Transcript First Aid Powerpoint Handout Page

Basic First Aid
Instructor
Tim Winer
Orange Coast College
(714) 432-0202, Ext. 26677
The Key Emergency Principle
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The key principle taught in almost all systems is that the rescuer, be they a
lay person or a professional, should assess the situation for Danger.
The reason that an assessment for Danger is given such high priority is that
it is core to emergency management that rescuers do not become
secondary victims of any incident, as this creates a further emergency that
must be dealt with.
A typical assessment for Danger would involve observation of the
surroundings, starting with the cause of the accident (e.g. a falling object)
and expanding outwards to include any situational hazards (e.g. fast moving
traffic) and history or secondary information given by witnesses, bystanders
or the emergency services (e.g. an attacker still waiting nearby).
Once a primary danger assessment has been complete, this should not end
the system of checking for danger, but should inform all other parts of the
process.
If at any time the risk from any hazard poses a significant danger (as a
factor of likelihood and seriousness) to the rescuer, they should consider
whether they should approach the scene (or leave the scene if appropriate).
Principles for assessing an
emergency
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Once a primary check for danger has been undertaken, a rescuer is then likely to
follow a set of principles, which are largely common sense. These assessment
principles are the types of information that the emergency services will ask when
summoned.
This information usually includes number of Casualties, history of what's happened
and at what time, location and access to the site and what emergency services are
likely to be required, or that are already on scene. There are several mnemonics
which are used to help rescuers remember how to conduct this assessment, which
include CHALET (Casualties, Hazards, Access, Location, Emergency Services, Type
of Incident) and ETHANE (Exact Location, Type of Incident, Hazards, Access,
Number of casualties, Emergency services required)
For small scale medical incidents (one or two casualties), the rescuer may also
conduct a first aid assessment of the patient(s) in order to gather more information.
The most widely used system is the ABC system and it's variations, where the
rescuer checks the basics of life on the casualty (primarily their breathing in modern
protocols).
In larger incidents, of any type, most protocols teach that casualty assessment should
not start until emergency services have been summoned (as multiple casualties are
expected).
Accurate reporting of this important information helps emergency services dispatch
appropriate resource to the incident, in good time and to the right place.
Summoning Emergency Services
• After undertaking a scene survey, the rescuer needs to
decide what, if any, emergency services will be required.
In many cases, an apparent emergency may turn out to
be less serious than first thought, and may not require
the intervention of the emergency services.
• If emergency services are required, the lay person would
normally call for help using their local emergency
telephone number, which can be used to summon
professional assistance. The emergency dispatcher may
well give instructions over the phone to the person on
scene, with further advice on what actions to take.
Action whilst awaiting emergency
services
• The actions following the summoning of the emergency services are
likely to depend on the response that the services are able to offer.
In most cases, in a metropolitan area, help is likely to be forthcoming
within minutes of a call, although in more outlying, rural areas, the
time in which help is available increases.
• Actions may include:
• First Aid for casualties on scene
• Obtaining further history on the incident to pass on the emergency
services
• Checking for further, previously unnoticed, casualties
• Or in instances where emergency assistance is delayed, actions
may include:
• Moving any casualties away from danger
• Undertaking more advanced medical procedures dependant on
training
Check the Patient
• ABC (and extensions of this initialism) is a
mnemonic for memorizing essential steps in
dealing with an unconscious or unresponsive
patient. It stands for Airway, Breathing and
Circulation. Some protocols add additional
steps, such as an optional "D" step for Disability
or Defibrillation. It is a reminder of the priorities
for assessment and treatment of many acute
medical situations, from first-aid to hospital
medical treatment. Airway, breathing and
circulation are vital for life, and each is required,
in that order, for the next to be effective.
ABC’s
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The key part of the mnemonic is made up of the first three letters of the alphabet — A, B and C.
Together they are designed to remind practitioners of the correct procedure (including the order)
in which to deal with a non-breathing patient.
A — Airway
If the patient's airway is blocked, oxygen cannot reach the lungs and so cannot be transported
round the body in the blood. Ensuring a clear airway is the first step in treating any patient.
Common problems with the airway involve blockage by the tongue or vomit.
Initial opening of the airway is often achieved by a "head tilt — chin lift" or jaw thrust technique,
although further maneuvers such as intubation may be necessary. (See Airway)
B — Breathing
The patient is next assessed for breathing. Common findings during an assessment of breathing
may include normal breathing, noisy breathing, gasping or coughing. The rescuer proceeds to act
on these based on his/her training. Generally at this point it will become clear whether or not the
casualty needs supportive care (such as the recovery position) or Rescue Breathing.
