SceneSafety Imaginethatyou’redrivingalonginyourcar,andtoyourhorroryouobservethecarinfrontofyoulosecontrol,driveintoadeepditchatthesideoftheroadandfliptwice,landingonit’sside.YouhavetakenCPRandFirstAidandyou’repreparedtohelp.Whatshouldyoudofirst? Sceneslikethesehappeneveryday.That’swhywetakethesecourses-sothatwecanhelpattherighttimeintherightway.Beforeyouattendtoanyvictim,thereisoneimportantstepyoumusttake:youmustensurethatthesceneissafe. Why?Scenesafetyisimportantbecausethelastthingyouwouldwanttodoinsuchasituationistobecomeavictimyourself-thatwouldbeofnohelptoanyone.Thereareseveralthingsthatyoushouldlookforwhendetermininginthesceneissafeforyoutoenter.Lookfor:

� Flamesorsmoke � Traffic(especiallyonthehighway) � Riskofanexplosion � Chemicalspills/fumes � Downedelectricalwires � Potentialcollapseofabuildingorstructure � Animals(frightenedanimalsmaybiteifyouattempttorenderassistancetotheirowner) � Potentialforviolencetowardsyourselforothers � Otherdangers

Onlywhenyouhaveensuredthatyouwillbesafeshouldyouprovidefirstaidtoavictim.

UniversalPrecautionsOneofyourmajorconcernswhenprovidingfirstaidshouldbetoprotectyourselffrombloodbornepathogens.Bloodbornepathogensareinfectiousmicroorganismthathavetheabilitytocausediseaseinhumans.Theyarespreadthroughdirectcontactwithinfectedblood.SomeoftheseincludehepatitisCandHIV,thevirusthatcausesAIDS.Universalprecautionsaremeasuresthathelptoprotectagainstbloodbornepathogensandassumethatallvictimsarepotentiallyinfectious.Byobservinguniversalprecautions,youareprotectingyourselfagainstexposuretopotentiallydisease-causingmicroorganismpresentinanother’sbloodorbodyfluids.Toprotectyourself,youshouldusePPE,orpersonalprotectiveequipment,suchasgloves.Ifyoudonothavegloves,youcanimprovisebyusingaplasticbagtocoveryourhands.Alwaysfollowtheseguidelineswhenprovidingfirstaidtoprotectyourself:

� Washyourhands,bothbeforeandafterprovisionoffirstaid(youwanttoprotectthevictimfromyourpathogensaswell,whichiswhyyoushouldwashyourhandsbeforeprovidingcare)

� Coveranyofyourownscrapesorcuts,asthesecanbecomeportalsofentryformicroorganisms

� Avoidtouchingyournose,mouthoreyeswhileprovidingcareanduntilyouhavewashedyourhandswellafterprovidingcare

� Becarefultoavoidinjuryatthesitebybeingawareofanyobjectsthatmaycutorscrapeyourskin

PatientAssessment

Onceyouhavedeterminedthatthesceneissafe(andonlyafteryouhaveensuredthatthisisso),youmayapproachthevictimtoperformanassessment.Assessmenthasthreeseparate,butequallyimportant,steps.

� CheckresponsivenessandABC’stoidentifyanylife-threateningemergenciesthatmustbedealtwithimmediately.

� Obtainahistoryfromthevictimandanybystanders. � Performanexamination,usingthehead-to-toemethod.

CheckresponsivenessandABCs Tocheckresponsiveness,talktothevictimtoseeiftheyrespond.Shaketheirshouldersandyell“Areyouokay?”.Iftheydonotrespond,thismeanstheyarelikelyunconsciousandyoumustmovequicklytoassessairway,breathingandcirculation.

Next,assessforbreathing.Lookfornormal,absentorabnormalbreathing(suchasgasping).Ifresponsivenessandbreathingareabsentorabnormal,callforhelp.Ifsomeoneisaround,askthemtoactivatetheemergencyresponsesystem(call9-1-1)andgetanAED(automatedexternaldefibrillator).Ifyouarealoneandnoonerespondstoyourcallforhelp,useyourcellphonetocall9-1-1.QuicklyleavetoobtainanAEDifyouknowwhereoneislocated. Checkthevictim’spulse.Ifthevictimisanadult,checkforapulseusingthecarotidartery.Use2or3fingerstolocatethetrachea(thewindpipe),thenslidethese2fingersintothegroovelocatedbetweenthetracheaandthemusclesonthesideofthevictim’sneck.Trytofeelapulsefor5,butnotmorethan10,seconds.Ifyoucannotfeelapulse,oryou’renotsurethatyoucanfeelapulse,startCPR,beginningwithcompressions.Ifthevictimisachild,youcanalsousethecarotidarterytofindapulse,oryoumayalsousethefemoralartery.Place2fingersintheinnerthigh,halfwaybetweenthevictim’shipboneandpubicboneandjustbelowthecreasewherethevictim’slegmeetstheabdomen.Ifthevictimisaninfant,usethebrachialarteryintheupperarm.Place2or3fingersontheinsideoftheinfant’sarmbetweentheelbowandshoulder.Inchildandinfantvictim’sifthereisnopulse,youarenotsureifthereisapulseORifthepulseislessthan60beatsperminutewithsignsofpoorperfusion(palecolororbluishdiscolorationaroundthemouthoratthenailbeds),startCPRbeginningwithcompressions. WhenperformingCPR,rememberthefollowing:

� PushHARDandFAST,100to120compressions/minuteforvictimsofallages � Allowthechesttofullyrecoilaftereachcompression(returntoitsnormalposition) � Pressdownonthechestatleast2inchesforanadultvictim;forchildrenandinfants,

compressthechestto1/3thedepthofthechest,orapproximately2inchesformostchildrenand1½inchesforinfantslessthan1yearofage.Use2handstocompressthechestofadults,1or2handstocompressthechestsofchildren(dependingonsize)and2fingerstocompressthechestsofinfants.When2rescuersarepresentwithaninfantvictim,thechestiscompressedusingthe2thumbsoftherescuer,whilethefingersencirclethechestandprovidesupporttotheback.

