First Aid in Construction from Construction Knowledge.net

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FIRST AID

1. Introduction
2. Basic Life Support
3. Bleeding
4. Shock
5. Soft Tissue Injuries
6. Bones, Joints and Muscles

Introduction:

The following information has been provided by the Department of the Navy Bureau of Medicine and Surgery, titled Operational Medicine 2001 Standard First Aid Course (NAVEDTRA 13119US).

First aid is the emergency care and treatment of a sick or injured person before professional medical services are obtained. FIRST AID MEASURES ARE NOT MEANT TO REPLACE PROPER MEDICAL DIAGNOSIS AND TREATMENT, but will only consist of providing temporary support until professional medical assistance is available. The purposes of first aid are (1) to save life, (2) prevent further injury, and (3) to minimize or prevent infection.

While administering first aid, the three primary objectives are (1) to maintain an open airway, (2) maintain breathing, and (3) to maintain circulation. During this process you will also control bleeding, and reduce or prevent shock.

You must respond rapidly, stay calm, and think before you act. Do not waste time looking for ready-made materials, do the best you can with what is at hand. Request professional medical assistance as soon as possible.

Initial Assessment
When responding to a casualty, take a few seconds to quickly inspect the area. Remain calm as you take charge of the situation, and act quickly but efficiently. Decide as soon as possible what has to be done and which one of the injuries needs attention first. During your initial assessment, consider the following:

1. Safety - Determine if the area is safe. If the situation is such that you or the casualty is in danger, you must consider this threat against the possible damage caused by early movement. If you decide to move the casualty, do it quickly and gently to a safe area where proper first aid can be given. You cannot help the casualty if you become one yourself.
2. Mechanism of injury - Determine the extent of the illness or injury and how it happened. If the casualty is unconscious, look for clues. If the casualty is lying at the bottom of a ladder, suspect that he or she fell and may have internal injuries.
3. Medical information devices - Examine the casualty for a MEDIC ALERT necklace, bracelet, or identification card. This medical tag, provides medical conditions, medications being taken, and allergies about the casualty. The VIAL OF LIFE, a small, prescription-type bottle, also contains medical information concerning the casualty. This bottle is normally located in the refrigerator.
4. Number of casualties - Look beyond the first casualty, you may find others. One casualty may be alert, while another, more serious or unconscious, is unnoticed. In a situation with more than one casualty limit your assessment to looking for an open airway, breathing, bleeding, and circulation, the life-threatening conditions.
5. Bystanders - Ask bystanders to help you find out what happened. Though not trained in first aid, bystanders can help by calling for professional medical assistance, providing emotional support to the casualty, and keeping onlookers from getting in the way.
6. Introduce yourself - Inform the casualty and bystanders who you are and that you know first aid. Prior to rendering first aid, obtain the casualties consent by asking is it "OK' to help them. Consent is implied if the casualty is unconscious or cannot reply.

General Rules
Every illness or injury presents with its own individual problems. Prior to learning first aid for a specific illness or injury, you must have a complete understanding of the following:

1. Keep the casualty lying down, head level with the body, until you determine the extent and seriousness of the illness or injury. You must immediately recognize if the casualty has one of the following conditions that represent an exception to the above.
            a. Vomiting or bleeding around the mouth - If the casualty is vomiting or bleeding around the mouth, place them
            on their side, or back with head turned to the side. Special care must be taken for a casualty with a
            suspected neck or back injury.
            b. Difficulty breathing - If the casualty has a chest injury or difficulty breathing place them in a sitting or semi
            sitting position.
            c. Shock - To reduce or prevent shock, place the casualty on his or her back, with their legs elevated 6 to 12
            inches. If you suspect head or neck injuries or are unsure of the casualty's condition, keep them lying
            flat and wait for professional medical assistance.

2. During your examination, move the casualty no more than is necessary. Loosen restrictive clothing, at the neck, waist, and where it binds. Carefully remove only enough clothing to get a clear idea of the extent of the injuries. When necessary, cut clothing along its seams. Ensure the casualty does not become chilled, and keep them as comfortable as possible. Inform the casualty of what you are doing and why. Respect the casualty's modesty, but do not jeopardize quality care. Shoes may have to be cut off to avoid causing pain or further injury.
3. Reassure the casualty that his or her injuries are understood and that professional medical assistance will arrive as soon as possible. The casualty can tolerate pain and discomfort better if they are confident in your abilities.
4. Do not touch open wounds or burns with your fingers or un-sterile objects unless it is absolutely necessary. Place a barrier between you and the casualty's blood or body fluids, using plastic wrap, gloves, or a clean, folded cloth. Wash your hands with soap and warm water immediately after providing care, even if you wore gloves or used another barrier.
5. Do not give the casualty anything to eat or drink because it may cause vomiting, and because of the possible need for surgery. If the casualty complains of thirst, wet his or her lips with a wet towel.
6. Splint all suspected, broken or dislocated bones in the position in which they are found. Do not attempt to straighten broken or dislocated bones because of the high risk of causing further injury. Do not move the casualty if you do not have to.
7. When transporting, carry the casualty feet first. This enables the rear bearer to observe the casualty for any complications.
8. Keep the casualty comfortable and warm enough to maintain normal body temperature.

Infectious Diseases
You will probably render first aid to someone you know - a shipmate or family member. For this reason you will probably know your risk of contracting an infectious disease. Adopt practices that discourage the spread of blood-borne diseases (Hepatitis and HIV) and air-borne diseases such as influenza when performing first aid.
1. Wear gloves or use another barrier.
2. Wash your hands with soap and warm water immediately.
3. When possible, use a pocket mask or mouthpiece during rescue breathing.

The risk of contracting infections from a casualty is very remote. Do not withhold rendering first aid because of this rare possibility.

Basic Life Support:

Atmospheric air that is essential for life contains approximately 21% oxygen. When you breathe in (inhale) only a quarter of the air is taken by the blood in the lungs. The air you breath out (exhale) contains approximately 16% oxygen. Enough to support life! Seconds after being deprived of oxygen, the heart is at risk of developing irregular beats or stopping. Within four to six minutes, the brain is subject to irreversible damage.

Basic life support is maintenance of the ABCs (airway, breathing, and circulation) without auxiliary equipment. The primary importance is placed on establishing and maintaining an adequate open airway. Airway obstruction alone may be the emergency: a shipmate begins choking on a piece of food. Restore breathing to reverse respiratory arrest (stopped breathing) commonly caused by electric shock, drowning, head injuries, and allergic reactions. Restore circulation to keep blood circulating and carrying oxygen to the heart, lungs, brain, and body. This course is not a substitute for formal training in basic life support.

Airway Obstruction
Airway obstruction, also known as choking, occurs when the airway (route for passage of air into and out of the lungs) becomes blocked. The restoration of breathing takes precedence over all other measures.. The reason for this is simple: If a casualty cannot breathe, he or she cannot live. Individuals who are choking may stop breathing and become unconscious. The universally recognized distress signal (Fig. 2-1) for choking is the casualty clutching at his or her throat with one or both hands. The most common causes of airway obstruction are swallowing large pieces of improperly chewed food, drinking alcohol before or during meals, and laughing while eating. The tongue is the most common cause of obstruction in the casualty who is unconscious. A foreign body can cause a partial or complete airway obstruction.

Partial Airway Obstruction
If the casualty can cough forcefully, and is able to speak, there is good air exchange. Encourage him or her to continue coughing in an attempt to dislodge the object. Do not interfere with the casualty's efforts to remove the obstruction. First aid for a partial airway obstruction is limited to encouragement and observation. When good air exchange progresses to poor air exchange, demonstrated by a weak or ineffective cough, a high-pitched noise when inhaling, and a bluish discoloration (cyanosis) of the skin (around the finger nails and lips), treat as a complete airway obstruction.

Complete Airway Obstruction
A complete airway obstruction presents with a completely blocked airway, and an inability to speak, cough, or breathe. If the casualty is conscious, he or she may display the universal distress signal. Ask "Are YOU choking?" If the casualty is choking, do the following:

1. Shout "Help"-Ask the casualty if you can help.
2. Request medical assistance - Say "Airway is obstructed" (blocked), call (Local emergency number or medical personnel).
3. Abdominal thrusts (Heimlich Maneuver)
            a. Stand behind the casualty.
            b. Place your arms around the (Fig. 2-2) casualties waist.
            c. With your fist, place the thumb side against the middle of the abdomen, above the navel and below the
            tip (xiphoid process) of the (sternum) breastbone.
            d. Grasp your fist with your other hand.
            e. Keeping your elbows out, press your fist (Fig. 2-3) into the abdomen with a quick upward thrust.
            f. Repeat until the obstruction is clear or the casualty becomes unconscious.

