort. Triage is used to sort patients into groups based on the severity of their health problems and the immediacy with which these problems must be treated. A basic and widely used system uses three categories: emergent, urgent, and non-urgent (Berner, 2001). Emergent patients have the highest priority—their conditions are life threatening, and they must be seen immediately. Urgent patients have serious health problems, but not immediately life threatening ones; they must be seen within 1 hour. Non-urgent patients have episodic illnesses that can be addressed within 24 hours without increased morbidity. 17 A fourth, increasingly used class is “fast-track.” These patients require simple first aid or basic primary care. 18  CHAPTER THREE SHOCK Shock is a condition resulting from a depressed state of many body functions due to the brain (vital centres in the medulla oblongata) being depleted of sufficient blood supply. Shock may be primary or secondary. Primary shock occurs immediately after the accident or sudden illness. Secondary shock may not develop until several hours after the accident or sudden illness, and is usually very serious. TYPES OF SHOCK 1. Anaphylactic/ Allergic shock: - this occurs as a result of injecting a patient with a drug or protein he/ she reacts to. 2. Cardiogenic shock: - this occurs as a result of acute heart condition, e.g. myocardial infarction. 3. Hypovolaemic/ Oligemic shock: - this occurs as a result of low blood volume. 4. Neurogenic shock: - this occurs as a result of nervous or emotional factors. 5. Septic shock: - this occurs as a result of infection. CAUSES OF SHOCK i. Haemorrhage ii. Severe vomiting and diarrhea iii. Burns iv. Infections v. Heart diseases vi. Effects of drugs, alcohol, chemicals and gases. vii. Pain viii. Emotional conditions like stress and fear 19 SIGNS AND SYMPTOMS OF SHOCK  Cold, moist and clammy skin  Cold extremities to touch  Pale or bluish skin and mucous membrane (pallor or cyanosis)  Rapid, weak and thready pulse  Rapid and shallow respiration, at times ‘air hunger’  Low blood pressure (both systolic and diastolic)  Subnormal temperature  Scanty and concentrated urine  At times insensitive to pain  Weakness  Severe thirst  Restlessness and anxiety. FIRST AID MANAGEMENT OF SHOCK 1. Reassure casualty if conscious and arrange for medical aid. 2. Lay the patient down either on bed or at a safe place. 3. If it is possible raise the lower part of the body except where there is head injury. 4. Place casualty on his back without a pillow with the head turned to one side if he is unconscious. 5. Provide warmth by using extra linen. Make sure the casualty is not overheated 6. Do not give the casualty any stimulant 7. Before anything is given by mouth, the first aider should make sure that the casualty will not need surgery when he is taken to the hospital. 8. Sips of water may be given when casualty is bleeding or in cases of burns. 9. Undo tight clothing around neck, chest and waist. 10. Make sure casualty is not being crowded by onlookers or spectators. 11. Keep the casualty absolutely still and quiet. 20 12. Any obvious bleeding must be stopped as soon as possible. 13. Pain must be relieved as far as possible, e.g. by supporting an injured limb, or placing the casualty in the most comfortable position. 21  CHAPTER FOUR HAEMORRHAGE OR BLEEDING It is loss of blood, usually through disease, injury, or other physical conditions. It may be internal or external and any type of blood vessel may be involved. CAUSES OF HAEMORRHAGE i. Direct injury to the blood vessel as a result of an accident or surgical intervention ii. Disease of the blood vessel wall iii. Disease of the blood, e.g. haemophilia CLASSIFICATION OF HAEMORRHAGE Bleeding may be classified in several different ways: 1. According to its situation. 2. According to its source. 3. According to the time it occurs. ACCORDING TO SITUATION OF BLEEDING We have external bleeding and internal bleeding EXTERNAL BLEEDING This is where the blood escapes from the blood-vessel on to the surface of the body and can be seen. INTERNAL BLEEDING Bleeding inside body cavity may follow an injury, such as a fracture or a penetrating wounds, but can also occur spontaneously for example, bleeding from a stomach ulcer. The main risk from internal bleeding is shock. In addition, blood can build up around organs such as the lungs or brain and exert damaging pressure on them. 22 You should suspect internal bleeding if a casualty develops signs of shock without obvious blood loss. Check for any bleeding from body openings (orifices) such as the ear, mouth, urethra, or anus. ACCORDING TO SOURCE OF BLEEDING Different types of blood vessels may be involved in hemorrhage when an injury occurs. ARTERIAL BLEEDING If an artery is injured the blood will be bright red in colour, spurting from the wound, escaping from that part of the wound nearest to the heart, and escaping from the wound under great pressure. VENOUS BLEEDING If an artery is injured the blood will be dark red in colour, escaping from the wound in a steady stream and not under great pressure, and escaping from the part of the wound farthest from the heart. CAPILLARY BLEEDING This occurs in superficial wounds. Blood will be oozing from the wound, neither bright red nor dark red in colour, and welling up from all over the wound. ACCORDING TO TIME OF BLEEDING Haemorrhage may occur at the time of injury or later PRIMARY HAEMORRHAGE This occurs at the time of the injury or operation or when the vessel has been damaged by the disease. 23 REACTIONARY HAEMORRHAGE Up to 24 hours after an injury or operation, bleeding may start again. This is due to the reaction of the body. When there is haemorrhage, the body employs three ways to prevent serious blood loss.  The blood pressure is lowered  A blood clot forms  The blood vessel constrict to hold the clot in position Reactionary haemorrhage may occur when the blood pressure returns to normal and the blood pressure is pushed out. SECONDARY HAEMORRHAGE This bleeding may occur 7 to 10 days after injury or operation due to infection. It is extremely dangerous and shows the importance of keeping wounds absolutely clean. SIGNS AND SYMPTOMS OF HAEMORRHAGE 1. Initially, pale, cold, clammy skin. If bleeding continues, skin may turn bluish-grey (cyanosis) 2. Rapid weak pulse 3. Thirst 4. Rapid, shallow breathing 5. Confusion, restlessness, and irritability The signs and symptoms are the same whether bleeding is internal or external. They only vary in degree depending on the amount of blood loss. Early detection of internal haemorrhage is very vital in saving the patient’s life. FIRST AID TREATMENT OF INTERNAL HAEMORRHAGE 1. The patient must be laid down, lying flat and kept absolutely still. 2. Reassured the patient to allay fears and anxiety 3. The lower end of the bed should be elevated if possible 4. Undo tight clothing around the neck, chest, and waist 24  5. Seek for medical aid. FIRST AID TREATMENT OF EXTERNAL HAEMORRHAGE Same as internal haemorrhage with the following additions: 1. The wound must be covered immediately with a clean dressing 2. Raise the involved part as high as possible if it is a limb 3. Apply direct pressure to the wound by placing a pad over the clean dressing and bandaging it firmly. 4. Digital pressure can be applied to the nearest artery supplying the injured part. 5. Only as a last resort should a tourniquet be applied. It can only be done for bleeding from a limb. It must be tight enough, there must be a piece of material between the tourniquet and the skin, it should not be left on for more than 15 minutes, and an indication of the presence of a tourniquet must be made obvious. SPECIAL HAEMORRHAGES EPISTAXIS This means bleeding from the nose. It occurs when a small blood vessel in the lining of the nose burst. It is very common in children and often results from activities such as blowing it too hard or too often, or from getting knocked on the nose when playing Causes 1. A blow to the nose 2. Forceful sneezing 3. High BP 4. Head injury 5. High altitudes 6. Rheumatic fever 7. Picking of the nose 25 FIRST AID MANAGEMENT OF EPISTAXIS 1. Place the patient in a chair in a sitting position with the head held forward 2. Loosen tight clothing round the neck, chest and waist, and place the patient near an open window. 