Internal Bleeding, Eye Wounds and Embedded Objects

Severe internal bleeding is a potentially life-threatening condition. While the blood may not be obvious, it is still lost from the circulatory system and the victim is therefore very likely to go into shock. Internal bleeding may also cause a build-up of pressure that, in areas such as the skull or around the heart, can cause serious problems, loss of consciousness and, if untreated, lead to death.

SITES OF BLEEDING. Internal bleeding can be very difficult to identify, It is not unusual for internal bleeding to happen slowly, with signs and symptoms showing up days after an accident. It can happen to any part of the body but the richness of the blood supply in the stomach, around the organs such as the liver and the spleen, and in the bowel make these sites particularly vulnerable. Internal bleeding is also likely to accompany some broken bones. The thigh bone protects the femoral artery and if broken may pierce it, causing a large and life-threatening bleed.

TREATMENT

1. Treat for shock. Keep the person warm. Place him in a comfortable position, preferably lying down with the legs slightly raised. Reassure him. Treat any external bleeding or bleeding from orifices.
2. Call 911 as soon as possible and explain what has happened. Monitor and record the person's pulse and breathing rates. This information will be useful for the medical staff in determining the extent of the injury.

If the person becomes unconscious, place in the recovery position and monitor airway and breathing. Be prepared to resuscitate in necessary.

MAJOR ORGANS SUSCEPTIBLE TO INTERNAL BLEEDING

Internal bleeding can happen in any part of the body but the stomach, the liver, spleen, and intestines are particularly vulnerable because they have a rich blood supply. Internal bleeding can be very difficult to identify and signs and symptoms may not arise until several days after an accident has occurred.

SIGNS AND SYMPTOMS

• The person is known to have had an accident (not necessarily in the immediate past)
• Signs and symptoms of shock
• Bruising
• Boarding-- this most commonly occurs where there is bleeding into the stomach area; the quantity of blood combined with the tissues swelling result in a rigidity to the tissues
• Swelling
• Bleeding from body orifices

If there is any combination of these signs and symptoms, suspect internal bleeding.

BRUISING

Less serious internal bleeding such as small bruises can be treated with a cold compress to relieve pain and reduce swelling. However, the possibility of further internal bleeding or underlying injury should not be ruled out, particularly if the victim is known, for example, to have hit his head on a window during a traffic accident, or has been hit in the stomach by a reversing automobile.

EYE WOUNDS AND EMBEDDED OBJECTS
Cuts to the eye can be very frightening and even small, difficult to notice injuries are potentially very serious. However, medical treatments mean that even injuries that appear to be very severe may not necessarily result in the loss of sight in the eye. Do not touch the affected eye.

TREATMENT
Prevent further injury and get medical help as soon as possible.

1. Lie the person down, on his back if possible, and hold the head to prevent movement and keep it stable.
2. Ask the person to try to keep his eyes still to prevent movement of the injured eye. Ask the person to focus on something to prevent movement.
3. Ask the victim to hold a clean pad over the eye to help prevent movement and infection. If the wait for an ambulance or other help may take some time, you may wish to hold the pad for the person or to gently bandage it in place. However, because blood loss from the eye area is not likely to be life-threatening, any bandage should be use only to hold the pad in place and not to apply pressure.

Do not attempt to remove any object embedded in the eye. If the object is very long, then gently support it to prevent movement at its base. If small, ensure that the pad you place over the eye does not push it in any further.

TREATING AN OBJECT EMBEDDED IN THE WOUND

The first step in the treatment of any external bleeding is to check the extent of the injury and see if there is anything  embedded in the wound.

1. Apply pressure around the edges of the wound using your hands or the victim's hands without pressing on the object.
2. Replace this pressure with a dressing or clean material and bandage firmly in place, avoiding pressure on the object.
3. Raise the injured limb if possible to staunch the flow of blood.
4. Prevent longer objects from moving by supporting them with your hands or by packing around the base of the object with blankets.
5. Treat for shock and reassure the victim.

If the victim is impaled on something which cannot be moved, support him or her to stop from pulling on the impaled object and causing further damage. Where possible, treat the victim and ensure that the emergency team is aware of the need for cutting equipment.

WARNING!

If there is something stuck into the injury, do not attempt to remove it because:

• If the object went in at an angle, you may cause more damage pulling it out
• You may leave splinters in the wound
• The object may be pressing against a vein or an artery, reducing blood loss
• You may have mistaken a broken bone for a foreign body

The principles of applying pressure, elevating, and treating for shock still apply.

