First Aid And Cpr

how to do it

TM

Mind & Body

First Aid & CPR

published by Barnes & Noble

In case of emergency, be prepared. You never know when you’ll be confronted by an accident or emergency: they can happen in the home, at work, or even out in public. To make sure you remain cool under pressure, learn the fundamentals of first aid, including: • When and how to intervene in a crisis • How to perform CPR, rescue breathing, and the Heimlich maneuver • How to respond to more than 30 different health emergencies

First Aid Basics First aid skills are techniques that a first responder to the scene of an injury or illness can use to help an injured or sick person until medical professionals arrive. First aid may involve assisting with something as simple as a minor cut or as complex as performing CPR (cardiopulmonary resuscitation).

First Aid and the Law People are sometimes hesitant to provide help during an emergency for fear of being sued if they do something wrong. Most states have passed Good Samaritan laws that protect volunteers who provide first aid from lawsuits, provided the volunteer follows three general guidelines: • Obtain consent before giving first aid: A person has the right to refuse first aid. Before acting at the scene of an emergency, identify yourself and tell the victim that you know first aid. Then ask for permission to help. • Expressed consent: If the victim gives permission, you may begin first aid. • Implied consent: If the victim is unconscious or unresponsive and the situation is life-threatening, you may assume that if the person were able to respond, he or she would likely have accepted help. You may then begin first aid. • Don’t abandon the victim: Once you’ve begun first aid, don’t stop until medical assistance arrives or until you’re so exhausted that you can’t continue giving care. • Give first aid according to your training: Follow the practices that you’ve been taught. Don’t try to perform first aid procedures beyond your skill level. Good Samaritan laws can’t guarantee that you won’t be sued for something you did or didn’t do at the scene of an emergency. But very few Good Samaritans are sued, and even fewer lose in court.

Duty to Act If you’ve been trained in first aid, you have a moral duty to provide first aid to the victim of an emergency. But in most states, you are legally compelled to provide care only if: • It’s your job: If you’re trained to perform first aid as a part of your job, then you must provide first aid in an emergency while you’re on duty. Nurses, doctors, policemen, firefighters, and lifeguards all must provide first aid when on duty.

• You’re responsible for the victim: If you’re in a position of responsibility for other people, such as a teacher or a Boy Scout leader, you must provide care for those in your charge if they’re injured or ill. A few states have laws that require any bystander to help the victim of an emergency to the best of their ability, as long as doing so doesn’t endanger the first aid provider. Check your state’s laws to confirm your responsibilities.

First Aid Courses The best way to learn, and the only way to get certified in first aid and CPR, is to take a first aid course. • What’s covered: Courses provide extensive training about what to do in a variety of emergency situations. • Who offers courses: Your local chapter of the American Red Cross or the American Heart Association (AHA) offer first aid and CPR courses. Many fire departments and medical centers do as well. • Length and cost: First aid and CPR courses vary in length and cost. Contact your local Red Cross or AHA chapter for further information. • Certification: You’ll have to pass a test in both first aid and CPR to get certified. To remain certified, you’ll need to update your knowledge and skills periodically. This guide serves as a handy quick-reference for some of the most important first aid and CPR procedures, but it should not serve as a replacement for the hands-on training provided by a course.

The First Aid Kit Though you can give basic first aid and CPR without tools, a few supplies can make it safer, easier, and more effective. It’s a good idea to assemble a simple first aid kit for your home, car, boat, workplace, or anywhere else you spend lots of time. You can find first aid supplies at pharmacies and medical supply stores. • Sterile gauze bandages: For covering cuts and wounds. They come in various sizes and forms. You should have 2"× 2" pads, 4"× 4" pads, a large absorbent pad, as well as roller-type gauze.

• Adhesive tape: To hold gauze bandages or splints in place. Usually sold in rolls, like Scotch tape. • Adhesive bandages: To cover cuts or wounds without the need for adhesive tape. You should have large and small bandages, and they should be sterile if possible. Latex-free bandages are best, since some people are allergic to latex. • Elastic bandages: To bind and immobilize fractures and sprains temporarily, or to hold splints in place. • Bandage scissors: To cut bandages to the appropriate size and to snip adhesive tape. • Instant cold pack: To provide immediate source of cold without the need for refrigeration. • Waterless hand wash or moist towelettes: To sanitize hands and skin after providing first aid.

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Protecting Yourself Blood, or body fluids contaminated with blood, may carry infectious diseases such as hepatitis or human immunodeficiency virus (HIV). First aid kits should contain medical exam gloves, CPR mouth shields, and/or other equipment to limit this risk. • Medical exam gloves: To protect your hands and skin from contact with blood and bodily fluids. Latex-free gloves are best, but any rubber gloves are better than nothing at all. • Mouth shield: To let you perform CPR without any actual mouth-to-mouth contact. There are two main types: Pocket Masks™ (generally used by medical professionals) and Microshields® (more common among Good Samaritan responders).