If the casualty becomes unconscious, do the following: Abdominal Thrust followed by Head Tilt-Chin Lift

4. Finger sweep - Place the casualty on his or her back, open casualty's mouth and grasp the tongue and lower jaw between your thumb and fingers, lift jaw with your index finger into the mouth along inside of cheek to base of tongue. Use "hooking" motion to dislodge object for removal.
5. Open airway (Head-tilt/Chin-lift) -Place your hand on the casualty's forehead. Place the fingers of your other hand under the (Fig. 2-4) bony part of the chin. Avoid putting pressure under the chin, it may cause an obstruction of the airway. Tilt the head and lift the jaw, avoid closing the casualty's mouth. Place your ear over the casualty's mouth and nose. Look at the chest, listen and feel for breathing, 3 to 5 seconds. If not breathing, say, "Not Breathing." (jaw-thrust maneuver) - If you suspect the casualty may have an injury to the head, neck, or back, you must minimize movement of the casualty when opening the airway. Kneeling at the top of the casualty's head, place your elbows on the surface. Place your fingers behind the angle of the jaw or hook your fingers under the jaw, bring jaw forward. Separate the lips with your thumbs to allow breathing through the mouth. Note that the head is not tilted and the neck is not extended.
6. Give breaths - Pinch nose, open your mouth, take a deep breath, and make an air-tight seal around the casualty's mouth. Give 2 full breaths, each lasting 1 to 1-¹/₂ seconds. Pause between each breath. If unsuccessful, perform abdominal thrusts.
7. Perform abdominal thrusts
            a. Straddle the casualty's thighs.
            b. Place the heel of your hand against the middle of the abdomen, above the navel and below the tip of
            the breastbone.
            c. Place your other hand directly on top of the first (Fingers should point towards the casualty's head).
            d. Press abdomen 6 to 10 times with quick upward thrusts.
8. Continue steps 4 to 7 -Until successful, you are exhausted, you are relieved by another trained individual, or by medical personnel.

If the casualty is found unconscious, do the following:
1. Check unresponsiveness - Tap or gently shake the casualty, shout, "Are you OK?"
2. Shout, "Help" - If there is no response from casualty.
3. Position casualty - Kneel midway between his or her hips and shoulders facing casualty. Straighten legs, and move arm closest to you above casualty's head. Place your hand on the casualty's shoulder and one on the hip. Roll casualty toward you as a unit, move your hand from the shoulder to support the back of the head and neck. Place the casualty's arm nearest you alongside his or her body.
4. Open airway (Head-tilt/Chin-lift or Jaw-thrust) - Place your hand on the casualty's forehead. Place the fingers of your other hand under the bony part of the chin. Avoid putting pressure under the chin, it may cause an obstruction of the airway. Tilt the head and lift the jaw, avoid closing casualty's mouth. Place your ear over the casualty's mouth and nose. Look at the chest, listen, and feel for breathing, 3 to 5 seconds. If not breathing, say, "Not Breathing."
5. Give breaths - Pinch nose, open your mouth, take a deep breath, and make an air-tight seal around the casualty's mouth. Give 2 full breaths, each lasting 1 to 1-¹/₂seconds. Pause between each breath. If unsuccessful, reposition head, and give 2 full breaths.
6. Request medical assistance - Say "Airway is obstructed" (blocked), call local emergency number or medical personnel.
7. Perform abdominal thrusts
            a. Straddle the casualty's thighs.
            b. Place the heel of your hand against the middle of the abdomen, above the navel and below the tip of
            the breastbone.
            c. Place your other hand directly on top of the first (fingers should point towards the casualty's head).
            d. Press abdomen 6 to 10 times with quick upward thrusts.
8. Finger sweep - Place the casualty on his or her back, open the casualty's mouth and grasp the tongue and lower jaw between your thumb and fingers, lift jaw, insert your index finger into the mouth along the inside of cheek to base of tongue. Use "hooking" motion to dislodge object for removal.
9. Give breaths - Pinch nose, open your mouth, take a deep breath, and make an air-tight seal around the casualty's mouth. Give 2 full breaths, each lasting 1 to 1 1/2 seconds. Pause between each breath.
10. Continue steps 7 to 9 - Until successful, you are exhausted, you are relieved by another trained individual, or by medical personnel.

Chest Thrusts
The chest thrust is the preferred method, in place of the abdominal thrust, for individuals who are overweight or pregnant. Manual pressure to the abdominal area in these individuals can be ineffective or cause serious damage. If the casualty is overweight or pregnant, do the following:

1. Conscious - Standing or Sitting.
            a. Stand behind the casualty.
            b. Place your arms under the casualty's armpits and around the chest.
            c. With your fist, place the thumb side against the middle of the breastbone.
            d. Grasp your fist with your other hand.
            e. Press your fist against the chest with a sharp, backward thrust until the obstruction is clear or casualty
            becomes unconscious.

2. Unconscious - Lying.
            a. Kneel, facing the casualty's chest.
            b. With the middle and index fingers of the hand nearest the casualty's legs, locate the lower edge of the rib
            cage on the side closest to you.
            c. Slide your fingers up the rib cage to the notch at t
            d. Place your middle finger on the notch, and your index finger next to it.
            e. Place the heel of your hand on the breastbone next to the index finger.
            f. Place the heel of your hand, used to locate the notch, on top of the heel of your other hand.
            g. Keep your fingers off the casualty's chest.
            h. Position your shoulders over your hands, with elbows locked and arms straight.
            i. Give 6 to 10 quick and distinct downward thrusts, each should compress the chest 1 1/2 to 2 inches.
            j. Finger sweep.
            k. Open the airway and give 2 full breaths.

Repeat the last three steps until the obstruction is clear, you are exhausted, you are relieved by another trained individual, or by medical personnel.

Self Abdominal Thrusts
If you are alone and choking, try not to panic, you can perform an abdominal thrust on yourself by doing the following:
1. With the fist of your hand, place the thumb side against the middle of your abdomen, above the navel and below the tip of the breastbone. Grasp your fist with your other hand and give a quick upward thrust.
2. You also can lean forward and press your abdomen over the back of a chair (with rounded edge), a railing, or a sink.

If the casualty is not breathing, do the following:
Rescue Breathing
Rescue breathing is the process of breathing air into the lungs of a casualty who has stopped breathing (respiratory arrest), also known as artificial respiration. The common causes are air-way obstruction, drowning, electric shock, drug overdose, and chest or lung (trauma) injury. Never give rescue breathing to a person who is breathing normally.

1. Check unresponsiveness - Tap or gently shake the casualty, shout, "Are you OK?"
2. Shout, "Help" - If there is no response from casualty.
3. Position casualty - Kneel midway between his or her hips and shoulders facing the casualty. Straighten legs and move arm closest to you above casualty's head. Place your hand on the casualty's shoulder and one on the hip. Roll casualty toward you as a unit, move your hand from the shoulder to support the back of the head and neck. Place the casualty's arm nearest you alongside his/her body.
4. Open airway (Head-tilt/Chin lift or Jaw thrust) - Place your hand on the casualty's forehead. Place the fingers of your other hand under the bony part of the chin. Avoid putting pressure under the chin, it may cause an obstruction of the airway. Tilt the head and lift the jaw, avoid closing the casualty's mouth. Place your ear over the casualty's mouth and nose. Look at the chest, listen, and feel for breathing, 3 to 5 seconds. If not breathing, say, "Not breathing."
5. Give breaths - Pinch nose, open your mouth, take a deep breath, and make an air-tight seal around the casualty's mouth. Give 2 full breaths, each lasting 1 to 1 1/2 seconds. Pause between each breath. Look for the chest to rise, listen, and feel for breathing.
6. Check pulse - While maintaining an open airway, locate the Adam's apple with your middle and index fingers. Slide your fingers down into the groove, on the side closest to you. Feel for a carotid pulse for 5 to 10 seconds. If you feel a pulse, say, "No breathing, but there is a pulse." Quickly examine the casualty for signs of bleeding.
7. Request medical assistance - Say "No breathing, has a pulse," call (Local emergency number or medical personnel).
8. Rescue breathing (mouth-to-mouth) Maintain an open airway with head-tilt/chin-lift or jaw-thrust maneuver, pinch nose. Open your mouth, take a deep breath, and make an air-tight seal around the casualty's mouth. Give 1 breath every 5 seconds, each lasting 1 to 1-¹/₂ seconds. Count aloud "one one-thousand, two one-thousand, three one-thousand, four one-thousand," take a breath, and then give a breath. Look at the chest, listen, and feel for breathing. Continue for 1 minute/12 breaths.
9. Recheck pulse - While maintaining an open airway, locate and feel the carotid pulse for 5 seconds. If you feel a pulse, say, "Has pulse." Look at the chest, listen, and feel for breathing 3 to 5 seconds. If the casualty is not breathing, say, "No breathing."
10. Continue sequence - Maintain an open airway, give 1 breath every 5 seconds, recheck pulse every minute. If pulse is absent, begin CPR. If pulse is present but breathing is absent, continue rescue breathing. If the casualty begins to breathe, maintain an open airway, until medical assistance arrives.

Special Situations
1. Air in the stomach (Gastric Distention) - During rescue breathing and CPR, air may enter the stomach in addition to the lungs. To avoid this, keep the casualty's head tilted back, breathe only enough to make the chest rise, and do not give breaths too fast. Do not attempt to expel stomach contents by pressing on the abdomen.
2. Mouth-to-nose breathing - Used when the casualty has mouth or jaw injuries, is bleeding from the mouth, or your mouth is too small to make an air-tight seal. Maintain head tilt with your hand on the forehead, use your other hand to seal the casualty's mouth and lift the chin. Take a deep breath and seal your mouth around the casualty's nose and slowly breathe into the casualty's nose using the procedures for mouth-to-mouth breathing.
3. Mouth-to-stoma breathing - Used when the casualty has had surgery to remove part of the windpipe. They breathe through an opening in the front of the neck, called a stoma. Cover the casualty's mouth with your hand, take a deep breath, and seal your mouth over the stoma and slowly breathe using the procedures for mouth-to-mouth breathing. Do not tilt the head back. (In some situations a person may breathe through the stoma as well as his or her nose and mouth. If the casualty's chest does not rise, you should cover his or her mouth and nose and continue breathing through the stoma).
4. Mouth-to-mask breathing - Used when rescue breathing is required in a contaminated environment, such as after a chemical or biological attack. A resuscitation tube is used to deliver uncontaminated air to the casualty. This resuscitation tube has an adapter at one end that attaches to your mask and a molded rubber mouthpiece at the other end for the mouth of the casualty.
5. Dentures - Leave dentures in place, they provide support to the mouth and cheeks during rescue breathing. If they become loose and block the airway or make it difficult to give breaths, remove them.

