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Health

First Aid



FirstAid
The hazards for a common people are numerous and accidents may happen at any time.
Commonly seen accident due to slips and falls, exposure to toxic fumes/materials, water accident, alcohol related crash injuries, electric shock etc.
In providing medical aid, the response must be both swift and efficient. A stitch in time may save more than nine lives out of ten.


Contents :-



General Principle


What is First Aid?


• First aid is the immediate assistance given to the injured or ill with available resources before medical help is available.
• First aid is emergency care given immediately to an injured person. The purpose of first aid is to minimize injury and future disability. In serious cases, first aid may be necessary to keep the victim alive.
• First aid is immediate help given to a person who has been injured before they go to hospital.
• Emergency treatment given to an injured, wounded or sick person before the services of a Medical Officer can be secured.
• First aid is a series of simple, life-saving medical techniques that a non-doctor or layman can be trained to perform. If you need to perform first aid, see Emergency Action Principles.


Aim of First Aid.


The aims of first aid are:
• To save life by removing any life thrilling danger/s.
• To prevent further injury and deterioration of the patient’s condition.
• To relieve pain.
• To make medical assistance available at the earliest.


Qualities of a First Aider.


A good first aider should be:
• A good observer.
• Able to act quickly .
• Calm and collected.
• Able to lead and control the crowd, and take form on-lookers.
Self-confident and able to judge which injuries need to be tackled first .
• Able to reassure the apprehensive victim and his/her anxious or nervous relatives by demonstrating competence, expressing sympathy and providing reassurance.


Principle of First Aid.


First aid is the initial care of a suddenly sick or injured person. It is the care administered by a person as soon as possible after an accident or illness. It is this prompt care and attention prior to the arrival of the ambulance that sometimes means the difference between life and death, or between a full or partial recovery.

The main aims of first aid are:
• To preserve life.
• To protect the casualty from further harm.
• To relieve pain.

First aid has limitations, as not everybody is a paramedic or doctor, but it is an essential and vital element of the total medical system. First aid saves lives, you can ask any person who works in the emergency medical field.


Immediate Action.


As in most endeavors, the principle to be adopted in first aid is immediate action. Bystanders or relatives not knowing what to do or being too timid to try may have unwittingly contributed to unnecessary deaths and chronic injuries. If a person is sick or injured, then they need help, and they need it immediately.
Quick action is necessary to preserve life and limb. A casualty who is not breathing effectively, or is bleeding heavily, requires immediate assistance. If quick effective first aid is provided, then the casualty has a much better chance of a good recovery.
It is important that quick action does not lead to panic. Careful and deliberate action undertaken without too much delay is most beneficial to the casualty. Try to remain calm and think your actions through. A calm and controlled first aider will give everyone confidence that the event is being handled efficiently and effectively.
Each emergency is different so it is impossible to provide you with a precise list of things you need to do for every emergency. However, if you follow the ‘principles of first aid’ as outlined in this book you should deliver appropriate care, even if we are not sure of what the underlying problem is.

Look for the following:
• Remove the patient to a place of safety.
• Loosen clothing around the neck and waist to aid breathing
• Reassure the patient
1. Is there any failure of breathing? If yes, start artificial respiration
2. Is there any failure of circulation? If yes, start external cardiac massage
3. Is there severe bleeding? If yes, stop bleeding by pressing firmly on the bleeding area with a clean pad for few minutes or apply pressure on the pressure areas

• Treat shock.
• Relieve pain.
• Avoid handling the casualty unnecessarily.
• Arrange of the safe removal of the casualty to hospital.


First Aid Kit.


Every office, factory, home and school should have an accessible first-aid box. It is readily available in shops but you can use a tin or card board box at home as your first aid box.

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Following are the common stuff you should have in your first aid box:
• First-aid book.
• Sterile adhesive bandages in assorted sizes.
• Small roll of absorbent gauze or gauze pads of different sizes.
• Adhesive tape.
• Triangular and roller bandages.
• Cotton (1 roll).
• Band-aids (Plasters).
• Scissors
• Pen torch.
• Latex gloves (2 pair)
• Tweezers.
• Needle
• Moistened towels and clean dry cloth pieces.
• Antiseptic (Savlon or dettol)
• Thermometer.
• Tube of petroleum jelly or other lubricant.
• Assorted sizes of safety pins.
• Cleansing agent/soap.
Non-prescription drugs:
• Aspirin or paracetamol pain relievers
• Anti-diarrhea medication
• Antihistamine cream for Bee Stings
• Antacid (for stomach upset)
• Laxative


Body Structure and Foundation


Skeletal System.


The human body can be compared to a well-oiled machine which is required to perform various functions in co-ordinations with other systems. As in a machine, co-ordinate functioning is essential as no particular system can be said to be more important than another.

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The Skeletal System serves many important functions; it provides the shape and form for our bodies in addition to supporting, protecting, allowing bodily movement, producing blood for the body, and storing minerals.

Functions
Its 206 bones form a rigid framework to which the softer tissues and organs of the body are attached.
Vital organs are protected by the skeletal system. The brain is protected by the surrounding skull as the heart and lungs are encased by the sternum and rib cage.
Bodily movement is carried out by the interaction of the muscular and skeletal systems. For this reason, they are often grouped together as the musculo-skeletal system. Muscles are connected to bones by tendons. Bones are connected to each other by ligaments. Where bones meet one another is typically called a joint. Muscles which cause movement of a joint are connected to two different bones and contract to pull them together. An example would be the contraction of the biceps and a relaxation of the triceps. This produces a bend at the elbow. The contraction of the triceps and relaxation of the biceps produces the effect of straightening the arm.
Blood cells are produced by the marrow located in some bones. An average of 2.6 million red blood cells is produced each second by the bone marrow to replace those worn out and destroyed by the liver.
Bones serve as a storage area for minerals such as calcium and phosphorus. When an excess is present in the blood, buildup will occur within the bones. When the supply of these minerals within the blood is low, it will be withdrawn from the bones to replenish the supply.

SKULL
The skull is the bony framework of the head. It is comprised of the eight cranial and fourteen facial bones.

Cranial Bones
The cranial bones makeup the protective frame of bone around the brain.
The cranial bones are:
• The frontal forms part of the cranial cavity as well as the forehead, the brow ridges and the nasal cavity.
• The left and right parietal forms much of the superior and lateral portions of the cranium.
• The left and right temporal form the lateral walls of the cranium as well as housing the external ear.
• The occipital forms the posterior and inferior portions of the cranium. Many neck muscles attach here as this is the point of articulation with the neck.
• The sphenoid forms part of the eye orbit and helps to form the floor of the cranium.
• The ethmoid forms the medial portions of the orbits and the roof of the nasal cavity.
The joints between bones of the skull are immovable and called sutures. The parietal bones are joined by the sagittal suture. Where the parietal bones meet the frontal is referred to as the coronal suture. The parietals and the occipital meet at the lambdoidal suture. The suture between the parietals and the temporal bone is referred to as the squamous suture. These sites are the common location of fontanelles or “soft spots” on a baby’s head.

Facial Bones
The facial bones makeup the upper and lower jaw and other facial structures.
The mandible is the lower jawbone. It articulates with the temporal bones at the temporomandibular joints. This forms the only freely moveable joint in the head. It provides the chewing motion.
• The left and right maxilla is the upper jaw bones. They form part of the nose, orbits, and roof of the mouth.
• The left and right palatine forms a portion of the nasal cavity and the posterior portion of the roof of the mouth.
• The left and right zygomatic are the cheek bones. They form portions of the orbits as well.
• The left and right nasal forms the superior portion of the bridge of the nose.

BACKBONE OR THE VERTEBRAL COLUMN:
It is composed of 33 small bones called vertebrae. There are 7 vertebrae in the neck (cervical vertebrae), 12 in the back (thoracic vertebrae), 5 in the loin together with the rump (sacrum) and 4 fused together in the vestigial tail (coccyx)

RIBS:
There are 12 ribs on each side, attached to the thoracic vertebrae at the back. Except the lowest four, the ribs are attached to the breast bone in front.

Breast Bone (STERNUM):
It is a flat bone forming the form of the thoracic cage. The sternum or breastbone is a long, flat bone located in the center of the thorax (chest). It connects to the rib bones via cartilage, forming the rib cage with them, and thus helps to protect the lungs, heart and major blood vessels from physical trauma.
The sternum is sometimes cut open (a median sternotomy) to gain access to the thoracic contents when performing cardiothoracic surgery

Collar Bone or CLAVICLE:
It extends from the sternum, or breast bone, to the shoulder In human anatomy, the clavicle or collar bone is a bone that makes up part of the shoulder girdle (pectoral girdle). It receives its name from the Latin clavicula (“little key”) because the bone rotates along its axis like a key when the shoulder is abducted. (This movement is palpable with the opposite hand).
Clavicles are found in many tetrapods but tend to be rudimentary or absent in those using their forelimbs primarily for support or running and present where the forelimbs are used for grasping or brachiation.

Shoulder Blade Scapula:
A thin flat forming bone forming a part of the shoulder girdle.

Upper Limb Bones:
There is one long bone in the arm—the humerus, and two long bones in the fore arm—the radius and ulna. The wrist has 8 small and the hand has 19 bones.

Hip Bone or Innominate Bone:
There are two hip bones attached to the sacrum. Each hipbone is made of three bones, ilium, ischium and the public bone.

Lower Limb Bones:
There is one long bone in the thigh, the femur, two long bones in the leg, tibia and fibula, seven small bones in the ankle and 19 bones in the foot.

The Joints:
The various bones in the human body are joined to one another by ligaments. The joints may be movable or immovable. Movements between bones may be only in one plane as in the hinge joints at knee and elbow, in all planes as in the ball and socket joint at the shoulder or there may be just a small degree of movement as in the wrist joint.


Muscular System.


The bones are covered with muscles. The muscles are attached to two bones and cross over joints, so that when the muscles contract, movement is produced at the joints by bringing the bones together. Since the muscles can be contracted at will, they are called voluntary muscles. They are also called striated muscles because they reveal striations under a microscope. There is another type of muscle called involuntary muscle, which cannot be contracted at will, e.g., muscle in the wall of the bowel as passages and blood vessels. These are also called smooth muscles because they do not show striations under a microscope. The muscle of the heart is a special type of involuntary muscle known as the cardiac muscle.

Skin :
The body is covered by skin, under which lies a layer of fat which act as insulation. The skin protects the underlying tissue from mechanical injury as well as from infections. It maintains body temperature and also functions as an excretory organ by the process of sweating.

Cavities :
Various organs in the body are placed in body cavities like the cranial cavity, thoracic cavity, abdominal cavity and pelvic cavity. The cranial cavity is bounded by the skull bones. Thus, brain inside this cavity is well protected. The thoracic cavity is bounded by the rib cage all around and the diaphragm below. The rib cage is formed by the vertebral column behind, the ribs on the sides and the sternum in front. The thoracic cavity contains the heart, lungs, trachea and bronchi, the esophagus, the major blood vessels draining into the heart and carrying blood away form it. The thoracic cavity expands during inspiration by flaring out of the ribs and downward movement of the diaphragm.
The abdominal cavity is bounded by the vertebral column behind and strong voluntary muscles on side and front. It contains stomach, liver, spleen, gall, bladder, pancreas, kidney, small intestine and most of the large intestine.
The pelvic cavity is protected by the bones of the sacrum and innominate bones. It contains the urinary bladder, part of the large intestine and the internal reproductive organs.

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Digestive System.


It is composed of the stomach, the small intestine, the large intestine, the rectum and glands which secrete digestive enzyme into gastro intestinal tract—the salivary glands, liver, pancreas etc.


Heart and Circulatory system.


The heart and its circulation:

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The cardiovascular system is made up of the heart, aorta, superior and inferior venacava, the pulmonary veins, and the peripheral blood vessels. The heart is of the size and shape of one’s closed fist and weighs about 300-350 gms in adults. It has three layers, the covering layer called pericardium, middle layer called myocardium and the inner-most layer called endocardium.
The heart has four chambers. The upper two are called atria and the lower two called ventricles. There is a valve with three cusps called the tricuspid valve between the right atrium and the right ventricle. The valve between the left atrium and the left ventricle has two cusps and is called the bicuspid valve or the mitral valve.
The right atrium receives impure blood form the lower part of the body through inferior venacava and the upper part of the body through the superior venacava. This blood passes into the right ventricle during the relaxation of the ventricle. From the right ventricle blood is pumped into the lungs through the pulmonary artery. Purified by the lungs blood returns to the left atrium through pulmonary veins and drains into the left ventricle through the mitral valve during ventricular relaxation. During ventricular contraction the mitral valve closes and blood is pumped into the aorta to be circulated to the body through various arteries.
The blood flow in the arteries is pulsatile due to rhythmic contractions of the heart. This is felt as pulse at different sites: The side of the neck—the carotid, on the front of wrist—the radial, at the root of the leg—the femoral, on the back of the knee—the popletial etc. The normal pulse rate is 70–80 per minute.
The pressure generated by the pumping of the blood by the heart and the resistance offered by the blood vessels is called blood pressure. It is different during contraction or systole of the heart and relaxation or diastole of the heart and is called systolic and diastolic blood pressure respectively. It is measured by using an instrument called BP apparatus. Normal blood pressure is between 110/70–130/90 mm Hg.