3. Ask patient to breathe through the mouth 4. Pinch the nose firmly between the thumb and forefinger 5. Apply cold compress over the bridge of the nose and at the back of the neck 6. Keep the patient sitting very still 7. Arrange for a doctor if bleeding persists for several minutes. HAEMOPTYSIS This is the term used to describe ‘coughing up’ of blood. The blood may be coming from any part of the respiratory tract commonly the lungs. The ‘cough up’ blood is always bright red in colour and ‘frothy’. FIRST AID MANAGEMENT OF HAEMOPTYSIS 1. Patient should sit up in a chair or propped up in a bed 2. Tight clothing round the neck, chest, and waist should be loosened. 3. The patient must be reassured, kept very still and quiet. 4. Ice may be given to suck. 5. Medical aid should be obtained. 6. Keep all sputum specimens for the doctor’s inspection. HAEMATEMESIS This is the term for vomiting of blood. The bleeding may be coming from any part of the upper alimentary tract. The commonest site is gastric ulcer, but it may be from the oesophagus or duodenal ulcer. The blood when vomited is gritty and dark brown in colour. It is sometimes referred to as ‘coffee ground sicknesses. 26 FIRST AID MANAGEMENT OF HAEMATEMESIS 1. Patient should immediately lie down 2. All tight clothing should be loosened 3. Reassure patient 4. Keep patient absolutely still and quiet 5. Patient should not be given anything by mouth 6. Arrange for a doctor to assess the extent of the bleeding 7. All specimens of vomitus should be kept for the doctor’s inspection. MELAENA This term is used to describe the presence of blood in stools. When the bleeding is from upper part of the intestinal tract, the stools appear black and tarry. The term melaena means black, tarry stools. Stools may contain bright red blood when the bleeding is coming from the lower end of the intestinal tract. Bleeding from the lower end of the intestinal tract may be due to: hemorrhoids, dysentery, cancer of the lower bowel, and colitis. NB: Patient taking iron tonic may pass black stools. FIRST AID MANAGEMENT OF MELAENA 1. Put patient to bed quietly and kept still 2. Any stool specimen should be kept for doctor’s inspection 3. Medical aid should be obtained. HAEMATURIA This term means blood in urine. If small amounts of blood are being loss, the urine will appear ‘smoky’. If large amounts are being loss, the urine will be bright red in colour. Very large amount of blood in the urine will make it appear very dark as in blackwater fever. 27 FIRST AID MANAGEMENT OF HAEMATURIA 1. The patient should be put to bed quietly 2. Medical aid should be obtained 3. Keep all urine specimens for doctor’s inspection. BLEEDING FROM A TOOTH SOCKET Bleeding from the tooth socket may be caused by extraction, trauma or periodontal disease. If a tooth has been extracted, it is possible for the socket to continue to bleed. If the patient cannot immediately get to a dentist, certain first-aid steps may be taken. 1. Ice may be given to suck 2. A plug of gauze or cotton wool may be fitted into the socket and the patient asked to clench the teeth very firmly. The bleeding should stop in about 10 minutes. 3. If the bleeding continues, the patient should see a dentist or any available doctor. 28  CHAPTER FIVE WOUNDS, LACERATIONS AND BRUISES A cut or break in the continuity of any tissue caused by an injury or operation or a wound is said to occur when the continuity of the skin or mucous membrane is broken. This condition may permit the escape of blood and allow the entry of microorganisms to cause infection. Wounds involving injury to soft tissues can vary from minor tears to severe crushing injuries. The primary goal is to restore the physical integrity and function of the injured tissue, with minimal scarring and without infection. CLASSIFICATION OF WOUNDS Wounds are classified according to the mechanism of injury or degree of cleanliness or degree of contamination. Lacerated wounds: this type of wounds usually has torn edges and tissues and is usually as a result of accident or injury. The edges of the wound are irregular and there is commonly crushing of the skin and muscles. Scratching by nails and claws of animals can also result in lacerated wounds. Contused wounds: in contused wounds there may be little damage to the skin but underlying tissues may be severely damaged with bleeding from blood vessels under the skin. They are caused by violence from blunt objects. In contused wounds there may be little or no external bleeding but quite considerable internal bleeding. Incised wounds: this type of wounds is usually as a result of operation and produced by knife or similar objects. The edges of the wound remain in apposition and usually heal by first intension. Punctured wounds: in punctured wounds the depth is great and there is the tendency to damage internal organs. This type is caused by pointed instruments such as a spike, needles, gunshots etc. Avulsion wounds are also types that a part of the tissue is taken off or is partially detached. An exaggerated form of lacerations where much of the tissue is taken off. The partially detached part may be cleansed and sutured back to the surrounding tissues. 29 Abrasion is a type of wound in which the skin is scraped or rubbed off. Abrasions are usually superficial wounds, meaning that only the outer layers of skin are affected. A deep abrasion, one that penetrates to the inner layers of skin, can leave a scar. Parts of the body with thin layers of skin, such as the knees and elbows, are most prone to abrasions. Wounds may also be classified according to the degree of cleanliness or contamination. 1. Clean; this is a wound made under strict aseptic condition. The only source of contamination of the wound is the skin. It is not exposed to the genitourinary, GIT, or respiratory tract. 2. Clean contaminated; it is also made aseptically, but the incision site communicates with the GIT, genitourinary or respiratory tract. Therefore apart from the skin, there is another source of contamination.eg surgical wounds for Laporatomy. They have a higher probability of wound infection than clean wounds. 3. Contaminated; these wounds are exposed to excessive amount of bacteria. Avulsion wounds or wounds as s result of operation with gross break in aseptic techniques or gross spillage from the GIT. Gunshots or lacerated wounds are also examples. 4. Infected; a wound with heavy bacteria loads of pus. Such wounds are usually left open with drains. SIGNS AND SYMPTOMS When wounds are infected, they give rise to general signs and symptoms and local signs and symptoms when not so severe. The S/S may include;  Irritation of the affected area  Redness of the affected area  Bleeding internally or externally  Swelling of the affected part  Pain as a result of pressure on the nerve ending as a result of swelling  Loss of function of the affected part  Headache  Pyrexia or fever in severe cases 30 FIRST AID TREATMENT OF WOUNDS 1. The wound must be covered immediately with a clean dressing to prevent infection. 2. Haemorrhage when present should be stopped as quickly as possible (refer to management of external bleeding). 3. Shock is likely to occur when the wound is severe and should be treated (refer to management of shock) 4. Severity and seriousness of the injury should be determined. If greater damage is suspected than the obvious breaking of the skin, arrangements for immediate medical attention should take place. 5. If glass or foreign bodies are present in a wound, the first aider should not try to remove them but should apply a ‘ring pad’. 