Circulation
Circulation is the movement of blood through the heart and blood vessels. The circulatory system consists of the heart, which pumps the blood, and the blood vessels, which carry the blood throughout the body.

Cardiac arrest is the failure of the heart to produce a useful blood flow or the heart has completely stopped beating. The signs of cardiac arrest include unconsciousness, the absence of a pulse, and the absence of breathing. If the casualty is to survive, immediate action must be taken to restore breathing and circulation.

Cardiopulmonary Resuscitation (CPR) is an emergency procedure for the casualty who is not breathing and whose heart has stopped beating (cardiac arrest). The procedure involves a combination of chest compressions and rescue breathing. The casualty must be lying face up on a firm surface. Do not assume that a cardiac arrest has occurred simply because the casualty appears to be unconscious. This course is not a substitute for formal training in cardiopulmonary resuscitation (CPR).

Chest Compressions
a. Kneel, facing the casualty's chest.

b. With your middle and index fingers (Fig. 2-11) of the hand nearest the casualty's legs, locate the lower edge of the rib cage on the side closest to you.

c. Slide your fingers up the rib cage to the notch at the end of the breastbone.

d. Place your middle finger on the notch, and your index finger next to it.

e. Place the heel of your other hand on the breastbone next to your index finger.

f. Place the heel of the hand used to locate the notch on top of the heel of your other hand.

g. Keep your fingers off the casualty's chest.

h. Position shoulders over your hands, with elbows locked and arms straight.

i. Give 15 compressions, each should compress the chest 1 1/2 to 2 inches at a rate of 80 to 100 compressions per minute. Count aloud, "One and two and three," until you reach 15. After each 15 compressions, deliver 2 full breaths. Compressions should be smooth, rhythmic, and uninterrupted.

j. Continue 4 complete cycles of 15 compressions and 2 breaths. Check for a carotid pulse and breathing for 5 seconds.

Continue CPR - If the casualty has no pulse, give 2 full breaths and continue CPR. Check for a pulse every few minutes. If the pulse is present but breathing is absent, continue rescue breathing. If the casualty begins to breathe, maintain an open airway until medical assistance arrives. Continue CPR until successful, you are exhausted, you are relieved by another trained in CPR, by medical personnel, or the casualty is pronounced dead. Do not interrupt CPR for more than 7 seconds except for special circumstances.

CPR with Entry of Second Person
When a second person who is trained in administering CPR arrives at the scene, do the following:

1. The second person shall identify himself or herself as being trained in CPR and that they are willing to help. ("I know CPR. Can I help?")
2. The second person should call the local emergency number or medical personnel for assistance if it has not already been done.
3. The person doing CPR will indicate when he or she is tired; and should stop CPR after the next 2 full breaths.
4. The second person should kneel next to the casualty opposite the first person, tilt the casualty's head back, and check for a carotid pulse for 5 seconds.
5. If there is no pulse, the second rescuer should give 2 full breaths and continue CPR.
6. The first person will monitor the effectiveness of CPR by looking for the chest to rise during rescue breathing and feeling for a carotid pulse (artificial pulse) during chest compressions.

CPR for Children and Infants
If the casualty is an infant (0-1 year old) or child (1-8 years old), do the following:

1. Check unresponsiveness - Infant: Tap or shake shoulder only. Child: Tap or gently shake the shoulder, shout, "Are you OK?"
2. Shout, "Help" - If there is no response from infant or child.
3. Position casualty - Turn casualty on back as a unit, supporting, the head and neck. Place casualty on a firm surface.
4. Open airway (Head-tilt/Chin-lift or jaw thrust) - Place your hand on the casualty's forehead. Place the fingers of your other hand under the bony part of the chin. Avoid putting pressure under the chin, it may cause an obstruction of the airway. Tilt the head and lift the jaw, avoid closing the casualty's mouth. Infant: Do not overextend the head and neck. Place your ear over the casualty's mouth and nose. Look at the chest, listen, and feel for breathing, 3 to 5 seconds.
5. Give breaths - Open your mouth, take a breath, and make an air-tight seal around the casualty's mouth and nose. Give 2 breaths (puffs for infants), each lasting 1 to 1 1/2 seconds. Pause between each breath. Look for the chest to rise, listen, and feel for breathing.
6. Check pulse - While maintaining an open airway, locate the carotid pulse (Infants: Locate the brachial pulse on the inside of the upper arm, between the elbow and shoulder). Feel for a pulse for 5 to 10 seconds. Quickly examine the casualty for signs of bleeding.
7. Request medical assistance - If someone responded to your call for help, send them to call the local emergency number or medical personnel.
8. Chest compressions (infant) -

a. Face infant's chest.

b. Place your middle and index fingers on the breastbone at the nipple line.

c. Give 5 compressions, each should compress the chest 1/2 to 1 inch at a rate of at least 100 compressions per minute. After each 5th compression, deliver 1 breath. Compressions should be smooth, rhythmic, and uninterrupted.

d. Continue for 10 complete cycles of 5 compressions and 1 breath. Check for a brachial pulse for 5 seconds.

9. Chest compressions (children) -

a. Face child's chest.

b. With your middle and index fingers of the hand nearest the child's legs, locate the lower edge of the rib cage on the side closest to you.

c. Slide your fingers up the rib cage to the notch at end of the breastbone.

d. Place your middle finger on the notch, and your index finger next to it.

e. While looking at the position of your index finger, lift that hand and place your heel (on breastbone at nipple line) next to where your index finger was.

f. Keep your fingers off the child's chest.

g. Position your shoulder over your hand, with elbow locked and your arm straight.

h. Give 5 compressions, each should compress the chest 1 to 1 1/2 inches at a rate of 80 to 100 compressions per minute. After each 5th compression, deliver 1 breath. Compressions should be smooth, rhythmic, and uninterrupted.

i. Continue for 10 complete cycles of 3 compressions and 1 breath. Check for a carotid pulse for 5 seconds.

10. Continue CPR - If the infant or child has no pulse, give 1 breath and continue CPR. Check for a pulse every few minutes. If the pulse is present but breathing is absent, continue rescue breathing (Infant: 20 breaths/min; Child: 15 breaths/min.) If the infant or child begins to breathe, maintain an open airway, until medical assistance arrives. Continue CPR until successful, you are exhausted, you are relieved by another trained in CPR or medical personnel, or the infant or child is pronounced dead. This course is not a substitute for formal training in cardiopulmonary resuscitation (CPR).

Bleeding:

Bleeding (hemorrhage) is the escape of blood from capillaries, veins, and arteries. Capillaries are very small blood vessels that carry blood to all parts of the body. Veins are blood vessels that carry blood to the heart. Arteries are large blood vessels that carry blood away from the heart. Bleeding can occur inside the body (internal), outside the body (external) or both. Blood is a fluid that consists of a pale yellow liquid (plasma), red blood cells (erythrocytes), white blood cells (leukocytes), and platelets (thrombocytes). Plasma is the fluid portion of the blood that carries nutrients. Red blood cells give color to the blood and carry oxygen. White blood cells defend the body against infection and attack foreign particles. Platelets are disk shaped and assist in clotting the blood, the mechanism that stops bleeding. There are three types of bleeding. Capillary bleeding is slow, the blood "oozes" from the (wound) cut. Venous bleeding is dark red or maroon, the blood flows in a steady stream. Arterial bleeding is bright red, the blood "spurts" from the wound. Arterial bleeding is life threatening and difficult to control.

In small wounds, only the capillaries are damaged. Deeper wounds result in damage to the veins and arteries. Damage to the capillaries is usually not serious and can easily be controlled with a Band-Aid. Damage to the veins and arteries are more serious and can be life threatening. The adult body contains approximately 5 to 6 quarts of blood (10 to 12 pints). The body can normally lose 1 pint of blood (usual amount given by donors) without harmful effects. A loss of 2 pints may cause shock, a loss of 5 to 6 pints usually results in death. During certain situations it will be difficult to decide whether the bleeding is arterial or venous. The distinction is not important. The most important thing to remember is that all bleeding must be controlled as soon as possible.

External Bleeding
While administering first aid to a casualty who is bleeding, you must remain calm. The sight of blood is an emotional event for many, and it often appears severe. However, most bleeding is less severe than it appears. Most of the major arteries are deep and well protected by tissue and bone. Although bleeding can be fatal, you will usually have enough time to think and act calmly. There are four methods to control bleeding: direct pressure, elevation, indirect pressure, and the use of a tourniquet.

Direct Pressure
Direct pressure is the first and most effective method to control bleeding. In many cases, bleeding can be controlled by applying pressure directly (Fig. 3-1) to the wound. Place a sterile dressing or clean cloth on the wound, tie a knot or adhere tape directly over the wound, only tight enough to control bleeding. If bleeding is not controlled, apply another dressing over the first or apply direct pressure with your hand or fingers over the wound. Direct pressure can be applied by the casualty or a bystander. Under no circumstances is a dressing removed once it has been applied.