Nervous System.


The brain is the master organ. It receives information form organs of special sense such as eyes, ears, nose, tongue and skin. It controls movement, interprets sensation, regulates body activities and generates memory and thought.


Urinary System.


It consists of the kidneys, ureters, urinary bladder & urethra. It is involved in the removal of chemical waste from the blood and helps to balance water and salt levels of the body by excreting urine.


Endocrine System.


It consists of a number of glands which secrete various hormones into the blood stream, which help to regulate body activities & functions. The pituitary gland is the master gland which controls the activity of other glands, such as thyroid, parathyroid, adrenal and sex glands or gonads—testis and ovary.


Reproductive System.


It consists of the gonads and the reproductive tract and the hormones needed for sexual reproduction.


Immune System.


It protects the body from disease-causing organisms.


Special Sense Organs.


It consists of various organs that link with the nervous system to provide:
• Sight
• Hearing
• Taste
• Smell
• Sensation


Respiratory System.


The respiratory system is composed of lungs and the respiratory tract consisting of the nose, naso-pharnyx, the larynx, the trachea or the wind pipe, the broncat and bronchioles. The bronchioles finally break into small sac called alveoli which are surrounded by pulmonary capillaries. Gaseous exchange between the inspired air in the alveoli and the impure blood in the capillaries occurs at this level. The lungs are covered by a sac called pleura. The inside of the sac is smooth and filled with a thin layer of fluid to allow expansion of lungs without friction. When thorax expands, the lungs expand and air is drawn into the alveoli, which is know as inspiration. With collapsing of the thorax to the original size, the air is thrown out, called expiration. The normal respiratory rate is 16–20 per minute at the age of 5. The ratio of respiratory rate to pulse rate is 1:4.


Disorders of Consciousness and Positioning of Casualties


Recovery Position.


A patient who is unconscious, if breathing and has got heart beat, should be nursed in recovery position.

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The position for an unconscious patient turn him face down, head to one side; no pillow should be used under the head. Pull up the leg and the arm on the side to which the head is facing, pull up the chin, stretch other arm as shown in the figure. His clothes should be loosened at the neck and waist, and any artificial teeth are removed.

Advantages of Recovery Position:
• It maintains open airway.
• Tongue cannot fall to the back of the throat.
• Head and neck will remain in the extended position so that the air passage is widened and that any vomiting or other fluid in the casualty’s mouth will drain freely.

Recovery Position Cannot Be Used:
• When there are fractures to the upper or lower body
• When the casualty is lying in a confined space or if it is not possible to bend the limbs.


Prone Position.


A patient is placed on his abdomen with head turned to one side. A pillow is placed under the head and the hands are kept on the sides.
This positions is used for:
• Burns of the back.

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Positioning in Shock.


Lay the casualty on the back, turn head to one side, raise the legs with 2 pillows to improve blood supply to the heart. If the victim has fracture on the lower limbs, it should not be elevated unless they are well splinted.


Fowlers Position.


When a patient is having difficulty in breathing, this position is used. The patient is kept in a sitting position with the help of three or four pillows.

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Dorsal Recumbent Position.


The patient is kept on his back. A pillow is placed under the head. The hands are kept on both the sides. It is used for examination of the patient. This position without pillow is used in case of fracture of the spine and also to give CPR

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Unconscious Casualties


Definition.


Unconsciousness is a state of complete loss of consciousness and the casualty is totally unresponsiveness to any painful stimulus. He is unaware of the surroundings and his body muscles are in a state of complete relaxation.
Unconsciousness is due to interference with the functions of the brain. Seriousness can be determined by testing the casualty’s response to stimuli such as sound or touch or pain.


Causes of Unconsciousness.


• Brain injuries.
• Fits or convulsion.
• Syncope or lack of cerebral circulation.
• Infection of the coverings of the brain or tissues of brain.
• Brain tumors.
• Exposure to extreme heat.
• Severe infections.
• Severe injuries.
• Drugs reaction.
• Electric shock.
• Failure of liver or kidney.
• Poisoning with chemical gas or alcohol.
• Severe heart attack .
• Drowning.
• Diabetes or over dose of insulin.
• Severe bleeding or fluid loss.


Level of Responsiveness.


There are stages through which a person may pass during progression from consciousness to unconsciousness or vice-versa:
Stage 1.    He may respond normally to questions and conversations.
Stage 2.    He answers direct questions.
Stage 3.    He responds vaguely to questions.
Stage 4.    He obey commands.
Stage 5.    He responds to pain only.
Stage 6.    He does not respond at all.


First Aid Management.


1. Maintain the airway open and keep it clear.
2. See that there is a free supply of fresh air and that the air passage is free.
3. Take the casualty away form harmful gases if any or if inside a room open doors and windows.
4. Remove any loose dentures or detached teeth and clear the casualty’s mouth of any vomit or blood.
5. Correct the tongue, which might have fallen back.
6. Loosen any tight clothing around the neck, chest and waist.
7. Keep the casualty warm but do not over heat him.
8. Keep the crowd back, they only obstruct.
9. If breathing has stopped or about to stop, put the person on a hard surface in spine position or in a flat position and start artificial respiration immediately.
10. Listen to the heart sounds and feel the pulse at the wrist and neck by placing the tips of two fingers of one hand into the groove between the windpipe and the large muscles at the side of the neck.
11. Check the pupils of the eyes to see if they are dilated or constricted. When the heart stops beating the pupils will stay dilated and will not react to light.
12. Start heart compression at once without wasting time if the heart has stopped beating, as delay in restoring blood flow will damage the brain and the person can die within 4–5 minutes.
13. Watch continuously for any changes in the condition of the pulse respiration and the level of responsiveness.
14. If pulse and respiration restores, then place the person in recovery position.
15. Turn casualty face down, head to one side and no pillow under the head should be placed.
16. Do not leave the casualty until he is passed on to the medical hands on a stretcher.
17. Nothing should be given orally until unconscious.
18. Remove the under-lying cause of unconsciousness.
19. Restore breathing and heart beat.
20. Control bleeding if any.
21. Remove poisons.
22. Prevent any further injuries to the patient.
23. Never under estimate and do not treat as minor cases to any unconscious casualty.


Dehydration and Heat Stroke.


The danger of dehydration and heat stroke:
Dehydration and heat stroke are two very common heat-related diseases that can be life-threatening if left untreated.

What is dehydration?
Dehydration can be a serious heat-related disease, as well as being a dangerous side-effect of diarrhea, vomiting and fever. Children and persons over the age of 60 are particularly susceptible to dehydration.

What causes dehydration?
Under normal conditions, we all lose body water daily through sweat, tears, urine and stool. In a healthy person, this water is replaced by drinking fluids and eating foods that contain water. When a person becomes so sick with fever, diarrhea, or vomiting or if an individual is overexposed to the sun, dehydration occurs. This is caused when the body loses water content and essential body salts such as sodium, potassium, calcium bicarbonate and phosphate. Occasionally, dehydration can be caused by drugs, such as diuretics, which deplete body fluids and electrolytes. Whatever the cause, dehydration should be treated as soon as possible.

What are the symptoms of dehydration?
The following are the most common symptoms of dehydration, although each individual may experience symptoms differently.
Symptoms may include:
• thirst
• less-frequent urination
• dry skin
• fatigue
• light-headedness
• dizziness
• confusion
• dry mouth and mucous membranes
• increased heart rate and breathing
In children, additional symptoms may include:
• dry mouth and tongue
• no tears when crying
• no wet diapers for more than 3 hours
• sunken abdomen, eyes or cheeks
• high fever
• listlessness
• irritability
• skin that does not flatten when pinched and released

Treatment for dehydration:
If caught early, dehydration can often be treated at home under a physician's guidance. In children, directions for giving food and fluids will differ according to the cause of the dehydration, so it is important to consult your pediatrician.
In cases of mild dehydration, simple rehydration is recommended by drinking fluids. Many sports drinks on the market effectively restore body fluids, electrolytes, and salt balance.
For moderate dehydration, intravenous fluids may be required, although if caught early enough, simple rehydration may be effective. Cases of serious dehydration should be treated as a medical emergency, and hospitalization, along with intravenous fluids, is necessary. Immediate action should be taken.

How can dehydration be prevented?
Take precautionary measures to avoid the harmful effects of dehydration, including:
• Drink plenty of fluids, especially when working or playing in the sun.
• Make sure you are taking in more fluid than you are losing.
• Try to schedule physical outdoor activities for the cooler parts of the day.
• Drink appropriate sports drinks to help maintain electrolyte balance.
• For infants and young children, solutions like Pedialyte will help maintain electrolyte balance during illness or heat exposure. Do not try to make fluid and salt solutions at home for children.

What is heat stroke?
Heat stroke is the most severe form of heat illness and is a life-threatening emergency. It is the result of long, extreme exposure to the sun, in which a person does not sweat enough to lower body temperature. The elderly, infants, persons who work outdoors and those on certain types of medications are most susceptible to heat stroke. It is a condition that develops rapidly and requires immediate medical treatment.

What causes heat stroke?
Our bodies produce a tremendous amount of internal heat and we normally cool ourselves by sweating and radiating heat through the skin. However, in certain circumstances, such as extreme heat, high humidity or vigorous activity in the hot sun, this cooling system may begin to fail, allowing heat to build up to dangerous levels.
If a person becomes dehydrated and can not sweat enough to cool their body, their internal temperature may rise to dangerously high levels, causing heat stroke.

What are the symptoms of heat stroke?
The following are the most common symptoms of heat stroke, although each individual may experience symptoms differently.
Symptoms may include:
• headache
• dizziness
• disorientation, agitation or confusion
• sluggishness or fatigue
• seizure
• hot, dry skin that is flushed but not sweaty
• a high body temperature
• loss of consciousness
• rapid heart beat
• hallucinations

How is heat stroke treated?
It is important for the person to be treated immediately as heat stroke can cause permanent damage or death. There are some immediate first aid measures you can take while waiting for help to arrive.
• Get the person indoors.
• Remove clothing and gently apply cool water to the skin followed by fanning to stimulate sweating.
• Apply ice packs to the groin and armpits.
• Have the person lie down in a cool area with their feet slightly elevated
Intravenous fluids are often necessary to compensate for fluid or electrolyte loss. Bed rest is generally advised and body temperature may fluctuate abnormally for weeks after heat stroke.
How can heat stroke be prevented?
There are precautions that can help protect you against the adverse effects of heat stroke. These include:
• Drink plenty of fluids during outdoor activities, especially on hot days. Water and sports drinks are the drinks of choice; avoid tea, coffee, soda and alcohol as these can lead to dehydration.
• Wear lightweight, tightly woven, loose-fitting clothing in light colors.
• Schedule vigorous activity and sports for cooler times of the day.
• Protect yourself from the sun by wearing a hat, sunglasses and using an umbrella.
• Increase time spent outdoors gradually to get your body used to the heat.
• During outdoor activities, take frequent drink breaks and mist yourself with a spray bottle to avoid becoming overheated.
• Try to spend as much time indoors as possible on very hot and humid days.


Resuscitation


Introduction.


Basic life support is an emergency life saving procedure that consists of recognizing and correcting failure of the respiratory or cardiovascular systems. Any profound disturbance of the airway, the breathing or the circulation can promptly result in brain death.
Basic life support comprises the ABC steps which concern the airway, breathing and circulation respectively.
Under normal conditions, we all lose body water daily through sweat, tears, urine and stool. In a healthy person, this water is replaced by drinking fluids and eating foods that contain water. When a person becomes so sick with fever, diarrhea, or vomiting or if an individual is overexposed to the sun, dehydration occurs. This is caused when the body loses water content and essential body salts such as sodium, potassium, calcium bicarbonate and phosphate. Occasionally, dehydration can be caused by drugs, such as diuretics, which deplete body fluids and electrolytes. Whatever the cause, dehydration should be treated as soon as possible.