C — Circulation
Once oxygen can be delivered to the lungs by a clear airway and efficient breathing, there needs
to be a circulation to deliver it to the rest of the body. This can be assessed in a number of ways,
including a pulse check, ECG analysis, or Capillary refill time. Other diagnostic techniques include
blood pressure checks or temperature checks on peripheral areas.
Circulation is the original meaning of the 'C' as laid down by Jude, Knickerbocker & Safar, but in
some revised modern protocols, this step stands for Cardiopulmonary Resuscitation or more
simply, Compressions, which is effectively artificial circulation. In this case, this step should only
apply to those patients who are in Cardiogenic or other form of Shock, and therefore not breathing
normally and with an unsatisfactory heart rhythm.
Recovery position
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The recovery position or semi-prone position is a first aid technique recommended for
assisting people who are unconscious, or nearly so, but are still breathing. It is frequently taught
as part of classes in CPR (cardiopulmonary resuscitation) or first aid.
When an unconscious person is lying face upwards, there are two main risks factors which can
lead to suffocation:
The tongue can fall to the back of the throat, due to loss of muscular control. The back of the
tongue then obstructs the airway.
Fluids, possibly blood but particularly vomit, can collect in the back of the throat, causing the
person to drown. When a person is lying face up, the esophagus tilts down slightly from the
stomach towards the throat. This, combined with loss of muscular control, can lead to the stomach
contents flowing into the throat, called passive regurgitation. As well as obstructing the airway,
fluid which collects in the back of the throat can also then flow down into the lungs; stomach acid
can attack the inner lining of the lungs and cause a condition known as aspiration pneumonia.
Many fatalities occur where the original injury or illness which caused unconsciousness is not
itself inherently fatal, but where the unconscious person suffocates for one of these reasons. This
is a common cause of death following unconsciousness due to excessive consumption of alcohol.
To a limited extent, it is possible to protect against risks to the airway from the tongue by tilting the
head back and lifting the jaw. However, an unconscious person will not remain in this position
unless held constantly, and crucially it does not safeguard against risks due to fluids. If the person
is placed in the recovery position, the action of gravity will both keep the tongue from obstructing
the airway and also allow any fluids to drain. Also the chest is raised above the ground, which
helps to make breathing easier.
Recovery position
When to use the Recovery
Position
• The recovery position is recommended for
unconscious people, those who are too
inebriated to assure their own continued
breathing, victims of drowning, and also
for victims of suspected poisoning (who
are liable to become unconscious). It is
suitable for any unconscious person who
does not need CPR.
Putting a victim in the Recovery
Position
• Before using the Recovery Position, perform the preliminary first aid
steps. First assess whether the scene is safe for the rescuer. If not,
leave. Assess whether the person is responsive to your voice by
asking something like "hey, buddy, are you OK?". If not, assess
whether the person responds to painful stimulus by rubbing their
sternum with your knuckles (this is not accepted practice in some
countries). Assess whether the victim has an open airway, is
breathing and has a pulse ("airway, breathing, and circulation" or
"ABC") . If the victim is alert and an adult, obtain consent before
performing first aid. For children, attempt to obtain consent from a
parent, guardian, or other responsible caregiver. If the victim is not
alert, and is not breathing, check for a pulse. If there is no pulse,
perform cardiopulmonary resuscitation. If there is circulation,
perform Rescue breathing. The initial assessment should be done
quickly, in a minute or less. Next, alert trained emergency medical
personnel. Call the emergency telephone number or other
emergency services.
Putting a victim in the Recovery
Position
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If no spinal or neck injury is indicated
The correct position is called the "lateral recovery position."[1] Start with the victim lying on the
back and with the legs straight out. Kneel on one side of the victim, facing the victim. Move the
arm closest to you so it is perpendicular to the body, with the elbow flexed (perpendicular). Move
the farthest arm across the body so that the hand is resting across the torso.
Bend the leg farthest from you so the knee is elevated. Reach inside the knee to pull the thigh
toward you. Use the other arm to pull the shoulder that is farthest from you. Roll the body toward
you. Leave the upper leg in a flexed position to stabilize the body.
Victims who are left in this position for long periods may experience nerve compression. Still, that
is a more desirable outcome for the victim than choking to death.
If spinal or neck injuries are possible
When the injury is apparently the result of an accidental fall, collision or other trauma, the risk of
spinal or neck injuries should be assumed. Normally, only trained medical personnel should
attempt to move a victim with neck or spinal injuries.[2] Such movements run the risk of causing
permanent paralysis or other injuries.
Movement of spinal-injured victims should be minimized. Such victims should only be moved to a
recovery position when it is necessary to drain vomit from the airway.