� Whenprovidingbreaths,useabarrierdevice(suchasapocketfacemask)ifavailableto

preventinhalationofexpiredairorothermatter.Ifyouchoosetoprovidemouth-to-mouthbreaths,useaheadtilt-chinlifttoopentheairwayandholdtheairwayopenwithyourhand.Withthehandyouuseontheforeheadtoholdtheairwayopen,pinchthevictim’snostrilsshut.Placeyourmouthoverthevictim’smouthtocreateatightseal.Takeanormalbreathandbreathethroughyourmouthintothevictim’smouth. Delivereachbreathover1secondandwatchforchestrise.Ifthechestdoesnotrise,trytheheadtilt-chinliftagainandattemptanotherbreath.Ifyoucannotventilatethevictim,returnimmediatelytochestcompressions.Forsmallchildrenandinfants,covertheirmouthANDnosewithyourmouth.Delivereachbreathover1secondandwatchforchestrise.

� Hands-onlyCPRcanbeprovidedwhenabarrierdeviceisnotavailable-providecontinuouschestcompressionsatarateof100to120compressionsperminute.

� Compression-ventilationratiosforadults(1and2rescuers)is30compressionsto2

breaths;forchildrenandinfants,thecompressionstoventilationratiois30:2when1rescuerispresent,andchangesto15:2whenasecondrescuerisavailable.

� Avoidexcessiveventilation-thismayleadtogastricinflation(airinthestomach),whichmaycausethevictimtovomit.Whenanunconsciousvictimvomits,vomitedmaterialmaytraveldowntheairwayintothepatient’slungs,whichmaycausewhatisknownasaspirationpneumonia.

� UseanAED(automatedexternaldefibrillatorassoonasitisavailable.FollowthestepsastheAEDguidesyou.Remember,thefirstandmostimportantstepwhenusinganAEDistoturnthemachineON-theAEDwillguideyouthroughthenextsteps.

Note:ThiscourseisnotdesignedtoteachyoutoperformCPR.IfyouhavenotlearnedtoperformCPR,weofferCPRwithAEDhere.{hyperlinktotheappropriatecourse}.Wehaveaddedthismaterialasaquickreview.WerecommendyoutakethefullCPR/AEDcourseifyouhavenotalreadydoneso. Obtainahistory

AssumingthevictimdoesnotrequireCPR,youshouldnextobtainahistoryfromthepatientandanywitnessesorbystanders.Askthevictimwhathappened,aswellasanyotherswhomay

beabletoprovideimportantinformationthatmaydeterminewhatyoudonext.Thisinformationmayalsobeimportanttoemergencyrespondersonetheyarriveonthescene.AneasywaytoobtainathoroughhistoryistousethemnemonicSAMPLE: S-signsandsymptoms-askthevictimhowhe/shefeels.Whatcanyounoticewhenyoulookatthevictim?Forexample,thevictimmaytellyouthattheirrightleghurts-thisisasymptom.Younoticethatthepatientisholdingtheirlegandgrimacinginapparentpain-thisisasign. A-allergy-askthepatientiftheyhaveanyallergiestoanything.Iffamilymembersorlovedonesarepresent,theymaybeabletoprovideyouwiththisinformationonthepatient’sbehalf. M-medications-askthepatientiftheytakeanymedications.Thisshouldincludeover-the-countermedications,vitaminsandsupplements,asthesecansometimeshaveunwantedsideeffects,suchasexcessivebleedingforexample. P-previousproblems-askifthepatienthaseverexperiencedasimilarevent.Alsoaskiftheyhaveanymajorhealthproblems,suchasheartdisease,diabetesorbleedingdisorders. L-lastmealtaken-askthepatientwhenthelasttimewasthatthepatientateordrankanything. E-event-askforasummaryofthepresentevent.Whatexactlyhappened?

Performanexamination Onceyouhaveobtainedthevictim’shistory,youshouldmoveontoperformingahead-to-toeexamination,startingattheheadandworkingyourwaydowntowardsthefeet.Youshouldlookfor:

� Bruises � Cuts/lacerations � Bumps/lumps � Sourcesofbleeding � Obviousdeformitiesofthearmsandlegs � Painfulareas

Note:Ifthepatientisconscious,youshouldaskforpermission(consent)beforeexaminingthevictim.Ifthevictimisunconscious,thereareGoodSamaritanlawsthatprotectyoulegally,providingyouarefollowingthestandardofcare(providingcareasyouhavelearnedorhavebeentrained). Takeacloselookatthevictim.Assessthevictim’sbreathing.Aretheybreathingveryshallowlyorquickly?Dotheyhavepainwhentheybreathe?Istheirbreathingtooslow?Alsoassesstheircolor(pale,bluishdiscolorationorflushing)andskintemperature.Istheskinwarmanddry,orcoolandclammy?Thismayprovideimportantinformation.

Duringyourexamination,youshouldimmediatelycall9-1-1forhelpifyoufindanylife-threateningsignsorsymptoms:

� Chestpainorpressure � Alteredlevelofconsciousness � Uncontrolledbleeding � Seriousbrokenbones � Difficultybreathing � Seizures � Signsofshock(pale,clammyandcoolskin)

Note:Youshouldnottrytomovethevictimunlessabsolutelynecessary,asmovingthevictimcouldcausefurtherinjury.Youmayneedtomovethevictimifthesceneisnotsafeforyouandthevictim(thereisfireorsmokenearby,oryoufearanexplosionmayoccur).Otherwise,youshouldleavethevictiminthesamepositiontheywerein.Remember,scenesafetyisofutmostimportance-althoughyoumaywantto,youshouldnotputyourownlifeatriskunnecessarily-doingsomaycreateanothervictim-YOU.

ControlofBleeding

Althoughmostbleedingepisodesarenotlife-threatening,severebleedingcanresultindeathifnotstopped.Asafirstaidresponder,protectyourselffrombloodbornepathogensbywearingglovesiftheyareavailable-aplasticbagoveryourhandcanbeusedifyoudon’thaveanygloves. Trytoidentifythesourceofthebleeding.Ifbloodisspurting,itislikelythatanarteryhasbeencut.Applydirectpressuretostopthebleeding.Ifthewoundisinthevictim'sbellyandorgansarevisible,doNOTtrytoputtheorgansbackintotheabdomen;simplycoverthewoundwithacleandressing,applypressureasneededtocontrolthebleedingandgetthevictimtomedicalcare. Forotherbleedingwounds,dothefollowing:

1. Encouragethevictimtoliedown;ifthevictimisdizzy,raisethevictim’sfeetabove

his/herhead.2. DoNOTremoveanyobjectthatisdeeplyembeddedinthewound.3. Ifthesourceofbloodisanextremity,raisetheaffectedarmorlegabovethelevelofthe

victim’sheart.Applypressuredirectlytothewoundusingacleanclothorclean/sterilebandage.Holdpressurefortenminutes;doNOTpeektoseeifbleedinghasstopped.

