First Aid

First aid is the assistance given to any person suffering a sudden illness or injury, with care provided to preserve life, prevent the condition from worsening, or to promote recovery. It includes initial intervention in a serious condition prior to professional medical help being available, such as performing CPR while awaiting an ambulance, as well as the complete treatment of minor conditions, such as applying a plaster to a cut. First aid is generally performed by someone with basic medical training. Mental health first aid is an extension of the concept of first aid to cover mental health.

There are many situations which may require first aid, and many countries have legislation, regulation, or guidance which specifies a minimum level of first aid provision in certain circumstances. This can include specific training or equipment to be available in the workplace (such as an Automated External Defibrillator), the provision of specialist first aid cover at public gatherings, or mandatory first aid training within schools. First aid, however, does not necessarily require any particular equipment or prior knowledge, and can involve improvisation with materials available at the time, often by untrained persons.

First aid can be performed on all mammals, although this article relates to the care of human patients.

Aims

The key aims of first aid can be summarized in four key points, sometimes known as ‘the three accidents’:-

  • Preserve life: The overriding aim of all medical care which includes first aid, is to save lives and minimize the threat of death.
  • Prevent further harm: Prevent further harm also sometimes called prevent the condition from worsening, or danger of further injury, this covers both external factors, such as moving a patient away from any cause of harm, and applying first aid techniques to prevent worsening of the condition, such as applying pressure to stop a bleed becoming dangerous.
  • Promote recovery: First aid also involves trying to start the recovery process from the illness or injury, and in some cases might involve completing a treatment, such as in the case of applying a plaster to a small wound.
  • first aid help to stop the unwanted injuries to be a big cause by providing the medical aid for instance the bandage, some kind of medicines , liquids to stop the clotting of blood , tubes for burns and deep cut to stop the blood coming out of the nerve.

Basic Method

In case of tongue fallen backwards, blocking the airway, it is necessary to hyper-extend the head and pull up the chin, so that the tongue lifts and clears the airway.

ABC of First Aid

Certain skills are considered essential to the provision of first aid and are taught ubiquitously. Particularly the “ABC”s of first aid, which focus on critical life-saving intervention, must be rendered before treatment of less serious injuries.

ABC stands for

  • A-Airway,
  • B-Breathing, and
  • C-Circulation.

The same mnemonic is used by all emergency health professionals.

 

1- Attention must first be brought to the airway to ensure it is clear.

Obstruction (choking) is a life-threatening emergency.

2-Following evaluation of the airway, a first aid attendant would determine adequacy of breathing and provide rescue breathing if necessary.

3- Assessment of circulation is now not usually carried out for patients who are not breathing, with first aiders now trained to go straight to chest compressions (and thus providing artificial circulation) but pulse checks may be done on less serious patients.

Some organizations add a fourth step of “D” for Deadly bleeding or Defibrillation, while others consider this as part of the Circulation step.

Variations on techniques to evaluate and maintain the ABCs depend on the skill level of the first aider.

Once the ABCs are secured, first aiders can begin additional treatments, as required.

Some organizations teach the same order of priority using the

ThreeBs (3Bs)

  • Breathing,
  • Bleeding, and
  • Bones

Four Bs (4Bs)

  • Breathing,
  • Bleeding,
  • Burns, and
  • Bones

While the ABCs and 3Bs are taught to be performed sequentially, certain conditions may require the consideration of two steps simultaneously.

This includes the provision of both artificial respiration and chest compressions to someone who is not breathing and has no pulse, and the consideration of cervical spine injuries when ensuring an open airway.

Preserving life

In order to stay alive, all persons need to have an open airway—a clear passage where air can move in through the mouth or nose through the pharynx and down into the lungs, without obstruction. Conscious people will maintain their own airway automatically, but those who are unconscious (with a GCS of less than 8) may be unable to maintain a patent airway, as the part of the brain which automatically controls breathing in normal situations may not be functioning.

If the patient was breathing, a first aider would normally then place them in the recovery position, with the patient leant over on their side, which also has the effect of clearing the tongue from the pharynx. It also avoids a common cause of death in unconscious patients, which is choking on regurgitated stomach contents.

The airway can also become blocked through a foreign object becoming lodged in the pharynx or larynx, commonly called choking. The first aider will be taught to deal with this through a combination of ‘back slaps’ and ‘abdominal thrusts’.

Once the airway has been opened, the first aider would assess to see if the patient is breathing. If there is no breathing, or the patient is not breathing normally, such as agonal breathing, the first aider would undertake what is probably the most recognized first aid procedure—cardiopulmonary resuscitation or CPR, which involves breathing for the patient, and manually massaging the heart to promote blood flow around the body.