In such instances, the correct position is called the "HAINES modified recovery position." HAINES
is an acronym of High Arm IN Endangered Spine. In this modification, one of the patient's arms is
raised above the head (in full abduction) to support the head and neck.[3][4]
There is less neck movement (and less degree of lateral angulation) than when the lateral
recovery position is used, and, therefore, HAINES use carries less risk of spinal-cord damage.[5]
Choking
• Choking is the mechanical obstruction of the flow of air
from the environment into the lungs. Choking prevents
breathing, and can be partial or complete, with partial
choking allowing some, although inadequate, flow of air
into the lungs. Prolonged or complete choking results in
asphyxiation which leads to hypoxia and is potentially
fatal.
• Choking can be caused by:
• Introduction of a foreign object into the airway, which
becomes lodged in the pharynx, larynx or trachea.
• Respiratory diseases that involve obstruction of the
airway.
• Compression of the laryngopharynx, larynx or trachea in
strangles.
Choking
• Foreign objects
• The type of choking most commonly recognized as such by the
public is the lodging of foreign objects in the airway. This type of
choking is often suffered by small children, who are unable to
appreciate the hazard inherent in putting small objects in their
mouth. In adults, it mostly occurs whilst the patient is eating.
• Symptoms and Clinical Signs
• The person cannot speak or cry out.
• The person's face turns blue (cyanosis) from lack of oxygen.
• The person desperately grabs at his or her throat.
• The person has a weak cough, and labored breathing produces a
high-pitched noise.
• The person does any or all of the above, and then becomes
unconscious.
Choking
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Treatment
Choking can be treated with a number of different procedures, with both basic techniques
available for first aiders and more advanced techniques available for health professionals.
Many members of the public associate abdominal thrusts, also known as the 'Heimlich
Maneuver' with the correct procedure for choking, which is partly due to the widespread use of
this technique in movies, which in turn was based on the widespread adoption of this technique in
the USA at the time, although it also produced easy material for writers to create comedy effect.
Most modern protocols (including those of the American Heart Association and the American Red
Cross, who changed policy in 2006[1] from recommending only abdominal thrusts) involve several
stages, designed to apply increasingly more pressure.
The key stages in most modern protocols include:
Encouraging the victim to cough
This stage was introduced in many protocols as it was found that many people were too quick to
undertake potentially dangerous interventions, such as abdominal thrusts, for items which could
have been dislodged without intervention. Also, if the choking is caused by irritating liquids
(alcohol, spice, mint, gastric acid, etc.) or anything without a solid shape, and if conscious, the
patient should be allowed to drink water on their own to try to clear the throat. Since the airway is
already closed, there is very little danger of water entering the lungs. Coughing is normal after
most of the irritant has cleared, and at this point the patient will probably refuse any additional
water for a short time.
Choking
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Abdominal thrusts
A demonstration of abdominal thrusts
Abdominal thrusts, also known as the Heimlich Maneuver (after Henry Heimlich, who first
described the procedure in a June 1974 informal article entitled "Pop Goes the Cafe Coronary,"
published in the journal Emergency Medicine. Edward A. Patrick, MD, PhD, an associate of
Heimlich, has claimed to be the uncredited co-developer of the procedure, and has been quoted
calling it the Patrick maneuver.[4] Heimlich has objected to the name "abdominal thrusts" on the
grounds that the vagueness of the term "abdomen" could cause the rescuer to exert force at the
wrong site.[citation needed]
Performing abdominal thrusts involves a rescuer standing behind a patient and using their hands
to exert pressure on the bottom of the diaphragm. This compresses the lungs and exerts pressure
on any object lodged in the trachea, hopefully expelling it. This amounts to an artificial cough.
Due to the forceful nature of the procedure, even when done correctly it can injure the person on
whom it is performed. Bruising to the abdomen is highly likely and more serious injuries can occur,
including fracture of the xiphoid process or ribs.[5]
Self treatment with abdominal thrusts
A person may also perform abdominal thrusts on themselves by using a fixed object such as a
railing or the back of a chair to apply pressure where a rescuers hands would normally do so. As
with other forms of the procedure, it is likely that internal injuries may result.
Choking
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Other uses of abdominal thrusts
Dr. Heimlich also advocates the use of the technique as a treatment for drowning[6] and asthma[7] attacks, but
Heimlich's promotion to use the maneuver to treat these conditions resulted in marginal acceptance. Criticism of
these uses has been the subject of numerous print and television reports which resulted from an internet and
media campaign by his son, Peter M. Heimlich, who alleges that in August 1974 his father published the first of a
series of fraudulent case reports in order to promote the use of abdominal thrusts for near-drowning rescue.[8]
Modified chest thrusts
A modified version of the technique is sometimes taught for use with pregnant women and obese casualties. The
rescuer places their hand in the center of the chest to compress, rather than in the abdomen.