4. Applyapressurebandage.Ifyounotethatthereisbloodcomingthroughthepressure

bandage,donotremoveit-simplyreinforcethebandageifyounoticebleedingaroundtheoriginalbandage.

5. Continuetoapplypressuretothewound.6. Ifthevictimbecomesdrowsy,extremelyanxious,thirsty,orifhisskinbecomesvery

cooland/orclammy,youshouldsuspectshock.Ifthevictimisanxious,trytokeepthemcalmandstill.Raisethevictim’slegsabovetheleveloftheirheart.

7. Getthevictimtoemergencycareassoonaspossible. Shock Shockiscausedbyinadequatebloodflowtothebody’sorgans.Itcanbecausedbybloodlossorlossofbodyfluids,asmayoccurfollowinguntreatedseverevomitingordiarrhea.Symptomsofshockmayincludethefollowing:

� Drowsiness � Confusion � Lossofconsciousness � Extremethirst � Paleskincolor � Rapidheartrate � Cool,clammyskin � Rapidbreathing � Anxiety

Victimsinshockmustreceiveemergencycareassoonaspossibletopreventdeath.Call9-1-1. Whilewaitingforemergencyservices:

1. Ensure the victim is lying down. 2. Elevatethevictim’slegsabovetheleveloftheirheart,approximately8to12inches.

Thiswillpromotebloodflowtotheheart.3. Coverthevictimwithablankettokeepthemwarm.4. Keepthevictimcalmandstill.

MusculoskeletalInjuries Sprains,strains,fracturesanddislocationsarealmostalwayscausedbytrauma.Anyoftheseinjuriesmaycausedeformity,swelling,andseverepain.Alloftheseinjuriesshouldbeevaluatedbyamedicalprofessional;however,therearesomestepsthatshouldbetakeninprovidingfirstaid.Thesestepsmaypreventfurtherinjuryanddisability:

� Call9-1-1iftheinjuryisaresultofmajortrauma.

� Assumethevictimhasaneckinjuryinanycaseofmajortraumaandavoidmovingthevictimuntilhelparrives.Donotallowthevictimtomovehis/herneck.

� Stabilizetheaffectedbodypartonlyifdoingsodoesnotcauseadditionalpain;donottryto

forceadeformedjointbackintoplaceasthismaycausefurtherdamage.

� Manyvictimsofmusculoskeletalinjurywillassumeapositionofcomfort-allowthemtodosoifthisdecreasestheirpain.

� RemembertheacronymRICEwhentreatinginjuredextremities(armsandlegs,feetand

hands):o Rest anyinjuredjoint o Applyacoldpackor Ice ifavailabletoreduceswellingandcontrolpain o Apply Compression (anelasticbandage)foranysprainsorstrains o Elevate theinjuredbodypartabovethehearttoreduceswelling

� Donotgivethevictimanythingbymouthuntilseenbyamedicalprofessional;theexceptionto

thisruleisifmedicalcareisnotavailablewithinacoupleofhours,anover-the-counterpainrelievermayhelpmanagepain.

� Controlbleedingifpresent(seesectiononControlofBleeding) � If the victim shows signs of shock (see section on Shock), have the victim lie

down and wait for help.

Burns Manyburnsareminorandcanbetreatedwithfirstaid;othersburnsaremoreseriousandrequiremedicalattention.Theseverityofaburncandependonmanyfactors,including:

� Theageofthevictim-burnscanbemoresevereinbabies,youngchildrenandtheelderly

� Thesizeoftheburn-howmuchofthebodyisaffected,oftendescribedasapercentage,whichmaybeanindicatorofsurvivability

� Thedepthoftheburn-howdeeplytheburnextendsdownintothesubcutaneoustissue

� Thelocationoftheburn-burnslocatedonthehands,face,groin/genitals,neck,handsandfeetcanhaveseverefunctionalandcosmeticconsequences

� Thepresenceofotherinjuries-burnscombinedwithothersevereinjuriesmayaffect

outcomeandsurvivability Itisimportanttobeabletorecognizethetypeofburninordertoprovidethecorrectcare.

TypeofBurn Appearance& Complications FirstAidTreatment Sensation FirstDegree Redness;Dryskin; Infection Firstdegree-cooltheburnwithcool

Painful runningwaterfor10-20minutes,or applyacoolwetcompress.Remove ringsfromburnedfingersasthearea mayswell.Applylotionoraloeveragel forcomfort.Maytakeanover-the- counterpainrelieverifneeded. Sunburnsareanexampleoffirst-degree burn. SecondDegree Redwithblisters; Infectionandcellulitis; Treatasforafirstdegreeburnunless (PartialThickness) Moist;Painful scarringand theburnedareaislarge.Seekmedical

contractures;may helpforlargerburns,especiallythoseon requiredebridement thehands,face,neck,groinorfeet. Leavelargeblistersintact-doNOT

puncture.Ifsmallblistersrupture (smallerthanyourfingernail)cleanse theareawithmildsoapandwaterand applyantibioticointmentandanon- stickdressing.Seekmedicalcarefor signsofinfection(increasedpain, redness,swelling,oozingfromthe wound) ThirdDegree(Full Stiff;dry;leathery; Scarringand Call9-1-1.Ifitissafetodoso,remove Thickness) whiteorbrowncolor; contractures;May thevictimfromfurthercontactwith

Painless requiredebridement heatand/orsmoke.Donotremove oramputation;large clothingthathasadheredtotheskin. thirddegreeburns Removebelts,jewelryorother mayresultindeath restrictiveitemsfromthevictimasthe burnedareaswillswellveryquickly.Do notimmerseverylargeburnsincool waterasthismayleadtoexcessiveloss ofbodyheat.Elevateburnedareasif possible.Coverburnedareaswitha cleanclothorasheet.Monitor breathingandcirculationandperform CPRifitbecomesnecessary. FourthDegree Black;charred;Painless Possiblegangrene; Asforafullthicknessburn