First Aid & CPR

www.quamut.com 1. Straighten the victim’s legs and place the arm closest to you at a right angle to the body. Remove any bulky items from the victim’s pockets.

If you’re exposed to body fluids in any way, call your healthcare provider as soon as possible for guidance.

What to Do During an Emergency No two emergencies are exactly the same. But there is a general plan of response that you should follow in every emergency situation.

1. Survey the Scene

2. With one hand, lift the arm farthest from you and bring it across the victim’s chest. Hold the arm so the back of the victim’s hand is against the cheek closest to you. With your other hand, lift the knee farthest from you so that the victim’s far foot rests flat against the ground.

You can’t help a victim if you get hurt yourself. Before providing first aid, always check the scene for dangers such as: • • • • •

Fire Downed power lines Hazardous chemicals Unsafe structures Traffic

Never attempt to enter a dangerous scene. Instead, call 911 and explain the situation. The 911 operator will dispatch the appropriate public safety workers.

2. Decide Whether to Move the Victim

Assessing Illness or Injury

3. Roll the victim gently toward you, without ever allowing the victim’s hand to lose contact with his cheek. The hip and knee of the victim’s top leg should both be bent at right angles. Tilt the head back slightly to keep the airway open.

In the vast majority of emergencies, you should not move the victim. Movement can worsen injuries the victim may already have sustained. However, there are a few scenarios in which you may need to move a victim: • If the victim is in immediate physical danger • If the victim’s injury or illness is life-threatening and the victim is positioned in a way that prevents you from providing first aid

How to Move a Victim If you do have to move a victim, follow these guidelines: • Keep the spine and neck straight: Always keep the neck and spine in a straight line. Never move a victim sideways—only in the direction of the head or feet. • Drag by the collar: If possible, try to pull the victim by the collar, using your forearms to support the head. • Pull from shoulders or feet: If you can’t move the victim using only his clothes, pull the body from both feet or both shoulders.

The Recovery Position The recovery position is a body position that keeps the victim’s airway unobstructed. It should be used when a person is injured or ill but breathing normally. It should not be used if breathing is unstable or if you suspect a spinal injury.

B. If you’re alone and the victim is an adult: Call for help yourself and then continue your assessment. C. If you’re alone and the victim is a child or infant: Deliver five cycles of CPR before calling 911. 3. Try to open the airway: A foreign object or the victim’s tongue may be obstructing the airway. With the victim on his back, open the airway by tilting the head back with one hand while tilting the chin upward with the other. 4. Take ten seconds—and no longer—to check for normal breathing: Watch to see whether the victim’s chest is rising. Put your ear close to the victim’s mouth and nose and listen and feel with your cheek for breathing. Don’t mistake gasping for breathing. A. If the victim is breathing: Put him in the recovery position and wait for medical help. B. If there’s no sign of breathing: Perform CPR.

If the victim is breathing, assess for illness or injury. Question the victim, question other people at the scene, and observe the victim. If you observe (or the victim reports) any of the signs listed below, call 911: • • • • • • • •

Sudden dizziness or fainting Decreased level of responsiveness Shortness of breath or difficulty breathing Sudden, severe vomiting Weakness in or loss of use of an extremity Change in vision Chest or abdominal pain or pressure Sudden or severe pain in any body part

You should also palpate (feel) the victim’s body from head to toe to check for:

3. Assess the Victim Assessing an ill or injured person will give you the information you need to begin providing first aid.

Assessing Airway and Breathing 1. Assess consciousness: Approach the victim and ask, “Are you okay?” A. If the victim is able to talk or cough: This means he has an open airway and is breathing. Skip to “Assessing Illness or Injury” below. B. If the victim does not speak: Check for responsiveness by tapping or gently shaking his arm. If the victim responds by talking or coughing, skip to “Assessing Illness or Injury” below. 2. If the victim still doesn’t respond: Call 911. A. If someone else is with you: Have that person call for help while you stay with the victim.

• • • • • • •

Severe bleeding Unusual skin color or temperature Abnormal breathing Deformities, such as extremities in abnormal positions Verbal complaint of pain when a body part is touched Swelling or tenderness in any area Cuts or scrapes

4. Calling for Help The most important aspect of first aid is knowing when and how to summon medical assistance. You should always call for help when: • The victim is unconscious or unresponsive • You believe that the victim’s condition is, or could become, life-threatening • There has been a car accident, fire, or explosion • There are downed electrical wires or a hazardous substance is present

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This chart and the information contained in this chart are for general educational and informational uses only. Nothing contained on this chart should be construed or intended to be used for medical diagnosis or treatment. Users are encouraged to confirm the information contained herein with other sources and review the information carefully with their physicians or qualified healthcare providers. The information is not intended to replace medical advice offered by physicians or healthcare providers. Should you have any healthcare-related questions, please call or see your physician or other qualified healthcare provider promptly. Always consult with your physician or other qualified healthcare provider before embarking on a new treatment, diet, or fitness program. The publishers will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising therefrom.

www.quamut.com Copyright © 2007 Quamut All rights reserved. Quamut is a registered trademark of Barnes & Noble, Inc. 10 9 8 7 6 5 4 3 2 1 Printed in the United States Writer: Linda Hepler

First Aid & CPR

www.quamut.com If you believe that the condition is or may be life threatening, or if you are uncertain what to do, you should always call for help—even if the victim refuses first aid.