Elevation
Raising (elevation) of an injured arm or leg (extremity) above the level of the heart will help control bleeding. Elevation should be used together with direct pressure. Do not elevate an extremity if you suspect a broken bone (fracture) until it has been properly splinted and you are certain that elevation will not cause further injury. Use a stable object to maintain elevation. Placing an extremity on an unstable object may cause further injury.

Indirect Pressure
In cases of severe bleeding when direct pressure and elevation are not controlling the bleeding, indirect pressure must be used. Bleeding from an artery can be controlled by applying pressure to the appropriate pressure point. Pressure points (Fig. 3-2) are areas of the body where the blood flow can be controlled by pressing the artery against an underlying bone. Pressure is applied with the fingers, thumb, or heel of the hand. Pressure points should be used with caution. Indirect pressure can cause damage to the extremity due to inadequate blood flow. Do not apply pressure to the neck (carotid) pressure points, it can cause cardiac arrest. Indirect pressure is used in addition to direct pressure and elevation. Pressure points in the arm (brachial) and in the groin (femoral) are most often used, and should be thoroughly understood. The brachial artery is used to control severe bleeding of the lower part of the upper arm and elbow. It is located above the elbow on the inside of the arm in the groove between the muscles. Using your fingers or thumb, apply pressure (Fig. 3-2E) to the inside of the arm over the bone. The femoral artery is used to control severe bleeding of the thigh and lower leg. It is located on the front, center part of the crease in the groin. Position the casualty on his or her back, kneel on the opposite side (Fig. 3-2H ) from the wounded leg, place the heel of your hand directly on the pressure point, and lean forward to apply pressure. If the bleeding is not controlled, it may be necessary to press directly over the artery with the flat surface of the fingertips and to apply additional pressure on the fingertips with the heel of your other hand.

Tourniquet
A tourniquet should be used only as a last resort to control severe bleeding after all other methods have failed and is used only on the extremities. Before use, you must thoroughly understand its dangers and limitations. Tourniquets cause tissue damage and loss of extremities when used by untrained individuals. Tourniquets are rarely required and should only be used when an arm or leg has been partially or completely severed and when bleeding is uncontrollable.

The standard tourniquet is normally a piece of cloth folded until it is 3 or more inches wide and 6 or 7 layers thick. A tourniquet can be a strap, belt, neckerchief, towel, or other similar item. A folded triangular bandage makes a great tourniquet. Never use wire, cord, or any material that will cut the skin.

To apply a tourniquet, do the following:
1. While maintaining the proper pressure point, place the tourniquet between the heart and the wound, leaving at least 2 inches of uninjured skin between the tourniquet and wound.

2. Place a pad (roll) over the artery.

3. Wrap the tourniquet around the extremity twice, and tie a half-knot on the upper surface.

4. Place a short stick or similar object on the half-knot, and tie a square knot.

5. Twist the stick to tighten, until bleeding is controlled.

6. Secure the stick in place.

7. Never cover a tourniquet.

8. Using lipstick or marker, make a 'T" on the casualty's forehead and the time tourniquet was applied.

9. Never loosen or remove a tourniquet once it has been applied. The loosening of a tourniquet may dislodge clots and result in enough blood loss to cause shock and death.

Do not touch open wounds with your fingers unless absolutely necessary. Place a barrier between you and the casualty's blood or body fluids, using plastic wrap, gloves, or a clean, folded cloth. Wash your hands with soap and warm water immediately after providing care, even if you wore gloves or used another barrier.

Internal Bleeding
Internal bleeding, although not usually visible, can result in serious blood loss. A casualty with internal bleeding can develop shock before you realize the extent of their injuries. Bleeding from the mouth, ears, nose, rectum, or other body opening (orifice) is considered serious and normally indicates internal bleeding.

The most common sign of internal bleeding is a simple bruise (contusion), it indicates bleeding into the skin (soft tissues). Severe internal bleeding occurs in injuries caused by a violent force (automobile accident), puncture wounds (knife), and broken bones.

Signs of internal bleeding include:
1. Anxiety and restlessness.

2. Excessive thirst (polydipsia).

3. Nausea and vomiting.

4. Cool, moist, and pale skin (cold and clammy).

5. Rapid breathing (tachypnea).

6. Rapid, weak pulse (tachycardia).

7. Bruising or discoloration at site of injury (contusion).

If you suspect internal bleeding, do the following:
1. Bruise (contusion) - Apply ice or cold pack, with cloth to prevent damage to the skin, to reduce pain and (edema) swelling.

2. Severe internal bleeding:

a. Call local emergency number or medical personnel.

b. Monitor airway, breathing, and circulation (ABCs).

c. Treat for shock.

d. Place casualty in most comfortable position.

e. Maintain normal body temperature.

f. Reassure casualty

Nosebleed
Nosebleeds (epistaxis) can be caused by an injury, disease, the environment, high blood pressure, and changes in altitude. They frighten the casualty and may bleed enough to cause shock. If a fractured skull is suspected as the cause, do not stop the bleeding. Cover the nose with a loose, dry, sterile dressing and call the local emergency number or medical personnel. If the casualty has a nosebleed due to other causes, do the following:

1. Keep the casualty quiet, sitting with head tilted forward.

2. Pinch the nose shut (if there is no fracture), place ice or cold packs to the bridge of the nose, or put pressure on the upper lip just below the nose. Inform the casualty not to rub, blow, or pick his or her nose. Seek medical assistance if the nosebleed continues, bleeding starts again, or bleeding is because of high blood pressure. If the casualty loses consciousness, place them on their side to allow blood to drain from the nose and call the local emergency number or medical personnel.

Foreign bodies in the nose usually occur among children. First aid consists of seeking professional medical attention. Nasal damage and the possibility of pushing the object farther up the nose can result from searching and attempts at removal by unqualified personnel.

Casualties with severe external bleeding and suspected internal bleeding must be seen by medical personnel as soon as possible. All casualties with external and internal bleeding should be treated for shock.

Shock:

Shock, is the failure of the heart and blood vessels (circulatory system) to maintain enough oxygen-rich blood flowing (perfusion) to the vital organs of the body. There is shock to some degree with every illness or injury; shock can be life threatening. The principles of prevention and control are to recognize the signs and symptoms and to begin treating the casualty before shock completely develops. It is unlikely that you will see all the signs and symptoms of shock in a single casualty. Sometimes the signs and symptoms may be disguised by the illness or injury or they may not appear immediately. In fact many times, they appear hours later.

The usual signs and symptoms of the development of shock are:
1. Anxiety, restlessness and fainting.

2. Nausea and vomiting.

3. Excessive thirst (polydipsia).

4. Eyes are vacant, dull (lackluster), large (dilated) pupils.

5. Shallow, rapid (tachypnea), and irregular breathing.

6. Pale, cold, moist (clammy) skin.

7. Weak, rapid (tachycardia), or absent pulse.

Hypovolemic Shock
Hypovolemic shock is caused by a decreased amount of blood or fluids in the body. This decrease results from injuries that produce internal and external bleeding, fluid loss due to burns, and dehydration due to severe vomiting and diarrhea.

Neurogenic Shock
Neurogenic shock is caused by an abnormal enlargement of the (vasodilation) blood vessels and pooling of the blood to a degree that adequate blood flow cannot be maintained. Simple fainting (syncope) is a variation, it is the result of a temporary pooling of the blood as a person stands. As the person falls, blood rushes back to the head and the problem is solved.

Psychogenic Shock
Psychogenic shock is a "shock like condition" produced by excessive fear, joy, anger, or grief. Shell shock is a psychological adjustment reaction to stressful wartime experiences. Care for shell shock is limited to emotional support and transportation of the casualty to a medical facility.

Anaphylactic Shock
Anaphylactic (allergic) shock occurs when an individual is exposed to a substance to which his or her body is sensitive. The individual may experience a burning sensation, loss of voice, itching (pruritus), hives, severe swelling, and difficulty breathing. The causative agents are injection of medicines, venoms by stinging insects and animals, inhalation of dust and pollens, and ingestion of certain foods and medications. Individuals with known sensitivities carry medication in commercially prepared kits.

Prevention and Treatment of Shock
While administering first aid to prevent or treat shock, you must remain calm. If shock has not completely developed, the first aid you provide may actually prevent its occurrence. If it has developed, you may be able to keep it from becoming fatal. It is extremely important that you render first aid immediately.

To provide first aid for shock, do the following:
1. Maintain open airway - Head-tilt/chin-lift or jaw-thrust.

2. Control bleeding - Direct pressure, elevation, indirect pressure, or tourniquet if indicated.

3. Position casualty - Place the casualty on his or her back, with legs elevated 6 to 12 inches. If it is possible, take advantage of a natural slope of ground and place the casualty so that the head is lower than the feet. If they are vomiting or bleeding around the mouth, place them on their side, or back with head turned to the side. If you suspect head or neck injuries, or are unsure of the casualty's condition, keep them lying flat.

4. Splint - Suspected broken and dislocated bones in the position in which they are found. Do not attempt to straighten broken or dislocated bones, because of the high risk of causing further injury. Splinting not only relieves the pain without the use of drugs but prevents further tissue damage and shock. Pain and discomfort are often eliminated by unlacing or cutting a shoe or loosening tight clothing at the site of the injury. A simple adjustment of a bandage or splint will be of benefit, especially when accompanied by encouraging words.