Usuallyleadstolossof functionand sometimesdeath Smokeinhalationmaybeasdeadlyassevereburns.Ifaburnvictimhassootaroundorintheirmouthornose,thisindicatesthattheairwaymaybeaffectedandbreathingmaybecomeaproblem.Ifyoususpectsmokeinhalation,call9-1-1. ChestPain Therearemanycausesofchestpain,someminorandsomeveryserious.Withoutamedicalworkup,itisoftenimpossibletotellwhetherchestpainislifethreatening.Forthisreason,ifyouoracompanionexperienceschestpainthatlastsmorethanafewminutes,itiscriticalthatchestpainbeevaluatedbymedicalprofessionals.Symptomsthatshouldraiseyoursuspicionofheartattackinclude:

� Chestpainthatgetsworsewhenyouareactivebutdecreaseswithrest � Pressureorsqueezingpaininthemiddleofyourchest � Painthatspreadstoyourshoulder,arm,neckorback � Painaccompaniedbydizziness,weakness,shortnessofbreath,nauseaorvomiting. � Pale,clammyskin(diaphoresisorsweating)

Anyofthesesymptomsmayindicateangina,pulmonaryembolism(abloodclotthatmovestothelung),aorticdissectionoramyocardialinfarction(heartattack).Ifyouorsomeoneyouarewithexperiencesanyofthesesymptoms:

1. Callimmediatelyforhelp(call9-1-1).Ifyoucannotcallforhelp,gettomedicaltreatmentassoonaspossible.

2. Ifyouhaveawell-stockedfirstaidkit,havethevictimchewanadultaspirinor2babyaspirins(unlessallergic).Thiscanhelpreducebloodclottingwhichisacauseofheartattack.

3. Have the victim lie or sit comfortably until help arrives, and keep the victim calm 4. Ifthevictimbecomesunresponsive,activatetheemergencyresponsesystemandbeginCPRif

indicated. Chestpainmaynotbelife-threatening.Forexample,pneumoniaandcostochondritis(paininthecartilageconnectingyourribstoyoursternum)arecommoncausesofchestpain.Strainedchestmuscles,gastricreflux,gallbladderdisease,andevenanxietycancausechestpain.Thesesyndromesanddiseasesmaycausechestpain;however,anychestpainshouldbediagnosedbymedicalpersonneltoruleoutoneofthedeadlyconditions.

RespiratoryEmergencies Respiratoryconditionsarecommoninthepopulationineveryagegroup.Forthisreason,it’simportanttoknowwhattodotoassistsomeoneexperiencingdifficultybreathing.Respiratoryproblemsarealmostalwaysanemergency,andmedicalassistancewillberequiredinalmostallcases.Commoncausesofrespiratorydistressinclude:

� Asthma � Emphysema � COPD(chronicobstructivepulmonarydisease,commonintheelderlypopulation) � Respiratoryinfections(suchaspneumonia,croup,whoopingcough) � Pneumothorax(collapsedlung,usuallyfromtrauma) � Heartfailureorsevereheartdisease � Fluidaroundtheheartorlungs(pericardialorpleuraleffusion) � Anaphylaxis(life-threateningallergicreaction) � Pulmonarythrombosis(bloodclotinthelung) � Injurytothechest,lungsorneck

Difficultybreathingmaypresentasdifficultytakingadeepbreath,beingshortofbreathorexperiencing‘airhunger’,thesensationofnotbeingabletogetenoughair.Theremayalsobepainwithbreathingincertainconditions,especiallyifthevictimhasbeeninvolvedinatrauma. Signsandsymptomsofrespiratorydistressareoftenquiteobvious,andmayinclude:

� Rapidbreathing � Inabilitytobreatheproperlyunlesssittingupright � Anxiety � Alteredlevelofconsciousness(drowsiness,confusionorunconsciousness) � Cough

� Dizziness � Painwithbreathing � Grunting,high-pitchedwhistling(stridor)orwheezingwhenbreathing � Bluishdiscolorationtothelips,nailbedsorfingers � Rapidheartrate � Diaphoresis(sweating) � Difficultyspeakingmorethanacoupleofwordsatatime � Gaspingforbreath � Fever(ifthecauseisinfectious) � Hemoptysis(coughingupblood) � Rashorhives(ifthevictimissufferingananaphylacticreaction)

Ascanbeseen,respiratoryemergenciescanpresentinnumerousways.Ifyouareadministeringfirstaidtosomeoneexperiencingarespiratoryemergency,youshould:

1. Call9-1-1.2. Loosentightclothingthatmayberestrictingthevictim’sbreathing.3. Assistthevictimtouseanyinhalers,oxygenorothermedicaldevices.4. Bandageanyopenwoundsoftheneckorchestifnecessary.Ifthevictimhasa‘sucking’chest

wound(achestwoundthatallowsairtoenterthechestcavitywitheachbreath),applyplasticwraporaplasticbagtothewound,sealingitinplaceEXCEPTforonesidetoallowairtoescape.Thiswillpreventairfromenteringthechest,butwillalsoallowanytrappedairtoescape.

5. Donotgivethepersonfoodordrink.6. Donotputapillowunderthevictim’shead(thismaycloseoffthevictim’sairway).7. Donotmovethepersoniftheyhavebeeninjured(incaseofspinalcordinjury).8. Continuetomonitorthevictim’sbreathingandheartrate.Shouldthevictimstopbreathingor

losetheirpulse,performrescuebreathingorCPRuntilhelparrives. Donotbefalselyreassuredifavictimwithnoisybreathing(wheezing,gurglesorhigh-pitchedwhistling)suddenlyhasquietbreathing-thismayindicatethatthevictimisnolongermovingairintothelungsandmaymeanthatthevictimisclosetorespiratorycollapse.