By: Unknown On 11:55 PM

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Treating Chest or Abdominal Wounds and Crush Injuries, Impalement, and Amputation

The chest wall protects the lungs, heart, and other essential organs such as the liver. A puncture wound to the chest can therefore be extremely serious. Wounds to the abdomen (stomach and intestine) are very serious. External bleeding may be severe and internal bleeding is likely, both of which will lead to serious shock. In addition, there may be damage to internal organs and the digestive system.

CHEST WOUNDS. Common complications of penetrating chest wounds include:

• Collapsed lung (pneumothorax), caused by air entering the space between the chest wall and the lungs. This applies pressure to the lungs, causing them to collapse. The lung can also be damaged directly, causing it to fill with blood.
• Tension pneumothorax which occurs when the pressure builds up sufficiently to affect the uninjured lungs and possibly even the heart.
• Damage to vital organs such as the liver-- this will result in severe shock as these organs have a large blood supply.

TREATMENT

1. Seal the wound using, in the first instance, your hand or the victim's hand.
2. Help the victim into a position that makes it easier for him to breathe. This will  usually be sitting up and inclined to the injured side. This allows the uninjured lung maximum room to move and allows blood to pool on the injured side.
3. Cover the wound with a dressing and cover the dressing with airtight material, such as plastic or foil. Seal this on three sides.
4. Call an ambulance and treat for shock.

If the victim is unconscious, monitor and maintain the airway, and be prepared to resuscitate if necessary (sealing the wound before resuscitating). Place the victim injured side down.

SIGNS AND SYMPTOMS OF CHEST WOUNDS

• Difficulty with breathing
• Shock
• Bright red, frothy blood (blood with air in it) being coughed up or escaping from the wound
• Pale skin with blue lips
• Sound of air being sucked into the chest

TREATING ABDOMINAL WOUNDS

1. Call an ambulance and help the victim to lie down in the most comfortable position.
2. Consider the position of the wound. If it is vertical-- runs down the abdomen-- moving the victim so that he is lying flat on the ground will help bring the edges together, ease discomfort, and help reduce bleeding. If the wound is horizontal, gently raising the legs will have the same effect.
3. Place a large dressing over the wound and secure in place. Add pads to this dressing as necessary.
4. Treat for shock.

Support the wound if the victim coughs, vomits, or needs to be moved into the recovery position. Press lightly on the bandage to prevent intestines protruding from the wound. If intestines are protruding, do not attempt to replace them. Cover with a clean piece of plastic film.

CRUSH INJURIES, IMPALEMENT, AND AMPUTATION
Crush injuries generally result from serious car accidents or explosions. There may be part of the body trapped under heavy debris; several broken bones, multiple external bleeding and much internal bleeding; burns from an explosions; severe shock, and deterioration into unconsciousness. If a person is impaled on an immovable object, treatment is similar to that for a foreign object embedded in a wound. An amputation is where a part of the body has been severed. This may occur through a straight and heavy cut or through twisting and pulling under extreme force.

TREATING CRUSH INJURIES

1. Ensure that it is safe to approach the scene. If in doubt, call 911 and wait for help.
2. Monitor and maintain airway and breathing and be prepared to resuscitate in necessary.
3. Treat major bleeding and cover smaller wounds with sterile dressings.
4. Keep the injure person still and try to reassure him or her while waiting for help.
5. Treat for shock.
6. Make an early call for an ambulance and inform medical staff what has happened.

IF THE INJURED PERSON IS TRAPPED. There are additional risks for the injured person if any part of the body is trapped. Releasing the body may bring on severe shock as fluid leaks to the injured part.

     An ever greater cause for concern is "crush syndrome." Toxins build up around the injury site and are trapped by an object crushing the person. If the object is removed, these toxins are suddenly released into the body, and the kidneys, the organs chiefly responsible for flushing out toxins, are overwhelmed. This condition can be fatal.

IF THE PERSON HAS BEEN TRAPPED FOR LESS THAN 10 MINUTES. Crush syndrome take some time to develop. If you can do so, safely remove the object. Treat as for crush injuries.

IF THE PERSON HAS BEEN TRAPPED FOR LONGER THAN 10 MINUTES. Make an early call for help, explaining the situation, but do not remove the object. Treat as for crush injuries and reassure the person.