Its prompt application is indicated for:
The following are the most common symptoms of dehydration, although each individual may experience symptoms differently.
A- Airway obstruction.
B- Breathing or respiratory arrest.
C- Circulatory or cardiac (heart) arrest.

Basic life support, requiring 40 instruments or supplies and the correct application of the steps for dealing with the above three problems can maintain life until the patient recovers sufficiently to be transported to a hospital where he can be provided with advanced life support, must be taken with the maximum sense of urgency and any inadequacy or absence of breathing or circulation must be determined immediately.
• If breathing alone is inadequate or absent all that as necessary as either to open the airway or to apply artificial respiration.
• If circulation is also absent, artificial circulation must be started through.
• Heart compression in combination with artificial respiration.
• If breathing stops before the heart stops enough oxygen will be available in the lungs to maintain life for several minutes. However, if heart arrest occurs first, delivery of oxygen to the brain ceases immediately.
• Brain damage is possible if the brain is deprived of oxygen for 4–6 minutes, beyond 6 minutes without oxygen brain damage is very likely.
Once you have started basic life support do not interrupt it for more than 5 seconds for any reason except when it is necessary to move the patient. Even in that case interruption should not exceed 15 seconds each.
A B C of CPR - (Steps)
• A for Airway clearance.
• B for Breathing—assist in breathing.
• C for Circulation—establish circulation.


Step: A (Airway).


• Establish an open airway.
• Place the person in a face up position on a hard surface.
• Put one hand under the patient’s neck and the other hand on the forehead.
• Lift the neck with one hand and apply pressure to the forehead with the other to lift the head backward. This extends the neck and moves the base of the tongue away from the back of the throat.
• The head should be maintained in the position during the entire artificial respiration and heart compression procedure.
• If the airway is still obstructed any foreign material in the mouth or throat should be removed immediately with the fingers.
• Once the airway has been opened the patient may or may not start to breath again.
• To assess whether breathing has returned the person providing the basic life support must place his ear about 2–3 cm above the nose and mouth of the patient.
• If the rescuer can feel and hear movement of air and can see the patient’s chest and abdomen move, breathing has returned.
• With airway obstruction it is possible that there will be not air movement even though the chest and abdominal movement is difficult when the patient is full clothed.

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Step: B (Breathing).


If the patient does not resume adequate, spontaneous breathing promptly after his head been tilted backward then artificial respiration should be given by the mouth to mouth or mouth to nose method or with other techniques of the method used the preservation of an open airway is essential.

Mouth To Mouth Respiration
• Keep the patient’s head of a maximum backward tilt with one hand under neck.
• Place the heel of the other hand on the forehead with the thumb and index finger toward the nose.
• Pinch together the patient’s nostrils with the thumb and index finger to prevent air form escaping.
• Continue to exert pressure on the forehead with the palm of the hand to maintain the backward tilt of the head.
• Take a deep breath then form a tight seal with your mouth over and around the patient’s mouth.
• Blow four quick full breaths in first without allowing the lungs to deflate fully.
• Watch the patient’s chest while inflating the lungs. If adequate respiration is taking place the chest should raise and fall.
• Remove your mouth and allow the patient to exhale passively. If you are in the right position, the patient’s exhalation will be felt on your check.
• Take another deep breath, form a tight seal around the patient’s mouth and blow in to the mouth again.
• Repeat this procedure 10–12 times a minute (one every five seconds) for adults and children over four years of age.
• If there is no air exchange and an airway obstruction exists that is to be removed with fingers then resume artificial respiration.

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Step: C (Heart Compression).


In attempting to bring back to life a non-breathing person whose heart has stopped beating heart compression (external cardiac compression) should be applied along with artificial respiration.


Checking effectiveness of Heart Compression


Compression of the sternum produces some artificial ventilation but not enough for adequate oxygenation of the blood. For this reason artificial respiration is always required whenever heart compression is used.
• Effective heart compression requires sufficient pressure to depress the patient’s lower sternum about 4–5 cms (in an adult).
• For chest compression to be effective the patient must be on a firm surface. If he is in a bed a board or improvised support should be placed under his back. However chest compression must not be delayed by a search for a firmer support.
• Kneel close to the side of the patient and place the heel of one hand over the lower half of the sternum.
• Avoid placing the hand over the tip of the breast bone which extends down over the upper abdomen as pressure on the lower end may tear the liver and lead severe internal bleeding.
• Feel the tip of the sternum and place the heel of the hand about 4 cm nearer the head of the patient.
• Your fingers must never rest on the patient’s ribs during compression since this increases the possibility of rib fracture.
• Place the heel of the other hand on top of the first one.
• Rock forward so that your shoulders are almost directly above patient’s chest.
• Keep your arms straight and exert adequate pressure almost directly downwards to depress an adult’s chest for 4–5 cms.
• Compress the chest 60 times per minute for an adult if help is available as this is enough to maintain blow flow and slow enough to allow the heart to full with blood.
• The compression should be regular, smooth and uninterrupted compression and relaxation being of equal duration.
• Under no circumstances should compression be interrupted for more than five seconds.
• It is preferable to have to rescuers because artificial circulation must be combined with artificial respiration.
• It is preferable to have to rescuers because artificial circulation must be combined with artificial respiration.
• The most effective artificial respiration and heart compression are achieved by giving one lung inflation quickly after each five heart compression (5:1 ratio). The compression rate should be 60 per minute if two rescuers are operating.
• One rescuer performs heart compression while the other remains at the patient’s head, keeps it tilted back and continues artificial respiration.
• A single rescuer has to perform both artificial respiration and artificial circulation using 15:2 ratio. Two very quick lung inflations should be delivered after each 15 chest compressions without waiting for full exhalation of the patient’s breath.
• A rate of 80 chest compressions per minute must be maintained by a single rescuer in order to achieve 50–60 actual compressions per minute because of interruptions for lung inflations.

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• A single rescuer has to perform both artificial respiration and artificial circulation using 15:2 ratio. Two very quick lung inflation should be delivered after each 15 chest compressions waiting for full exhalation of to patient’s breath.

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Chest Pain Heart Attack


Chest Pain / Heart Attack Symptoms
What is a heart attack?

A heart attack, or myocardial infarction, results from heart disease – a condition in which one of the coronary arteries that supplies blood to the heart becomes blocked, ultimately damaging the heart muscle. The blockage is often a result of atherosclerosis – a buildup of plaque, known as cholesterol, and other fatty substances. Plaque inhibits and obstructs the flow of blood and oxygen to the heart, thus, reducing the flow to the rest of the body.
If the blood and oxygen supply is cut off severely or for a long period of time, muscle cells of the heart suffer severe and devastating damage and die. The result is damage or death to the area of the heart that became affected by reduced blood supply.

The danger of chest pain
It is important to know that restricted blood flow to the heart:
• Usually occurs before the heart attack happens.
• May happen days, weeks, or even months before the heart attack occurs.
• May be mild and easy to ignore.
• May be confused with indigestion.
• May be confused with sore muscles.

Warning signs of a heart attack
In some, but not all, cases, the body will send warning signs that indicate a heart attack. These include:
• Uncomfortable pressure, fullness, squeezing, pain, or discomfort in the center of the chest that lasts for more than two minutes. This pain may be persistent, or may go away and return.
• pain or discomfort that spreads to the shoulders, neck, or arms
• Pain, sweating, nausea, or shortness of breath.
• any chest discomfort that causes anxiety or concern
• any chest discomfort that is accompanied by lightheadedness, fainting, or dizziness
• any of the above symptoms that disappear with rest, then return with exertion
• unexplained weakness or fatigue
• palpitations, cold sweat, or paleness
Pain that lasts for 10 to 15 minutes while you are resting should also be evaluated immediately.

Responding to heart attack warning signs:
If you, or someone you know exhibits any of the above warning signs, act immediately. Call your local emergency number. If necessary, give CPR if you are trained, or ask someone who is.

What are the risk factors for heart attack?
A risk factor is anything that may increase a person’s chance of developing a disease. It may be an activity, such as smoking, diet, family history, or many other things. Different diseases have different risk factors.
Although these factors can increase a person’s risk, they do not necessarily cause the disease. For example, some people with one or more risk factors never develop cancer, while others develop cancer and have no known risk factors.
But, knowing your risk factors to any disease can help to guide you into the appropriate actions, including changing behaviors and being clinically monitored for the disease.

The following have been suggested as risk factors for a heart attack:
• age
• smoking
• diabetes
• male gender
• high cholesterol level
• high blood pressure (hypertension)
• family history of heart disease/heart attack
• obesity
• atherosclerosis (hardening of the arteries)
• lack of exercise and physical activity
• race – African-Americans have three times the risk of severe hypertension than Caucasians

Indigestion
Indigestion, also known as upset stomach or dyspepsia, is a painful or burning feeling in the upper abdomen that may be accompanied by:

• nausea
• abdominal bloating
• belching
• vomiting
The symptoms of indigestion may resemble other medical conditions, such as chest pain. Always consult your physician for diagnosis.

Indigestion might be caused by:
• a disease or an ulcer in the digestive tract
• eating too much
• eating too quickly
• eating high-fat foods
• eating during stressful situations
• smoking
• exercising right before eating
Smoking, drinking too much alcohol, using medications that irritate the stomach lining, being tired, and having ongoing stress can also cause or aggravate indigestion. Some people have persistent indigestion that is not related to any of these factors.

Indigestion may resemble, or be a symptom of, another, more serious, medical condition. Consult your physician immediately under the following circumstances:
• vomiting, weight loss, or appetite loss
• black, tarry stools or blood in vomit
• severe pain in the upper right abdomen
• discomfort unrelated to eating
• indigestion accompanied by shortness of breath, sweating, or pain radiating to the jaw, neck, or arm


Bleeding


Introduction.


The human body contains approximately 5 liters of blood. A healthy adult can loose up to half a liter of blood without harmful effects but the loss of more than this can be threatening to life.


Definition.


Bleeding (haemorrhage) is an escape of blood vessels or haemorrhage or bleeding is a flow of blood from an artery vein or capillary.


Types of Bleeding.


There are three different types of haemorrhage or bleeding.
1. ARTERIAL BLEEDING:
• Blood is bright red in colour.
• It spurts at each contraction of heart.
• Flow is pulse tile.
2. VENOUS BLEEDING:
• Bleeding is from the veins, which carries impure blood to heart.
• Blood is dark red in colour.
• It does not spurt.
• Steady flow of blood.
3. CAPILLARY BLEEDING
• Blood is red in colour.
• It does not spurt.
• Slow but even flow.


External & Internal Bleeding.


Bleeding may occur externally following an injury to the outside of the body or internally form an injury in which blood escapes into tissue spaces or the body cavity.
(A) External Bleeding
If the bleeding is from the surface of the body it is called external bleeding.
(i) Evidence of major external blood loss.

(ii) Symptoms and signs or shock.
• Casualty complains of thirst.
• Blurring of vision.
• Fainting and giddiness.
• Face and lips becomes pale.
• Pulse becomes faster but weaker.
• Restlessness and sweating.
• Breathing becomes shallow.
• Unconsciousness.

(B) Internal Bleeding
If the bleeding is with in the chest skull or abdomen etc. it is called internal bleeding because this can not be seen immediately but later the blood may ooze out through nose or ear or coughed up from the lungs or vomited from stomach.
• History of sufficient injury to cause internal bleeding.
• Wounds that have penetrated the skull.
• Wounds that have penetrated chest or abdomen.
• History or Medical condition, which may cause internal bleeding, like ulcer etc.
• Pain and swelling around the affected area.
• Signs of shock.
• Blood may appear form one of the body orifices as nose, ear, mouth, rectum, urethra, vagina etc.


First Aid Management.


AIM:
1. Control of bleeding as soon as possible.
2. Keep the wound clean and dress it to minimize blood loss to prevent infection.

General Management
1. Place the person in such a position that he/she will be least affected by the loss of blood.
2. Lie the person down and raise his legs in semi flexed position.
3. Control the bleeding.
4. Maintain airway.
5. Prevent the loss of body heat by putting blankets under and over the person.
6. Keep him at rest as movement will increase heart action, which causes the blood to flow faster and perhaps interfere with clot formation.


Specific Management.


(A) Minor Bleeding:
1. Wash your hands before dealing with wound.
2. If the wound is dirty lightly rinse it with running water if available.
3. Protect the wound with clean cloth and clean the surrounding skin with soap and water if available and make it dry.
4. Dress a small wound with an Band-Aid.
5. Raise and support the injured part unless you suspect and under lying fracture.
6. If the wound is larger then apply unmediated dressing or gauze or clean pad and bandage firmly in position.
7. If in doubt seek medical help.