6. If a fracture is suspected, the wound should be dressed and the limb immobilized.. MANAGEMENT OF PATIENT WITH THE STABBED KNIFE IN THE ABDOMEN 1. Place patient in a supine position and call a doctor 2. Flex the knees to prevent further protrusion of abdominal organs against the knife 3. Reassure patient (explain) 4. Withhold oral fluids 5. Instruct patient to avoid coughing, forceful blowing of nose, sneezing and deep breathing 6. Prevent touching or contact with knife 7. Cut clothing away from point of entry of knife 8. Check vital signs every 5 – 10 minutes and record 9. Observe signs of shock and assess for signs and symptoms of bleeding 10. Set a tray for IVF 11. Insert indwelling urethral catheter for renal assessment including, urine output, haematuria etc. 12. Prepare patient for theatre (give little details of the preparation) 31 COMPLICATIONS OF WOUNDS 1. Hemorrhage 2. Shock 3. Infection 4. Damage to internal organs 5. Keloids 6. Contractures 7. Wound dehiscence 8. Wound evisceration 32  CHAPTER SIX STRAINS, SPRAINS, DISLOCATIONS AND FRACTURES Multiple injuries to the skeletal system including the bones, joints, ligaments and to the adjacent soft tissue are common in all types of major accidents. STRAIN It is an injury to muscle resulting from over stretching. The fibers are stretched and sometimes partially torn. Commonly strains occur on the back muscles, due to improper lifting technique. SIGNS AND SYMPTOMS OF STRAIN Localized pain Stiffness Inflammation Bruising SPRAINS A sprain is a complete or incomplete tear in the supporting ligaments surrounding a joint. A sprained ankle is a common joint injury. It is caused by forceful wrenching and stretching of muscles, ligaments, and tendons which surrounds a joint. Classification Grade 1 (mild): minor or partial ligament tear with normal joint stability and function. Grade 2 (moderate): partial tear with mild joint laxity and some function loss. Grade 3 (severe): complete tear or incomplete separation of ligament from bone, causing total joint laxity and function loss. 33  CAUSES A sprain usually follows a sharp twisting motion of the affected joint. S/S 1. Severe pain which increases in severity with any movement of the affected joint. 2. Tenderness and swelling over the site of the injury. 3. Bruising will occur due to bleeding from torn structures 4. If pain is severe shock may be present and the patient may faint. 5. Loss of power of the affected joint. Complications A sprain can result in an avulsion fracture, which occurs when a bone fragment is pulled out of place by a ligament. TREATMENT Ice should be applied to the injury site as soon as possible to control swelling. After 24 to 48hrs, treatment should switch to heat to encourage reabsorbtion of blood and to promote healing and comfort. The injured site may be immobilized or splinted. Patient may need surgery if the muscle, tendon or ligament ruptures. Exercise may help ensure a gradual progression of activity. FIRST AID MEASURES FOR STRAIN AND SPRAIN The RICE procedure is used in the treatment  R – Rest the injured part (restrict movement of the part)  I – Ice or cold compress application at the affected site  C – Compress (bandage) the injured part to prevent swelling  E – Elevate the injured part to reduce inflammation If swelling and pain persist, seek medical attention. 34  DISLOCATION It is a displacement of a bone end from the joint particularly at the shoulder, elbow, fingers or thumb usually as a result of a fall or a direct blow. Unless proper care is given, a dislocation may occur repeatedly. SIGNS AND SYMPTOMS OF DISLOCATION 1. Swelling 2. Obvious deformity 3. Pain upon movement 4. Tenderness to touch 5. Discolouration FIRST AID MEASURES OF DISLOCATION 1) Splint and immobilize the affected joint in the position in which it was found. 2) Apply a sling if appropriate 3) Elevate the affected part 4) Seek medical attention promptly 5) Never attempt to reduce a dislocation as a first aider. FRACTURES A fracture is a break in the continuity of a bone, separating it into two or more parts. CAUSES OF FRACTURE a. Direct violence b. Crushing forces c. Sudden twisting motion d. Extreme muscle contraction e. Diseases (pathological causes) f. Malnutrition g. Drug, e.g. prolonged steroid therapy h. Aging 35  TYPES OF FRACTURE 1. Simple fracture (closed fracture); the bone is broken but the skin is intact 2. Compound fracture (open fracture); the bone and the skin are broken 3. Complicated fracture: this is the fracture that is associated with injury to the surrounding tissues, e.g. lung, liver, nerves, blood vessels etc. VARIETIES OF FRACTURES  Greenstick fracture – this fracture has one side of the bone broken and the other side bent. It is common in children  Transverse fracture – the bone is broken straight across  Oblique – a fracture occurring at an angle across the bone  Spiral – a fracture twisting around the shaft of the bone  Comminuted – the fractured part has bones broken into several fragments.  Depressed fracture – a fracture bone fragment is driven in, e.g. skull fractures  Impacted – bones fragments are driven into another  Pathologic fracture – fracture as a result of disease process, e.g. tumours, tuberculosis, osteoporosis etc.  Avulsion fracture – a pulling away of a fragment of a bone by ligament or tendon, e.g. fractured patella. 36 SPECIAL FRACTURES  colles’ fracture – this is wrist fracture involving the distal portion of the radius.  Pott’s fracture – this occurs at the ankle joint and the foot is often displaced outwards. CLINICAL MANIFESTATIONS OF FRACTURE Pain Crepitation Swelling Shortening of extremities Displacement Deformity Haemorrhage Shock Loss of function Impaired sensation Ecchymosis 37 GENERAL PRINCIPLES OF FIRST AID TREATMENT FOR ALL FRACTURES 1. The patient should be kept lying down unless the particular fracture makes this position unsuitable. 2. Any wound should be covered immediately with a clean dressing 3. Obvious haemorrhage must be stopped immediately 4. Treat for shock(refer to shock management) 5. Immobilise the injured part as quickly as possible using common sense and available resources. Two methods may be used: a. Body splinting: it is sometimes much more practical to immobilize a part by bandaging it to another part of the body. b. Mechanical splinting: if splints are to be applied as a first-aid measure; they should be strong enough; they should be long enough; they should be padded to prevent direct pressure on the injured part; they should be tie in position above and below the fracture and above and below the adjacent joints, but never over the site of a fracture. 6. A patient with a fracture should never be moved unless there are sufficient people to lift and carry him or her satisfactorily. 7. use stretchers or improvised stretchers to carry casualty FRACTURE OF THE SKULL There are two dangers involved in a fracture of the skull: 1. Concussion – when the brain has had a ‘shaking up’. Dizziness, headache, and usually vomiting occur in mild cases. Shock will be present in more serious cases. 2. Compression of the brain – this may be caused by pieces of bone from skull fracture pressing on the brain, or by development of hematoma between the skull and the brain following an injury. SIGNS AND SYMPTOMS OF BRAIN COMPRESSION a. Restlessness and headache in early stages. b. Twitching of muscles at one side of the body which develops into limpness and subsequently paralysis if pressure continues. c. Hyperpyrexia 38  d. Very slow and strong bounding pulse e. Slow and deep respiration f. Dilated and unequal pupils which do not react to light. g. There may be bleeding from the nose and ears. MANAGEMENT OF CASUALTY WITH SUSPECTED OR ACTUAL FRACTURE OF THE SKULL 1. Put casualty flat in a semi prone or prone position with the head turned to one side if unconscious. 