How to Summon Help Calling 911 is the most common way to access the emergency response system, though some phone systems have different contact methods. In some locations, dialing 911 doesn’t work, so make sure you know the specific numbers to call for emergency help from home, work, and anywhere else you spend considerable time. When you call your local emergency number, be ready to share the following information:

Chest Compressions

Automated External Defibrillators (AEDs)

Chest compressions circulate blood through the victim’s body until the heart begins to beat on its own. Chest compressions for adults and children are performed differently from those for infants.

An automated external defibrillator (AED) is a machine that can deliver an electric charge, or defibrillation, that for certain types of cardiac arrest can “shock” the heart back into normal rhythm. Used in combination with CPR, AEDs greatly increase survival rates. AEDs can be dangerous to you and to the victim if used incorrectly. They should be used only by people who have received the proper training. Most Red Cross and American Heart Association chapters offer AED training.

Chest Compressions for Adults and Children 1. Place the heel of one hand in the center of the victim’s chest, on the sternum (breastbone). Place the heel of your other hand on top of the first hand. Interlock your fingers and lift them up, but keep the heel of the hand against the victim’s chest. Make sure the heel of your hand is on the middle of the victim’s sternum, not on the bottom end, which is fragile and may break off.

• Your name, location, and the telephone number from which you’re calling • Type of emergency (car accident, animal bite, heart attack, etc.) • Number of persons injured • Condition of victims and treatment received so far.

Choking is the partial or total obstruction of the airway by a piece of food or other object. First aid for a choking adult is different from first aid for a choking infant.

First Aid for a Choking Adult

CPR

Rescue Breathing If the victim is not breathing, it’s crucial to get air into his body by giving rescue breaths. Rescue breaths can be given through a face shield or mask, or directly mouth-to-mouth. The steps for delivering rescue breaths are: 1. Head tilt: Use a head tilt to make sure the victim’s airway is open (see Assess the Victim). 2. Form a seal: If using a face shield or mask, place it over the victim’s face, holding the edges of the shield snugly against the face with the fingers of both hands to make a tight seal. If providing direct mouth-tomouth, place your mouth over the victim’s mouth to make a seal. Pinch closed the nose, using the hand that’s tilting the victim’s head back.

Respiratory problems can be caused by many different injuries and illnesses. The most common are choking, asthma, and hyperventilation.

Choking

Don’t hang up until the emergency response operator tells you to do so. You may need to answer further questions or follow instructions vital to the victim’s survival.

CPR, short for cardiopulmonary resuscitation, is a technique that keeps blood and oxygen flowing through the body of a person who isn’t breathing and whose heart has stopped. Immediate CPR applied until medical help arrives doubles a victim’s chances of survival.

Respiratory Problems

2. With your body directly over the victim and elbows straight, push down firmly. Compress the chest about 1 1/2–2". Allow the chest to return to the normal position between compressions but always keep your hands in contact with the victim’s chest. Give compressions at a rate of about 100 per minute— about one and a half compressions per second.

Chest Compressions for Infants To give chest compressions to an infant, place your middle and index fingers slightly below the nipple line at the center of the chest. Push the chest in about 1/2–3/4".

Ask the victim, “Are you choking?” If the victim can talk or cough, the airway is not completely blocked. Encourage the victim to try to Signs of Choking cough out the object. • Coughing or wheezing If the victim can’t talk • Difficulty breathing or cough, then the air• Grasping at the throat way is blocked. Ask • Bluish color around mouth the victim’s permission to administer the Heimlich maneuver. 1. Stand behind the victim. Wrap your arms around the victim’s abdomen (or chest, if the victim is heavyset or pregnant). 2. Make a fist and place it between the victim’s sternum and navel, with the thumb side facing the victim. 3. With your other hand, grasp the hand that’s formed into a fist. Thrust your hands quickly inward and upward to expel the object. If the victim loses consciousness, check his airway and breathing. If necessary, begin CPR.

First Aid for a Choking Infant

3. Give two rescue breaths: Take a normal breath, then give a one-second-long rescue breath. Repeat. Watch for the victim’s chest to rise with each rescue breath. 4. If the chest does not rise: The breath may not be getting through the airway. Re-tilt the head and give two more rescue breaths. If the breaths still aren’t going in, give care for choking. 5. If the victim begins breathing: Put him in the recovery position and wait for medical help. 6. If the victim does not begin breathing: Begin chest compressions (see below).