(B) Major External Bleeding
There Are Four Method to Control External Bleeding.
(1) Direct Pressure:

Do not waste your time hunting for dressing. Place your hand directly over the wound and apply pressure. Keep applying firm and steady pressure. If the wound is large then squeeze the edges together.
• If dressing is available then apply it or a clean cloth and apply pressure until bleeding has stop. This may take 10-30 minutes or longer.
• Tie the bandage firmly enough to control bleeding but not so tight as to cut off circulation.
• Never replace any dressing once it is in place.
• If the dressing is soak with blood place another dressing directly over the blood soaked dressing and hold with in place with firm pressure.
• Inmobilise the support the injured part.
(2) Elevation:
Raise the bleeding part of the body above the level of the heart so that the flow of blood will slow down in that part and clotting will speed up.


Pressure Points.


• Arterial bleeding can be controlled by thumb or finger pressure applied at the pressure points
• Pressure points are the places over a loose where arteries are close to the skin.
• Pressing the artery against the underlying bone can control flow of control flow of blood to the injured part.

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Internal Bleeding First Aid.


• Keep the person down with the head low and to one side to ensure good blood supply to brain.
• Advise the person not to move.
• It condition allows raise his legs to aid the return of blood flow to important body organs.
• Loose any tight clothing around neck, chest and waist.
• Minimise shock.
• Check breathing rate, pulse and level or consciousness.
• Place the person in recovery position if unconscious but breathing.
• If breathing is stopped then begin mouth to mouth respiration with chest massage and continue it.
• Move to hospital immediately and transport as a stretcher case.
• Keep the person warm.
• Do not apply hot water bottles or ice bags to chest or abdomen.
• Do not give anything to eat or drink because he may have to undergo surgery.


Management of Shock


Definition


Shock is a state of circulatory dysfunction in which tissue O2 delivery is less than required. If untreated, multi-organ failure and death result. Shock is the final common pathway of numerous disease states.


Effects of Shock


• It can vary form faintness to complete collapse
• Early loss of consciousness that mainly involves the nervous system and that may be fatal
• Progressive loss of blood from active circulation which may lead to failure of heart out put and insufficient oxygen to cells that are vital for survival.
• Continuous lowering of blood pressure which may lead to kidney and liver failure


Causes of Shock


• Severe or extensive injuries
• Severe pain
• Heart attack
• Loss of blood that is internal or external bleeding
• Severe burns which leads to loss of body fluids
• Electric shock or electrocution
• Exposure to extreme heat and cold
• Drugs or allergic reactions
• Poisoning form drugs, gases and other chemicals and also from alcohol intoxication
• Emotional up set due to good or bad news
• Stress and fright
• Bites or stings of poisonous snakes or insects


Types of Shock.


1. Nervous Shock
Nervous shock is due to strong emotional upset that is fear, pain, good or bad new. It may also result form spinal or head injury resulting in loss of nerve control or loss or control of nervous system.

2. Haemorrhagic Shock:
Due to loss of blood from external or internal bleeding or loss of blood / fluid due to wounds, multiple injuries or severe burns, severe vomiting and loose motions.

3. Cardiaogenic Shock:
Cardiac muscles not pumping effectively due to injury or previous heart attack, the damaged heart muscles no longer imparts sufficient pressure to circulate the blood.

4. Bacterial or Septic Shock:
Severe infection, discharge of poisons or toxins into the blood caused by bacteria, toxins causes pooling of blood in capillaries with dilation of vessels and not enough blood remains available for tissues.

5. Anaphylactic Shock
It is a severe allergic reaction of the body with some drugs or foreign protein to which the person is sensitive. It causes dilatations of blood vessels and loss of blood in the surrounding area.

6. Electric Shock
Due to electrocution or high voltage electric current. If any part of the body comes in contact with a live wire which is exposed and not covered by insulator or with a cable or rail in which current is leaking a person gets an electric shock.

Signs and Symptoms
• Casualty is anxious and restless.
• Weakness, fainting or giddiness and disorientation.
• The skin is pale, cold and often moist but later it may develop a bluish, ashes colour.
• Shallow, rapid or grasping breathing.
• Nausea, vomiting and extreme thirst.
• Unconsciousness.
• Weak and rapid pulse.
• Blood pressure falls.
• Pupils are deleted.
• Evidence of associated external injury.

First Aid Treatment
• Reassure and comfort the casualty when conscious.
• Remove the causes of shock, this includes controlling of bleeding, restoring breathing and relieving severe pain.
• Loose any tight clothing to help the circulation and assist breathing.
• Keep the patient warm but do not over heat.
• Check the breathing rat, pulse rate and level of consciousness.
• Keep the person in recovery position.
• If breathing and heart beat stop then clear and establish an airway.
• Begin mouth to mouth respiration with chest message.
• Administer fluids but liquids should not be given by mouth if the patient is unconscious and having any injuries to chest and abdomen.
• Remove to hospital immediately.
• Transport as stretcher case maintaining the treatment position.

Do not:
Apply hot water bottle as this will increase the blood flow to the vessels of the skin and take it away from the vital organs.
• Move the casualty unnecessarily as this will increase shock.
• Give the casualty any thing by mouth as it will present or delay the surgery.
• Give alcohol.
• Let the casualty smoke.


Burns, Scalds and Accidents Caused By Electricity


Burns


Burns and Scalds are dangerous because not only they can cause death, but delayed effects like Scarring and deformity can be quite distressing. Hence Prompt and correct treatment of burns and scalds are essential.

Burns are the injuries that result form dry heat like:
• Fire.
• Contract with hot metals.
• Chemicals (Nitric acid, Sulphuric acid, Ammonia, Caustic soda etc.).
• Electricity.
• Radiation.
Scalds are injurious caused by moist heat like boiling water, steam, oil, hot tar and hot liquids. The result of the burns and scalds are same.


Danger of Burns


Burns and Scalds are dangerous because not only they can cause death, but delayed effects like Scarring and deformity can be quite distressing. Hence Prompt and correct treatment of burns and scalds are essential.

• Shock:
Shock develops because plasma leaks out of circulatory system into the burn area.
• Infection:-
There is big risk of infection with burns because skin is damaged and there is no protection against micro organisms.


Classification of Burns


AREA:
Burns are classified on the basis of area by rule of 9.
Rule of nine to estimate % of burn.

(a) SEVERITY OF BURN:
Superficial burn involves the skin and blister formation takes place. All other burns are deep burns.
• Keep the part in cold water for 15-20 minutes or until the pain disappears. If that is not possible soak clean cloth water and put it over the burnt area. It needs to be changed frequently. Application of cold water removes residual heat from tissues and prevent further damage.
• Cover burnt area with sterile dressing or freshly laundered linen. Avoid exposure to air. In case of burns over face, make dressing in the shape of a mask, with holes at the levels of the nose for breathing.
• Remove rings, bracelets, shoes and any other light article as swelling may develop later on making it difficulty to remove them.
• Arrange for immediate transfer to hospital.
• Give plenty of fluids to drink, if patient can tolerate.
• When large area is damaged, pack ice in a clean towel and apply it to the burnt are during transfer to a hospital.
• Do not put oil, lotions or ointments on the burned area.
• Do not pull away burnt clothing stuck to the body.
• Do not handle or touch the patient than absolutely necessary.
In chemical burns the damage continues as long as the chemical remains in contact with skin.
• Remove the contaminated clothing carefully after soaking in water. Take care not to contaminate yourself.
• Flood the affected area with water thoroughly and systematically for 10-15 minutes. One may use soda bicarbonate solution to wash acid burns and vinegar to wash alkali burns before washing with water.
• Give general care.

ELECTRIC BURNS:-
Electrical injuries are due to the effect of high tension electric current or atmospheric electricity as in lightening. The heat generated during passage of current through the body causes deep burns at the exit and entrance of the current.
In case of DC shock to the source patient remains stuck to the source of electricity until the current is broken, hence the damage is extensive. In case of AC shock the damage is less. There may be physical injury when the patient falls down. The electrical current can disturb the respiratory centre and the cardiovascular centre causing respiratory arrest and cardiac arrest respectively. Damp clothing, damp foot wear and damp ground increase electrical conductivity and make the damage worse. The patient may be in shock. The measures should be taken care.
• Switch off the current and remove the plug form the socket.
• If the patient is lying in water keep out of it yourself, as water is an excellent conductor of electricity. For the same reason do not hold the patient under the arm pit.
• If the patient is in contact with a live wire, the current in which cannot be switched off, separate the wire from the patient using a long wooden stick and while standing on a non-conductor of electricity like a wooden board or a pile of newspapers. Wear rubber gloves if necessary.
• Treat if necessary.
• Treat shock if present.
• Treat burns.
• Give fluids to drink
• Arrange for medical aid.+


Rule of Nine


Burns are classified on the basis of area by the rule of nine. Any burn of over 30% irrespective of deep degree should be hospitalized as priority. Burns larger than 25 cms. (1”) square require medical attention. The dangers of a burn increased with its surface area (even if it is superficial) and if one third or more of the skin area is involved, the patient may become dangerously ill. In small children and infants even small burns should be considered as serious injuries an medical aid should be sort without delay.


Transportation of Casualties


Rescue and Transportation of Casuality


The removal of a sick or injured person either form the site of an accident or ashore is a matter of importance, since his life may depend on the arrangements made.

General Principles To Be Observed While Transporting A Patient:-
• Arrest severe haemorrhage, treat shock, split fracture securely and cover wounds before moving the patient.
• Support the injured part well while moving the patient.
• Do not allow the patient with shock, haemorrhage, or head injury to walk even if the patient in conscious.
• During transportation close and constant observation of the casualties condition should be done.
• Transportation must be safe, steady and speedy.

Method:
Method of transportation depends upon various factors.

• Number of helpers available.
• Modes of transportation.
• Type of injury.
• Distance to be covered.
• Nature of the route to be covered.

1. Carriage by One Bearer *
• Cradle
• Ambulance stretchers
• Improvised stretchers with coat, blankets, poles, ground sheet, bedding, sacks, web belt etc.
• Scoop stretcher.
2. Carriage by Four Bearers:-
• By stretcher drill
• Neil Robertson stretcher
3. Carriage by Transport:
• By ambulance
• By ambulance train
• By helicopter
• By aircraft
• By hospital shop

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Miscellaneous


Snake Bites


The danger of snake bites:
Each year, nearly 8,000 people receive poisonous snake bites in the United States. Even a bite from a so-called "harmless" snake can cause infection“ or allergic reaction in some people. People who frequent wilderness areas, camp, hike, picnic, or live in snake-inhabited areas should be aware of the potential dangers posed by venomous snakes.

What snakes cause poisonous bites?
Any of the following snakes cause poisonous bites:

• Rattlesnake
• Copperhead
• Cottonmouth Water Moccasin
• Coral Snake

What are the symptoms of poisonous bites?
While each individual may experience symptoms differently, the following are the most common symptoms of poisonous snake bites:
• bloody wound discharge
• fang marks in the skin and swelling at the site of the bite
• severe localized pain
• diarrhea
• burning
• convulsions
• fainting
• dizziness
• weakness
• blurred vision
• excessive sweating
• fever
• increased thirst
• loss of muscle coordination
• nausea and vomiting
• numbness and tingling
• rapid pulse

How are snake bites treated?
Call for emergency assistance immediately if someone has been bitten by a snake. Responding quickly in this type of emergency is crucial.
While waiting for emergency assistance:
• Wash the bite with soap and water.
• Immobilize the bitten area and keep it lower than the heart.
• Cover the area with a clean, cool compress or a moist dressing to minimize swelling and discomfort.
• Monitor vital signs.
If a victim is unable to reach medical care within 30 minutes, the American Red Cross recommends:
• Apply a bandage, wrapped two to four inches above the bite, to help slow the venom. This should not cut off the flow of blood from a vein or artery - the band should be loose enough t– slip a finger under it.
• A suction device can be placed over the bite to help draw venom out of the wound without making cuts. These devices are often included in commercial snake bite kits.

Most often, physicians use antivenin -- an antidote to snake venom -- to–react serious snake bites. An–venin is derived from antibodies created in a horse's blood serum when the animal is injected with snake venom. Because antivenin is obtained from horses, snake bite victims sensitive to horse products must be carefully managed.
Preventing snake bites:
Some bites, such as those inflicted when you accidentally step on a snake in the woods, are nearly impossible to prevent. However, there are precautions that can reduce your chances of being bitten by a snake.
These include:
• Leave snakes alone. Many people are bitten because they try to kill a snake or get too close to it.
• Stay out of tall grass unless you wear thick leather boots and remain on hiking paths as much as possible.
• Keep hands and feet out of areas you cannot see. Do not pick up rocks or firewood unless you are out of a snake's striking distance.
• Be cautious add alert when climbing rocks.