2. Keep casualty as still as possible with head slightly raised if conscious 3. Assess level of consciousness 4. Re-assure casualty 5. Ensure airway is clear 6. Cover wound with clean dressing or linen 7. Leave any depression untouched to avoid brain damage. 8. Seek medical aid as quickly as possible. FRACTURE OF HUMERUS All classical signs and symptoms of a fracture will be present. MANAGEMENT OF FRACTURED HUMERUS  Sit the patient down in c chair  Reassure casualty  Cover wound with a clean cloth  Apply a sling to the damaged arm  Arrange for casualty to get medical aid as soon as possible FRACTURE OF FOREARM When it involves the lower end of the radius, it is called Colles’ fracture. Signs and symptoms and management are the same as fracture of humerus. FRACTURE OF FEMUR 39 In addition to classical signs and symptoms of a fracture, there will be shortening of the leg and ‘eversion’ of the foot. MANAGEMENT OF FRACTURED FEMUR 1. Apply a clean dressing if the skin is broken 2. Put patient in the recumbent position 3. Tie the legs together with pads placed in between the ankles and knees, if no splints are immediately available. You tie the feet together, the ankles together and the thighs together, making sure the bandage is not applied over the fractured site 4. If a splint is available it should be long enough to extend from the axilla to beyond the foot. Pad it and tie across the whole length except the fractured site 5. Transport the patient to hospital. FRACTURE OF TIBIA If the shaft of the tibia fractured the danger of a simple fracture becoming a compound fracture is very great because of its closeness to the surface of the body. MANAGEMENT OF FRACTURED TIBIA o Put patient in the recumbent position o Apply clean dressing if there is a wound o Place a pad between the ankles and knees and tie together at the levels of the thigh, knee, and ankle leaving the fractured site. o If a splint is available it should extend from above the knee joint to below the ankle joint. o Transport casualty to hospital. NOTE: when the lower end of the fibula is fractured, it is termed Pott’s fracture MANAGEMENT OF A FRACTURED PATELLA/ KNEE 1. Put the patient in the recumbent position 2. Apply a splint extending from the buttock to beyond the ankle 3. Raise the leg and bandage it firmly into position 40 4. Keep the leg raised by placing rolled-up cushions or a pillow under the patient’s heel 5. Put patient in a sitting position 6. The casualty should be transported in the sitting position to the hospital 41  CHAPTER SEVEN UNCONSCIOUSNESS The brain is the organ of the mind. Normal conscious alertness depends upon its continuous adequate supply with oxygen and glucose, both of which are essential for the brain cells to function normally. If either or both of these are interrupted, altered consciousness results. Unconsciousness may be temporary, prolonged or indefinite depending upon the severity of the initiating incident. The patient’s recovery depends upon the cause and success of treatment, where given. Memory may be affected, as may motor and sensory functions; but short periods of unconsciousness as a result, say, of trauma have little obvious effect on brain function. Repeated bouts of unconsciousness may, however, have a cumulatively damaging effect, as can be seen on CT (COMPUTED TOMOGRAPHY) scans of the brain. Severe blood loss will cause anoxia of the brain. Any of these can result in altered brain function in which impairment of consciousness is a vital sign. Sudden altered consciousness will also result from fainting attacks (syncope) in which the blood pressure falls and the circulation of oxygen is thereby reduced. Similarly an epileptic fit causes partial or complete loss of consciousness by causing an abrupt but temporary disruption of the electrical activity in the nerve cells in the brain. In these events, as the brain’s function progressively fails, drowsiness, stupor and finally coma ensue. If the cause is removed (or when the patient spontaneously recovers from a fit or faint), normal consciousness is usually quickly regained. Strokes are sometimes accompanied by a loss of consciousness; this may be immediate or come on slowly, depending upon the cause or site of the strokes. Comatose patients are graded according to agreed test scales – for example, the GLASGOW COMA SCALE – in which the patient’s response to a series of tests indicate numerically the level of coma. Treatment of unconscious patients depends upon the cause, and range from first-aid care for someone who has fainted to hospital intensive care treatment for a victim of a severe head injury or massive stroke. 42 GLASGOW COMA SCALE (GCS) It is a scale used to assess the level of consciousness or responses of patients. The client best response to each area is given a numerical value and the three values totaled for a score ranging from 3 to 15. The three responses used are; eye opening, motor response and verbal response. 1. EYE OPENING: Spontaneous =4 To speech =3 To pain =2 No response =1 2. MOTOR RESPONSE: Obeys commands =6 Localizes pain =5 Withdraws =4 Abnormal flexion =3 Extention =2 No response =1 3. VERBAL RESPONSE Oriented =5 Confused =4 Inappropriate words =3 Incomprehensible sound =2 No response =1 A score of 7 or less indicates coma. FAINTING/SYNCOPE Fainting, or syncope, is a temporary loss of consciousness caused by inadequate supply of blood to the brain. It may be preceded by nausea, sweating, loss of vision, and ringing in the ears. It is most often caused by pooling of blood in the extremities, which reduces venous 43 return and thus cardiac output: this may be due to hot weather or prolonged standing. Occasionally, fainting on standing occurs in people with low blood pressure, autonomic neuropathy (in which normal vasomotor reflexes are absent), or those taking antihypertensive drugs. Hypovolaemia produced by bleeding, prolonged diarrhoea, or vomiting may also cause fainting, and the condition can be produced by severe pain or emotional upset. Treatment must be directed towards the underlying cause. CAUSES OF SYNCOPE/FAINTING 1. Anxiety 2. Emotional upset 3. Stress 4. Severe pain 5. Hunger 6. Standing for too long 7. Standing up too fast 8. Some medications 9. Diabetes 10. Low blood pressure SIGNS AND SYMPTOMS 1. Nausea and vomiting 2. Excessive sweating 3. Blurred vision 4. Dizziness 5. Slow irregular pulse 6. Confusion 7. Lightheadedness 8. Yawning 9. A feeling of heaviness in the legs FIRST AID MANAGEMENT OF A FAINTING VICTIM 1. Rush to the aid of the victim and support him/her to a safe position while ensuring safety to yourself and the victim. 2. Access and manage ABC’s 3. Put an unconscious victim in the supine position and elevate the feet slightly to facilitate blood flow to the brain. 4. Loosen tight clothing around the neck, chest and waist. 44  5. If the casualty is not breathing but pulse is present, initiate rescue breathing, but if both breathing and pulse is absent; commence CPR. 6. Provide adequate ventilation by putting on fans, opening windows or asking bystanders to clear off if it happens outside. 7. Reassure a conscious victim by telling him that he/she will be alright and that help will arrive soon. 8. Continue to monitor vital signs whiles you send for medical aid or while transporting victim to hospital. APOPLEXY/STROKE/BRAIN ATTACK/CEREBROVASCULAR ACCIDENT This is the rapid loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia (lack of blood flow) caused by blockage (thrombosis, arterial embolism), or a hemorrhage. As a result, the affected area of the brain cannot function, which might result in an inability to move one or more limbs on one side of the body, inability to understand or formulate speech, or an inability to see one side of the visual field. A stroke is a medical emergency and can cause permanent neurological damage and death. TYPES There are two types of stroke; haemorrhagic stroke and ischemic stroke. 1. Haemorrhagic stroke: this is due to rupture of cerebral blood vessels leading to intracranial bleeding. The rupture may be due to high blood pressure, arteriosclerosis or congenital malformations. 