Rescue Breaths on Infants Rescue breathing for infants is identical to that for adults, except that you should form a seal over both nose and mouth with your mouth.

Cycles of CPR After the two initial rescue breaths, CPR should be given in cycles—30 chest compressions followed by two rescue breaths. Two full cycles of CPR would be: • First cycle: 30 compressions, 2 breaths • Second cycle: 30 compressions, 2 breaths Continue giving cycles of breathing and compression until the victim has started to breathe on his own or until medical help has arrived. If the victim starts breathing at any time, put him in the recovery position and wait for medical help.

1. Lay infant face down on your forearm, with your hand beneath the chest and fingers supporting the head. 2. Give 3–5 quick, sharp blows with the heel of your hand to the baby’s back, between the shoulder blades. 3. If the object is not expelled, back blows turn the infant face up on your other forearm, keeping the infant’s head supported. 4. Give 3–5 chest thrusts with two fingers placed in the center of the chest, a finger width below the nipple line. 5. Alternate back blows and chest thrusts chest thrusts until the object is expelled. If the infant loses consciousness, check his airway and breathing. If needed, call 911 and begin CPR.

First Aid & CPR

www.quamut.com Asthma Attacks

External Bleeding

Asthma is a condition Signs of an Asthma Attack in which the airways • Wheezing in the lungs narrow, • Coughing making it difficult to • Chest tightness breathe. Dust, smoke, and exercise are common triggers for asthma attacks, though attacks may also occur without an obvious trigger.

Most external bleeding can be stopped by applying direct pressure to the wound.

1. Assist the victim into a comfortable position. 2. Ask the victim to try to breathe slowly and deeply. 3. Most people with asthma have blue-capped reliever inhalers that help lessen attacks. If the victim has an inhaler, help him find and use it. Most asthma attacks ease after three or four minutes. If the attack continues past five minutes or the inhaler seems to have no effect, call 911. If the victim becomes unconscious, check his airway and breathing. If necessary, begin CPR.

Hyperventilation Hyperventilation is overly fast and deep breathing, often brought about by anxiety or panic.

Signs of Hyperventilation • Fast or deep breathing • Lightheadedness • Tingling in the hands

1. Reassure the victim. 2. Lead the victim to a quiet place, if possible. 3. Ask the victim to concentrate on breathing with his abdominal muscles and to breathe in through the nose and slowly out through the mouth. Breathe along with the victim to help slow his breathing down. Do not have the victim breathe into a paper bag.

Anaphylactic Shock Anaphylactic shock Signs of Anaphylactic Shock is a severe, life-threat• Itching skin, eyes, or nose ening allergic reaction. • Congestion and sneezing Common triggers may • Hives (red skin rash) include insect stings, • Difficulty breathing medications, and cer• Swollen face and tongue tain foods, such as shellfish or peanuts. If you suspect anaphylactic shock, call 911 immediately. Assist the victim into the position of greatest comfort and try to determine what caused the allergic reaction. If the victim loses consciousness, monitor his airway and breathing and be ready to perform CPR.

Auto-Injectors Some people who know they have severe allergies carry an auto-injector, a device that injects a substance called epinephrine, which relieves allergic reactions. Auto-injectors are often referred to by the brand name EpiPen ®. If the victim has an auto-injector, you may have to help him use it. The injection is given in the side of the thigh. Follow the instructions on the wrapper.

Bleeding Bleeding occurs when blood vessels, which circulate blood throughout the body, are ruptured in an injury. If the injury breaks the skin, external bleeding occurs. If the skin isn’t broken, internal bleeding occurs, in which blood from broken blood vessels pools within the body. Both types of bleeding can result in shock. When providing first aid for a bleeding person, wear gloves if possible.

1. Apply direct pressure to the wound using your fingers or palm. If available, use a sterile gauze dressing folded in half or fourths. If you don’t have a clean dressing, a handkerchief, scarf, T-shirt, or other clean cloth will do. 2. Unless you believe there has been a fracture, lift the injured limb above the level of the heart to limit blood loss (see Skeletal Injuries for more on fractures). 3. If blood soaks through the dressing, put another dressing on top of the first and apply increased pressure. 4. If the bleeding slows, clean the wound and surrounding area with running water or alcohol-free wipes. Pat dry and cover with gauze or an adhesive bandage. 5. If the bleeding does not slow, call 911. Continue to apply pressure to the wound until medical help arrives. 6. If the victim has lost a lot of blood and is dizzy or confused, or if he has clammy skin and is breathing rapidly, treat him for shock.