Animal Bite and Rabies


The danger of animal bites:
Animal bites and scratches, even when they are minor, can become infected and spread bacteria to other parts of the body. Whether the bite is from a family pet or an animal in the wild, scratches and bites can carry disease. Cat scratches, for examples, even from a kitten can carry "cat scratch disease," a bacterial “infection. Other animals can transmit rabies and tetanus. Bites that break the skin are even more likely to become infected.

Care for animal bites
For superficial bites from a familiar household pet who is immunized and in good health:

• Wash the wound with soap and water under pressure from a faucet for at least five minutes, but do not scrub, as this may bruise the tissue. Apply an antiseptic lotion or cream.
• Watch for signs of infection at the site, such as increased redness or pain, swelling, drainage, or if the person develops a fever. Call your physician or healthcare provider right away if any of these symptoms occur.
For deeper bites or puncture wounds from any animal, or for any bite from a strange animal:
• If the bite or scratch is bleeding, apply pressure to it with a clean bandage or towel to stop the bleeding.
• Wash the wound with soap and water under pressure from a faucet for at least five minutes, but do not scrub, as this may bruise the tissue.
• Dry the wound and cover it with a sterile dressing, but do not use tape or butterfly bandages to close the wound, as this trap could harmful bacteria in the wound.
• Call your physician or healthcare professional for guidance in reporting the attack and to determine whether additional treatment, such as antibiotics, a tetanus booster, or rabies vaccination is needed. This is especially important for bites on the face, or for bites that cause deeper puncture wounds of the skin.
• If possible, locate the animal that inflicted the wound. Some animals need to be captured, confined, and observed for rabies. Do not try to capture the animal yourself; instead contact the nearest animal warden or animal control office in your area.
• If the animal cannot be found, or if the animal was a high-risk species (skunk or bat), or the animal attack was unprovoked, the victim may need a series of rabies shots.
• Call your physician or healthcare provider for any flu-like symptoms such as a fever, headache, malaise, decreased appetite, or swollen glands following an animal bite.

What is rabies?
Rabies is a viral infection of certain warm-blooded animals and is caused by a virus in the Rhabdoviridae family. It attacks the nervous system and, once symptoms develop, it is 100 percent fatal in animals, if left untreated.
Rabies occurs primarily in skunks, raccoons, foxes, and bats. In some areas, these wild animals infect domestic cats, dogs, and livestock. In the United States, cats are more likely than dogs to be rabid.
Generally, rabies is rare in small rodents such as beavers, chipmunks, squirrels, rats, mice, or hamsters. Rabies is also rare in rabbits. In the mid-Atlantic states, where rabies is increasing in raccoons, woodchucks can also be rabid.

How does rabies occur?
The rabies virus enters the body through a cut or scratch, or through mucous membranes (such as the lining of the mouth and eyes), and travels to the central nervous system. Once the infection is established in the brain, the virus travels down the nerves from the brain and multiplies in different organs.
The salivary glands and organs are most important in the spread of rabies from one animal to another. When an infected animal bites another animal, the rabies virus is transmitted through the infected animal's saliva. Scratches by claws of animals are also dangerous because these animals lick their claws.

How is rabies diagnosed?
In animals, the direct fluorescent antibody test (dFA) is most frequently used to detect rabies. Within a few hours, diagnostic laboratories can determine whether an animal is rabid and provide this information to medical professionals. These results may save a person from undergoing treatment if the animal is not rabid.
In humans, a number of tests are necessary to confirm or rule out rabies, as no single test can be used to rule out the disease with certainty. Tests are performed on samples of serum, saliva, and spinal fluid. Skin biopsies may also be taken from the nape of the neck.

Treatment for rabies
Unfortunately, there is no known, effective treatment for rabies once symptoms of the disease occur. However, there is an effective new vaccine which provides immunity to rabies when administered after an exposure. It may also be used for protection before an exposure occurs, for persons such as veterinarians and animal handlers.

How can animal bites and rabies be prevented?
Being safe around animals, even your own pets, can help reduce the risk of animal bites. Some general guidelines for avoiding animal bites and rabies include the following:

• Do not try to separate fighting animals.
• Avoid strange and sick animals.
• Leave animals alone when they are eating.
• Keep pets on a leash when out in public.
• Select family pets carefully.
• Never leave a young child alone with a pet.
• All domestic dogs and cats should be immunized against rabies and shots kept current.
• Do not approach or play with wild animals of any kind, and be aware that domestic animals may also be infected with the rabies virus.
• Supervise pets so they do not come into contact with wild animals. Call your local animal control agency to remove any stray animals.
Reporting the incident to your healthcare provider:
If you or someone you know is bitten by an animal, remember these facts to report to your healthcare provider:

• location of the accident
• type of animal involved (domestic pet or wild animal)
• type of exposure (cut, scratch, licking of open wound)
• part of the body involved
• number of exposures
• whether or not the animal has been immunized against rabies
• whether or not the animal is available for testing or quarantine


Insect Bytes


First aid for Insect Bytes or Bee sting
• Remove the stinger by scraping with your fingernail or the blade of a knife
• Wash with soap and cold water over and around the sting to relieve pain and slow the absorption of the poison.
• Apply ice pack, calamine lotion, or baking soda-and-water mixture to relieve the swelling and pain.
• Application of juice of crushed onion also provides relief.
• Seek medical help if an allergic reaction develops such as difficulty breathing, coughing, headache, unconsciousness etc.


Fever


What is fever?
Fever (also called pyrexia) is defined as body temperature that is higher than normal for each individual. It generally indicates that there is an abnormal process occurring in the body. Exercise, hot weather, and common childhood immunizations can also make body temperature rise.
Fever is not an illness, but, rather, a symptom or an indicator that something is not right within the body. A fever does not tell you what disorder is causing it, or even that a disease process is occurring. It may be a bacterial or viral infection, or simply a reaction from an allergy to food or medication, or becoming overheated at play or in the sun.

What constitutes a fever?
Although high fevers may bring on convulsions or delirium, generally it is not how high the temperature is, but how rapidly the temperature rose that causes a convulsion.
If symptoms of an illness are present:
• A temperature between 99.8oF - 100.8oF is considered a low-grade fever.
• A temperature between 101oF - 102oF is considered a mild fever.
• Between 102oF - 103oF is considered a moderate fever.
• Anything around 104oF or above is considered a high fever, and delirium or convulsions may occur.
Your child's physician may have different definitions of fever than these, and will provide guidelines for when to treat fever yourself and when to call the physician's office.

What are the signs that indicate fever?
Because a baby, young child, or disabled person may not be able to express how he or she is feeling, be sure to look for signs -- outward indications -- that fever is present before using a thermometer.
Signs that indicate fever may include:
• flushed face
• hot, dry skin
• low output of urine, and/or dark urine
• not interested in eating
• constipation or diarrhea
• vomiting
• headache
• aching all over
• nausea
Taking the temperature:
The best means of taking temperature is with a thermometer. There are several types of thermometers, including:

• glass thermometers with mercury (oral or rectal)
• digital thermometer
• ear thermometer
Taking a temperature reading with a thermometer directly touching certain areas of the skin, such as under the armpit or in the bend of the elbow, is not recommended because it is not considered to be reliable.

Treating fever
Once you have determined that the person has a fever, you may treat it by giving acetaminophen (Tylenol, Tempra, or Fever all) or ibuprofen (Advil or Motrin), or both, in dosages or combinations advised by your physician. Never give aspirin to a child or young adult who has a fever.
A tepid bath (water that is neither too cool nor too warm to the touch) may reduce the fever, as well as comfort the person. Alcohol rubdowns are no longer recommended.
Call your physician for guidance anytime you are uncomfortable with the conditions of the fever, and remember to contact your physician anytime a temperature spikes rapidly or persists despite treatment.

When to call the doctor?
Call your physician immediately if any of the following conditions accompany a fever:

• seizure
• feeling dull or sleepy
• irregular breathing
• stiff neck
• confusion
• purple spotted rash
• ear pain (a child tugging on his/her ear)
• sore throat that persists
• vomiting
• diarrhea
• painful, burning or frequent urination


Poisoning


There are many poisonous substances that can potentially turn fatal if inhaled, digested, or absorbed by the body. Listed in the directory to the left are some, for which we have provided a brief overview.


Food Poisoning


Food Poisoning Treatment : Self-Care at Home
• Do not eat solid food while nauseous or vomiting but drink plenty of fluids.
• Small, frequent sips of clear liquids (those you can see through) are the best way to stay hydrated.
• Avoid alcoholic, caffeinated, or sugary drinks, if possible. Over-the-counter rehydration products made for children such as Pedialyte and Rehydralyte are expensive but good to use if available.
• Sports drinks such as Gatorade and Powerade are fine for adults if they are diluted with water because at full strength they contain too much sugar, which can worsen diarrhea.
• After successfully tolerating fluids, eating should begin slowly, when nausea and vomiting have stopped. Plain foods that are easy on the stomach should be started in small amounts. Consider eating rice, wheat, breads, potatoes, cereals (low-sugar cereals), lean meats, and chicken (not fried) to start. Milk can be given safely, although some people may experience additional stomach upset due to lactose intolerance.
• Most food poisonings do not require the use of over-the-counter medicines to stop diarrhea, but they are generally safe if used as directed. It is not recommended that these medications be given to children. If there is a question or concern, we should always check with your doctor.


Allergy


What does an allergy mean?
An allergy refers to a misguided reaction by our immune system in response to bodily contact with certain foreign substances. It is misguided because these foreign substances are usually harmless and remain so to non- allergic people. Allergy-producing substances are called "allergens." Examples of allergens include pollens, dust mite, molds, danders, and foods. To understand the language of allergy it is important to remember that allergens are substances that are foreign to the body and can cause an allergic reaction in certain people.
When an allergen comes in contact with the body, it causes the immune system to develop an allergic reaction in persons who are allergic to it. When you inappropriately react to allergens that are normally harmless to other people, you are having an allergic reaction and can be referred to as allergic or atopic. Therefore, people who are prone to allergies are said to be allergic or "atopic."

What are common allergic conditions?
The parts of the body that are prone to react to allergies include the eyes, nose, lungs, skin, and stomach. Although the various allergic diseases may appear different, they all result from a misguided immune response to foreign substances in sensitive people. The following brief descriptions will serve as an overview of common allergic disorders.
In The Air We Breathe
Breathing can be hazardous if you are allergic. Aside from oxygen, the air contains a wide variety of particles; some toxic, some infectious, and some "innocuous," including allergens. The usual diseases that result from airborne allergens are hay fever, asthma, and conjunctivitis. The following allergens are usually harmless, but can trigger allergic reactions when inhaled by sensitized individuals.
• Pollens: trees, grasses, and/or weeds;
• Dust mites
• Animal proteins: dander, skin, and/or urine
• Mold spores
• Insect parts: cockroaches

FirstAid27

Hay Fever
Hay fever (Allergic Rhinitis) is the most common of the allergic diseases and refers to seasonal nasal symptoms that are due to pollens. Year round or perennial allergic rhinitis is usually due to indoor allergens, such as dust mites or molds. Symptoms result from the inflammation of the tissues that line the inside of the nose (mucus lining or membranes) after allergens are inhaled. Adjacent areas, such as the ears, sinuses, and throat can also be involved.
The most common symptoms include:
• Runny nose
• Stuffy nose
• Sneezing
• Nasal itching (rubbing)
• Itchy ears and throat
• Post nasal drip (throat clearing)
In 1819, an English physician, John Bostock, first described hay fever by detailing his own seasonal nasal symptoms, which he called "summer catarrh". The condition was called hay fever because it was thought to be caused by "new hay" .

Asthma
Asthma is a breathing problem that results from the inflammation and spasm of the lung's air passages (bronchial tubes). The inflammation causes a narrowing of the air passages, which limits the flow of air into and out of the lungs. Asthma is most often, but not always, related to allergies.
Common symptoms include:
• Shortness of breath
• Wheezing
• Coughing
• Chest tightness

Allergic Eyes
Allergic Eyes (Allergic Conjunctivitis) is inflammation of the tissue layers (membranes) that cover the surface of the eyeball and the undersurface of the eyelid.
The inflammation occurs a result of an allergic reaction and may produce the following symptoms:
• Redness under the lids and of the eye overall
• Watery, itchy eyes
• Swelling of the membranes

Allergic Eczema
Allergic Eczema (Atopic Dermatitis) is an allergic rash that is usually not caused by skin contact with an allergen.
This condition is commonly associated with allergic rhinitis or asthma and features the following symptoms:
• Itching, redness, and or dryness of the skin.
• Rash on the face, especially children.
• Rash around the eyes, in the elbow creases, and behind the knees, especially in adults.