2. Ischemic stroke: In an ischemic stroke, blood supply to part of the brain is decreased, leading to dysfunction of the brain tissue in that area. Thrombotic stroke (obstruction of a blood vessel by a blood clot forming locally) Embolic stroke (obstruction due to an embolus from elsewhere in the body). An embolic stroke refers to the blockage of an artery by an arterial embolus, a travelling particle or debris in the arterial bloodstream originating from elsewhere. An embolus is most frequently a thrombus, but it can also be a number of other substances including fat (e.g., from bone marrow in a broken bone), air, cancer cells or clumps of bacteria Thromboembolic stroke Transient ischemic attack (TIA): temporary decrease blood flow to the brain that improves before cells die. It is a precursor to thrombotic stroke or short time embolus. 45  RISK FACTORS 1. Old age 2. Increased blood pressure 3. Previous stroke 4. Transient ischemic attack 5. Diabetes 6. High cholesterol 7. Tobacco smoking 8. Atrial fibrillation SIGNS AND SYMPTOMS 1. Dizziness 2. Inability to walk properly 3. Loss of balance and coordination 4. Difficulty in speaking 5. Difficulty in swallowing 6. Weakness of the affected part 7. Numbness of the affected part 8. Paralysis of the affected part 9. Blurred vision 10. Severe headache 11. Double vision (diplopia) 12. Increased intracranial pressure 13. Incontinence 14. Unequal pupils 15. Disorientation 16. Drooling of saliva from the mouth on the affected side. 46 FIRST AID MANAGEMENT OF A CLIENT WITH STROKE The aims of first aid management for stroke include; maintain a patent airway, ease pressure on the brain and arrange for urgent transport to hospital. 1. If you notice someone is showing signs stroke, quickly rush to the aid of the victim and support him into a safe position. 2. Put a conscious casualty in the supine position with the heat and shoulders slightly raised and supported. 3. Ensure patency of airway, breathing and circulation by assessing and managing appropriately 4. Loosen tight clothing around neck, chest and waist. 5. Act quickly to perform the FAST test. F: Face: ask victim to smile. A stroke victim has weakness on one side of the face causing the face to fall that side when trying to smile. A: Arms: ask the victim to raise both hands evenly or one hand at a time. A stroke victim has difficulty raising both hands at the same time or only the affected arm. S: Speech: ask casualty to speak to you. A stroke victim has slurred speech which is not easily understood. T: Time: act quickly to look for transport or call for ambulance. No time should be wasted if the above indicates the victim have suffered a stroke. NB: when stroke strikes, act FAST. The earlier you act FAST, the less the damage to the brain and the better the chances of survival. 6. Put the unconscious victim in the recovery position. This helps keep the airway patent and encourages easy dribbling of saliva. Provide a towel to absorb saliva. 7. Transport victim to hospital as soon as possible preferably with an ambulance. PREVENTION OF STROKE 1. Know your BP and check it regularly 2. Moderate consumption of cholesterol 3. Exercise and avoid sedentary lifestyle 4. Avoid smoking and alcohol 5. Treat diabetes effectively 6. Manage stress and anxiety in a healthy way 7. Hypertensive clients should adhere to medication regimen 47  CHAPTER EIGHT EPILEPSY AND CONVULSIONS Both epilepsy and infantile convulsion are characterized by fits (seizures). FITS OR SEIZURES A fit is an attack of unconsciousness usually of violent onset. COMMON CAUSES OF FITS/ SEIZURES  Severe dehydration  Febrile illnesses such as meningitis, malaria and tetanus  Epilepsy  Toxaemia of pregnancy  Head injuries and brain tumours SIGNS AND SYMPTOMS OF FITS/ SEIZURES 1. Rigidity of body muscles from a few seconds to perhaps half a minute followed by jerking movement. 2. Bluish discoloration of the face and lips 3. Foaming at the mouth or drooling 4. Gradual subsidence (improvement) OBSERVATIONS DURING FIT/ SEIZURES 1. Where the twitchings started 2. What parts of the body where involved 3. The duration of the fit 4. Whether incontinence occurred or not 5. Any peculiar attitude present, e.g. twisting of the head to one side, or if one side of the body was involved more than the other FIRST AID MANAGEMENT OF FITS/ SEIZURES 1. Position victim in a way that he should not injure himself 2. Do not attempt to restrain the victim 3. Undo tight clothing around the neck, chest, and waist 48  4. Do not force a blunt object between the victim’s teeth. If the victim’s mouth is open you might place a soft object such as rolled handkerchief or padded spatula between his teeth 5. Do not pour any liquid into his mouth 6. Avoid overcrowding and ensure enough ventilation 7. Keep victim lying down 8. Reassure victim 9. Seek medical attention EPILEPSY Epilepsy is a chronic disease usually of unknown cause characterized by repeated convulsion. TYPES OF EPILEPSY 1. Petit mal or minor epilepsy 2. Grand mal or major epilepsy PETIT MAL OR MINOR EPILEPSY This is characterized by unconsciousness which may pass unnoticed. The victim appears to be lost and confused and may drop anything that may be held, but the period is so short that he may not fall down. GRAND MAL OR MAJOR EPILEPSY Two types of major epilepsy are described: idiopathic and symptomatic. In idiopathic epilepsy there is no evidence of gross disease and the fits usually begin in childhood or adolescence In symptomatic epilepsy there are recognizable pathological conditions which may be responsible directly or indirectly for the seizure. These conditions include intracranial tumours, head injuries, and hypertension. 49 SIGNS AND SYMPTOMS OF EPILEPSY Sequence of events usually takes place during the fit 1. The aura or stage of warning: this last only for a few seconds. Commonly the victim has an indescribable feeling in the stomach which rises to the throat, or particular taste in the mouth, or sensation of smell. There are flashes of light. 2. Tonic phase: there is sudden loss of consciousness. The victim falls to the ground without any attempt to save himself. The muscles become rigid with the hands and teeth clenched. There is sudden contraction of respiratory muscles which forces air through the larynx, producing a typical loud shout known as ‘Epileptic Cry’. The face become cyanosed and the veins engorged. This stage last for about 30 seconds. 3. Clonic phase: the whole body is convulsed with twitchings and jerkings. The tongue may be badly bitten, and the patient begins to foam at the mouth. Occasionally, urine and faeces may be passed involuntarily. The violent jerking of muscles subsides gradually and the patient goes to a stage of coma. This period may last for 60 seconds 4. Coma: when the twitchings cease the victim remain in a deep sleep for approximately half an hour (30 minutes). During this period the muscles relax and the colour of the face returns to normal. The breathing is noisy for a time and then gradually becomes quiet and normal. 5. Final phase: usually, after the fit and recovery from coma, victim becomes confused; at times he may wander about. He may vomit and or complain of headache and pains in the body. FIRST AID TREATMENT OF EPILEPSY During the Tonic stage 1. If necessary remove the patient to safer surroundings. 2. Try to lay the patient flat on his or her back 3. Undo tight clothing round the neck, chest and waist. 4. Push away near 5. Place a firm, well-padded article between the victim’s teeth. During the Clonic stage 6. Do not try to restrain the patient when twitchings begin. 50  7. Try to support and protect the patient’s head. During the stage of Coma 8. When jerking is over, loosen the clothing around his neck, chest and waist. 