Stroke Astrokeisatruemedicalemergency.Thereisasayinginmedicine,“TimeisBrain”,whichmeansthatthelongerapersonwaitstoreceivemedicalcareafterastroke,thegreaterthechancesofseriousneurologicaldamageordeath.Thebrainrequiresoxygenandnutrientstofunctionandcannotlastlongwithoutthese-braincellsbegintodiewithinminuteswhendeprivedofoxygen. Itisimportantthateveryoneisfamiliarwiththesignsofstroke:

� Weaknessornumbnessononesideofthebodyorface � Facialdrooping(onesideofthemouthwillappeartobelowerthantheother,smilewillbe

crooked) � Changesinvision(blurredvision,lossofvisionordimness) � Difficultyspeakingordifficulty“finding”words/slurredspeech � Alteredgait/difficultywalking

� Severeheadache(notalwayspresent) � Dizzinessorweakness

Avictimofstrokemaybefoundunconsciousifthestokeissevere. Astrokeoccursforoneoftworeasons:abloodclotblocksbloodflowtoaportionofthebrain(calledischemicstroke),orthereisbleedingintothebrain(calledhemorrhagicstroke).Themostimportantthingtonotewitheithertypeofstrokeiswhensymptomsfirstappeared(whenthevictimwaslastknowntonenormal).Thisisbecausecertaintreatmentsforstrokearetime-dependent. Ifyoususpectstroke:

� Call9-1-1.Thisisyourpriorityaction.Besureyoutelldispatchthatyoususpectstroke,asthiswillstartimportantpreparationsatthehospital.

� Keepthevictimcalm. � Trytodeterminewhenthevictimwaslastnormal,orwithoutsymptoms. � DoNOTgivefoodorwater.Somestrokesmayaffectswallowing. � DoNOTgiveaspirin.Althoughmoststrokesareischemicinnature,somearehemorrhagic,and

givingaspirininthesecaseswouldworsenbleedingandcouldcausedeath. � Ifthevictimisunconscious,monitorbreathingandpulseandbepreparedtoperformCPRif

itshouldbecomenecessary.

Seizures Seizures(convulsions)arenotuncommonandcanbequitefrighteningtowitnessifyouhaveneverseenonebefore.Seizuresarenotadiseaseinandofthemselves,butratherareasymptomofanynumberofdisordersthataffectthebrain,includingepilepsy.Seizuresdonotcausepermanentbraindamage.Aseizureisasuddensurgeofelectricalactivityinthebrainwhichaffectsthewayapersonmovesandacts.Someseizuresaresevere,whileothersarebarelynoticeableunlessyouknowwhatyouarelookingfor.Youwillnotneedtoprovidefirstaidunlesstheseizureisagrandmalseizure,inwhichthepersonlosesconsciousness,fallstothegroundandexperiencesjerkingandstiffeningofthemuscles.Thesearealsocalledgeneralizedseizures,ortonic-clonicseizures.Thesetypesofseizuresusuallylast1to3minutesandsubsideontheirownwithouttreatment.Seizuresthatlastlongerthan5minutesrequiremedicalcareandmonitoring. Ifyouareassistingavictimwhoissufferingaseizure:

1. Loosenandtightorrestrictiveclothingthatmayhamperbreathing.

2. DoNOTtrytorestrainthevictimorholdthemdown-thismayresultininjurytothevictim.3. DoNOTtrytoputanythinginthevictim’smouthtopreventthembitingtheirtongue-the

victimmaychokeontheobjectorinjuretheirmouth.4. Removeanydangerousobjects/furniturefromthevictim’sspacethatcouldcauseinjury5. Iftherearepanickedbystanders,askthemtomovebackandgivethevictimsomespace.

Reassurethemthattheseizurewillpassandthereisnoreasontopanic.6. Oncethevictimhasstoppedseizing,theymaybeconfusedanddisorientedforaperiodoftime.

Providereassurance.Ifthevictimissemiconsciousorunconscious,placethevictimonhis/hersidetopreventchokingonanysecretionsfromthemouth,particularlyifthevictimbittheirtongueanditisbleeding.

7. Monitorbreathingandpulseuntilhelparrives.8. Call9-1-1.Manyseizurepatientswillnotrequiretransporttoahospitaliftheseizureistheir“usual”

patternofseizure,butitisawiseideatoallowmedicalpersonneltomakethatdecision. Childrenwillsometimesexperiencewhatisknownasfebrileseizureswhentheyhaveahighfever-treatmentisthesameasforanadultvictim.Controllingfeverwilloftenpreventthesetypesofseizures.Mostchildrenoutgrownthesetypesofseizuresastheirbraindevelops.

DiabeticEmergencies

Millionsofpeoplearoundtheworldsufferfromdiabetes,anddiabeticemergenciesarecommon.Intype1diabetes,thebodyproducesnoinsulin,andtheindividualmustuseartificialinsulintosurvive.Intype2diabetes,theindividual’spancreasproducesinsulin,buttheperson’sbodyisunabletoutilizeitproperly.Ourcellsrequireaconstantsupplyofsugartosurvive,particularlythebrain.Toomuchsugarintheblood(hyperglycemia)andtoolittlesugar(hypoglycemia)havedifferentsymptoms,anditisimportanttobeabletorecognizethedifferencebetweenthetwo. Signsandsymptomsofhyperglycemiainclude:

� Fatigue(tiredness) � Thirst � Warm,dryskin � Sweetorfruitybreath � Rapidheartrateandbreathing � Drowsiness � Lossofconsciousness(diabeticcoma)

Signsandsymptomsofhypoglycemiainclude:

� Weakness/faintness � Hunger � Shakiness/trembling � Sweating � Cold,clammyskin � Combativeness,confusionorirrationalbehaviour � Rapidheartrate � Lossofconsciousness(severe)

Totreathyperglycemia:

1. Call9-1-1.Ifyouknoworsuspectthevictimisadiabetic,telldispatch.2. Monitorbreathingandpulseandpreparetoactifthepersonbecomesunconscious.

Totreathypoglycemia:

1. Have the victim sit or lie down. 2. Iftheyhavetheirownsourceofsugar(i.e.glucosegel)havethemtakeit;iftheydonot,

givethemfoodordrinkcontainingsugar,suchassoda,juicewithsugarinitorcandy.3. Iftheyshowsignsofimproving,askthemtochecktheirbloodglucose(iftheyhaveatestingkit).4. Givethemmoresugarifnecessary.5. Iftheydonotimprovequicklycall9-1-1.Lookforothercauses.6. Continuetomonitorbreathingandpulseandpreparetoactifthepersonbecomesunconscious.