CPR
In most protocols, once the patient has become unconscious, the emphasis switches to performing CPR, involving
both chest compressions and artificial respiration. These actions are often enough to dislodge the item sufficiently
for air to pass it, allowing gaseous exchange in the lungs.
Finger Sweeping
Some protocols advocate the use of the rescuer's finger to 'sweep' foreign objects away once they have reached
the mouth. However, many modern protocols recommend against the use of the finger sweep as if the patient is
conscious, they will be able to remove themselves, or if they are unconscious the rescuer should simply place
them in the recovery position (where the object should fall out due to gravity). There is also a risk of causing
further damage (for instance inducing vomiting) by using a finger sweep technique.
Direct vision removal
The advanced medical procedure to remove such objects is inspection of the airway with a laryngoscope or
bronchoscope, and removal of the object under direct vision, followed by CPR if the patient does not start
breathing on their own. Severe cases where there is an inability to remove the object may require cricothyrotomy.
Heart Attack
• Acute myocardial infarction (AMI or MI), more commonly known
as a heart attack, is a medical condition that occurs when the blood
supply to a part of the heart is interrupted, most commonly due to
rupture of a vulnerable plaque. The resulting ischemia or oxygen
shortage causes damage and potential death of heart tissue. It is a
medical emergency, and the leading cause of death for both men
and women all over the world.[1] Important risk factors are a history
of vascular disease such as atherosclerotic coronary heart disease
and/or angina, a previous heart attack or stroke, any previous
episodes of abnormal heart rhythms or syncope, older age—
especially men over 40 and women over 50, smoking, excessive
alcohol consumption, the abuse of certain drugs, high triglyceride
levels, high LDL (low-density lipoprotein, "bad cholesterol") and low
HDL (high density lipoprotein, "good cholesterol"), diabetes, high
blood pressure, obesity, and chronically high levels of stress.
Chronic kidney disease[2] and a history of heart failure[3] are also
significant risk factors which may also predict fatality from MI.
Heart Attack
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Risk factors
Risk factors for atherosclerosis are generally risk factors for myocardial infarction:
Older age
Male sex
Tobacco smoking
Hypercholesterolemia (more accurately hyperlipoproteinemia, especially high low density
lipoprotein and low high density lipoprotein)
Hyperhomocysteinemia (high homocysteine, a toxic blood amino acid that is elevated when
intakes of vitamins B2, B6, B12 and folic acid are insufficient)
Diabetes (with or without insulin resistance)
High blood pressure
Obesity[14] (defined by a body mass index of more than 30 kg/m², or alternatively by waist
circumference or waist-hip ratio).
Stress Occupations with high stress index are known to have susceptibility for atherosclerosis.
Many of these risk factors are modifiable, so many heart attacks can be prevented by maintaining
a healthier lifestyle. Physical activity, for example, is associated with a lower risk profile.[15] Nonmodifiable risk factors include age, sex, and family history of an early heart attack (before the age
of 60), which is thought of as reflecting a genetic predisposition.[13]
Heart Attack
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Symptoms
Rough diagram of pain zones in myocardial infarction (dark red = most typical area, light red = other possible areas, view of
the chest).
Back view.
The onset of symptoms in myocardial infarction (MI) is usually gradual, over several minutes, and rarely instantaneous.[44]
Chest pain is the most common symptom of acute myocardial infarction and is often described as a sensation of tightness,
pressure, or squeezing. Chest pain due to ischemia (a lack of blood and hence oxygen supply) of the heart muscle is termed
angina pectoris. Pain radiates most often to the left arm, but may also radiate to the lower jaw, neck, right arm, back, and
epigastrium, where it may mimic heartburn. Levine's sign, in which the patient localizes his chest pain by clenching his fist
over the sternum, has classically been thought to be predictive of cardiac chest pain, although a prospective observational
study showed that it had a poor positive predictive value.[45]
Shortness of breath (dyspnea) occurs when the damage to the heart limits the output of the left ventricle, causing left
ventricular failure and consequent pulmonary edema. Other symptoms include diaphoresis (an excessive form of sweating),
weakness, light-headedness, nausea, vomiting, and palpitations. These symptoms are likely induced by a massive surge of
catecholamines from the sympathetic nervous system[46] which occurs in response to pain and the hemodynamic
abnormalities that result from cardiac dysfunction. Loss of consciousness (due to inadequate cerebral perfusion and
cardiogenic shock) and even sudden death (frequently due to the development of ventricular fibrillation) can occur in
myocardial infarctions.