5. Keep the casualty comfortable, and warm enough to maintain normal body temperature. If possible, remove wet clothing and place blankets underneath the casualty. Never use an artificial means of warming.

6. Keep the casualty as calm as possible. Excitement and excessive handling will aggravate their condition. Prevent the casualty from seeing his or her injuries, reassure them that their injuries are understood and that professional medical assistance will arrive as soon as possible.

7. Give nothing by mouth - Do not give the casualty anything to eat or drink because it may cause vomiting. If the casualty complains of thirst, wet his or her lips with a wet towel.

8. Request medical assistance - Ask bystanders to call the local emergency number or medical personnel.

Soft Tissue Injuries:

The most common injuries (trauma) seen in a first aid setting are soft tissue injuries with bleeding and shock. Injuries that cause a break in the skin, underlying soft tissue, or other body membrane are known as a wound. Injuries to the soft tissues vary from bruises (contusion) to serious cuts (lacerations) and puncture wounds in which the object may remain in the wound (impaled objects). The two main threats with these injuries are bleeding and infection.

Classification of Wounds
Wounds are classified according to their general condition, size, location, the manner in which the skin or tissue is broken, and the agent that caused the wound. It is usually necessary for you to consider some or all of these factors in order to determine what first aid treatment is appropriate.

General Condition
If the wound is new, first aid consists mainly of controlling the bleeding, treating for shock, and reducing the risk of infection. If the wound is old and infected, first aid consists of keeping the casualty quiet, elevating the injured part, and applying a warm wet dressing. If the wound contains foreign objects, first aid may consist of removing the objects if they are not deep. Do not remove impaled objects or objects embedded in the eyes or skull.

Size
Generally, large wounds are more serious than small ones and they usually involve severe bleeding, more damage to the underlying tissues and organs, and a greater degree of shock. However, small wounds are sometimes more dangerous than large ones: they may become infected more readily due to neglect. The depth of a wound also is important because it may lead to a complete (through & through) perforation of an organ or the body, with the additional complication of an entrance and exit wound.

Location
Since a wound can cause serious damage to deep structures, as well as to the skin and tissues below it, the location is an important consideration. A knife wound to the chest is likely to puncture a lung and cause difficulty breathing. The same type of wound in the abdomen can cause a life-threatening infection, internal bleeding, or puncture the intestines, liver, or other vital organs. A bullet wound to the head may cause brain damage, but a bullet wound to the arm or leg, may cause no serious damage.

Types of Wounds
As the first line of defense against most injuries, soft tissues are most often damaged. There are two types of soft tissue injuries: open and closed. An open wound is one in which the skin surface has been broken, a closed wound is where the skin surface is unbroken but underlying tissues have been damaged.

Closed Wounds
A blunt object that strikes the body will damage tissues beneath the skin. When the damage is minor, the wound is called a bruise (contusion). When the tissue has extensive damage, blood and fluid collect under the skin causing discoloration (ecchymosis), swelling (edema), and pain. First aid consists of applying ice or cold packs to reduce swelling and relieve discomfort. To guard against frostbite, never apply ice or cold packs directly to the skin.

Hematomas are the result of a severe blunt injury with extensive soft tissue damage, tearing of large blood vessels, and pooling of large amounts of blood below the skin. With large hematomas, look for broken bones, especially if deformity is present. First aid consists of applying ice or cold packs to reduce swelling and relieve pain, direct pressure (manual compression) to help control internal bleeding, splinting, and elevation. When large areas of bruising are present, shock may develop.

Open Wounds
In open soft tissue injuries, the protective layer of the skin has been damaged. This damage can cause serious internal and external bleeding. Once the protective layer of skin has been broken, the wound becomes contaminated and may become infected. When you consider the way in which the skin or tissue has been broken, there are six basic types of open wounds: abrasions, amputations, avulsions, incisions, lacerations, and punctures. Many wounds are a combination of two or more of these types.

Abrasions
Abrasions are caused when the skin is rubbed or scraped off. Rope burns, floor burns, and skinned knees or elbows are common examples of abrasions. Abrasions easily can become infected, because dirt and germs are usually ground into the tissues. There is normally minimal bleeding or oozing of clear fluid.

Amputations
Amputations (traumatic) are the non-surgical removal of the fingers, toes, hands, feet, arms, legs, and ears from the body. Bleeding is heavy and normally requires a tourniquet, to control the blood flow. There are three types of amputation:
1. Complete - Body part is completely torn off (severed).
2. Partial - More than 50% of the body part is torn off.
3. De-gloving - Skin and tissue are torn away from body part.

If the casualty has an amputation, do the following:
1. Establish and maintain the airway, breathing, and circulation (ABCs).
2. Control bleeding with direct pressure, elevation, indirect pressure, or tourniquet only as a last resort, never remove or loosen a tourniquet once it has been applied.
3. Apply dressing to the stump with an ace wrap to replace direct pressure.
4. Treat for shock.
5. Request medical assistance immediately.

Avulsions
An avulsion is an injury in which the skin is torn completely away from a body part or is left hanging as a flap. Usually, there is severe bleeding. If possible, obtain the part that has been torn away, rinse it in water, wrap it in a dry sterile gauze, seal it in a plastic bag, and send it on ice with the casualty. Do not allow part to freeze and do not submerge in water. If the skin is still attached, fold the flap back into its normal position.

Incisions
Incisions, commonly called cuts, are wounds made by sharp cutting instruments such as knives, razors, or broken glass. Incisions tend to bleed freely because the blood vessels are cut cleanly, without ragged edges. The wound edges are smooth and there is little damage to the surrounding tissues. Of all the classes of open wounds, incisions are the least likely to become infected.

Lacerations
Lacerations are wounds that are torn, rather than cut. They have ragged, irregular edges and torn tissue underneath. These wounds are usually made by a blunt, rather than a sharp, object. A wound made by a dull knife is more likely to be a laceration than an incision. Many of the wounds caused by machinery accidents are lacerations, often complicated by crushed tissues. Lacerations are frequently contaminated with dirt, grease, or other materials that are ground into the wound; they are very likely to become infected.

Punctures
Punctures are caused by objects that enter the skin while leaving a surface opening. Wounds made by nails, needles, wire, knives, and bullets are normally punctures. Small puncture wounds usually do not bleed freely; however, large puncture wounds may cause severe internal bleeding. The possibility of infection is great in all puncture wounds, especially if the penetrating object is contaminated. Perforation (through & through) is a variation, it is the result of a penetrating object entering, passing through, and exiting the body.

Causes
Although it is not necessary to know what object or method has caused a wound, it is helpful. Knowing what caused the wound and how it occurred can help you determine its general condition, possible size, type, and seriousness of the wound. This information will help you provide the appropriate first aid to the casualty.

Treatment of Wounds
First aid treatment for all wounds consists of controlling the flow of blood, treating for shock, and preventing infection. When providing first aid to casualty with multiple injuries, treat the wounds that appear to be life-threatening first. Since most of the body is covered by clothing, carefully examine the entire body for bleeding. When necessary, tear or cut clothing away from the wound because excessive movement of the injured part will cause pain and additional damage.

Bleeding
After establishing an adequate open airway, the main concern will be to control bleeding, by direct pressure and elevation. Indirect pressure and the use of a tourniquet should be used only if direct pressure and elevation do not control the bleeding. A protective covering (dressing) that is properly applied should adequately control the bleeding. In cases of severe bleeding, you may need to double the dressing. Never remove a dressing that is soaked with blood to replace it with another; just place the new dressing over the old one.

Infection
Infections can occur in any wound. Infection is a hazard in wounds that do not bleed freely; in wounds where tissue is torn or the skin falls back into place and prevents the entrance of air; and in wounds that involve the crushing of tissue. Incisions, in which there is a free flow of blood and relatively little crushing of tissues, are the least likely to become infected. The signs of infection are tenderness, redness, heat, swelling, and a discharge. Serious infections develop red streaks that lead from the wound to the heart. Infections are dangerous, especially in the area of the nose and mouth. From this area infections spread easily into the bloodstream, causing blood poisoning (septicemia), and into the brain, causing a collection of pus (abscess) and infection. Small wounds should be washed immediately with soap and water, dried, and treated with an application of a mild, non-irritating antiseptic. Apply a dressing if necessary. Make no attempt to wash a large wound and do not apply an antiseptic. Cover the wound with a dry, sterile dressing. Further treatment of large wounds should be conducted by medical personnel. All puncture wounds must be evaluated by medical personnel.

Foreign Bodies
Many wounds contain foreign bodies. Wood or glass splinters, bullets, metal fragments, wire, fishhooks, nails, and small particles from grinding wheels are examples of materials that are found in wounds. In most cases, first aid will include the removal of this material if the wound is minor and the object is near the surface and exposed. However, first aid does not include the removal of deeply embedded objects, powdered glass, or any scattered material. Never attempt to remove bullets, examine the casualty to find out whether the bullet remains in the body by looking for both an entrance and exit wound. The general rule is: Remove foreign objects from a wound ONLY when you can do so easily and without causing further damage. Do not attempt to remove an object that is embedded in the eye or that has penetrated the eye.

Treatment of Specific Conditions
It is impossible to list all wounds in simple categories. Some require special treatment and precautions. You may see wounds that are not described in this course, but most wounds can be treated by calmly remembering the general treatment of wounds.