Nosebleeds 1. Place the victim in a seated position with his head tilted slightly forward and ask him to breathe through his mouth. This will prevent blood from obstructing the airway or running down the back of the throat. 2. Using a gloved hand, pinch the nostrils together. If the victim is able to do this himself, allow him to do so. 3. Check to see whether the bleeding has stopped after ten minutes. If not, continue pinching for ten minutes, and then, if necessary, ten minutes more. 4. If the bleeding stops, advise the victim to rest for a few hours and to avoid blowing his nose, spitting, coughing, or sniffing during this time. 5. If the bleeding doesn’t stop, transport the victim to a medical center.

Internal Bleeding

Signs of Internal Bleeding

Internal bleeding can be • Bruising minor (mild bruises) or • Pain severe (bleeding organs). • Swollen or tender area If you believe that the internal bleeding is severe, call 911 immediately. If you suspect that the internal bleeding is due to a bone injury, treat the bone injury (see Skeletal Injuries) and summon medical assistance.

Shock Shock is a life-threatSigns of Shock ening condition that oc• Confusion or dizziness curs when a person’s • Change in responsiveness circulatory system is • Cool, clammy, pale skin unable to supply the • Nausea, vomiting, or thirst body with oxygen. The most common cause of shock is blood loss, though it can also be caused by a heart attack, burns, or fluid loss from vomiting or diarrhea. Symptoms of shock may appear suddenly or slowly, which makes it difficult to spot. Any time a victim has severe fluid loss, burns, or heart trouble, look out for signs of shock. 1. If a victim appears to be in shock, call 911. 2. Search for and treat the cause of the shock, if you are not already aware of it. 3. Help the victim to lie on his back. 4. Elevate the legs about 12 inches from the floor. Be very careful doing this if there are possible fractures. 5. Cover the victim with a coat or blanket to help maintain body temperature. Loosen any tight clothing that might restrict blood flow. 6. If the victim vomits, make sure he can still breathe and put him in the recovery position. 7. If the victim becomes unconscious, check for airway and breathing. If there is no breathing, begin CPR.

Heat and Cold Ailments Extremely hot or cold temperatures can cause medical problems, especially if the victim is exposed to such condition for a long period of time. Temperature-related injuries often have a gradual onset but then progress rapidly to an emergency-level situation.

Cold-Related Ailments The two most common cold injuries are frostbite and hypothermia.

Frostbite Frostbite is the freezing Signs of Frostbite of skin tissues. It occurs • White or gray waxy skin when skin is exposed to • Numb or tingling skin freezing temperatures (or • Severe frostbite: less near-freezing with a wind pain and hard skin chill) for an extended period of time. Severe frostbite can result in tissue death, called gangrene. Frostbite victims should receive immediate medical attention as soon as possible. Meanwhile, provide the following first aid: 1. 2. 3. 4.

Move the victim to a warm area. Remove any wet clothing. Remove any clothing or jewelry around the frostbite. Don’t warm the frostbitten area unless medical facilities are inaccessible. 5. Elevate the frostbitten area to reduce swelling. If you must re-warm the frostbitten area, immerse the body part in lukewarm water. If immersion is impossible, cover with lukewarm towels. Pat dry and cover in light gauze to protect against rubbing.

Hypothermia Hypothermia is a drop Signs of Hypothermia in a person’s body tem• Lowered responsiveness perature after long expo• Unnatuarlly cool skin sure to cold air or water. • Violent shivering If the victim is elderly or an infant, call 911 immediately. If victim is young and fit and the symptoms are not extreme, provide first aid and wait a few minutes to determine whether medical attention is required. 1. Move the victim quickly to a warm place. 2. Remove any wet clothing. Cover the victim with dry clothing, a blanket, or even newspapers. 3. If the victim can swallow, give warm liquids to drink. 4. If you’re at all unsure of the victim’s condition, transport him to a medical care facility or call 911.

Heat-Related Ailments The most common heat-related illnesses are sunburn, heat exhaustion, and heat stroke.

Sunburn Sunburn is caused by excessive Signs of Sunburn exposure to sunlight or to the rays • Red skin from a sunlamp in a tanning salon. • Pain Certain medicines make people • Blistering more susceptible to sunburn. If you’re on medication, check whether it has any side effects related to sun exposure. 1. Move the sunburned person into the shade or indoors. Provide cool water to drink. 2. Sponge the affected skin with cold water or soak the affected areas in cold water for 10–15 minutes. 3. If no blistering develops, soothe the skin with calamine lotion. If blistering develops, get medical assistance.

First Aid & CPR

www.quamut.com Heat Exhaustion Heat exhaustion results when a person loses too much water and salt as a result of excessive sweating. It can be caused by overexertion, hot weather, or illness.

Signs of Heat Exhaustion • • • •

Sweating, clammy skin Headache Dizziness and confusion Nausea or cramps

1. Move the victim to a cool place, and have him lie down and elevate his legs. 2. Provide plenty of cool water to drink. If possible, add salt to the water at a ratio of one teaspoon per quart. 3. Transport the victim to a medical center, even if he seems to have recovered. 4. If the victim’s condition deteriorates, put him in the recovery position and monitor breathing. Be ready to provide CPR if necessary.