Women often experience markedly different symptoms than men. The most common symptoms of MI in women include
dyspnea, weakness, and fatigue. Fatigue, sleep disturbances, and dyspnea have been reported as frequently occurring
symptoms which may manifest as long as one month before the actual clinically manifested ischemic event. In women, chest
pain may be less predictive of coronary ischemia than in men.[47]
Approximately half of all MI patients have experienced warning symptoms such as chest pain prior to the infarction.[48]
Approximately one fourth of all myocardial infarctions are silent, without chest pain or other symptoms.[49] These cases can
be discovered later on electrocardiograms or at autopsy without a prior history of related complaints. A silent course is more
common in the elderly, in patients with diabetes mellitus[50] and after heart transplantation, probably because the donor
heart is not connected to nerves of the host.[51] In diabetics, differences in pain threshold, autonomic neuropathy, and
psychological factors have been cited as possible explanations for the lack of symptoms.[50]
Any group of symptoms compatible with a sudden interruption of the blood flow to the heart are called an acute coronary
syndrome.[
Bleeding and Wound Care
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Basic external wound management
The type of wound (incision, laceration, puncture etc.) will have a major effect on the way a wound
is managed, as will the area of the body affected and the presence of any foreign objects in the
wound. The key principles of wound management are:[1]
Elevation - Keeping the wound above the level of the heart will decrease the pressure at the point
of injury, and will reduce the bleeding. This mainly applies to limbs and the head, as it is
impractical (and in some cases damaging) to attempt to move the torso around to achieve this.
Most protocols also do not use elevation on limbs which are broken, as this may exacerbate the
injury.
Direct Pressure - Placing pressure on the wound will constrict the blood vessels manually,
helping to stem any blood flow. When applying pressure, the type and direction of the wound may
have an effect, for instance, a cut lengthways on the hand would be opened up by closing the
hand in to a fist, whilst a cut across the hand would be sealed by making a fist. A patient can
apply pressure directly to their own wound, if their consciousness level allows. Ideally a barrier,
such as sterile, low-adherent gauze should be used between the pressure supplier and the
wound, to help reduce chances of infection and help the wound to seal. Third parties assisting a
patient are always advised to use protective latex or nitrile medical gloves to reduce risk of
infection or contamination passing either way. Direct pressure can be used with some foreign
objects protruding from a wound, and to achieve this, padding is applied from either side of the
object to push in and seal the wound - objects are never removed.
Bleeding and Wound Care
• Pressure points
• In situations where direct pressure and elevation are either not
possible or proving ineffective, and there is a risk of exsanguination,
some training protocols advocate the use of pressure points to
constrict the major artery which feeds the point of the bleed. This is
usually performed at a place where a pulse can be found, such as in
the femoral artery. There are significant risks involved in performing
pressure point constriction, including necrosis of the area below the
constriction, and most protocols give a maximum time for
constriction (often around 10 minutes). There is particularly high
danger if constricting the carotid artery in the neck, as the brain is
sensitive to hypoxia and brain damage can result within minutes of
application of pressure. Other dangers in use of a constricting
method include rhabdomyolysis, which is a build up of toxins below
the pressure point, which if released back in to the main
bloodstream may cause cardiogenic shock
Bleeding and Wound Care
• A bandage is a piece of material used either to support
a medical device such as a dressing or splint, or on its
own to provide support to the body. Bandages are
available in a wide range of types, from generic cloth
strips, to specialized shaped bandages designed for a
specific limb or part of the body, although bandages can
often be improvised as the situation demands, using
clothing, blankets or other material.
• In common speech, the word "bandage" is often used to
mean a dressing, which is used directly on a wound,
whereas a bandage is technically only used to support a
dressing, and not directly on a wound.
Shock
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Shock may result from trauma, heatstroke, allergic reactions, severe infection, poisoning or other
causes. Various signs and symptoms appear in a person experiencing shock:
The skin is cool and clammy. It may appear pale or gray.
The pulse is weak and rapid. Breathing may be slow and shallow, or hyperventilation (rapid or
deep breathing) may occur. Blood pressure is below normal.
The eyes lack luster and may seem to stare. Sometimes the pupils are dilated.
The person may be conscious or unconscious. If conscious, the person may feel faint or be
very weak or confused. Shock sometimes causes a person to become overly excited and anxious.
If you suspect shock, even if the person seems normal after an injury:
Dial 911 or call your local emergency number.
Have the person lie down on his or her back with feet higher than the head. If raising the legs
will cause pain or further injury, keep him or her flat. Keep the person still.
Check for signs of circulation (breathing, coughing or movement). If absent, begin CPR.
Keep the person warm and comfortable. Loosen belt(s) and tight clothing and cover the person
with a blanket. Even if the person complains of thirst, give nothing by mouth.
Turn the person on his or her side to prevent choking if the person vomits or bleeds from the
mouth.
Seek treatment for injuries, such as bleeding or broken bones.