Touching Our Skin
Allergic contact dermatitis is an inflammation of the skin that is caused by a local allergic reaction. The majority of these localized skin reactions does not involve IgE, but are caused by cells of inflammation. The rash produced is similar to that of a poison ivy rash. It should be noted that when some allergens (e.g., latex) come into contact with the skin, they are absorbed by the skin and can also potentially cause reactions throughout the body, not just the skin. For most people, however, the skin is a formidable barrier that can be only locally affected.

Examples of allergic contact dermatitis include:
• Latex (causes IgE and non-IgE reactions
• Plants (poison ivy and oak)
• Dyes
• Chemicals
• Metals (nickel)
• Cosmetics
Allergic contact dermatitis does not involve IgE antibody, but involves cells of the immune system which are programmed to react when triggered by a sensitizing allergen. Touching or rubbing a substance to which you were previously sensitized can trigger a skin rash.


Drowing


Most drowning occur in water, 90% in freshwater (rivers and lakes) 10% in seawater, drowning in other fluids are rare and often industrial accidents.
Common conditions that may lead to drowning include but are not limited to:
• Water conditions exceed the swimmer's ability; - turbulent or fast water, water out of depth, falling through ice, rip currents, undertows, currents, waves and eddies.
• Entrapment; - physically unable to get out of the situation because of a lack of an escape route, snagging or by being hampered by clothing or equipment.
• Impaired judgment and physical incapacitation arising from the use of drugs, principally alcohol.
• Incapacitation arising from the conditions; - cold (hypothermia), shock, injury or exhaustion.
• Incapacitation arising from acute illness while swimming; - heart attack, seizure or stroke.
• Forcible submersion by another person; - murder or misguided children's play.
• Blackout underwater after rapid breathing to extend a breath-hold dive; - shallow water blackout.
• Blackout on ascent from a deep breath-hold dive due to latent hypoxia; - deep water blackout.
No person should attempt a rescue that is beyond his or her ability or level of training!
DO
• Learn to swim
• Learn and practice water rescue.
• Know your strengths and limitations in the water.
• Stay within your depth if you are not a strong swimmer.
• Keep a watch out for others.
• Swim with company, find a buddy, children swim with a responsible adult.
• Ensure that children have competent supervision in or near water.
• Swim in areas supervised by lifeguards in preference to areas without.
• Be cautious and very conservative when swimming at night.
• Ensure that your boat is reliable, properly loaded and that functional emergency equipment is onboard.
• Wear a properly fitting lifejacket while enjoying water sports such as sailing, surfing or canoeing.
• Pay attention to the weather, tides and water conditions, especially currents. Currents always look weaker from the outside!

NEVER
• Never swim while drunk or on drugs.
• Never hyperventilate to extend a breathe-hold dive, see deep and shallow water blackout
• Never rely on swimming aids, they may fail.
• Never play games that will put your life, or others', at risk.
• Never pretend to be a drowning victim, unless all bystanders are informed that this is an exercise.
• Never dive into water where you cannot clearly see the bottom or do not know the depth.
• Never walk on ice unless you know absolutely that the ice is thick enough over the entire route.
• Never handle electrical devices in or near the water.
• Never exceed your limits.
• Never swim in cold water.
Treatment
In the event of drowning, first remove the victim from the water. Check for consciousness and for breathing. If the victim is not breathing, do not waste time trying to remove water from the victim's lungs. Quickly remove any obstructions such as seaweed or excess mud from the victim's mouth, and open the airway and apply mouth-to-mouth recuscitation.
If breaths do not do in, re-tilt the head and attempt rescue breathing again. If air still does not go in, give children and adults abdominal thrusts using the Heimlich maneuver to clear the airway. Once the airway is clear, begin mouth-to-mouth and chest compression as necessary.
Hypothermia is the result of body temperatures falling below 35 C (95 F). The casualty will show signs of shivering and slurred speech, then confusion, irrationality, sleepiness, clumsiness, and shivering may stop. Babies may exhibit drowsiness and floppiness, and the face, hands, and feet will feel very cold.
Hypothermia victims should be gradually rewarmed by a warm bath and hot drinks. These are much preferable to a mere hot water bottle or electric blanket. If there are no other means of warmth, body heat can be used to warm the victim. The casualty should move to improve circulation, especially moving the legs, but the skin should not be rubbed.

Fainting
Fainting, which medical professionals call syncope (pronounced SIN-ko-pea), is a temporary loss of consciousness. Unlike a seizure, the person who faints usually regains alertness soon after regaining consciousness. Fainting is caused by a temporary loss of the brain’s blood supply. Fainting can sometimes be a sign of a more serious condition.
People of any age can faint, but elderly persons more often have a serious underlying cause.
• Three percent of adults aged 30-62 years have an episode of syncope, but 6% of those older than 75 years faint.
• Syncope accounts for 1-3% of emergency department visits and 1-6% of hospital admissions.

Fainting has many different causes.
Vasovagal syncope: Also known as the "common faint," this is the most frequent cause of syncope. It results from an abnormal circulatory reflex. The heart pumps more forcefully and the blood vessels relax, but the heart rate does not compensate fast enough to maintain blood flow. People older than 45 years rarely experience a first "common faint."
Causes of vasovagal syncope include the following:
• Environmental factors

Most commonly in a hot, crowded setting
• Emotional factors
Stress or the sight or threat of injury
• Physical factors
Standing too long with locked knees
• Illness
Fatigue, hypoglycemia (low blood sugar), dehydration, or other current illness

Situational syncope
Susceptible people have episodes of syncope only in particular situations.
Causes of situational syncope include the following:
• Cough syncope occurs in people with lung disease when coughing forcefully.
• Swallow syncope occurs upon swallowing in some people with disease in the throat or esophagus.
• Micturition syncope occurs when a susceptible person empties an overfilled bladder. It is most common in males who are intoxicated with alcohol.
• Carotid sinus hypersensitivity occurs in some elderly people when turning the neck, shaving, or wearing a tight collar.
• Postprandial fainting can occur in elderly people when their blood pressure falls about an hour after eating.
Medical Treatment
The treatment of fainting depends on the diagnosis.
Vasovagal syncope
• Lifestyle alterations:

Drink plenty of water, increase salt intake (under medical supervision), and avoid prolonged standing.
• Medications:
Medication may be prescribed if episodes are frequent.
Postural syncope
• Lifestyle alterations:

Sit up and flex calf muscles for a few minutes before getting out of bed. Avoid dehydration. Elderly people with low blood pressure after eating should avoid large meals or plan to lie down for a few hours after eating.
• Medications:
In most cases, medications that cause fainting are withdrawn or changed.
Cardiac syncope
• Medication and lifestyle alterations:

These treatments are designed to optimize the heart's performance while limiting its demands. Controlling high blood pressure, for example, would call for a medication and lifestyle change. In some cases, specific anti-arrhythmic medication may be prescribed.
• Surgery:
Bypass surgery or angioplasty is used to treat coronary heart disease. For some valve problems, valves can be replaced. Catheter ablation is available to treat some arrhythmias.
• Pacemaker:
A pacemaker may be implanted to slow the heart in certain types of fast arrhythmias.
• Implanted defibrillators
are used to control life-threatening fast arrhythmias.


Question and Answers


You Must See


1. What is First Aid?
• First aid is the immediate assistance given to the injured or ill with available resources before medical help is available.
• First aid is emergency care given immediately to an injured person. The purpose of first aid is to minimize injury and future disability. In serious cases, first aid may be necessary to keep the victim alive.
• First aid is immediate help given to a person who has been injured before they go to hospital.

2. What is the Aim of First Aid?
The aims of first aid are:

• To save life by removing any life thrilling danger/s.
• To prevent further injury and deterioration of the patient’s condition
• To relieve pain
• To make medical assistance available at the earliest

3. What are the Qualities of a first Aider?
A good first aider should be:

• A good observer
• Able to act quickly
• Calm and collected
• Able to lead and control the crow, and take form on-lookers
• Self-confident and able to judge which injuries need to be tackled first
• Able to reassure the apprehensive victim and his/her anxious or nervous relatives by demonstrating competence, expressing sympathy and providing reassurance

4. What is the Principle of First Aid?
First aid is the initial care of a suddenly sick or injured person. It is the care administered by a person as soon as possible after an accident or illness. It is this prompt care and attention prior to the arrival of the ambulance that sometimes means the difference between life and death, or between a full or partial recovery.

5. What is the Immediate action required?
Look for the following:

• Remove the patient to a place of safety
• Loosen clothing around the neck and waist to aid breathing
• Reassure the patient
1. Is there any failure of breathing? If yes, start artificial respiration
2. Is there any failure of circulation? If yes, start external cardiac massage
3. Is there severe bleeding? If yes, stop bleeding by pressing firmly on the bleeding area with a clean pad for few minutes or apply pressure on the pressure areas
• Treat shock
• Relieve pain
• Avoid handling the casualty unnecessarily
• Arrange of the safe removal of the casualty to hospital

6. What is Skeleton System?
The Skeletal System serves many important functions; it provides the shape and form for our bodies in addition to supporting, protecting, allowing bodily movement, producing blood for the body, and storing minerals.

7. What is skull?
The skull is the bony framework of the head. It is comprised of the eight cranial and fourteen facial bones.

8. What are RIBS?
There are 12 ribs on each side, attached to the thoracic vertebrae at the back. Except the lowest four, the ribs are attached to the breast bone in front.

9. What are the UPPER LIMB BONES?
There is one long bone in the arm—the humerus, and two long bones in the fore arm—the radius and ulna. The wrist has 8 small and the hand has 19 bones.

10. What are the LOWER LIMB BONES?
There is one long bone in the thigh, the femur, two long bones in the leg, tibia and fibula, seven small bones in the ankle and 19 bones in the foot.

11. What Is Digestive System?
It is composed of the stomach, the small intestine, the large intestine, the rectum and glands which secrete digestive enzyme into gastro intestinal tract—the salivary glands, liver, pancreas etc.

12. What is NERVOUS SYSTEM?
The brain is the master organ. It receives information form organs of special sense such as eyes, ears, nose, tongue and skin. It controls movement, interprets sensation, regulates body activities and generates memory and thought.

13. What is URINARY SYSTEM?
It consists of the kidneys, ureters, urinary bladder & urethra. It is involved in the removal of chemical waste from the blood and helps to balance water and salt levels of the body by excreting urine.

14. What is ENDOCRINE SYSTEM?
It consists of a number of glands which secrete various hormones into the blood stream, which help to regulate body activities & functions. The pituitary gland is the master gland which controls the activity of other glands, such as thyroid, parathyroid, adrenal and sex glands or gonads—testis and ovary.

15. What is REPRODUCTIVE SYSTEM?
It consists of the gonads and the reproductive tract and the hormones needed for sexual reproduction.

16. What are the SPECIAL SENSE ORGANS?
• Sight
• Hearing
• Taste
• Smell
• Sensation

17. What are the advantages of RECOVERY POSITION?
• It maintains open airway
• Tongue cannot fall to the back of the throat
• Head and neck will remain in the extended position so that the air passage is widened and that any vomiting or other fluid in the casualty’s mouth will drain freely

18. What is PRONE POSITION?
A patient is placed on his abdomen with head turned to one side. A pillow is placed under the head and the hands are kept on the sides.

19. Positioning In Shock
Lay the casualty on the back, turn head to one side, raise the legs with 2 pillows to improve blood supply to the heart. If the victim has fracture on the lower limbs, it should not be elevated unless they are well splinted.

20. DORSAL RECUMBENT POSITION
The patient is kept on his back. A pillow is placed under the head. The hands are kept on both the sides. It is used for examination of the patient. This position without pillow is used in case of fracture of the spine and also to give CPR

21. What is unconsciousness?
Unconsciousness is a state of complete loss of consciousness and the casualty is totally unresponsiveness to any painful stimulus. He is unaware of the surroundings and his body muscles are in a state of complete relaxation.
Unconsciousness is due to interference with the functions of the brain. Seriousness can be determined by testing the casualty’s response to stimuli such as sound or touch or pain.