TREATING AN IMPALEMENT

1. Do not attempt to remove the object or to move the injured person.
2. Provide swift assistance for the injured person, supporting his body weight where possible to prevent any further damage.
3. If bleeding is severe, apply pressure around the edges of the wound without pressing on the object.
4. Try to stop the object moving around as much as possible, enlisting bystander support where available.
5. Call an ambulance, make sure that you explain the need for cutting equipment or tools.
6. Treat for shock as best you can.

 TREATING AMPUTATION

1. Your priority is to stop any bleeding at the site of injury. Apply direct pressure and raise the injured stump. An amputation high on the arm or leg can be accompanied by severe arterial bleeding, particularly if caused by a twisting or tearing movement. Be prepared to apply continuous pressure using several pads as necessary.
2. If the bleeding comes under control, cover the wound with a sterile dressing or clean non-fluffy material tied in place with a bandage.
3. Treat for shock and reassure the person.
4. Call 911, advising that there is an amputation.

FOR THE AMPUTATED PART

A surgeon may be able to reattach the amputated part.

1. Wrap the part in a plastic bag and wrap the bag in a clean cloth.
2. Place the cloth-wrapped bag in ice and place into a sturdy container. Do not let the ice come into close contact with the amputated part, because this will damage the flesh. Do not wash the amputated part.
3. Label the container with the time of injury and the victim's name and make sure that you personally hand it over to medical staff.

By: Unknown On 10:12 PM

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Diabetes and Bleeding

Diabetes mellitus is a medical condition in which the body is unable to effectively regulate the amount of sugar in the blood. The pancreas (an organ in the body) normally produces a hormone called insulin that regulates blood sugar level. In a person suffering from diabetes this does not happen effectively and as a result blood sugar levels become too high (this is known as hyperglycemia). Most diabetics control the condition through a combination of diet and injections of insulin. Too much insulin can lead to a condition known as hypoglycemia (low blood sugar).

HYPERGLYCEMIA. Hyperglycemia is most likely to occur in an undiagnosed diabetic. Diabetes is generally first noticed in early adolescence or middle age. If left untreated, a high blood sugar level will lead to unconsciousness and death. Onset may be gradual with deterioration often happening over a number of days.

TREATMENT. During the early stages, encourage immediate contact with the local doctor. If this is difficult, or the condition deteriorates, take or send the person to hospital. Monitor airway and breathing and be prepared to resuscitate if necessary.

HYPOGLYCEMIA. Low blood sugar level has a quick and serious effect on the brain. Most commonly it is caused by somebody with diabetes either taking too much insulin, or taking the right amount of insulin and then either not eating enough or burning off sugar through vigorous exercise. Less commonly, it can accompany heat exhaustion, alcohol abuse, or epileptic fits.

TREATMENT. If the person is unconscious, monitor the airway and breathing and be prepared to resuscitate as necessary. If the person is fully conscious, help him to sit down or to lie down with the shoulders raised. Give something high in sugar and easy to consume, such as chocolate or a sugary drink,
to try to restore the body's chemical balance. If this marks an improvement, give more. If the condition does not improve, seek medical advice. Stay with the person until he recovers. Ask his guidance on what he wants to do next. Arrange for some help to take him home or to the doctor. If the condition continues to deteriorate, call an ambulance.

SIGNS AND SYMPTOMS
Early signs:

• Wanting to drink a lot (the body is trying to flush sugar from the system)
• Passing water regularly (urine may smell sweet)
• Lethargy

As the condition deteriorates:

• Dry skin and rapid pulse
• Deep, labored breathing
• Increasing drowsiness
• Breath or skin smells strongly of acetone (like nail-polish remover) as the body tries to get rid of sugar
• History of diabetes (however, a diabetic suffering a hypoglycemia attack is often confused or aggressive and  may not admit to having diabetes)
• Hunger
• Feeling faint or dizzy
• Strange behavior: confusion, aggression, or even violence
• Pale, cold, sweaty skin
• Rapid loss of consciousness
• Shallow breathing
• Evidence of diabetes, e.g. medic alert, sugar solution, or syringe in pocket
• Evidence of recent heavy exercise or drinking

CONFUSION WITH OTHER CONDITION

It is not unusual for diabetes to be mistaken for other common situations such as drunkenness, substance abuse, compression, or a stroke. The treatment in all these situations is to monitor and maintain the airway, be prepared to resuscitate if necessary, use the recovery position if the person becomes unconscious, and seek medical advice or call emergency help.