Burns
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The most common system of classifying burns categorizes them as first-, second-, or
third-degree. Sometimes this is extended to include a fourth or even up to a sixth
degree, but most burns are first- to third-degree, with the higher-degree burns
typically being used to classify burns post-mortem. The following are brief
descriptions of these classes:[4]
First-degree burns are usually limited to redness (erythema), a white plaque and
minor pain at the site of injury. These burns only involve the epidermis.
Second-degree burns manifest as erythema with superficial blistering of the skin,
and can involve more or less pain depending on the level of nerve involvement.
Second-degree burns involve the superficial (papillary) dermis and may also involve
the deep (reticular) dermis layer.
Third-degree burns occur when most of the epidermis is lost with damage to
underlying ligaments, tendons and muscle. Burn victims will exhibit charring of the
skin, and sometimes hard eschars will be present. An eschar is a scab that has
separated from the unaffected part of the body. These types of burns are often
considered painless, because nerve endings have been destroyed in the burned
area. Hair follicles and sweat glands may also be lost due to complete destruction of
the dermis. Third degree burns result in scarring and may be fatal if the affected area
is significantly large.
Burns
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For minor burns, including first-degree burns and second-degree burns limited to an area no
larger than 3 inches (7.5 centimeters) in diameter, take the following action:
Cool the burn. Hold the burned area under cold running water for at least five minutes, or until
the pain subsides. If this is impractical, immerse the burn in cold water or cool it with cold
compresses. Cooling the burn reduces swelling by conducting heat away from the skin. Don't put
ice on the burn.
Cover the burn with a sterile gauze bandage. Don't use fluffy cotton, which may irritate the skin.
Wrap the gauze loosely to avoid putting pressure on burned skin. Bandaging keeps air off the
burned skin, reduces pain and protects blistered skin.
Take an over-the-counter pain reliever. These include aspirin, ibuprofen (Advil, Motrin, others),
naproxen (Aleve) or acetaminophen (Tylenol, others). Never give aspirin to children or teenagers.
Minor burns usually heal without further treatment. They may heal with pigment changes, meaning
the healed area may be a different color from the surrounding skin. Watch for signs of infection,
such as increased pain, redness, fever, swelling or oozing. If infection develops, seek medical
help. Avoid re-injuring or tanning if the burns are less than a year old — doing so may cause more
extensive pigmentation changes. Use sunscreen on the area for at least a year.
Caution
Don't use ice. Putting ice directly on a burn can cause frostbite, further damaging your skin.
Don't apply butter or ointments to the burn. This could prevent proper healing.
Don't break blisters. Broken blisters are vulnerable to infection.
Burns
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Third-degree burn
The most serious burns are painless, involve all layers of the skin and cause
permanent tissue damage. Fat, muscle and even bone may be affected. Areas may
be charred black or appear dry and white. Difficulty inhaling and exhaling, carbon
monoxide poisoning, or other toxic effects may occur if smoke inhalation
accompanies the burn.
For major burns, dial 911 or call for emergency medical assistance. Until an
emergency unit arrives, follow these steps:
Don't remove burnt clothing. However, do make sure the victim is no longer in
contact with smoldering materials or exposed to smoke or heat.
Don't immerse large severe burns in cold water. Doing so could cause shock.
Check for signs of circulation (breathing, coughing or movement). If there is no
breathing or other sign of circulation, begin cardiopulmonary resuscitation (CPR).
Elevate the burned body part or parts. Raise above heart level, when possible.
Cover the area of the burn. Use a cool, moist, sterile bandage; clean, moist cloth; or
moist towels.
Fractures
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A fracture is a broken bone. It requires medical attention. If the broken bone is the result of major
trauma or injury, call 911 or your local emergency number. Also call for emergency help if:
The person is unresponsive, isn't breathing or isn't moving. Begin cardiopulmonary resuscitation
(CPR) if there's no respiration or heartbeat.
There is heavy bleeding.
Even gentle pressure or movement causes pain.
The limb or joint appears deformed.
The bone has pierced the skin.
The extremity of the injured arm or leg, such as a toe or finger, is numb or bluish at the tip.
You suspect a bone is broken in the neck, head or back.
You suspect a bone is broken in the hip, pelvis or upper leg (for example, the leg and foot turn
outward abnormally).
Take these actions immediately while waiting for medical help:
Stop any bleeding. Apply pressure to the wound with a sterile bandage, a clean cloth or a clean
piece of clothing.
Immobilize the injured area. Don't try to realign the bone, but if you've been trained in how to
splint and professional help isn't readily available, apply a splint to the area.
Apply ice packs to limit swelling and help relieve pain until emergency personnel arrive.
Don't apply ice directly to the skin — wrap the ice in a towel, piece of cloth or some other material.