Poisoning

Poisoningcanoccurwithalmostanysubstance,evenwithmedicationsprescribedbyahealthcareprovider.Infact,intentionalandunintentionaloverdosesofmedicinesaremuchmorecommonthanpoisoningsbyothersubstances.YoushouldknowthenumberofyourregionalpoisoncontrolcenterortheUnitedStatesNationalPoisonCenterat800-222-1222andcallthembeforeprovidingfirstaidtoanyonesuspectedofhavinganykindofpoisoning.Whenyoucall,havesomegeneralinformationaboutthevictimreadilyavailable.Inaddition,ifyouknowthemedicine,productorplantthevictimingested,thiswillbeinvaluabletotheexpertonthephone.

Beawarethatthesymptomsofpoisoningcanbethesameasmanyotherdiseasesandconditions;however,therearecertainsignstolookforifyoususpectpoisoning.Ifyounoticeanyofthese,callformedicalassistanceBEFOREcallingpoisoncontrol:

� Alteredlevelofconsciousness(maybesleepyorhyperactive) � Alteredrespiratorypattern(breathingveryslowlyortooquickly) � Slurredspeech � Nauseaand/orvomiting � Chemicalsmellonthevictim’sbreath � Burnsonoraroundthelipsorinthemouth � Seizures � Emptypillbottlesinthearea � Spilledchemicalbottles

Whileyouarewaitingformedicalassistance,besureyouandthevictimarebothsafe.Movetofreshairifyoususpectthevictimhasbeenbreathinglethalfumes,asincarbonmonoxidepoisoning.Lookintothevictim’smouthand,withaglovedhand,removeanythingyoucaneasilyreach.Ifthepoisonspilledonthevictim,removeanycontaminatedclothingandbegintoflushtheareawithwateruntilhelparrives,butonlyifyouhaveproperprotectivewear,suchasgloves.DoNOTmakethevictimvomitunlessadvisedtodoso.MonitorthevictimandstartCPRifthatbecomesnecessary. Ifyoureachthepoisoncontrolcenter,followanyinstructionsgivenbythem.Ifthevictimistakentohospital,takeorsendanypills,bottlesorplants.

Hyperthermia(HeatExposure) Heatrelatedinjuriesincludeheatcramps,heatexhaustionandheatstroke.Heatstrokeisthemostsevereoftheseinjuriesandtypicallyhappenswhenthevictimhasbeenperformingheavyworkorengaginginsportsinaveryhotenvironment.Thevictimusuallyhasbeensweatingheavilyandnotreplenishingfluidslosttosweating.Inaddition,somemedicationsandalcoholusemaypredisposeanindividualtoheatstroke.Themainsymptomsofheatstrokeinclude:

� Faintness/dizziness � Headache � Nausea/vomiting � Hot,dryskinorcool,clammyskin � Rapidandweakpulse � Weakness � Alteredlevelofunconsciousness(mayloseconsciousness)

Untreatedheatexhaustionorheatstrokecancausedeath.Actquicklyifyoususpecteithercondition.Ifyoususpectapersonhashyperthermia,thereareseveralthingsyoucandotohelpthevictim:

1. Call9-1-12. Movethepersontoacoolerenvironment,outofthesunandintoashadyorair-

conditionedspace.

3. Lie the victim down and elevate their legs and feet. 4. Removerestrictiveortightclothing.5. Begintoactivelycoolthevictimbyfanningthepersonandapplyingcoolcompressestothe

armpits,neckandgroinareas.6. Ifthevictimisawakeenoughtodrinkandisnotvomiting,trygivingcoolliquidstodrink.Do

NOTgivethepersonalcoholorbeveragescontainingcaffeine.Movethepersonoutofthesunandintoashadyorair-conditionedspace.

7. Ifthevictimlosesconsciousness,monitorairway,breathingandcirculationandpreparetoperformCPRifnecessary.

Hypothermia

Hypothermiaiscausedbyprolongedexposuretothecold(coldweatherorcoldwater).

� Shiveringandlossofcoordination � Slurredspeech,apathy,confusion � Extremelyslowbreathing � Lossofconsciousness(severehypothermia)

Ifyoususpectsomeonehashypothermia,thereareseveralthingsyoucandotohelpthevictim:

1. Call9-1-12. Movethepersontoawarmerenvironment.3. Removeanywetclothingandcoverthevictimwithadryblanket(ordressindryclothing

formildcases).4. Begintoactivelywarmthevictimbyapplyinghotwaterbottlesorchemicalhotpacks(wrapped

intowelsorblanketstopreventburns)tothechestandabdominalareas(coreareas).Donotworryaboutwarmingthearmsandlegs;warmthebloodatthecenter(core)ofthebodyandallowthatwarmbloodtowarmtheextremities.

5. DoNOTimmersethevictiminhotwater-warmingthevictimtooquicklymaycauselethalheartrhythms

6. DoNOTuseaheatingpadorheatinglamp.7. Ifthevictimisawakeenoughtodrinkandisnotvomiting,trygivingwarmliquidstodrink.Do

NOTgivethepersonalcoholorcaffeinatedbeverages.8. Ifthevictimisunconscious,monitorbreathingandpulseandpreparetoperformCPRif

necessary.

Frostbite Frostbiteiscausedbyexposuretocoldtemperaturesforprolongedperiods,whichcausesdamagetotheskinandunderlyingtissues. Symptomsoffrostbitemayinclude:

� Pinsandneedlessensation,followedbynumbness � Paleandhardskin � Aching,throbbingorlackofsensationintheaffectedarea � Redandverypainfulskin/tissueasunthawingoccurs

� Blistersandblackened,deadtissue(severefrostbite) Areaswithpoorercirculationaremostpronetofrostbite,suchasthenose,ears,handsandfeet.Whenfrostbiteextendstothebloodvesselsanddamagesthem,theaffectedareamaynotrecoverandamputationisoftennecessary. Totreatfrostbite:

1. Lookforsignsandsymptomsofhypothermiaandtreatfirst(seesectiononHypothermiaabove).Call9-1-1immediatelyiffrostbiteissevereoriftherearesignsandsymptomsofhypothermia.

2. Bringthevictimintoawarm,dryplace.3. Removetightjewelleryiffingersareaffected,orsocksandbootsiffeetareaffected.Remove

anywetclothingtopreventfurthercooling.4. Ifmedicalassistanceiscloseby:wraptheaffectedareawithdrygauze,separatingfingersand

toes.5. Ifmedicalassistanceisnotcloseby,youwillneedtorewarmtheaffectedareas.6. Soakaffectedareasinwarmwaterfor20to30minutes(doNOTusehotwater).Keepchangingthe

waterasitcools.Ifthevictim’sfaceisaffected,applywarmcompressesoneafteranother.Pain,colorchangesandchangesinsensationwilloccurasthetissuewarms.Warmingiscompletewhentheaffectedtissueissoftagainandfullfeelingreturns.