22. What are the CAUSES OF UNCONSCIOUSNESS?
• Brain injuries
• Fits or convulsion
• Syncope or lack of cerebral circulation
• Infection of the coverings of the brain or tissues of brain
• Brain tumors
• Exposure to extreme heat
• Severe infections
• Severe injuries
• Severe burns
• Drugs reaction
• Electric shock
• Failure of liver or kidney
• Poisoning with chemical gas or alcohol
• Severe heart attack
• Drowning
• Diabetes or over dose of insulin
• Severe bleeding or fluid loss

23. What are the LEVEL OF RESPONSIVENESS?
There are stages through which a person may pass during progression from consciousness to unconsciousness or vice-versa:
Step 1- He may respond normally to questions and conversations
Step 2- He answers direct questions
Step 3- He responds vaguely to questions
Step 4- He obey commands
Step 5- He responds to pain only
Step 6- He does not respond at all

24. What is Basic life support?
Basic life support is an emergency life saving procedure that consists of recognizing and correcting failure of the respiratory or cardiovascular systems. Any profound disturbance of the airway, the breathing or the circulation can promptly result in brain death.

25.Checking Effectiveness Of Heart Compression
• Check the reaction of the pupils. If the pupils contract when exposed to light this is a sign that the brain is receiving adequate oxygen and blood.
• Carotid (neck pulse) should be felt after the first minute of heart compressions and artificial respiration and every five minutes there after. The pulse will indicate the effectiveness of the heart compression.
• Return of colour of skin.

26. What is the definition of bleeding?
Bleeding (hemorrhage) is an escape of blood vessels or hemorrhage or bleeding is a flow of blood from an artery vein or capillary.

27. What are the EFFECTS OF BLEEDING (Hemorrhage)?
Haemorrhage from major blood vessel of the arms, neck and thigh may occur so rapidly and extensively that death occurs in a few minutes so haemorrhage must be controlled immediately to prevent excessive loss of blood.
• The loss of red blood cells causes a lack of oxygen to the body systems.
• A decrease in blood volume causes a decrease in blood pressure.
• The heart’s pumping rate increases to compensate for reduced blood pressure.
• The force of the heart beat has reduced since there is less blood to pump.

28. What are the types of BLEEDING?
There are three different types of hemorrhage or bleeding.

1. ARTERIAL BLEEDING
2.VENOUS BLEEDING
3.CAPILLARY BLEEDING

29. What is EXTERNAL BLEEDING?
If the bleeding is from the surface of the body it is called external bleeding.
(i) Evidence of major external blood loss.
(ii) Symptoms and signs or shock.
• Casualty complains of thirst.
• Blurring of vision.
• Fainting and giddiness.
• Face and lips becomes pale.
• Pulse becomes faster but weaker.
• Restlessness and sweating.
• Breathing becomes shallow.
• Unconsciousness.

30. What is internal bleeding?
INTERNAL BLEEDING

If the bleeding is with in the chest skull or abdomen etc. it is called internal bleeding because this can not be seen immediately but later the blood may ooze out through nose or ear or coughed up from the lungs or vomited from stomach.
• History of sufficient injury to cause internal bleeding.
• Wounds that have penetrated the skull.
• Wounds that have penetrated chest or abdomen.
• History or Medical condition, which may cause internal bleeding, like ulcer etc.
• Pain and swelling around the affected area.
• Signs of shock.
• Blood may appear form one of the body orifices as nose, ear, mouth, rectum, urethra, vagina etc.

31. What is first aid management for bleeding?
1. Control of bleeding as soon as possible.
2. Keep the wound clean and dress it to minimize blood loss to prevent infection.

32. What is Shock?
Shock is a state of inadequate tissue perfusion. In other words it is state of not enough oxygen and nutrients are being delivered to the cells to keep them alive.
Shock is the result of a decrease is the vital function of various organs of the body that results form a decrease in effective circulation oxygenated blood or fluid in the body as a result of injury or illness.

33. What are the causes of Shock?
• Severe or extensive injuries
• Severe pain
• Heart attack
• Loss of blood that is internal or external bleeding
• Severe burns which leads to loss of body fluids
• Electric shock or electrocution
• Exposure to extreme heat and cold
• Drugs or allergic reactions
• Poisoning form drugs, gases and other chemicals and also from alcohol intoxication
• Emotional up set due to good or bad news
• Stress and fright
• Bites or stings of poisonous snakes or insects

34. What the effect of burns?
Burns and Scalds are dangerous because not only they can cause death, but delayed effects like Scarring and deformity can be quite distressing. Hence Prompt and correct treatment of burns and scalds are essential.

35. Danger of Burns
• Shock:

Shock develops because plasma leaks out of circulatory system into the burn area.
• Infection:
There is big risk of infection with burns because skin is damaged and there is no protection against micro organisms.

36. What is Classification of Burns?
AREA:

Burns are classified on the basis of area by rule of 9.
Rule of nine to estimate % of burn.

(a) SEVERITY OF BURN:
Superficial burn involves the skin and blister formation takes place. All other burns are deep burns.
• Keep the part in cold water for 15-20 minutes or until the pain disappears. If that is not possible soak clean cloth water and put it over the burnt area. It needs to be changed frequently. Application of cold water removes residual heat from tissues and prevent further damage.
• Cover burnt area with sterile dressing or freshly laundered linen. Avoid exposure to air. In case of burns over face, make dressing in the shape of a mask, with holes at the levels of the nose for breathing.
• Remove rings, bracelets, shoes and any other light article as swelling may develop later on making it difficulty to remove them.
• Arrange for immediate transfer to hospital.
• Give plenty of fluids to drink, if patient can tolerate.
• When large area is damaged, pack ice in a clean towel and apply it to the burnt are during transfer to a hospital.
• Do not put oil, lotions or ointments on the burned area.
• Do not pull away burnt clothing stuck to the body.
• Do not handle or touch the patient than absolutely necessary.
In chemical burns the damage continues as long as the chemical remains in contact with skin.
• Remove the contaminated clothing carefully after soaking in water. Take care not to contaminate yourself.
• Flood the affected area with water thoroughly and systematically for 10-15 minutes. One may use soda bicarbonate solution to wash acid burns and vinegar to wash alkali burns before washing with water.
• Give general care.

ELECTRIC BURNS:-
Electrical injuries are due to the effect of high tension electric current or atmospheric electricity as in lightening. The heat generated during passage of current through the body causes deep burns at the exit and entrance of the current.
In case of DC shock to the source patient remains stuck to the source of electricity until the current is broken, hence the damage is extensive. In case of AC shock the damage is less. There may be physical injury when the patient falls down. The electrical current can disturb the respiratory centre and the cardiovascular centre causing respiratory arrest and cardiac arrest respectively. Damp clothing, damp foot wear and damp ground increase electrical conductivity and make the damage worse. The patient may be in shock. The measures should be taken care.
• Switch off the current and remove the plug form the socket.
• If the patient is lying in water keep out of it yourself, as water is an excellent conductor of electricity. For the same reason do not hold the patient under the arm pit.
• If the patient is in contact with a live wire, the current in which cannot be switched off, separate the wire from the patient using a long wooden stick and while standing on a non-conductor of electricity like a wooden board or a pile of newspapers. Wear rubber gloves if necessary.
• Treat if necessary.
• Treat shock if present.
• Treat burns.
• Give fluids to drink
• Arrange for medical aid.+

37 What is First aid Box Kit consists?
Answer: First Aid Box Consist of:

• First-aid book.
• Sterile adhesive bandages in assorted sizes.
• Small roll of absorbent gauze or gauze pads of different sizes.
• Adhesive tape.
• Triangular and roller bandages.
• Cotton (1 roll).
• Band-aids (Plasters).
• Scissors
• Pen torch.
• Latex gloves (2 pair)
• Tweezers.
• Needle
• Moistened towels and clean dry cloth pieces.
• Antiseptic (Savlon or dettol)
• Thermometer.
• Tube of petroleum jelly or other lubricant.
• Assorted sizes of safety pins.
• Cleansing agent/soap.
Non-prescription drugs:
• Aspirin or paracetamol pain relievers
• Anti-diarrhea medication
• Antihistamine cream for Bee Stings
• Antacid (for stomach upset)
• Laxative

38: What is the danger of dehydration and heat stroke?
Dehydration and heat stroke are two very common heat-related diseases that can be life-threatening if left untreated.

39: What is dehydration?
Dehydration can be a serious heat-related disease, as well as being a dangerous side-effect of diarrhea, vomiting and fever. Children and persons over the age of 60 are particularly susceptible to dehydration.

40: What causes dehydration?
Under normal conditions, we all lose body water daily through sweat, tears, urine and stool. In a healthy person, this water is replaced by drinking fluids and eating foods that contain water. When a person becomes so sick with fever, diarrhea, or vomiting or if an individual is overexposed to the sun, dehydration occurs. This is caused when the body loses water content and essential body salts such as sodium, potassium, calcium bicarbonate and phosphate.
Occasionally, dehydration can be caused by drugs, such as diuretics, which deplete body fluids and electrolytes. Whatever the cause, dehydration should be treated as soon as possible.

41: What are the symptoms of dehydration?
The following are the most common symptoms of dehydration, although each individual may experience symptoms differently.
Symptoms may include:
• thirst
• less-frequent urination
• dry skin
• fatigue
• light-headedness
• dizziness
• confusion
• dry mouth and mucous membranes
• increased heart rate and breathing

42: In children, what are the additional symptoms may include?
• dry mouth and tongue
• no tears when crying
• no wet diapers for more than 3 hours
• sunken abdomen, eyes or cheeks
• high fever
• listlessness
• irritability
• skin that does not flatten when pinched and released

43: Treatment for dehydration?
If caught early, dehydration can often be treated at home under a physician's guidance. In children, directions for giving food and fluids will differ according to the cause of the dehydration, so it is important to consult your pediatrician.
In cases of mild dehydration, simple rehydration is recommended by drinking fluids. Many sports drinks on the market effectively restore body fluids, electrolytes, and salt balance.
For moderate dehydration, intravenous fluids may be required, although if caught early enough, simple rehydration may be effective. Cases of serious dehydration should be treated as a medical emergency, and hospitalization, along with intravenous fluids, is necessary. Immediate action should be taken.

44: How can dehydration be prevented?
Take precautionary measures to avoid the harmful effects of dehydration, including:

• Drink plenty of fluids during outdoor activities, especially on hot days. Water and sports drinks are the drinks of choice; avoid tea, coffee, soda and alcohol as these can lead to dehydration.
• Wear lightweight, tightly woven, loose-fitting clothing in light colors.
• Schedule vigorous activity and sports for cooler times of the day.
• Protect yourself from the sun by wearing a hat, sunglasses and using an umbrella.
• Increase time spent outdoors gradually to get your body used to the heat.
• During outdoor activities, take frequent drink breaks and mist yourself with a spray bottle to avoid becoming overheated.
• For infants and young children, solutions like Pedialyte will help maintain electrolyte balance during illness or heat exposure. Do not try to make fluid and salt solutions at home for children.

45: What is heat stroke?
Heat stroke is the most severe form of heat illness and is a life-threatening emergency. It is the result of long, extreme exposure to the sun, in which a person does not sweat enough to lower body temperature. The elderly, infants, persons who work outdoors and those on certain types of medications are most susceptible to heat stroke. It is a condition that develops rapidly and requires immediate medical treatment.

46: What causes heat stroke?
Our bodies produce a tremendous amount of internal heat and we normally cool ourselves by sweating and radiating heat through the skin. However, in certain circumstances, such as extreme heat, high humidity or vigorous activity in the hot sun, this cooling system may begin to fail, allowing heat to build up to dangerous levels.
If a person becomes dehydrated and can not sweat enough to cool their body, their internal temperature may rise to dangerously high levels, causing heat stroke.

47: What are the symptoms of heat stroke?
The following are the most common symptoms of heat stroke, although each individual may experience symptoms differently. Symptoms may include:

• headache
• dizziness
• disorientation, agitation or confusion
• sluggishness or fatigue
• seizure
• hot, dry skin that is flushed but not sweaty
• a high body temperature
• loss of consciousness
• rapid heart beat
• hallucinations

48: How is heat stroke treated?
It is important for the person to be treated immediately as heat stroke can cause permanent damage or death. There are some immediate first aid measures you can take while waiting for help to arrive.
• Get the person indoors.
• Remove clothing and gently apply cool water to the skin followed by fanning to stimulate sweating.
• Apply ice packs to the groin and armpits.
• Have the person lie down in a cool area with their feet slightly elevated
Intravenous fluids are often necessary to compensate for fluid or electrolyte loss. Bed rest is generally advised and body temperature may fluctuate abnormally for weeks after heat stroke.