Heat Stroke Heat stroke occurs when the body can no longer cool itself. It can stem from prolonged heat exhaustion, fever, or heat exposure. The goal of heat stroke first aid is to lower the victim’s body temperature.

Signs of Heat Stroke • • • • • • •

Dry, red, hot skin Absence of sweating High fever Vomiting Rapid, shallow breathing Seizures Unresponsiveness

1. Call 911. 2. Move the victim to a cool place. 3. Wrap the victim in a cool, wet sheet, or sponge with cool water and/or place ice packs against his neck. If no water or ice is available, fan the victim. 4. If possible, monitor the victim’s body temperature with the goal of reducing it to at least 100.4°F (38°C). 5. If the victim’s body temperature falls to target level, replace the wet blanket with a dry one and put the victim into the recovery position. 6. Monitor body temperature and breathing. If the victim’s body temperature rises, return to cooling the body. If the victim loses consciousness, check his breathing and, if necessary, begin CPR.

Head, Neck, and Spinal Injuries Head, neck, and spinal injuries are most often caused by falls, car crashes, diving accidents, or blows to the head, neck, or chest.

Head Injuries Head injuries range from concussions that cause brief impairment of consciousness to grave, life-threatening injuries. Any serious head injury should be treated also as an injury to the spine or neck.

Concussion Concussion occurs when the brain is “shaken” by an impact. To provide first aid for a concussion:

Signs of Concussion • Brief impairment of consciousness • Nausea or dizziness • Memory loss

1. Monitor the victim’s vital signs and responsiveness. 2. Do not leave the victim to his own care, even if he seems to have recovered. Make sure a person responsible for the victim remains near him at all times. 3. Advise the victim to go to the hospital if a headache, nausea, or drowsiness develops.

Serious Head Wounds

First Aid for Open (Compound) Fractures

The most common serious head wounds are skull fractures and cerebral compressions, in which internal bleeding puts pressure on the brain.

• Cover the open wound with a loose, sterile dressing. • Check for signs of shock. • Build up pads around and over the wound and bone. Never put direct pressure on a protruding bone. • Keep the victim still until medical help arrives. If the victim has to be transported to the emergency room, bandage as you would a closed fracture.

Skull Fracture

Cerebral Compression Symptoms

• • • • • •

• • • • • •

Falling responsiveness Head wound or bruising Soft scalp depression Bruising around eyes Blood from nose or ear Asymmetry of head or face

Falling responsiveness Drowsiness Intense headache Fever or flushed skin Unequal pupil size Paralysis on one side of the body

Treatment Call 911. If the victim is conscious, keep him comfortable but keep his head and neck motionless. If the victim is unconscious, monitor breathing until medical help arrives.

Call 911. If the victim is conscious, lay him down with his head and neck stabilized. If there is bleeding, control with pressure around (not directly on) the wound. If the victim is unconscious, monitor breathing until medical help arrives.

Spinal Injuries If you suspect a neck or spinal injury, don’t move the victim unless absolutely necessary.

Signs of Spinal Injury • Injury to head, neck, or back • Lack of feeling in extremities • Paralysis

1. Lay the victim flat and advise him not to move. 2. Call 911. 3. Kneel behind the victim’s head. Grasp both sides of the head to stabilize it in line with the neck and spine. If you must turn the victim to keep the airway open, roll him while supporting the head, neck, and trunk. Moving a victim with a spinal injury is an absolute last resort and should be done only if the need is dire.

Skeletal Injuries

A dislocation occurs Signs of Dislocation when a bone pops out • Searing pain of its normal position • Inability to move the area at a joint. Dislocations • Swelling and discoloration occur most often in • Awkward bending the shoulder, jaw, and fingers, though they can occur at any joint. As a first responder, your goal is to immobilize the injury and get the victim to the hospital. Never attempt to “snap” a dislocation back into place. 1. Call for medical help. Watch for signs of shock. 2. Keep the injured area immobilized. 3. Support the injured area with a sling secured with a bandage wrapped around an uninjured body part. 4. Check bandages every ten minutes to make sure they aren’t cutting off circulation.

Strains, Sprains, and Tears Other injuries that can occur to the ligaments, muscles, and tendons include strains, sprains, and tears. They have symptoms much like those for closed fractures. 1. If the pain is severe, call for medical help. 2. If not, immobilize the area with elastic bandaging. Try to reduce pain and swelling with ice and elevation. 3. If pain persists, call for medical help or transport the victim to the hospital.

Burns Heat, chemicals, and electricity can all cause burns. Though minor burns may only need first aid care, major burns need professional medical attention.