Eye Wounds
Foreign bodies such as particles of dirt, sand, paint chips, or fine pieces of metal frequently find their way into the eyes. They not only cause discomfort, but if not removed, they can cause inflammation and infection. Fortunately, through an increased flow of tears, nature dislodges many of these particles before any damage is done. Never let the casualty rub the eye, since rubbing, can cause scratches (abrasions) to the eye and can push a foreign body deeper into the eye, causing further damage. Gently flush the casualty's eye with water at least 15 to 20 minutes. If flushing the eye is not successful in removing the foreign body, patch both eyes and get the casualty to medical personnel. It is always safer to send the casualty to medical personnel than for you to attempt to remove foreign bodies. If the casualty has an object embedded in, or penetrating from, the eye, or the eyeball is protruding from the socket, do the following:

1 .Take a thick dressing or several dressings and cut a hole in the middle, large enough to go over the eye without touching the object. If you cannot cut a hole in the dressing, you can build several dressings around the object.

2. Take a paper cup or other object that is wide enough and strong enough to adequately protect the object without putting pressure on the eye. Place this over the top of the object. Close and cover the unaffected eye to minimize movement of the injured eye.

3. Take a roller bandage and wrap it over the cup and around the head several times ensuring that the cup and dressing are snug enough not to come off, but not tight enough to cause discomfort.

When finished, this type of dressing will adequately protect the eye.

Laceration of the Eyelids
Soft tissues around the eye bleed extensively. This bleeding may make the wound look more serious than it is. However, the bleeding can be controlled easily with a pressure dressing. Before any pressure is applied to the eye, make sure that the eyeball is not cut. If the eye is cut, do not apply pressure to the eye, even to stop bleeding from the eyelid. Pressing on the eye will cause the fluid to leak out, and will result in irreparable damage. If the eyelid is cut and you find fragments of skin, rinse them in water, wrap in a dry sterile gauze, seal in a plastic bag, and send it on ice with the casualty. Do not allow part to freeze and do not submerge in water. If the skin is still attached, fold the flap back into its normal position. When you cover the injured eye you must also cover the good eye. The eyes move together, and even when the injured eye is patched it will move when the good eye moves. Tell the casualty what you are doing, this will reduce their fears of not being able to see.

Foreign Objects in the Ear
Foreign bodies such as particles of dirt, paint chips, or small insects find their way into the ears. They not only cause discomfort but, if not removed, they can cause inflammation and infection. Never insert anything into the ear to dislodge foreign bodies because you can damage the lining of the ear or cut (perforate) the ear drum. Do not attempt to flush objects out with water; many absorb water and can cause damage from swelling. In the case of insects, if it is alive, shining a light into the ear may attract the insect and cause it to come out. It is always safer to send the casualty to medical personnel than for you to attempt to remove foreign bodies.

Head Wounds
Injuries to the head (scalp) can occur as a result of diving, automobile accidents, falls, blunt trauma, knives, bullets, and many other causes. Head wounds can be open or closed. In open head wounds there is an obvious injury in which there is normally a lot of bleeding. Closed head wounds may not be obvious, many times you will have to treat the casualty based on how the accident happened. You may see only the delayed symptoms, such as a seizure, confusion, or personality changes. Head wounds must be treated with particular care, since there is always the possibility of brain damage.

If you suspect the casualty has suffered a head injury, look for the following:
1. Depressions, lacerations, deformities, bruising around the eyes (Raccoon's Sign) or behind the ears (Battle's Sign).
2. Never touch a wound, examine a wound to determine depth, separate the edges of a wound, or remove impaled objects.
3. Check the eyes: Are the pupils (constricted) small, (dilated) large, equal, or unequal?
4. Blood or clear (cerebrospinal) fluid dripping from the nose or ears. (Cover loosely with a sterile dressing to absorb but not stop the flow).

If you suspect a head injury, do the following:
1. Position the casualty flat, stabilize the head and neck as you found them by placing your hands on both sides of the head.
2. Establish and maintain open airway using the jaw-thrust maneuver. Note that the head is not tilted and the neck is not extended. Check the airway, breathing, and circulation (ABC's).
3. Finger sweep to remove any foreign bodies from the mouth.
4. Maintain a neutral position of the head and neck and, if possible, apply a cervical collar or improvised (towel) collar.
5. Control bleeding using gentle, continuous pressure. Never apply direct pressure if the skull is depressed or bone fragments are seen.
6. Apply dressing - Do not use direct pressure or tie knots over the wound. Apply ice or cold packs with cloth to prevent damage to the skin.
7. Treat for shock - Casualtyies with suspected head and neck injuries are to remain flat. Do not raise the casualty's feet. If casualty is vomiting or bleeding around the mouth, place them on their side keeping the neck straight. Do not give anything to eat or drink.
8. Request medical assistance immediately - Time is critical.

Facial Wounds
Facial wounds are treated, generally, like other flesh wounds. However, ensure that the tongue or soft tissue does not cause an airway obstruction. Keep the nose and throat clear of all foreign material and position the casualty so that blood will drain out of the mouth and nose. Facial wounds and scalp wounds bleed freely. Any casualty that has suffered a facial wound that involves the eye, eyelids, or the tissues around the eye must receive professional medical attention as soon as possible. First aid for other facial wounds is the same as head wounds.

Standard First Aid Boxes
Non-medical personnel are an important element in providing first aid to casualties prior to the arrival of professional medical personnel. Many lives have been saved by the first aid rendered by a shipmate. Standard first aid boxes are distributed throughout a ship to provide easy access to first aid supplies. The number of first aid boxes and their location depends on the ship's mission and the size of her crew. Various dressings, wire splints, tape, Band-Aids, tourniquets, skin pencils, and other first aid supplies are included in these boxes. Each box is secured with a wire or plastic seal that can be easily broken. The seals are used to identify whether the kit has been opened. A broken seal indicates that the first aid box must be inventoried and restocked. The standard first aid box has three compartments. Each compartment should have a plastic bag that is complete with the basic first aid supplies. Take one of these bags with you on your way to the casualty. Failure to take a bag to the scene may result in you having to go back for supplies. The box does not contain needles, syringes, or medications; but does contain the proper supplies needed to render first aid until medical assistance arrives. First aid boxes are for emergency use only! Report all broken seals to medical personnel as soon as possible. It is important that you know the contents and locations of these boxes.

Dressings
A dressing is a protective covering for a wound and is used to control bleeding and prevent contamination of the wound. A compress is a sterile pad that is placed directly on the wound. A bandage is material used to hold a compress in place. When applying a dressing, ensure that it remains as sterile as possible. The part of the dressing that is placed against the wound must never touch your fingers, clothing, or any un-sterile object. If you drop, a dressing across the casualty's skin or it slips after it is in place, the dressing should not be used.

Battle Dressings
Battle dressings are used most often aboard ship and in the field. Each dressing is complete (no other materials are needed) with four tabs which help in applying and securing the dressing. They have "other side next to wound" marked on the outer side. This will help you in placing the sterile side against the wound. Unless contraindicated, to assist in controlling the bleeding, tie the knot of the dressing over the wound.

Compresses
Emergencies may occur when it is not possible to obtain a sterile compress. During these situations, use the cleanest cloth available, a freshly laundered handkerchief, towel, or shirt. Unfold the material carefully so that you do not touch the part that will be placed against the wound. The compress should be large enough to cover the entire wound and extend at least 1 inch beyond its edges. If a compress is not large enough, the edges of the wound will become contaminated. Materials that will stick to a wound or may be difficult to remove should never be used directly on a wound. Absorbent cotton, adhesive tape, and paper napkins are examples of materials that should never come in contact with a wound.

Bandages
Bandages are strips or rolls of gauze or other materials that are used for wrapping or binding any part of the body and to hold compresses in place. It is not necessary to take time to ensure that the bandage resembles the textbook pictures. However, it is important that the dressing controls the bleeding, prevents further contamination, and protects the wound from further injury. Some of the most commonly used bandages are the roller bandage and the triangular bandage.

Roller Bandages
The roller bandage consists of a long strip of material (usually gauze, or elastic) that is rolled and is available in several widths and lengths. Most are sterile, so pieces may be used as a compress on wounds. A strip of roller bandage can be used to make a four-tailed bandage, by splitting the cloth from each end, leaving as large a center as needed. This type of bandage is used to hold a compress on the chin, or the nose.

Triangular Bandages
Triangular bandages are usually made of muslin. They are useful because they can be folded in a variety of ways to fit almost any part of the body. Padding can be added to areas that may become uncomfortable.

The triangular bandage can be folded to make a cravat bandage, which is useful in controlling bleeding from wounds of the scalp or forehead. To make a cravat bandage, bring the point of the triangular bandage to the middle of the base and continue to fold until a 2-inch width is obtained. If specially prepared bandages are not available, use whatever material you can find. Remember that the basic purpose of a bandage is to hold the sterile compress in place. Any material or method of application that does not cause further injury to the casualty will be acceptable. Material used as a bandage does not have to be sterile, since it will not come in direct contact with the wound. However, it should be as clean as possible. Cloth bandages should be fastened by tying the ends with a square knot or by tacking the ends with safety pins. If you use a knot to fasten the bandage, be sure to use a square knot. This knot is easy to tie, will not slip, and can be untied quickly. Place the knot so it will cause the least amount of discomfort to the casualty and where it can be removed easily and quickly. Bandages should be applied firmly but not too tight. A loose bandage will slip off the wound. A bandage that is too tight can cut off the blood supply to the injured part and cause damage to the blood vessels and tissues. When you fasten a bandage around an arm or leg, leave the fingers or toes uncovered. If they become blue or swollen, you will know that the bandage is too tight and should be loosened.