The first aider is also likely to be trained in dealing with injuries such as cuts, grazes or bone fracture. They may be able to deal with the situation in its entirety (a small adhesive bandage on a paper cut), or may be required to maintain the condition of something like a broken bone, until the next stage of definitive care (usually an ambulance) arrives.

Training

Basic principles, such as knowing to use an adhesive bandage or applying direct pressure on a bleed, are often acquired passively through life experiences. However, to provide effective, life-saving first aid interventions requires instruction and practical training. This is especially true where it relates to potentially fatal illnesses and injuries, such as those that require cardiopulmonary resuscitation (CPR); these procedures may be invasive, and carry a risk of further injury to the patient and the provider. As with any training, it is more useful if it occurs before an actual emergency, and in many countries, emergency ambulance dispatchers may give basic first aid instructions over the phone while the ambulance is on the way.

Training is generally provided by attending a course, typically leading to certification. Due to regular changes in procedures and protocols, based on updated clinical knowledge, and to maintain skill, attendance at regular refresher courses or re-certification is often necessary. First aid training is often available through community organizations such as the Red Cross and St. John Ambulance, or through commercial providers, who will train people for a fee. This commercial training is most common for training of employees to perform first aid in their workplace. Many community organizations also provide a commercial service, which complements their community programmes.

Specific disciplines

There are several types of first aid (and first aider) which require specific additional training. These are usually undertaken to fulfill the demands of the work or activity undertaken.

  • Aquatic/Marine first aid is usually practiced by professionals such as lifeguards, professional mariners or in diver rescue, and covers the specific problems which may be faced after water-based rescue or delayed MedEvac.
  • Battlefield first aid takes into account the specific needs of treating wounded combatants and non-combatants during armed conflict.
  • Hyperbaric first aid may be practiced by SCUBA diving professionals, who need to treat conditions such as the bends.
  • Oxygen first aid is the providing of oxygen to casualties who suffer from conditions resulting in hypoxia.
  • Wilderness first aid is the provision of first aid under conditions where the arrival of emergency responders or the evacuation of an injured person may be delayed due to constraints of terrain, weather, and available persons or equipment. It may be necessary to care for an injured person for several hours or days.
  • Mental health first aid is taught independently of physical first aid. How to support someone experiencing a mental health problem or in a crisis situation. Also how to identify the first signs of someone developing mental ill health and guide people towards appropriate help.

 

Conditions that often require first aid

 

  • Altitude sickness, which can begin in susceptible people at altitudes as low as 5,000 feet, can cause potentially fatal swelling of the brain or lungs.
  • Anaphylaxis, a life-threatening condition in which the airway can become constricted and the patient may go into shock. The reaction can be caused by a systemic allergic reaction to allergens such as insect bites or peanuts. Anaphylaxis is initially treated with injection of epinephrine.
  • Battlefield first aid—This protocol refers to treating shrapnel, gunshot wounds, burns, bone fractures, etc. as seen either in the ‘traditional’ battlefield setting or in an area subject to damage by large-scale weaponry, such as a bomb blast.
  • Bone fracture, a break in a bone initially treated by stabilizing the fracture with a splint.
  • Burns, which can result in damage to tissues and loss of body fluids through the burn site.
  • Cardiac Arrest, which will lead to death unless CPR preferably combined with an AED is started within minutes. There is often no time to wait for the emergency services to arrive as 92 percent of people suffering a sudden cardiac arrest die before reaching hospital according to the American Heart Association.
  • Choking, blockage of the airway which can quickly result in death due to lack of oxygen if the patient’s trachea is not cleared, for example by the Heimlich Maneuver.
  • Childbirth.
  • Cramps in muscles due to lactic acid build up caused either by inadequate oxygenation of muscle or lack of water or salt.
  • Diving disorders,
  • drowning or
  • asphyxiation.
  • Gender-specific conditions, such as dysmenorrhea and testicular torsion.
  • Heart attack, or inadequate blood flow to the blood vessels supplying the heart muscle.
  • Heat stroke, also known as sunstroke or hyperthermia, which tends to occur during heavy exercise in high humidity, or with inadequate water, though it may occur spontaneously in some chronically ill persons. Sunstroke, especially when the victim has been unconscious, often causes major damage to body systems such as brain, kidney, liver, gastric tract. Unconsciousness for more than two hours usually leads to permanent disability. Emergency treatment involves rapid cooling of the patient.
  • Hair tourniquet a condition where a hair or other thread becomes tied around a toe or finger tightly enough to cut off blood flow.
  • Heat syncope, another stage in the same process as heat stroke, occurs under similar conditions as heat stroke and is not distinguished from the latter by some authorities.
  • Heavy bleeding, treated by applying pressure (manually and later with a pressure bandage) to the wound site and elevating the limb if possible.
  • Hyperglycemia (diabetic coma) and Hypoglycemia (insulin shock).
  • Hypothermia, or Exposure, occurs when a person’s core body temperature falls below 33.7 °C (92.6 °F). First aid for a mildly hypothermic patient includes rewarming, which can be achieved by wrapping the affected person in a blanket, and providing warm drinks, such as soup, and high energy food, such as chocolate.However, rewarming a severely hypothermic person could result in a fatal arrhythmia, an irregular heart rhythm.
  • Insect and animal bites and stings.
  • Joint dislocation.
  • Poisoning, which can occur by injection, inhalation, absorption, or ingestion.
  • Seizures, or a malfunction in the electrical activity in the brain. Three types of seizures include a grand mal (which usually features convulsions as well as temporary respiratory abnormalities, change in skin complexion, etc.) and petit mal (which usually features twitching, rapid blinking, or fidgeting as well as altered consciousness and temporary respiratory abnormalities).
  • Muscle strains and Sprains, a temporary dislocation of a joint that immediately reduces automatically but may result in ligament damage.
  • Stroke, a temporary loss of blood supply to the brain.
  • Toothache, which can result in severe pain and loss of the tooth but is rarely life-threatening, unless over time the infection spreads into the bone of the jaw and starts osteomyelitis.
  • Wounds and bleeding, including lacerations, incisions and abrasions, Gastrointestinal bleeding, avulsions and Sucking chest wounds, treated with an occlusive dressing to let air out but not in.