Major and Minor Burns

Skeletal injuries can involve bones, joints, or muscles. Bones can be fractured or dislocated from their correct position in a joint, while soft tissue such as muscles and ligaments may suffer strains, sprains, or tears.

Bone Fractures Bone fractures can be closed, meaning that the skin is left intact, or open, meaning that the broken bone has punctured the skin. Open fractures are also

Dislocations

Signs of Fracture • Loss of function • Pain, swelling, bruising called compound fractures.

First Aid for Closed Fractures 1. Ask the victim to keep still. 2. If there is significant bruising, or the fracture is of a large bone, call 911. Check for signs of shock. 3. Bandage the broken bone to an uninjured part of the body. If an arm is broken, bandage against the torso; if a leg is broken, bandage to the uninjured leg. The ties on the bandage should be on the uninjured side. 4. If bandaging the broken bone causes pain, stop immediately and call 911. If the victim feels coldness or tingling in his extremities, the bandages are too tight. 5. If possible, place a cold pack or bag of ice on the injured area. Keep a cloth between the ice and skin. 6. If movement causes the victim pain, call 911. If the victim can move without pain, transport him to the closest hospital emergency room.

The classification of a burn as minor or major depends on the burn’s depth and the area it covers. • Minor burns include: • All superficial burns, which cause red skin and pain. • Any partial thickness burns that cover an area smaller than your palm and don’t affect the head, neck, hands, feet, genitals, or respiratory system. Partial thickness burns cause blistering, swelling, and blotchiness. • Major burns include: • Any partial thickness burns larger than your palm or that affect the head, neck, hands, feet, genitals, or respiratory system. • All full thickness burns, which leave a charred or white appearance and usually are painless (because they cause nerve damage).

Thermal Burn First Aid Thermal burns are caused by fire or other heat sources. 1. If the victim’s clothing is on fire, help him drop to the ground and roll around in order to smother any flames. You can also smother the fire by covering it with a blanket or coat. 2. Once the fire is out, remove the burned clothing unless it is stuck to the skin. Remove jewelry over any burn before swelling occurs.

First Aid & CPR

www.quamut.com 3. If the burn is major, or if victim’s clothes were on fire, call 911 and treat him for shock. If the victim loses consciousness, check his airway and breathing. If there is no breathing, begin CPR. 4. If the burn is minor, immerse the burned area in a sink or bucket of cool (not cold) water, or cover it with a wet cloth for ten minutes. If possible, cover the burn loosely with a dry sterile dressing, but don’t tape the dressing.

Chemical Burn First Aid Chemical burns are caused by contact with harmful chemicals. If there are fumes or spilled chemicals on the scene, call 911 rather than provide first aid yourself. If the scene is safe: 1. Summon medical assistance for any chemical burn. 2. If the victim has been burned with a dry chemical, brush any remaining chemical off of the skin. Be very careful not to let the chemical touch your own skin. 3. Run water over the burned area for 30–60 minutes. 4. Remove jewelry and clothing from the burned area. 5. Put a dry sterile dressing over the burn, if available.

Electrical Burn First Aid Electrical burns are caused by direct exposure to electricity. For any electrical burn, make sure the source of electricity is no longer present or active before entering the scene, and call 911. Care for an electrical burn just as you would for a thermal burn (see above).

Poisoning Poisons are substances that have a toxic effect on body tissues. They can range from overdoses of medicine to household chemicals, industrial gases, or natural plant substances. The treatment depends on the specific poison. Poisons are most commonly ingested or inhaled.

Ingested Poisons An ingested poison can damage the digestive tract and, if absorbed into the bloodstream, can cause additional damage to the body. Never induce vomiting in a case of ingested poison.

Signs of Ingested Poison • Burns or redness around mouth or lips • Breath smells like chemicals • Empty pill bottles • Nausea or vomiting

1. Try to determine what caused the poisoning. Look for a bottle and ask the victim or his family. 2. If victim is responsive, call the national Poison Control Center (800.222.1222) and follow directions for care. 3. If victim is unresponsive, call for help, check his airway and breathing, and provide CPR if needed. Make sure there are no chemicals on the mouth before performing CPR.

Inhaled Poisons

Signs of Inhaled Poison

Gases or fumes that may • Headache cause poisoning include • Confusion or falling everything from carbon responsiveness monoxide (produced by • Dizziness auto engines and other • Seizures machines) to the fumes from household cleaners. Do not enter a scene where there may be gases or fumes until you’re absolutely sure it’s safe. 1. 2. 3. 4.

Move the victim to an area free of fumes. Once away from the fumes, call for medical help. If the victim vomits, put him in the recovery position. If the victim becomes unresponsive, check his airway and breathing. If necessary, begin CPR.

Heart Attack

Bites and Stings Insect and spider bites and stings can be a painful nuisance, or, if the victim is allergic, the source of a life-threatening emergency. Animal and snake bites can also cause lifethreatening situations.