Do not make assumptions as to the cause of the problem. Instead, look for clues to diagnosis for the medical staff. Somebody who is drunk may also be suffering from head injury; the syringe in a person's coat may be for diabetic medication of for drug abuse. While you do not need to know the cause the medical staff do and any clues that you can hand over could be potentially life-saving.

BLEEDING
Blood is carried around the body in a transport system of arteries, capillaries, and veins, and any damage to this network results in bleeding. Bleeding can be both external and internal. External bleeding involves a break to the skin surface, known as a wound, which can take many different forms. Internal bleeding is bleeding that occurs inside the body when there is no external injury for the blood to escape from. The most common form of internal bleeding is a small bruise from a minor impact. Heavy impact from  car accidents, fights, or falls, for example, can lead to serious internal bleeding, which may kill.

TRANSPORT OF BLOOD. Arteries have thick muscular walls, that contract. This pushes blood out from the heart under pressure. The blood contained within them is full of oxygen, which has been collected from the lungs, and the main function of the arteries is to take this oxygen-rich blood to the organs and body tissue. Because the blood is under pressure, and is so full of oxygen, arterial bleeding is characterized by bright red blood pumping from an injury. Arterial bleeding is very serious as blood is rapidly lost.
     Veins have thin walls and return blood from the organs and tissues to the heart. They do not have muscles of their own and rely on the actions of the muscles around them to squeeze the blood around. To keep the blood moving in one direction around the body, they have series of one-way valves that ensure a one-way flow. When these valves deteriorate, blood pools in the veins, making them swell. This weakens the vein wall, resulting in a condition known as varicose veins. While the blood loss from a bleeding vein does not tend to be as quick as a bleeding artery, it does nonetheless have the potential to be a very serious and even fatal injury. Bleeding from a vein will seem to flow from an injury and  because it has little or no oxygen it will appear to be a dark red.
     Capillaries are very thin-walled vessels. Blood is forced through them under pressure, causing the nutrients and oxygen stored in the blood to be pushed out into the body tissues and organs.

TYPES OF INJURY. Small blood loss is very common and rarely needs much treatment. Large blood loss may lead, if untreated, to shock and, potentially, death.

Incisions. Clean and deep cuts characterized by paper cuts and knives are known as incisions. While these wounds do not tend to bleed a lot, there may be underlying damage to tendons and other tissues.

Lacerations are jagged wounds, which tend to bleed a lot.

Puncture wounds are, as their name suggest, deep injuries caused by a pointed object such as a knitting needle. They do not tend to bleed a great deal but they carry the risk of infection because dirt can be carried a long way into the tissue. There is also a greater risk of damage to vital organs such as the lungs or liver.

Scrapes are a commonplace injury and involve damage to the top layers of the skin. They do not cause major blood loss but often dirty, because grazes tend to have debris embedded within them.

HOW DOES THE BODY STOP BLEEDING?
When a blood vessel is torn or cut, a series of chemical reactions takes place that causes the formation of a blood clot to seal the injury. Components of the blood known as platelets clump together at the injury site. Damaged tissue and platelets release chemicals that activate proteins called clotting factors. These react with a special protein (fibrinogen) to form a mesh of filaments that traps blood cells. These form the basis of a blood clot that contains white blood cells to help fight infection and specialized blood cells that help promote repair and recovery. A scab will form to protect the wound until repair has taken place. When applying pressure to the site of wound you are helping the clotting process.

By: Unknown On 6:55 AM

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Unconsciousness and Epilepsy

Unconsciousness is an interruption of normal brain activity. It can happen suddenly or gradually. Unconsciousness can be caused by a range of injuries and medical conditions, as well as by a number of different drugs. An unconscious person may still have some reactions to pain or to commands, or may have no reactions at all.

Whatever the cause or degree of unconsciousness, the immediate emergency treatment remains the same:

• Assess whether the person is unconscious by gently squeezing the shoulders and asking a question.
• Open the airway by lifting the chin, clearing the mouth, and tilting the head. Check the breathing and be prepared to resuscitate if necessary.
• If breathing, check for life-threatening conditions and then turn into the recovery position.
• Call for emergency help.

This may be all that you have time to do before emergency help arrives. However, if you have longer, there are some things that you can do to gather information that may help medical staff with their diagnosis and treatment.