9. Keep him lying down 10. Allow the victim to sleep and rest. 11. Medical aid should be obtained, especially if this is the first fit. INFANTILE CONVULSION The signs and symptoms are similar to epileptic fit but the twitching are less severe. The causes are many and varied. Some of them are: 1. Onset an infectious disease such as malaria 2. Teething 3. Constipation 4. Worms infestation 5. Gastro-intestinal upsets. FIRST AID TREATMENT OF INFANTILE CONVULSION Method 1 a. Lie the child down b. Treat the fit (refer management of fit) c. Arrange for immediate medical attention d. Reassure the parents Method 2 a. Undress child and give a warm bath for approximately 10 to 15 minutes b. Apply cold compresses to the forehead when the skin is hot or temperature is high c. Stop the bath when twitchings ceased, and dry the child. d. Cover child with a clean linen e. Reassure parents f. Seek for medical aid 51 CHAPTER NINE ASPHYXIA AND CHOKING ASPHYXIA Asphyxia or asphyxiation is a condition of severely deficient supply of oxygen to the body that arises from being unable to breathe normally. Asphyxia is a condition in which there is lack of oxygen or excess amount of carbon dioxide in the blood streams, resulting in unconsciousness and often death caused by interruption of breathing or inadequate oxygen supply. Asphyxia causes generalized hypoxia, which primarily affects the tissues and organs. Asphyxia can cause coma or death. There are many circumstances that can induce/cause asphyxia, all of which are characterized by an inability of an individual to acquire sufficient oxygen through breathing for an extended period of time. These circumstances can include but are not limited to: 1. Constriction or obstruction of airways, such as from a. Asthma b. Strangulation with a rope, necktie or belt c. Impaction of foreign bodies in the throat such as food, bone d. Swelling of tissue of the airway or any adjacent structure e. Aspiration of fluids such as saliva, vomitus or blood f. Compression of the chest or abdomen with a heavy weight g. Falling back of the tongue in an unconscious victim 2. Being in environments where oxygen is not readily accessible: such as a. underwater, b. in a low oxygen atmosphere, c. or in a vacuum; 3. Environments where sufficiently oxygenated air is present, but cannot be adequately breathed due to air contamination such as excessive smoke. 4. Paralysis of the muscles of respiration: due to a. electric shock, 52  b. disease condition (poliomyelitis), c. chemicals (toxins), and d. substances like morphine e. fracture or dislocation of the spine 5. The effect of certain poisonous gasses like; a. carbon monoxide b. ammonia c. chlorine 6. Malfunction or damage of some vital organs a. heart failure b. lungs collapse c. liver disease Asphyxia can be classified as partial or complete. In partial asphyxia, the obstruction of the airways is incomplete. The casualty is able to obtain some amount of oxygen from the atmosphere to support life just for some few minutes. It occurs in conditions such as epilepsy and diphtheria. It requires prompt action to prevent it from progression to complete asphyxia. In complete asphyxia, there is complete obstruction of the airways and the casualty is unable to obtain oxygen to support life. Urgent intervention is required to restore adequate supply of oxygen to the blood stream in order to protect vital organs from damage. Types of asphyxia 1. Compressive asphyxia: this is a mechanical limitation to the expansion of the lungs by compression the chest or abdomen. Instances of compressive asphyxia includes; a. using a car jack to repair a car only to be crushed under weight of the car either on the chest or abdomen b. constriction by a constrictor snake e.g. pyton c. overlying an infant during co-sleeping d. Being compressed or crushed against a crowd during disaster or stampede. 53  2. Restraint or postural asphyxia: this occurs as a result of being restraint in position that they cannot breath due to facial, neck, abdominal or chest compression. They end up losing consciousness and eventually dying from anoxic brain damage. 3. Perinatal asphyxia: this is a medical condition in which a new born infant is deprive of oxygen (hypoxia) that causes death. 4. Nitrogen asphyxia: this describes a situation in which an individual inhales nitrogen either accidentally or in an attempt to commit suicide. SIGNS AND SYMPTOMS 1. Difficulty in breathing 2. The victim begins to struggle 3. Cyanosis 4. Coughing and 5. Spluttering 6. Restlessness or agitation 7. Distended jugular veins 8. Dilated pupils 9. Respiratory or cardiac arrest 10. Reduction in the level of consciousness 11. coma FIRST AID MANAGEMENT a. Remove the victim from the cause or the source of danger from the victim b. Undo tight clothing around the neck, chest and waist. c. Clear any obstruction from the mouth e.g. vomits, sputum, blood or any other particles. d. If breathing has ceased start with artificial respiration external cardiac compressions. e. If the weather is cold, keep victim reasonably warm, but take care not to overheat the victim. f. Send victim to hospital if necessary. 54  CHOKING Choking is a blockage of the upper airway by food or other objects, which prevents a person from breathing effectively. In adults, choking most often occurs when food is not chewed properly. The risk factors for choking in older adults include advancing age, poor dental fitting and excessive alcohol consumption. In children, choking is often caused by eating large pieces of food or too much food at one time, eating hard candy or putting small objects such as nuts, marbles, small toys or coins in the mouth, which gets lodged in the throat. The condition is a true medical emergency that requires immediate, appropriate action by anyone available. SIGNS AND SYMPTOMS 1. Coughing 2. The person may grasp both hands near the throat, 3. become breathless 4. May not be able to talk. 5. The skin, lips and nails may turn blue or dusky and 6. The person may lose consciousness. FIRST AID FOR CHOKING When a person chokes, the following approach of first aid is recommended: a. First, deliver five back blows between the person’s shoulder blades with the heel of your hand. b. Next, perform five abdominal thrusts (Heimlich maneuver). c. Alternate between five back blows and five abdominal thrusts until the blockage is dislodged. 55 HEIMLICH MANEUVER ON A VICTIM: a. Stand behind the person. Wrap your arms around the waist. b. Make a fist with one hand and place your fist with thumb side in, just above the navel but below the person’s rib cage in the front. c. Grasp the fist with the other hand. Keeping your arms off the person’s rib cage, give four quick inward and upward thrusts. d. Repeat this several times (four to five times) until the object is coughed out or the person becomes unconscious. e. If choking continues, seek medical help. HEIMLICH MANEUVER ON YOURSELF: a. Place a fist slightly above your navel. b. Grasp your fist with the other hand and bend over a hard surface (such as chair). c. Shove your fist inward and upward. HEIMLICH MANEUVER ON A PREGNANT WOMAN OR OBESE PERSON: a. Keep the position of your hands a bit higher than that with a normal Heimlich maneuver, at the base of the breastbone, just above the joining of the lowest ribs. b. Proceed as with the Heimlich maneuver (giving chest thrusts instead of abdominal thrusts). CLEARING THE AIRWAY OF AN INFANT: a. Assume a seated position and hold the infant face down on your forearm, which is resting on your thigh. b. Thump the infant gently but firmly four times on the middle of the back using the heel of your hand. c. Immediately, turn the baby over and give four forceful thrusts to the chest to a depth of 1 inch with two fingers one finger width below an imaginary line connecting the nipples. 