7. Oncefingersandtoeshavethawed,wrapthemindrygauze,beingcarefultoseparatethedigits.8. Movetheinjuredtissueaslittleaspossible.9. Ifthefrostbiteissevereandaffectsmorethanonearea,givewarmfluids(NOTalcohol)to

warmthevictimandreplenishfluids.10. DoNOTbreakanyblistersthatform11. DoNOTrewarmifthereisariskofrefreezing-waituntilyoucangetmedicalassistance)12. DoNOTusedirectheattothawdamagedtissue(i.e.hairdryer,heatingpad)13. DoNOTmassagetheaffectedarea

ForeginBodiesAforeignobjectinanypartofthebodycancausepain,infection,andotherproblems.Mostcommonly,foreignbodiesarefoundintheear,eye,noseorskin. Ear Foreignbodiesintheearcanleadtohearingloss,pain,andinfection.TheimportantthingtorememberistoNEVERstickanythingintheearinanattempttoremoveanobject.Doingsomaypushtheforeignbodydeeperintotheearandmayresultindamagetotheear.Ifyoucanseetheobjectandgrabitwithapairoftweezers,removeit.Usegravitybyhavingthepersontilttheirheadtowardtheearwiththeforeignbody. Manytimes,aninsectwillcrawlintoanearseekingthewarmthandconfinedspace.Ifyouknowthataninsectisintheear,youmaybeabletoremoveitbywarmingsomebabyoilandpouringitintotheear.Theoilwillservetodrowntheinsectandmayallowtheinsecttofloatoutoftheear.DoNOTusethismethodifthereisanydrainagefromtheearthatmightindicatearupturedeardrum.Youshouldnotusethismethodinanychildwhohastubesinhisearsforrecurrentearinfections. Whetherornotthesemethodsaresuccessfulinremovingtheforeignbodyfromtheear,alicensedpractitionershouldchecktheaffectedearassoonaspossible. Eye Foreignbodiesintheeyecanleadtovisionloss,painandinfection.Besureyourhandsarecleanbeforeyoustartworkingwiththeeyes.Manytimes,itmaybepossibletoremovetheforeignobjectbyflushingtheeyewithsalinesolutionorcleanwaterwhileholdingyoureyelidopen. Iftheobjectisembeddedintheeyeball,doNOTremoveit.Instead,covertheeyelooselywithagauzepadandgetimmediatemedicalattention.Anobjectdeeplyembeddedintheeyeballmustberemovedsurgicallytopreventfurtherdamagetotheeye. Ifyouflushaforeignbodyfromtheeyebutthevictimcontinuestohavepainorredness,orifthevictimcannotseenormally,medicalattentionisimmediatelyrequired. Nose Foreignbodiesinthenosecanleadtopainandinfection.TheimportantthingtorememberistoNEVERstickanythinginthenoseinanattempttoremoveanobject.Doingsomaypushtheforeignbodydeeperintothenoseandmayresultindamagetothestructuresofthenose.Ifyoucanseetheobjectandgrabitwithapairoftweezers,removeit. Instructthevictimtobreathethroughhismouthuntiltheforeignbodyisremoved.Breathingthroughhisnosemaycausetheobjecttoenterthevictim'swindpipeorlungs.Instead,havehimblowhisnosegentlyinanattempttoremovetheobject.Iftheobjectisnotremovedusingthesemethods,seekmedicalhelpforprofessionalremoval. Skin Foreignbodiesintheskincanleadtoinfectionandpain.Beforeattemptingtoremoveanobjectfromtheskin,makesureyourhandsareclean.Iftheobjectintheskiniswood,doNOTsoaktheextremity.Gettingthewoodwetwillcauseittoswellandfragment,makingtheremovalmoredifficult.Ifenoughoftheforeignbodyisabovetheskin,youmaybeabletograspitwithtweezersandpullitout.After

removal,gentlysqueezetheareaaroundthewoundtoencouragebleedingtowashoutanyfragmentsthatmightbeleftbehind.Applysomeantibioticointmentandcovertheareaifitislikelytogetdirty.Besuretoconsultwithyourhealthcareprovidertodetermineifyoushouldreceiveatetanusshot. Occasionally,theforeignbodywillbecompletelyunderthetoplayerofskin.Ifyoufeelcomfortableusingasharpneedletoremovetheobject,youmustfirstcleantheneedleaswellaspossibleusingrubbingalcoholorsoapandwater.Ifyoucanseethepointofentryfortheobject,usetheneedletolifttheskinabovetheobjectandmovethepointoftheneedletoliftthetipoftheforeignbodyoutabovetheleveloftheskin.Usethetweezerstograsptheobjectandpullitout.Cleansethewoundthoroughly,applyatopicalantibioticointment,andcoverthewoundifitislikelytogetdirty.Again,besuretocheckonthestatusofyourtetanusimmunization.

TraumaticToothLoss Losingatoothduetotraumadoesnotalwaysmeanthatatoothislostforever.Ifatoothislostduetotraumayoushould:

1. Avoidtouchingtherootsofthetooth-handleitbythecrownonly.2. Avoidrubbingthetoothinanefforttocleanitofdebris.

3. Ifdebrisispresent,gentlyswishthetootharoundforlessthan10secondsinabowl

oflukewarmwater-doNOTrinsethetoothunderrunningwater.

4. Attempttoplacethetoothbackinitssocket.Bitedowngentlyonapieceofgauzeormoistenedpapertowelifitwillnotgoallthewayin.

5. Ifthetoothwillnotgobackintothesocket,placeitinsomemilkoramildsaltwatersolution.

6. Seeadentistassoonaspossible-thesooneradentistisconsulted,thebetterthechanceof

successfulreimplantation.

BitesandStings Animalbitescanbedangerousforseveralreasons.Animalbitescanbedeepandthereisahighriskofinfection.