Treat for shock. If the person feels faint or is breathing in short, rapid breaths, lay the person
down with the head slightly lower than the trunk and, if possible, elevate the legs.
Strains and Sprains
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For immediate self-care of a sprain or strain, try the P.R.I.C.E. approach — protection, rest, ice, compression,
elevation. In most cases beyond a minor strain or sprain, you'll want your doctor and physical therapist to help you
with this process:
Protection. Immobilize the area to protect it from further injury. Use an elastic wrap, splint or sling to immobilize
the area. If your injury is severe, your doctor or therapist may place a cast or brace around the affected area to
protect it and instruct you on how to use a cane or crutches to help you get around, if necessary.
Rest. Avoid activities that cause pain, swelling or discomfort. But don't avoid all physical activity. Instead, give
yourself relative rest. For example, with an ankle sprain you can usually still exercise other muscles to prevent
deconditioning. For example, you could use an exercise bicycle, working both your arms and the uninjured leg
while resting the injured ankle on a footrest peg. That way you still exercise three limbs and keep up your
cardiovascular conditioning.
Ice. Even if you're seeking medical help, ice the area immediately. Use an ice pack or slush bath of ice and water
for 15 to 20 minutes each time and repeat every two to three hours while you're awake for the first few days
following the injury. Cold reduces pain, swelling and inflammation in injured muscles, joints and connective tissues.
It also may slow bleeding if a tear has occurred. If the area turns white, stop treatment immediately. This could
indicate frostbite. If you have vascular disease, diabetes or decreased sensation, talk with your doctor before
applying ice.
Compression. To help stop swelling, compress the area with an elastic bandage until the swelling stops. Don't
wrap it too tightly or you may hinder circulation. Begin wrapping at the end farthest from your heart. Loosen the
wrap if the pain increases, the area becomes numb or swelling is occurring below the wrapped area.
Elevation. To reduce swelling, elevate the injured area above the level of your heart, especially at night. Gravity
helps reduce swelling by draining excess fluid.
Continue with P.R.I.C.E. treatment for as long as it helps you recover. Over-the-counter pain medications such as
ibuprofen (Advil, Motrin, others) and acetaminophen (Tylenol, others) also can be helpful. If you want to apply heat
to the injured area, wait until most of the swelling has subsided.
After the first two days, gently begin to use the injured area. You should see a gradual, progressive improvement
in the joint's ability to support your weight or your ability to move without pain.
Mild and moderate sprains usually heal in three to six weeks. If pain, swelling or instability persists, see your
doctor. A physical therapist can help you to maximize stability and strength of the injured joint or limb.
Poisoning
• Many conditions mimic the signs and symptoms of poisoning,
including seizures, alcohol intoxication, stroke and insulin reaction.
So look for the signs and symptoms listed below if you suspect
poisoning, but check with the poison control center at 800-222-1222
(in the United States) before giving anything to the affected person.
• Signs and symptoms of poisoning:
• Burns or redness around the mouth and lips, which can result from
drinking certain poisons
• Breath that smells like chemicals, such as gasoline or paint thinner
• Burns, stains and odors on the person, on his or her clothing, or on
the furniture, floor, rugs or other objects in the surrounding area
• Empty medication bottles or scattered pills
• Vomiting, difficulty breathing, sleepiness, confusion or other
unexpected signs
Poisoning
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When to call for help:
Call 911 or your local emergency number immediately if the person is:
Drowsy or unconscious
Having difficulty breathing or has stopped breathing
Uncontrollably restless or agitated
Having seizures
If the person seems stable and has no symptoms, but you suspect poisoning, call the poison control center at 800222-1222. Provide information about the person's symptoms and, if possible, information about what he or she
ingested, how much and when.
What to do while waiting for help:
If the person has been exposed to poisonous fumes, such as carbon monoxide, get him or her into fresh air
immediately.
If the person swallowed the poison, remove anything remaining in the mouth.
If the suspected poison is a household cleaner or other chemical, read the label and follow instructions for
accidental poisoning. If the product is toxic, the label will likely advise you to call the poison control center at 800222-1222. Also call this 800 number if you can't identify the poison, if it's medication or if there are no instructions.
Follow treatment directions that are given by the poison control center.
If the poison spilled on the person's clothing, skin or eyes, remove the clothing. Flush the skin or eyes with cool or
lukewarm water, such as by using a shower for 20 minutes or until help arrives.
Take the poison container (or any pill bottles) with you to the hospital.
What NOT to do
Don't administer ipecac syrup or do anything to induce vomiting. In 2003, the American Academy of
Pediatrics advised discarding ipecac in the home, saying there's no good evidence of effectiveness and that it can
do more harm than good.