Bones, Joints & Muscles:

Accidents cause many different types of injuries to bones, joints and muscles. When rendering first aid, you must be alert for signs of broken bones (fractures), dislocations, sprains, strains, and bruises (contusions). Injuries to the joints and muscles often occur together, and it is difficult to tell whether the injury is to a joint, muscle, or tendon. It is difficult to tell joint or muscle injuries from fractures. When in doubt, always treat the injury as a fracture.

The primary process of first aid for fractures consists of immobilizing the injured part to prevent the ends of broken bones from moving and causing further damage to the nerves, blood vessels, or internal organs. Splints are also used to immunize injured joints or muscles and to prevent the enlargement of severe wounds. Before learning first aid for injuries to the bones, joints, and muscles, you need to have a general understanding of the use of splints.

Splints
In an emergency, almost any firm object or material will serve as a splint. Thus, umbrellas, canes, rifles, sticks, oars, wire mesh, boards, cardboard, pillows, and folded newspapers can be used. A fractured leg can be immobilized by securing it to the uninjured leg. Whenever possible, use ready-made splints such as the pneumatic or traction splints.

Splints should be lightweight, padded, strong, rigid, and long enough to reach the joint above and below the fracture. If they are not properly padded, they will not adequately immobilize the injured part. Articles of clothing, bandages, blankets, or any soft material may be used as padding. If the casualty is wearing heavy clothes, you may be able to apply the splint on the outside, allowing the clothing to serve as a part of the required padding.

Fasten splints in place with bandages, adhesive tape, clothing, or any suitable material. One person should hold the splints in position while another person fastens them.

Splints should be applied tight, but never tight enough to stop the circulation of blood. When applying splints to the arms or legs, leave the fingers or toes exposed. If the tips of the fingers or toes turn blue or cold, loosen the splints or bandages. Injuries will probably swell, and splints or bandages that were applied correctly may later be too tight.

Fractures
A break or rupture in a bone is called a fracture. There are two basic types; open and closed. A closed fracture does not produce an open wound in the skin, also known as a simple fracture (Fig. 6-lA). An open fracture produces an open wound in the skin, also known as a compound fracture. Open wounds are caused by the sharp end of broken bones pushing through the skin; or by an object such as a bullet that enters the skin from the outside.

Open fractures are usually more serious than closed fractures. They involve extensive tissue damage and are likely to become infected. Closed fractures can be turned into open fractures by rough or careless handling of the casualty. Always use extreme care when treating a suspected fracture.

It is not easy to recognize a fracture. All fractures, whether open or closed, can cause severe pain or shock. Fractures can cause the injured part to become deformed, or to take an unnatural position. Compare the injured to the uninjured part if you are unsure of a deformity. Pain, discoloration, and swelling may be at the fracture site, and there may be instability if the bone is broken clear through. It may be difficult or impossible for the casualty to move the injured part. If movement is possible, the casualty may feel a grating sensation (crepitus) as the ends of the bones rub against each other. If a bone is cracked rather than broken, the casualty may be able to move the injured part without much difficulty. An open fracture is easy to see if the end of the bone sticks out through the skin. If the bone does not stick out, you might see a wound but fail to see the broken bone. It can be difficult to tell if an injury is a fracture, dislocation, sprain, or strain. When in doubt, splint.

If you suspect a fracture, do the following:
1. Control bleeding with direct pressure, indirect pressure, or tourniquet only as a last resort.
2. Treat for shock.
3. Monitor the airway, breathing, and circulation (ABCs).
4. Remove all jewelry from the injury site, unless the casualty objects. Gently cut clothing away so that you don't move the injured part and cause further damage.
5. Check the distal pulse of the injured part, if pulse is absent, gently move injured part to restore circulation.
6. Cover all wounds with sterile dressings, including open fractures. Do not push bone ends back into the skin. Avoid excessive pressure on the wound.
7. Apply splint - Do not attempt to straighten broken bones.
            a. Apply and maintain traction until the splint has been secured.
            b. Wrap from the bottom of the splint to the top, firmly but not too tight.
            c. Check the distal pulse to ensure that circulation is still present. If the pulse is absent, loosen the splint until circulation returns. Do not move the casualty until the injury has been splinted.
8. Request medical assistance - All suspected fractures require professional medical treatment.

Fracture of the Forearm
There are two long bones in the forearm, the radius and the ulna. When both are broken, the arm usually appears to be deformed. When only one is broken, the other acts as a splint and the arm retains a more natural appearance. Fractures usually result in pain, tenderness, swelling, and loss of movement.

In addition to the general procedures above, apply a pneumatic (air) splint if available; if not, apply two padded splints; one on the top (backhand side), and one on the bottom (palm side). Make sure the splints are long enough to extend from the elbow to the wrist.

Once the forearm is sprinted, place the forearm across the chest. The palm of the hand should be turned in with the thumb pointing up. Support the forearm in this position with a wide sling and cravat bandage. The band should be raised about 4 inches above the level of the elbow.

Fracture of the Upper Arm
There is one bone in the upper arm, the humerus. If the fracture is near the elbow, the arm is likely to be straight with no bend at the elbow. Fractures usually result in pain, tenderness, swelling, and loss of movement. In addition to the general procedures above, do the following:

If the fracture is in the upper part of the arm, near the shoulder, place a pad or folded towel in the armpit, bandage the arm securely to the body, and support the forearm in a narrow sling. If the fracture is in the middle of the upper arm, you can use one well padded splint on the outside of the arm. The splint should extend from the shoulder to the elbow. Secure the arm firmly to the body and support the forearm in a sling.

If the fracture is at or near the elbow, the arm may be either bent or straight. Regardless what position you find the arm, do not attempt to straighten or move it. Gently splint the arm in the position in which you find it.

Fracture of the Rib
Make the casualty as comfortable as possible so that the chances of further damage to the lungs, heart, or chest wall is minimized.

A common finding in all casualties with fractured ribs is pain at the site of the fracture. Ask the casualty to point to the exact area of pain to assist you in determining the location of the fracture. Deep breathing, coughing, or movement is usually painful. The casualty should remain still and may lean toward the injured side, with a hand over the fracture to immobilize the chest and ease the pain.

Simple rib fractures are not bound, strapped, or taped if the casualty is comfortable. If the casualty is more comfortable with the chest immobilized, use a sling and swathe. Place the arm on the injured side against the chest, with the palm flat, thumb up, and the forearm raised to a 45-degree angle. Immobilize the chest, using wide strips of bandage (ace wrap) to secure the arm to the chest.

Fracture of the Thigh
There is one long bone in the upper leg between the kneecap and the pelvis, the femur. When the femur is fractured, any attempt to move the leg results in a spasm of the muscles that causes severe pain. The leg is not stable, and there is complete loss of control below the fracture. The leg usually assumes an unnatural position, with the toes pointing outward. The injured leg is shorter than the uninjured one due to the pulling of the thigh muscles. Serious bleeding is a real danger since the broken bone may cut the large (femoral) artery. Shock usually is severe.

In addition to the general procedures above, gently straighten the leg, apply two padded splints, one on the outside and inside of the injured leg. The outside splint should reach from the armpit to the foot, the inside splint from the groin to the foot. The splint should be secured in five places: (1) around the ankle, (2) over the knee, (3) just below the hip, (4) around the pelvis, and (5) just below the armpit. The legs can then be tied together to support the injured leg. Do not move the casualty until the leg has been splinted.

Fracture of the Lower Leg
There are two long bones in the lower leg, the tibia and fibula. When both are broken, the leg usually appears to be deformed. When only one is broken, the other acts as a splint and the leg retains a more natural appearance. Fractures usually result in pain, tenderness, swelling, and loss of movement. A fracture just above the ankle is often mistaken for a sprain.

In addition to the general procedures above, gently straighten the leg, apply a pneumatic (air) splint if available; if not, apply three padded splints, one on each side and underneath the leg. Place extra padding (Fig. 6-6) under the knee and just above the heel. The splint should be secured in four places: (1) just below the hip, (2) just above the knee, (3) just below the knee, and (4) just above the ankle. Do not place the straps over the area of the fracture.

A pillow and two side splints also work well. Place a pillow beside the injured leg, then gently lift the leg and place it in the middle of the pillow. Bring the edges of the pillow around to the front of the leg and pin them together. Then place one splint on each side of the leg, over the pillow, and secure them in place with a bandage or tape.

Fracture of the Kneecap
The kneecap is also known as the patella. Although fractures of the kneecap do occur, the more common injuries are dislocations and sprains.

In addition to the general procedures above, gently straighten the leg, apply a pneumatic (air) splint if available; if not, apply a padded board under the injured leg. The board should be at least 4 inches wide and should reach from the buttock to the heel. Place extra padding under the knee and just above the heel. The splint should be secured in four places: (1) just below the hip, (2) just above the knee, (3) just below the knee, and (4) just above the ankle. Do not place the straps directly over the kneecap.

Fracture of the Collarbone
The collarbone is also known as the clavicle. When standing, the injured shoulder is lower, and the casualty is unable to raise the arm above the shoulder. The casualty attempts to support the shoulder by holding the elbow. This is the typical stance taken by a casualty with a broken collarbone. Since the collarbone lies near the surface of the skin, you may be able to see the point of fracture by the deformity and tenderness.