56  d. Repeat both back blows and chest thrusts until foreign body is expelled or the infant becomes unconscious. e. Start infant CPR if the blockage is removed but the infant is not breathing. PREVENTION OF CHOKING a. While eating, chew food slowly and thoroughly, especially if wearing dentures. b. Avoid laughing and talking during chewing and swallowing. c. Avoid excessive intake of alcohol before and during meals. d. Give easily chewable, soft food in small quantity to children. e. Do not leave tiny objects or toys within the reach of children. f. Supervise mealtime for infants and young children. 57  CHAPTER TEN POISONS AND POISONING A poison is a substance which, if taken into the body in sufficient quantity, may cause temporary or permanent damage. Poisons can be swallowed, absorbed through the skin, inhaled, splashed into the eyes, or injected. Once in the body, they may enter the bloodstream and be carried swiftly to all organs and tissues. Signs and symptoms of poisoning vary with the type of poison- they may develop quickly or over a number of days. CAUSES OF POISONING There are usually three causes of poisoning: 1. Accident (commonest cause) – this may occur in several ways:  By eating contaminated food, poisonous fruits, or fungi (mushrooms)  By drinking contaminated water, or drinking poisonous liquids from wrong labeled bottles.  By accidentally taking an overdose of drugs. 2. Suicide: casualty trying to kill himself. Very common in mental illness 3. Murder or attempted murder: the poison may be administered in a large dose or in repeated small doses to kill casualty. EXAMPLES OF POISONS AROUND THE HOME Poisonous substances within the home environment are extremely prevalent and it would be difficult to name all of them. A few typical household poisons are listed below: i. Cosmetics and hair preparations ii. Gasoline, kerosene and other petroleum products iii. Paint and turpentine iv. Strong detergents v. Bleaches vi. Acids vii. Ammonia viii. Glue ix. Poisonous plants 58  x. Non edible mushrooms xi. DDT xii. Dry cell SOME COMMON EXAMPLES OF POISONING  Over doses of drugs taken either accidentally or with suicidal intent  Poisons transferred from original containers to other containers or soft drink bottles.  Carelessness of the parents in leaving dangerous substance and medicines within the reach of children.  Improper storage and disposal of poisonous substances  Improper handling of spray equipment including the mixing of pesticides, insecticides and weedicides.  Inhalation and swallowing of poisonous substance.  Combining some drugs and alcohol CLASSIFICATION OF POISONS Poisons are usually classified under irritants, narcotics and corrosives IRRITANT POISONS These poisons act on the alimentary tract causing irritation and inflammation. Common sources of irritant poisons are: contaminated food, poisonous berries or fungi, and chemical substances like arsenic, mercury, phosphorus, iodine and lead. NARCOTIC POISONS These act on the nervous system. Examples are opium, morphine, heroin, cocaine, phenobarbitone, diazepam, and atropine CORROSIVE POISONS These burn the part of the body with which they come in contact. Corrosives may be acidic or alkaline in reaction. Acid corrosives are sulphuric acid, hydrochloric acid, nitric acid, acetic acid. Alkaline corrosives are caustic soda, caustic potash and ammonia. 59  SIGNS AND SYMPTOMS OF POISONING These vary greatly with the poison. To determine whether or not a victim has swallowed poison, the following should be considered: 1. Information from the victim or from an observer 2. Presence of a container known to contain poison 3. condition of the victim (sudden onset of pain or illness) 4. Burns around the lips or mouth 5. Breathe odour 6. Pupil of the eye contracted to pinpoint size (morphine or similar drugs overdose) AIMS OF FIRST AID TREATMENT IN POISONING 1. To remove or counteract the effect of the poison as quickly as possible 2. To arrange for medical aid immediately 3. To maintain respiration and circulation 4. To identify the poison. Remains of poisons or containers should be kept for inspection 5. Any vomit, urine or feces should also be kept for medical inspection 6. If death occurs the police must be informed and nothing in the vicinity of the body touched or moved until their arrival. FIRST AID TREATMENT OF POISONING FOR A CONSCIOUS VICTIM 1. Ask casualty quickly what happened; remember he may loose consciousness at any time 2. Make him vomit repeatedly if there are no signs of burns on the lips or mouth from corrosive acids or alkalis.  Tickle the back of his throat with your fingers, or give tepid water with salt (sodium chloride) or soap dissolved in it. 3. Do not induce vomiting if the poison is one which burns or if it is kerosene or petrol. Instead give quantities of water, milk with egg white, or mixture of flour and water 4. Send casualty to hospital as quickly as possible 5. Place him in the recovery position. Ensure a clear airway. 60  6. Safe the remaining poison or container for identification. If the victim vomits safe a sample of the vomitus. FIRST AID TREATMENT OF POISONING FOR AN UNCONSCIOUS VICTIM 1. Maintain an open airway and administer artificial respiration 2. Do not give fluids and do not induce vomiting 3. If the victim is vomiting, position him and turn the head so that the vomitus drains out of the mouth. 4. Safe the remaining poison or container for identification. If the victim vomits safe a sample of the vomitus. 5. Send casualty to hospital as quickly as possible. CARBON MONNOXIDE POISONING It is a colorless, odorless gas present in coal gas, in the exhaust emitted by petrol engines and in the gas emitted when any carbon-based fuel is burned in the presence of insufficient oxygen. SIGNS AND SYMPTOMS OF CARBON MONOXIDE POISONING I. Victim becomes difficult, unruly and perverse II. Mental confusion III. Heaviness of the limbs, headache, and sleepiness IV. Unconsciousness V. Fair-skinned individuals will appear pink in colour due to presence of carboxyhaemoglobin. MANAGEMENT OF CASUALTY WITH CARBON MONOXIDE/ CARBON DIOXIDE POISONING OR SUFFOCATION BY SMOKE 1. Use a life-line safety precaution when entering a gas filled room or a space whenever available. If the casualty is in a room or enclosed space, before entering breathe in and out several times and then take a deep breath and hold it. 61  2. Go in and get casualty out. If you cannot do so at once, cut off the source of danger. Turn off gas or switch off the engine, obtain a full supply of fresh air. Open door and windows and get out. 3. Start resuscitation immediately if breathing is failing or has stopped. 4. Ensure absolute rest after rescue 5. Place casualty in the recovery position PREVENTION OF POISONING 1. Properly label all poisonous substances 2. Keep poisons out of reach of children 3. Do not store poisons in food containers even if they are well labeled. 4. Education on the dangers of drug overdose 5. Never eat wild plants, mushrooms, roots or berries unless you know what you are doing. 6. Avoid taking medicines in the presence of children since they turn to mimic adults 7. Poisonous containers should be disposed of properly or burned. 8. Expired drugs and food should be disposed off properly. 62  CHAPTER ELEVEN BURNS AND SCALDS Burns is the destruction of the body tissues by dry heat, moist heat, or chemical. TYPES OF BURNS 1. DRY BURN: - caused by flames, contact with hot objects, friction/ mechanical heat etc. 2. SCALDS: - caused by steam, hot liquids such as soup, tea and hot water 3. COLD INJURY: - caused by contact with freezing metals, dry ice, freezing vapours e.g. liquid oxygen and liquid nitrogen 4. ELECTRICAL BURN: - caused by high or low voltage current. Also caused by lightning strike 5. CHEMICAL BURN: - caused by chemical substances. E.g. Industrial chemicals including inhale fumes and corrosive gases, Domestic chemicals and agents such as paint remover, caustic soda, weedcides, bleach, strong acid and alkali etc. 6. RADIATION BURN: - caused by sun burn or exposure to radio-active source such as X-ray. DEGREE OF BURNS  First degree burn: -This involves the epidermis of the skin and is characterized by redness, swelling and tenderness. Pain is the major complain. No scar is left. Healing is mostly complete in 10 days.  