1. Ifthebiteisminor,cleanthewoundthoroughlywithsoapandwaterandapplyathinlayerofantibioticcream.Coverwithabandage.

2. Fordeeperwounds,applypressuretostopanybleedingandseekmedicalattention.Ifmedicalhelpisnotreadilyavailable,stopanybleeding,cleanthewoundwellandapplyacleandressinguntilmedicalattentionisavailable.

Anytimetheskinisbroken,thereisriskofinfection.Signsofinfection(redness,swelling,painthatisgettingworseinsteadofbetter,warmth,redstreaksmovingoutfromthewound)requiremedicalhelpimmediately.Atetanusshotisrequirediftetanusisnotuptodate. Ifthereisachancethattheanimalcarriedrabies,itiscriticalthatmedicalhelpbesoughtimmediately.Ifpossible,cagetheanimalthatbitthevictim,butdonotriskasecondbitetoyourself.Rememberthatunimmunizeddomesticatedanimalscanalsocarryrabies.InmanyareasoftheUS,alargeproportionof

thepopulationsofbatsandskunksarerabid.Anywildanimalthatisactingunusually(i.e.itletsyougetclosetoit)maybeillwithrabies. HumanBites Thehumanmouthisverydirty--andhumanbitescanbeworsethananimalbites.Forhumanbites,itisimportanttocleanthewoundverywellwithsoapandwater.Applyathinlayerofantibioticcreamandacleanbandage.Watchforsignsandsymptomsofinfectionandseekmedicalcareifanydevelop. Ifthewoundisverydeep,gethealthcareassoonaspossible.Again,ifyouhavenothadatetanusshotinthelasttenyears,seekmedicalcaretogetoneassoonaspossibleafterthewound. InsectBitesorStings Insectbitesandstingscanbeaproblemnotonlyduetolocalizedpainandswelling,butalsobecauseofthegeneralizedsystemicreactionsthatcanoccur.Ifavictimhasbeenbitorstung:

1. Movetoanareawherethevictimissafefromadditionalbitesorstings.2. Removethestingerifitisstillstuckintheskin.Dothisbyscrapingafingernailorotherobject,

suchasacreditcard,acrosstheskin;avoidtryingtopluckthestingeroutwithyourfingersasthismayreleasemorevenomintotheskin.

3. Cleansetheareawithsoapandwater.4. Applyanicepackorcoldclothtohelpreduceswellingandpain.5. Ibuprofenoracetaminophenmayrelievethepaincausedbyinflammation.Atopical

antihistaminemayhelprelievepainandswelling.CalamineorCaladryllotionmayhelpwithitching.Apastecreatedfromwaterandmeattenderizerorbakingsodamayalsohelpreduceswellinganditching.

SnakeBite

Mostsnakeswillavoidyouifpossibleandwillbiteonlywhenthreatenedorsurprised.Ifyoucomeacrossasnake,backawayslowlyandleavethesnakealone. Ifyouorsomeonearoundyouarebitbyasnake:

1. Call9-1-1.2. Remaincalmandtrytorememberwhatthesnakelookslike(color,markings,shapeofpupils).3. DoNOTtrytocatchthesnake(andneverbringalivesnaketothehospital).

4. Immobilizetheaffectedareawithasplint.5. Keeptheareaaffectedbythebitelowerthantheheart.6. Keepthevictimasquietaspossibletokeepthevenomfromspreading.7. Ifpossible,cleanthewoundgently.Donotflushitwithwater.8. DoNOTcutthewoundortrytosuckthevenomfromthebite.DoNOTapplyiceora

tourniquet.9. Removeanyjewelryorotheritemsthatmightconstricttheareaifswellingoccurs.

Anaphylaxis

Somepeoplearehighlyallergictocertaininsectbitesorstings.Certainfoods,suchaspeanuts,canalsocauseasevereandlife-threateningallergicreaction. Anaphylaxisisasevereallergicreactionthatcanrapidlycausedeathifnotimmediatelytreated.Anaphylaxiscausesadangerousdropinbloodpressureleadingtoshock.Itcanalsocauseswellingoftheairwayleadingtoinabilitytobreathe.Symptomsmayoccurwithinminutesofexposuretotheallergen. Symptomsandsignsmayinclude:

� Shortnessofbreath � Swellingoflips,eyes,mouthorthroat � Dizzinessorfaintness � Wheezingordifficultybreathing � Rapidheartrate � Nausea/vomitingordiarrhea � Hivesorrash � Flushedorpaleskin � Lossofconsciousness

Ifyouarewithsomeoneexperiencingananaphylacticreaction:

� Call9-1-1immediately. � Checktoseeifhe/sheiscarryinganEpiPen.Ifthevictimisable,havetheminjectthemselves;if

theyareunable,assistthemtousetheEpiPen.EpiPenuseissimple:Remember“bluetothesky,orangetothethigh”.Holdthepenfirmlywiththeorangesidepointingdown.Removethebluecapbypullingstraightup-donotbendortwist.Pushtheorangetipfirmlyintothemid-outerthigh.Youwillhearaclick-holdfirmlyinplaceforseveralseconds.

� Lie the victim down with the legs and feet elevated, loosen tight clothing and keep them warm.

� Monitorthepatientclosely.Ifthepatientstopsbreathingorlosestheirpulse,startCPRandcontinueuntilhelparrives.

ThemedicationcontainedinEpiPensispotentbutwearsoffquickly.Evenifthevictimfeelsbetterafterreceivingtheinjectionofepinephrine,theymustgotothehospitalincasesymptomsreturn.

MinorCutsandPunctureWounds Cutsandpuncturewoundsarecommoninjuries.Firstaidfortheseinjuriesincludes:

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Controlbleedingbyapplicationofpressuretothearea(seethesectiononBleeding). Elevatetheinjury. Applyacoldpacktoreduceswellingandpain. Cleanthewoundthoroughlywithsoapandwaterandapplyatopicalantibioticcream. CoverthewoundwithaBand-Aidorcleanbandage. Changethedressingifitbecomessoiled. Ifthewoundisdeeporlarge,seekmedicalcaretodetermineifstitchesarerequired.Thismustbedonewithinthefirstfewhoursafterinjury.

� Atetanusshotmaybenecessaryifyouhavenothadoneinthelasttenyears-checkwithyourphysician.

• Watchforsignsofinfection(redness,swelling,drainage,orpainthatisgettingworseinsteadofbetter)andgettreatmentifyouthinkthewoundisgettinginfected.