In addition to the general procedures above, gently bend the casualty's arm and place the forearm across the chest. The palm of the hand should be turned in, with the thumb pointing up. Support the arm in this position (Fig. 6-7) with a wide sling. The hand should be raised about 4 inches above the level of the elbow. A wide roller bandage (or any wide strip of cloth) may be used to secure the casualty's arm to the body.

Fracture of the Jaw
The lower jaw is also known as the mandible. The casualty may have difficulty breathing, difficulty in talking, chewing, and swallowing, and have pain of movement of the jaw. The teeth may be out of line, and the gums may bleed, and swelling may develop. The most important consideration is to maintain an adequate open airway.

In addition to the general procedures above, apply a four-tailed bandage, be sure the bandage pulls the lower jaw forward. Never apply a bandage that forces the jaw backward, since this may interfere with breathing. The bandage must be firm enough to support and immobilize the lower jaw, but it must not press against the casualty's throat. The casualty should have scissors or a knife to cut the bandage in case of vomiting.

Fracture of the Skull
The skull is also known as the cranium. The primary danger is that the brain may be damaged. Whether or not the skull is fractured is of secondary importance. The first aid procedures are the same in either case, and the primary intent is to prevent further damage. Some injuries that fracture the skull do not cause brain damage. But brain damage can result from minor injuries that do not cause damage to the skull.

It is difficult to determine whether an injury has affected the brain, because symptoms of brain damage vary. A casualty who has suffered a head injury must be handled carefully and given immediate medical attention.

Signs and symptoms that may indicate brain damage include:
            1. Wounds of the scalp, deformity of the skull.
            2. Dizziness, weakness, conscious or unconscious.
            3. Pain, tenderness, or swelling.
            4. Severe headache, nausea and vomiting.
            5. Restlessness, confusion, and disorientation.
            6. Paralysis of the arms, legs, or face.
            7. Unequal pupils, abnormal reaction to light.
            8. Blood or clear fluid from the ears, nose, or mouth.
            9. Pale, flushed skin.
            10. Bruising behind the ear (Battle's Sign).
            11. Bruising under or around the eyes in the absence of trauma to the eyes (Raccoon's Sign).

If you suspect a head injury, do the following:
1. Position the casualty flat, stabilize the head and neck as you found them by placing your hands on both sides of the head.
2. Establish and maintain an open airway - jaw-thrust maneuver. Note that the head is not tilted and the neck is not extended. Check the airway, breathing, and circulation (ABCs).
3. Finger sweep to remove any foreign bodies from the mouth.
4. Maintain neutral position of head and neck and, if possible, apply a cervical collar or improvised (towel) collar.
5. Apply dressing - Do not use direct pressure or tie knots over the wound. Apply ice or cold packs if available. (For blood or clear fluid from the nose or ears, cover loosely with a sterile dressing to absorb but not stop the flow).
6. Treat for shock - Casualties with suspected head and neck injuries are to remain flat. Do not raise the casualty's feet. If they are vomiting or bleeding around the mouth, place them on their side keeping the neck straight. Do not give anything to eat or drink.
7.Request medical assistance immediately - Time is critical. Head and neck injuries should be treated by professional medical personnel, if possible. Do not attempt procedures that you are not trained to do.

Fracture of the Spine
The spine is also known as the backbone or spinal column. If the spine is fractured, the spinal cord may be crushed, cut, or damaged so severely that death or paralysis may occur. If the fracture occurs in a way that the spinal cord is not damaged, there is a chance of complete recovery. Twisting or bending of the neck or back, whether due to the original injury or careless handling, is likely to cause irreparable damage. The primary symptoms of a fractured spine are pain, shock, and paralysis. Pain may be acute at the point of fracture and radiate to other parts of the body. Shock is usually severe, but the symptoms may be delayed. Paralysis occurs if the spinal cord is damaged. If the casualty cannot move the legs, the injury is probably in the back; if the arms and legs cannot move, the injury is probably in the neck. A casualty who has back or neck pain following an injury should be treated for a fractured spine.

If you suspect a fractured spine, do the following:
1. Position the casualty flat, stabilize the head and neck as you found them by placing your hands on both sides of the head.
2. Establish and maintain an open airway - jaw-thrust maneuver. Note that the head is not tilted and the neck is not extended. Check the airway, breathing, and circulation (ABCs).
3. Finger sweep to remove any foreign bodies from the mouth.
4. Maintain neutral position of head and neck and, if possible, apply a cervical collar or improvised (towel) collar.
5. Keep the casualty comfortable and warm enough to maintain normal body temperature.
6. Treat for shock - Casualties with suspected spinal injuries are to remain flat. Do not raise the casualty's feet. If the casualty is vomiting or bleeding around the mouth, place them on their side keeping the neck straight. Do not give anything to eat or drink.
7. Request medical assistance immediately - Time is critical. Do not move the casualty unless it is absolutely necessary. Do not bend or twist the casualty's body. Do not move the head forward, backward, or sideways. Do not allow the casualty to sit up.

Fracture of the Pelvis
Fractures often result from falls, heavy blows, and crushing accidents. The greatest danger is damage to the organs that are enclosed by the pelvis. There is danger that the bladder will be ruptured or that severe internal bleeding may occur, due to the large blood vessels being torn by broken bone. The primary symptoms are severe pain, shock, and loss of the ability to use the lower part of the body. The casualty is unable to sit or stand and may feel like the body is "coming apart."

Treat for shock, but do not raise the casualty's feet. Do not move the casualty unless absolutely necessary. Request medical assistance immediately.

Dislocations
A dislocation occurs when a bone is forcibly displaced from its joint. Many times the bone slips back into its normal position; other times, it becomes locked and remains dislocated until it is put back into place (reduction). Dislocations are caused by falls or blows and occasionally by violent muscular exertion. The joints that are most frequently dislocated are the shoulder, hip, finger, and jaw.

A dislocation may bruise or tear muscles, ligaments, blood vessels, and tendons. The primary symptoms are rapid swelling, discoloration, loss of movement, pain, and shock. You should not attempt to reduce a dislocation. Unskilled attempts at reduction may cause damage to the nerves and blood vessels or may fracture a bone. You should leave this treatment to professional medical personnel and concentrate your efforts on making the casualty comfortable.

If you suspect a dislocation, do the following:
1. Loosen clothing from around the injury.
2. Place the casualty in the most comfortable position.
3. Support the injured part with a sling, pillow, or splint.
4. Treat for shock.
5. Request medical assistance as soon as possible.

Sprains
A sprain is an injury to the ligaments that support a joint. It usually involves a sudden dislocation, with the bone slipping back into place on its own. Sprains are caused by the violent pulling or twisting of the joint beyond its normal limits of movement. The joints that are most frequently sprained are the ankle, wrist, knee, and finger. Tearing of the ligaments is the most serious aspect of a sprain, and there is a considerable amount of damage to the blood vessels. When the blood vessels are damaged, blood may escape into the joint, causing pain and swelling.

If you suspect a sprain, do the following:
1. Splint to support the joint and put the ligaments at rest. Gently loosen the splint if it becomes so tight that it interferes with circulation.
2. Elevate & rest the joint to help reduce the pain and swelling.
3. Apply ice or cold packs, with cloth to prevent damage to the skin, the first 24 hours, then apply warm compresses to increase circulation.
4. Request medical assistance as soon as possible.

Treat all sprains as fractures until ruled out by x-rays.

Strains
A strain is caused by the forcible over-stretching or tearing of a muscle or tendon. They are caused by lifting heavy loads, sudden or violent movements, or by any action that pulls the muscles beyond their normal limits. The primary symptoms are pain, lameness, stiffness, swelling, and discoloration.

If you suspect a strain, do the following:
1. Elevate & rest the injured area to help reduce the pain and swelling.
2. Apply ice or cold packs, with cloth to prevent damage to the skin, the first 24 hours, then apply warm compresses to increase circulation.
3. Request medical assistance as soon as possible.

Treat all strains as fractures until ruled out by x-rays.

Contusions
A contusion (bruise) is an injury that causes bleeding into or beneath the skin, but it does not break the skin. The primary symptoms are pain, tenderness, swelling, and discoloration. At first, the injured area is red due to local irritation; as time passes the characteristic "black and blue" (ecchymosis) mark appears. Several days after the injury, the skin becomes yellow or green in color. Usually, minor contusions do not require treatment.

If you suspect a contusion, do the following:
1. Elevate & rest the injured area to help reduce the pain and swelling.
2. Apply ice or cold packs, with cloth to prevent damage to the skin, the first 24 hours, then apply warm compresses to increase circulation.
3. Request medical assistance as soon as possible.

The preceding information has been provided by the Department of the Navy Bureau of Medicine and Surgery, titled Operational Medicine 2001 Standard First Aid Course (NAVEDTRA 13119US).

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CONSTRUCTION KNOWLEDGE >> GENERAL TECHNICAL KNOWLEDGE >>

FIRST AID

Introduction:

Basic Life Support:

Bleeding:

Shock:

Soft Tissue Injuries:

Bones, Joints & Muscles:

NEWSLETTER

Construction Topics

ADS

Become a FB fan

Construction Network

CONSTRUCTION KNOWLEDGE >> GENERAL TECHNICAL KNOWLEDGE >> FIRST AID

Introduction:

Basic Life Support:

Bleeding:

Shock:

Soft Tissue Injuries:

Bones, Joints & Muscles:

CONSTRUCTION KNOWLEDGE >> GENERAL TECHNICAL KNOWLEDGE >>

FIRST AID