Second degree burn: - It involves all the epidermis and part of the dermis. Superficial second degree burns are characterized by blister formation while deeper burns have a more reddish or non-viable whitish appearance.  Third degree burn: - This involves the full thickness of the skin and there may be some damage to the nerves, fat tissues and muscles. It is characterized by non-viable whitish appearance. It may demonstrate darkened brown or black adipose tissue. Sensation is loss due to burnt nerve endings. Urgent medical attention is required. 63  THE EXTENT OF BURNS This is the means by which burns is usually assessed. The criteria commonly used are the palmer method, Wallace Rule of nine, and the Berkow method. PALMER METHOD This method assesses smaller areas of burns. With gloved hand, the patient uses the palm to measure the burnt area. Each palmer measurement amounts to 1 % of the total body area. WALLACE’S RULE OF NINE For purposes of examination, this rule is preferred since it is convenient to calculate. Adult (% of total body area) Small Child (% of total body area) Head 9% 18% Each arm 9% (hand 1%) 9% Each leg 18% (foot 1%) 6.75% Front of trunk 18% 18% Back of trunk 18% 18% Perineum 1% 1% The surface area of the body involved in burns is very critical to the survival of the client due to fluid shift and loss In children, the head represents a larger proportion of the body than adults. If 15% of the body of an adult, or 10% of the body of a child, is burned the condition should be considered serious and requires immediate hospital treatment. FIRST AID TREATMENT OF FIRST DEGREE BURNS 64  1. Rinse the injured part with cold water for at least 10 minutes to stop burning and relieve pain 2. Gently remove any jewelry, watches, belts or constricting clothing from injured area before it begins to swell. 3. Cover area with sterile dressing, or any clean, non-fluffy material and bandage loosely in place. NOTE: cold burns should not be rinsed with cold water FIRST AID MANAGEMENT OF SECOND AND THIRD DEGREE BURNS 1. Lay the casualty down and protect the burnt area from contact with the ground if possible 2. Rinse injured part with plenty cold water for at least 10 minutes or use burn-cooling gel. 3. Arrange for medical aid 4. While cooling the burnt part, watch for signs of difficulty in breathing and be ready to resuscitate if necessary. 5. Remove any ring, watch, belts, or shoe from injured area before it begins to swell 6. Remove burnt clothing, unless it is sticking to the burn. 7. Cover area with sterile dressing or some suitable material to prevent infection 8. Do not burst any blister, touch affected area or apply any lotions to the injury as this will retain heat within the burn. MANAGEMENT OF CASUALTY WITH BURNING CLOTHING  If Casualty’s clothing is on fire, instruct him to roll on the floor to put off the flames or cover him with a blanket and roll him to extinguish the fire.  Reassure casualty  Soak burnt area with cold water  Leave burnt clothing on  Treat for shock (mention the steps)  Cover with a clean linen  Arrange for medical attention. 65 MANAGEMENT OF CASUALTY WITH SCALDS  Reassure casualty  Remove clothing as quickly as possible  Gently run cold water over the scalded area  Leave any blister intact  Cover with linen  Arrange for medical aid MANAGEMENT OF CASUALTY WITH CHEMICAL BURNS  Reassure casualty  Quickly pour plenty water over burnt area to neutralize chemical. Add sodium bicarbonate to water if burns are caused by acid. Add weak vinegar or lemon juice if burns are caused by corrosive alkali.  Remove contaminated clothing if possible and cover with clean linen.  Treat for shock (refer)  Seek medical aid MANGEMENT OF CASUALTY WITH RADIATION BURNS  Rest casualty in a shade  Reassure casualty  Give cold drink  Immerse burnt parts in cold water  Apply cream or powder  If severe seek medical treatment MANAGEMENT OF CASUALTY WITH ELECTRICAL BURNS (ELECTRIC SHOCK) 1. Break contact of electric source with casualty by switching off electrical current, or insulating hands with rubber gloves and dragging casualty from source of electric current 2. If unable to reach cable, stand on insulating material, e.g. plastic mat, wooden box and push casualty’s limbs away from source with a broom or stick. 3. Do not touch the person until the power supply is turned off. 4. Be careful in areas that are wet 66 5. Treat for shock 6. Reassure casualty 7. Cover burns with a clean dry linen 8. Seek for medical aid. COMPLICATIONS OF BURNS  Shock  Infection  Renal failure  Anaemia  Pressure sores  Dehydration  Keloid formation  Contracture formation 67  CHAPTER TWELVE BITES AND STINGS Bite is a wound made on the skin by the teeth of human beings or animals. Common bites include that of dogs, snakes, and human beings. DOG BITE A wound caused by a dog bite is usually of the punctured type and may be deceptively deep. In most cases the danger is mostly transmission of rabies. FIRST AID MANAGEMENT OF DOG BITE 1) Sit casualty down comfortably 2) Reassure casualty 3) Wash area with soap and water 4) Cover area with a clean cloth 5) Immobilize the part if necessary 6) Report incident to health personnel for casualty to be given anti-rabies vaccine if necessary. 7) Educate relatives to observe the dog for signs of rabies and veterinary officers. SNAKE BITE There are different kinds of poisonous snakes. All reactions from poisonous snake bites are aggravated by acute fear and anxiety. FACTORS AFFECTING THE OUTCOME OF POISONOUS SNAKE BITES a. the amount of venom injected and the speed of absorption of the venom into the victim’s circulation b. the size of the victim c. protection from clothing, including shoes d. location of the bite e. Specific anti venom therapy as soon as possible. 68 SIGNS AND SYMPTOMS OF SNAKE BITE  Swelling and pain at affected site  Nausea and vomiting  Difficulty in breathing  In severe cases collapse, paralysis and convulsion  Poisonous snakes leave the marks of two fangs whereas non-poisonous snakes leave the marks of rows of teeth, but not fangs. FIRST AID TREATMENT OF SNAKE BITE 1. Sit casualty down 2. Reassure casualty 3. Tie above the site of bite and keep part low 4. Cut side of bite or squeeze to promote bleeding 5. Wash wound with soap and water 6. Cover wound with a clean dressing or linen 7. Treat for shock if any 8. Transport casualty to hospital TREATING SNAKE BITE WITH BLACK STONE 1. Sit casualty down 2. Reassure casualty 3. Tie above the site of bite and keep part low 4. Make several small incisions at the site 5. Apply gentle pressure from above the site to express as much blood as possible, then use clean cloth to wipe the area 6. Place medium size black stone on the incised site and apply slight pressure. 7. Leave stone when it sticks to site 8. Leave the black stone in place until it falls by itself. 9. Wash hands and reassure the patient RECHARGING BLACK STONE 1. Pick used stone with a piece of cloth or paper (don’t touch used stone with bare hands) 69  2. Put used stone in fresh or evaporated milk or coconut milk for about an hour. 3. Remove the stone and rinse with plain water 4. Place in cool dry place to dry. 5. Store dry stone for further use 6. Wash hands thoroughly afterwards. FIRST AID MANAGEMENT OF HUMAN BITES 1) Sit casualty down comfortably 2) Reassure casualty 3) Wash area with soap and water 4) Cover area with a clean cloth 5) Immobilise the part if necessary 6) Seek medical aid. STINGS This is the introduction of a sharp, curved, needle-like part of the insect or animal which releases poison into the skin. E.g. scorpion, bees, wasp, and ants stings SIGNS AND SYMPTOMS 1. Profuse sweating 2. Swelling 3. Loss of function of the affected limb 4. Headache 5. Itching 6. Restlessness 7. Generalized bodily weakness 8. Fever 9. Nausea and sometimes vomiting 10. Shock FIRST AID MANAGEMENT a. Ensure safety at the scene b. Remo