Insect Stings and Bites The first step when dealing with an insect sting or bite is to ask whether the victim has an allergy to insect stings. If yes, call 911 immediately and prepare to provide first aid for anaphylactic shock. If the victim is not allergic: 1. Remove the stinger by gently scraping it away. Clean the area with soap and water if possible. 2. Apply a cold pack or ice to the sting site, keeping a cloth between the skin and the ice. 3. Observe the victim for 30 minutes for signs of an allergic reaction. At any sign of an allergic reaction, call 911 and treat for anaphylactic shock. Medical personnel should see any spider bite that causes symptoms such as sweating, nausea, or stomach cramps.

Animal Bites Animal bites can cause blood loss, spread disease, and lead to infection. Notify police about any animal bite. 1. If there are large or multiple wounds, call 911. 2. Stop bleeding with direct pressure to the wound ( see External Bleeding). 3. If necessary, treat the victim for shock ( see Shock). 4. Wash the wound with soap (if available) and water. 5. If medical assistance is not on its way, transport the victim to an emergency room as soon as possible.

Snake Bites Though few snakes in the United States are poisonous, it’s always best to be cautious when dealing with a snake bite. Call 911 and then follow these guidelines while awaiting the arrival of medical personnel. 1. Wash the bite with soap (if available) and water. 2. Immobilize the bitten body part and gently compress the part of the limb above the bite with bandages. 3. If the victim loses consciousness, check his airway and breathing and provide CPR if needed. Do not slash a snakebite with a knife, try to suck the poison from the wound, or do anything that prevents blood from reaching or leaving the site of the wound.

Emergency Medical Issues A number of medical conditions can appear very suddenly, demanding first aid care. The most common are fainting, hypoglycemia, seizure, heart attack, and stroke.

Fainting Fainting is a brief period of unconsciousness after which the victim recovers fully. It can result from pain, hunger, exhaustion, stress, surprise, or sudden action after inactivity.

Signs of Fainting • Lightheadedness • Brief loss of consciousness • Slow pulse

1. If the victim feels faint, advise him to lie down. If the victim faints while standing up, try to ease his fall. 2. Once the victim is lying down, elevate his feet about 12 inches above the ground. 3. Treat injuries that may have occurred during a fall. 4. When the victim regains consciousness, advise him to rest. As dizziness subsides, help him to a sitting position and then gradually to a standing position. 5. If dizziness persists after 15 minutes, transport the victim to a hospital or medical care facility.

A heart attack is a sudden loss of or drop in blood supply to the heart, usually caused by a blockage of one of the heart’s coronary arteries. 1. If you suspect a heart attack, call 911. 2. Sit the victim in a comfortable position. 3. If possible, have the victim slowly chew a tablet of aspirin. 4. Monitor breathing and be prepared to give CPR if necessary.

Signs of Heart Attack • Intense chest pain • Viselike pressure around the chest • Gasping for air • Sweating • Faintness • Sudden collapse • Ashen skin; blue lips Women, diabetics, and the elderly may experience different heart attack symptoms: a feeling similar to heartburn or indigestion, or discomfort in the jaw, shoulder, abdomen, back or neck.

Hypoglycemia Hypoglycemia is a lack of glucose (sugar) in the blood. It tends to strike people who are diabetic.

Signs of Hypoglycemia • Faintness or confusion • Clammy, sweaty skin

1. Provide a quick source of sugar, such as juice, non-diet soda, or a sugar packet. Many diabetics carry special glucose tablets for just this purpose. 2. If the victim does not improve within 15 minutes, give more sugar and call for help. Be prepared to provide CPR if necessary. 3. If the victim has a seizure, take actions to protect him (see below).

Seizure A seizure involves a loss Signs of Seizure or impairment of con• Loss of consciousness sciousness and loss of • Convulsive movements muscle control. Many • Arching of the back seizures are caused by a medical condition called epilepsy, but they can also result from head injuries, hypoglycemia, heat stroke, or poisoning. 1. Protect the victim by moving objects out of his way. If possible, put a towel or blanket beneath his head to protect it against impact with the floor. 2. Call for medical help. 3. After the seizure is over, check his airway and breathing. If necessary, begin CPR. 4. If the victim is breathing, help him into the recovery position. Stay with him until help arrives. Never try to restrain a seizure victim by force or try to pry open or put anything inside a seizure victim’s mouth.

Stroke A stroke occurs when blood flow to the brain is stopped or impaired by a blood clot or rupture of a blood vessel. Strokes tend to affect older people or people suffering from high blood pressure. Speedy medical care is the priority for any stroke victim. 1. Call 911. 2. If the victim is conscious, lay him down with his head and shoulders slightly elevated, and rest his head slightly to the side. The victim may dribble from the mouth. 3. If the victim becomes unconscious, check his airway and breathing. If necessary, begin CPR.