Heat Exhaustion
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Heat exhaustion is one of the heat-related syndromes, which range in severity from mild heat cramps to heat
exhaustion to potentially life-threatening heatstroke.
Signs and symptoms of heat exhaustion often begin suddenly, sometimes after excessive exercise, heavy
perspiration and inadequate fluid intake. Signs and symptoms resemble those of shock and may include:
Feeling faint or dizzy
Nausea
Heavy sweating
Rapid, weak heartbeat
Low blood pressure
Cool, moist, pale skin
Low-grade fever
Heat cramps
Headache
Fatigue
Dark-colored urine
If you suspect heat exhaustion:
Get the person out of the sun and into a shady or air-conditioned location.
Lay the person down and elevate the legs and feet slightly.
Loosen or remove the person's clothing.
Have the person drink cool water.
Cool the person by spraying or sponging him or her with cool water and fanning.
Monitor the person carefully. Heat exhaustion can quickly become heatstroke.
If fever greater than 102 F (38.9 C), fainting, confusion or seizures occur, dial 911 or call for emergency medical
assistance.
Heatstroke
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Heatstroke is the most severe of the heat-related problems, often resulting from exercise or heavy work in hot
environments combined with inadequate fluid intake.
Young children, older adults, people who are obese and people born with an impaired ability to sweat are at high
risk of heatstroke. Other risk factors include dehydration, alcohol use, cardiovascular disease and certain
medications.
What makes heatstroke severe and potentially life-threatening is that the body's normal mechanisms for dealing
with heat stress, such as sweating and temperature control, are lost. The main sign of heatstroke is a markedly
elevated body temperature — generally greater than 104 F (40 C) — with changes in mental status ranging from
personality changes to confusion and coma. Skin may be hot and dry — although if heatstroke is caused by
exertion, the skin may be moist.
Other signs and symptoms may include:
Rapid heartbeat
Rapid and shallow breathing
Elevated or lowered blood pressure
Cessation of sweating
Irritability, confusion or unconsciousness
Feeling dizzy or lightheaded
Headache
Nausea
Fainting, which may be the first sign in older adults
If you suspect heatstroke:
Move the person out of the sun and into a shady or air-conditioned space.
Dial 911 or call for emergency medical assistance.
Cool the person by covering him or her with damp sheets or by spraying with cool water. Direct air onto the person
with a fan or newspaper.
Have the person drink cool water, if he or she is able.
Cold Emergencies
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Under most conditions your body maintains a healthy temperature. However, when exposed to
cold temperatures or to a cool, damp environment for prolonged periods, your body's control
mechanisms may fail to keep your body temperature normal. When more heat is lost than your
body can generate, hypothermia can result.
Wet or inadequate clothing, falling into cold water, and even having an uncovered head during
cold weather can all increase your chances of hypothermia.
Hypothermia is defined as an internal body temperature less than 95 F (35 C). Signs and
symptoms include:
Shivering
Slurred speech
Abnormally slow breathing
Cold, pale skin
Loss of coordination
Fatigue, lethargy or apathy
Confusion or memory loss
Signs and symptoms usually develop slowly. People with hypothermia typically experience
gradual loss of mental acuity and physical ability, so they may be unaware that they need
emergency medical treatment.
Older adults, infants, young children and people who are very lean are at particular risk. Other
people at higher risk of hypothermia include those whose judgment may be impaired by mental
illness or Alzheimer's disease and people who are intoxicated, homeless or caught in cold
weather because their vehicles have broken down. Other conditions that may predispose people
to hypothermia are malnutrition, cardiovascular disease and an underactive thyroid
(hypothyroidism).
Cold Emergencies
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To care for someone with hypothermia:
Dial 911 or call for emergency medical assistance. While waiting for help
to arrive, monitor the person's breathing. If breathing stops or seems
dangerously slow or shallow, begin cardiopulmonary resuscitation (CPR)
immediately.
Move the person out of the cold. If going indoors isn't possible, protect
the person from the wind, cover his or her head, and insulate his or her
body from the cold ground.
Remove wet clothing. Replace wet things with a warm, dry covering.
Don't apply direct heat. Don't use hot water, a heating pad or a heating
lamp to warm the victim. Instead, apply warm compresses to the neck,
chest wall and groin. Don't attempt to warm the arms and legs. Heat applied
to the arms and legs forces cold blood back toward the heart, lungs and
brain, causing the core body temperature to drop. This can be fatal.
Don't give the person alcohol. Offer warm nonalcoholic drinks, unless the
person is vomiting.
Don't massage or rub the person. Handle people with hypothermia gently,
because they're at risk of cardiac arrest.
Acknowledgements
• Thank you to:
• Wikipedia and MayoClinic.com for the
information provided in this handout.