50: How can heat stroke be prevented?
There are precautions that can help protect you against the adverse effects of heat stroke.
These include:
• Drink plenty of fluids during outdoor activities, especially on hot days. Water and sports drinks are the drinks of choice; avoid tea, coffee, soda and alcohol as these can lead to dehydration.
• Wear lightweight, tightly woven, loose-fitting clothing in light colors.
• Schedule vigorous activity and sports for cooler times of the day.
• Protect yourself from the sun by wearing a hat, sunglasses and using an umbrella.
• Increase time spent outdoors gradually to get your body used to the heat.
• During outdoor activities, take frequent drink breaks and mist yourself with a spray bottle to avoid becoming overheated.
• Try to spend as much time indoors as possible on very hot and humid days.

51: What snakes cause poisonous bites?
Any of the following snakes cause poisonous bites:

• Rattlesnake
• Copperhead
• Cottonmouth Water Moccasin
• Coral Snake
52: What are the symptoms of poisonous bites?
While each individual may experience symptoms differently, the following are the most common symptoms of poisonous snake bites:
While each individual may experience symptoms differently, the following are the most common symptoms of poisonous snake bites:
• bloody wound discharge
• fang marks in the skin and swelling at the site of the bite
• severe localized pain
• diarrhea
• burning
• convulsions
• fainting
• dizziness
• weakness
• blurred vision
• excessive sweating
• fever
• increased thirst
• loss of muscle coordination
• nausea and vomiting
• numbness and tingling
• rapid pulse

53: How are snake bites treated?
Call for emergency assistance immediately if someone has been bitten by a snake. Responding quickly in this type of emergency is crucial.
While waiting for emergency assistance:
• Wash the bite with soap and water.
• Immobilize the bitten area and keep it lower than the heart.
• Cover the area with a clean, cool compress or a moist dressing to minimize swelling and discomfort.
• Monitor vital signs.
If a victim is unable to reach medical care within 30 minutes, the American Red Cross recommends:
• Apply a bandage, wrapped two to four inches above the bite, to help slow the venom. This should not cut off the flow of blood from a vein or artery - the band should be loose enough t– slip a finger under it.
• A suction device can be placed over the bite to help draw venom out of the wound without making cuts. These devices are often included in commercial snake bite kits.

Most often, physicians use antivenin -- an antidote to snake venom -- to–react serious snake bites. An–venin is derived from antibodies created in a horse's blood serum when the animal is injected with snake venom. Because antivenin is obtained from horses, snake bite victims sensitive to horse products must be carefully managed.

54: What is rabies?
Rabies is a viral infection of certain warm-blooded animals and is caused by a virus in the Rhabdoviridae family. It attacks the nervous system and, once symptoms develop, it is 100 percent fatal in animals, if left untreated.
Rabies occurs primarily in skunks, raccoons, foxes, and bats. In some areas, these wild animals infect domestic cats, dogs, and livestock. In the United States, cats are more likely than dogs to be rabid.
Generally, rabies is rare in small rodents such as beavers, chipmunks, squirrels, rats, mice, or hamsters. Rabies is also rare in rabbits. In the mid-Atlantic states, where rabies is increasing in raccoons, woodchucks can also be rabid.

55: How does rabies occur?
The rabies virus enters the body through a cut or scratch, or through mucous membranes (such as the lining of the mouth and eyes), and travels to the central nervous system. Once the infection is established in the brain, the virus travels down the nerves from the brain and multiplies in different organs.
The salivary glands and organs are most important in the spread of rabies from one animal to another. When an infected animal bites another animal, the rabies virus is transmitted through the infected animal's saliva. Scratches by claws of animals are also dangerous because these animals lick their claws.

56: How is rabies diagnosed?
In animals, the direct fluorescent antibody test (dFA) is most frequently used to detect rabies. Within a few hours, diagnostic laboratories can determine whether an animal is rabid and provide this information to medical professionals. These results may save a person from undergoing treatment if the animal is not rabid.
In humans, a number of tests are necessary to confirm or rule out rabies, as no single test can be used to rule out the disease with certainty. Tests are performed on samples of serum, saliva, and spinal fluid. Skin biopsies may also be taken from the nape of the neck.

57 : How can animal bites and rabies be prevented?
Being safe around animals, even your own pets, can help reduce the risk of animal bites. Some general guidelines for avoiding animal bites and rabies include the following:

• Do not try to separate fighting animals.
• Avoid strange and sick animals.
• Leave animals alone when they are eating.
• Keep pets on a leash when out in public.
• Select family pets carefully.
• Never leave a young child alone with a pet.
• All domestic dogs and cats should be immunized against rabies and shots kept current.
• Do not approach or play with wild animals of any kind, and be aware that domestic animals may also be infected with the rabies virus.
• Supervise pets so they do not come into contact with wild animals. Call your local animal control agency to remove any stray animals.

58: What is fever?
Fever (also called pyrexia) is defined as body temperature that is higher than normal for each individual. It generally indicates that there is an abnormal process occurring in the body. Exercise, hot weather, and common childhood immunizations can also make body temperature rise.
Fever is not an illness, but, rather, a symptom or an indicator that something is not right within the body. A fever does not tell you what disorder is causing it, or even that a disease process is occurring. It may be a bacterial or viral infection, or simply a reaction from an allergy to food or medication, or becoming overheated at play or in the sun.

59 : What constitutes a fever?
Although high fevers may bring on convulsions or delirium, generally it is not how high the temperature is, but how rapidly the temperature rose that causes a convulsion.
If symptoms of an illness are present:
• A temperature between 99.8oF - 100.8oF is considered a low-grade fever.
• A temperature between 101oF - 102oF is considered a mild fever.
• Between 102oF - 103oF is considered a moderate fever.
• Anything around 104oF or above is considered a high fever, and delirium or convulsions may occur.
Your child's physician may have different definitions of fever than these, and will provide guidelines for when to treat fever yourself and when to call the physician's office.

60 : What are the signs that indicate fever?
Because a baby, young child, or disabled person may not be able to express how he or she is feeling, be sure to look for signs -- outward indications -- that fever is present before using a thermometer.
Signs that indicate fever may include:
• flushed face
• hot, dry skin
• low output of urine, and/or dark urine
• not interested in eating
• constipation or diarrhea
• vomiting
• headache
• aching all over
• nausea

61 : What does an allergy mean?
An allergy refers to a misguided reaction by our immune system in response to bodily contact with certain foreign substances. It is misguided because these foreign substances are usually harmless and remain so to non- allergic people. Allergy-producing substances are called "allergens." Examples of allergens include pollens, dust mite, molds, danders, and foods. To understand the language of allergy it is important to remember that allergens are substances that are foreign to the body and can cause an allergic reaction in certain people.
When an allergen comes in contact with the body, it causes the immune system to develop an allergic reaction in persons who are allergic to it. When you inappropriately react to allergens that are normally harmless to other people, you are having an allergic reaction and can be referred to as allergic or atopic. Therefore, people who are prone to allergies are said to be allergic or "atopic."

62 : What are common allergic conditions?
The parts of the body that are prone to react to allergies include the eyes, nose, lungs, skin, and stomach. Although the various allergic diseases may appear different, they all result from a misguided immune response to foreign substances in sensitive people. The following brief descriptions will serve as an overview of common allergic disorders.

63 : What is the Treatment for a victim of Drowing?
In the event of drowning, first remove the victim from the water. Check for consciousness and for breathing. If the victim is not breathing, do not waste time trying to remove water from the victim's lungs. Quickly remove any obstructions such as seaweed or excess mud from the victim's mouth, and open the airway and apply mouth-to-mouth recuscitation.
If breaths do not do in, re-tilt the head and attempt rescue breathing again. If air still does not go in, give children and adults abdominal thrusts using the Heimlich maneuver to clear the airway. Once the airway is clear, begin mouth-to-mouth and chest compression as necessary.
Hypothermia is the result of body temperatures falling below 35 C (95 F). The casualty will show signs of shivering and slurred speech, then confusion, irrationality, sleepiness, clumsiness, and shivering may stop. Babies may exhibit drowsiness and floppiness, and the face, hands, and feet will feel very cold.
Hypothermia victims should be gradually rewarmed by a warm bath and hot drinks. These are much preferable to a mere hot water bottle or electric blanket. If there are no other means of warmth, body heat can be used to warm the victim. The casualty should move to improve circulation, especially moving the legs, but the skin should not be rubbed.

64 : How should the First aid provider react when dealing with an emergency?
1. KEEP CALM -

Remaining calm while helping a child will help him/her to keep calm and cooperate. If your child becomes anxious or excited the extent of the damage from the injury can increase.
2. PLAN QUICKLY ABOUT WHAT YOU NEED TO DO -
Learn basic procedures, or have your first aid manual available, so you can care for the child.
3. SEND FOR PROFESSIONAL HELP -
Reaching for help quickly could save a life. Keep your local emergency telephone numbers handy.
4. AN ENCOURAGEMENT TO THE INJURED PERSON -
Let the child know that help is on the way and try to make him as comfortable as possible. Showing care and concern can give them hope during the circumstances.

65 : What are the Principles of managing an injury:?
RICE for Injury Relief
The "RICE" method can help control pain and swelling and minimize the side effects of an injury.
Rest
Ice
Compression
Elevation


66 : How does RICE work?
When tissue is damaged, fluid accumulates in the injured area, leading to swelling. Swelling will limit the motion of the joint and may contribute to pain if it gets bad enough.
Rest is essential to keep an injury from getting worse. If you ignore the problem, you may continue to aggravate the tissue damage. This doesn't mean you have to stop all activities completely. You can try "relative rest," which means continuing an activity if pain allows, or switching to an activity that doesn't cause pain - like swimming for an ankle sprain. If any activity hurts, don't do it. If it doesn't, continue. It may mean you can do only part of an activity, but this might be better than stopping it completely.
Ice or anything cold can effectively decrease pain from an injury. Icing deadens pain and beneficially changes blood circulation: It increases circulation to the skin but decreases it in deeper tissues where bleeding may be occurring. An ice pack can be used on the injured part as soon as possible and kept there for 20 minutes. Place a thin sheet, napkin, or layer of mineral oil between the skin and the pack to protect the skin surface.
Smaller areas can be treated with ice massage. Ice cubes in a handkerchief can be rubbed on the injured part for 5 to 10 minutes.
If the skin turns white or blue during icing or ice massage, stop immediately. Cold treatments can be repeated every 2 hours. There is no advantage to using ice packs or massage longer or more often.
Compression of the injured area prevents fluid from collecting. An elastic wrap or stocking can be very effective. It should be applied, firmly but not tightly, right away. (You can ice right through a thin wrap.) If the part of the arm or leg that is farthest from the heart throbs after compression, the wrap is too tight and needs to be loosened. Reapply compression wraps every 4 hours. Compression will help if the swelling is from bleeding, and it may also decrease pain. The reason for this is not well understood, but many people feel better with something tight (but not too tight) on an injured wrist or ankle.
Elevation of the affected extremity limits swelling by using gravity to help drain fluid from the injured tissue. Of course, this advice is more practical for ankles and hands than backs and hips. Whenever resting, elevate his injured arm or leg.
Resuming normal activity: Using the RICE method for pain control may allow you to get your child back into the normal routine without taking a lot of time off. But remember: He is not healed just because the injury doesn't hurt anymore. He still has to regain normal range of movement and strength. Until this happens, your child is more likely to get reinjured.

67: What about applying Heat?
Heat, like ice, can deaden pain, and every one feels good with heat fomentation. The problem is that it can also promote swelling--something we want to avoid after an injury. Also, heat may increase deep circulation, which can be devastating if bleeding is involved.
Once the injury is under control, and the greatest discomfort is due to stiffness, heat can help. Usually this means at least 2 or 3 days after an injury has occurred. You can use hot packs to help loosen up the joint before activity. But beware: If any swelling develops, keep heat away from your child.

68 : What to do? MINOR INJURIES?
CUTS:
Cleanse area thoroughly with soap and warm water, carefully washing away any dirt.
Apply direct pressure to wound until bleeding stops.
Put sterile bandage on wound. Clean, sterile piece of gauze is enough. Do not use any ointment/ powder/ turmeric till you reach your doctor. Idea is to cover the wound with a clean pad and to apply compression to stop the flow of blood.
If cut is deep, get to a doctor as quickly as possible.
ABRASIONS (SCRATCHES):
1. Wash thoroughly with soap and warm water.
2. If it bleeds or oozes, bandage it to protect it from infection.
MINOR BITE
1. Wash carefully with soap and water
2. Apply an antiseptic (i.e. hydrogen peroxide)
3. Apply an antibiotic cream
4. Clean the bite to rid it of infection
5. Victim should be treated by a doctor

Whether the bite is large or small, a doctor should be contacted in case of swelling, increasing redness, or discharge, or if there are flu like symptoms, fever, or swollen glands.



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