Many accidents can happen at home, office, schools, laboratories etc. which require immediate attention before the patient is attended by the doctor.

First aid kits

A first aid kit consists of a strong, durable bag or transparent plastic box. They are commonly identified with a white cross on a green background. A first aid kit does not have to be bought ready-made. The advantage of ready-made first aid kits are that they have well organized compartments and familiar layouts.

Contents

There is no universally agreed upon list for the contents of a first aid kit. The UK Health and Safety Executive stress that the contents of workplace first aid kits will vary according to the nature of the work activities. As an example of possible contents of a kit, British Standard “BS 8599 First Aid Kits for the Workplace” lists the following items:

  • Information leaflet
  • Medium sterile dressings
  • Large sterile dressings
  • Triangular dressings
  • Safety pins
  • Adhesive dressings

Sterile wet wipes

  • Microporous tape
  • Nitrile gloves
  • Face shield
  • Foil blanket
  • Burn dressings
  • Clothing shears
  • Conforming bandages
  • Finger dressing

CPR

Cardiopulmonary resuscitation (CPR) is an emergency procedure that combines chest compressions often with artificial ventilation in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest.

It is recommended in those who are unresponsive with no breathing or abnormal breathing, for example, agonal respirations.

CPR involves chest compressions for adults between 5 cm (2.0 in) and 6 cm (2.4 in) deep and at a rate of at least 100 to 120 per minute. The rescuer may also provide artificial ventilation by either exhaling air into the subject’s mouth or nose (mouth-to-mouth resuscitation) or using a device that pushes air into the subject’s lungs (mechanical ventilation). Current recommendations place emphasis on early and high-quality chest compressions over artificial ventilation; a simplified CPR method involving chest compressions only is recommended for untrained rescuers.In children, however, only doing compressions may result in worse outcomes. Chest compression to breathing ratios is set at 30 to 2 in adults.

CPR alone is unlikely to restart the heart. Its main purpose is to restore partial flow of oxygenated blood to the brain and heart.

The objective is to delay tissue death and to extend the brief window of opportunity for a successful resuscitation without permanent brain damage.

Administration of an electric shock to the subject’s heart, termed defibrillation, is usually needed in order to restore a viable or “perfusing” heart rhythm. Defibrillation is effective only for certain heart rhythms, namely ventricular fibrillation or pulseless ventricular tachycardia, rather than asystole or pulseless electrical activity. Early shock when appropriate is recommended. CPR may succeed in inducing a heart rhythm that may be shockable. In general, CPR is continued until the person has a return of spontaneous circulation (ROSC) or is declared dead.

Compressions with rescue breaths

A universal compression to ventilation ratio of 30:2 is recommended for adults. With children, if at least 2 trained rescuers are present a ratio of 15:2 is preferred.In newborns a rate of 3:1 is recommended unless a cardiac cause is known in which case a 15:2 ratio is reasonable.

Compression only

For adults with cardiac arrest, compression-only (hands-only or cardio-cerebral resuscitation) CPR which involves chest compressions without artificial ventilation is recommended as the method of choice for the untrained rescuer or those who are not proficient as it is easier to perform and instructions are easier to give over a phone.In adults with out-of-hospital cardiac arrest, compression-only CPR by the lay public has an equal or higher success rate than standard CPR.It is hoped that the use of compression-only delivery will increase the chances of the lay public delivering CPR

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