ASSESS THE LEVEL OF RESPONSE. There is an agreed scale for assessing how responsive an injured or ill person is-- the Glasgow Coma Scale. A fully alert person will score 15 while somebody who is totally unresponsive will score 3 with several variations in between. You can help collect information to inform medical staff using some of the checks from this scale:

EYES. Do they:

• Open without you having to ask the person to open them?
• Open on command?
• Open if you cause the person pain (this is often done by pinching the earlobe)?
• Remain closed?

MOVEMENTS. Does the person:

• Understand and follow sensible instructions?
• Move only in response to pain?
• Not move at all?

SPEECH. Does the person:

• Answer questions sensibly?
• Answer questions in a confused way?
• Make sounds that cannot be understood?
• Make no noise?

Do the checks of eyes, movement, and speech every 10 minutes and record your answers.

FAINTING

A faint is a brief loss of consciousness. Shock is one of the potential causes of fainting but other causes include lack of food, a reaction to emotional news, or long periods of inactivity, for example, guardsmen standing for a long time in the summer.

To treat someone who has fainted, open the airway and check for breathing. If the person is breathing and there are no signs of injury, then the best treatment is to lie her on her back with her legs raised. This puts maximum oxygen back to the brain and speeds up recovery from a faint. If she has not begun to come around after 3 minutes, or if breathing becomes difficult, put her into the recovery position and call for help.

EXAMINING THE UNCONSCIOUS PERSON

Your initial check of the injured or ill person will be for life-threatening conditions, particularly serious bleeding. If you have more time while waiting for the ambulance, a more thorough check may show up less serious injuries or illness and potential clues to the cause of unconsciousness. This check should never be at the cost of monitoring and maintaining the airway or of keeping the injured person as still as possible. If doing a check of the body, it is sensible to do so in the presence of a third person.

Check the body from head to toe, looking for areas of bleeding, signs of broken bones or burns, or clues as to the cause of unconsciousness.

MONITORING AND RECORD BREATHING

Breathing is measured by counting the number of breaths in 1 minute (one breath being one rise and fall of the chest).

MONITOR AND RECORD PULSE RATE

Pulse rate is measured by counting the number of beats at the pulse at either the neck or the wrist for 1 minute. The easiest place to feel a pulse is in the carotid artery in the neck, though you can also check the wrist. Take recordings of breathing and pulse rate every 10 minutes and write down the results for the medical staff.

EPILEPSY
Epilepsy is a very common condition, best described as a rogue electrical discharge across the brain. As the body's functions are controlled be electrical impulses this discharge can lead to a number of physical reactions. Many things may start a seizure (fit): tiredness, stress, or flashing lights are common triggers.

MAJOR SEIZURE
This is what most people would recognize as epilepsy, and there are typically four stages:

1. Many people get a sense that a seizure is likely to occur.
2. The electrical impulses lead to a contraction in the muscles that causes the epilepsy sufferer to fall to the ground with a cry. This is known as the tonic phase. The victim's muscles may then go into spasm. This is known as the clonic stage. During this stage the victim will not be breathing.
3. When the convulsion is over, the victim will be in a state of unconsciousness.
4. On recovery from unconsciousness, the victim will be very sleepy and will want to rest for some time.

MINOR FITS. During a minor fit, somebody with epilepsy suffers a brief disturbance in the brain's normal activity, leading to a lack of awareness of his or her surroundings. To the observer it might seem like the person is daydreaming or has suddenly switched off.

     There is little for you to do other than to guide the person away from danger and reassure him when he returns to normal. If he is not aware of any similar episodes happening before, advise him to see a doctor.

TREATMENT FOR A MAJOR EPILEPTIC SEIZURE

1. During the seizure, do not try to restrain the person. The muscular contractions are so strong during a fit that holding a person down may lead to broken bones-- yours and his. Do not attempt to put anything in the mouth. Try to protect the victim-- move sharp objects out of the way, remove constrictions and, if possible, place a soft coat under the head.
2. Once the seizure has finished, check the victim's airway and breathing and be prepared to resuscitate in the unlikely event that this is necessary. Place the person in the recovery position.
3. When the victim comes round, offer reassurance. The person may have lost control of bowel or bladder function so cover him up and, when he is steady on his feet, help him to find somewhere to clean up. He is likely to be very tired so, if possible, find him somewhere to lie down and sleep. Most of all, ask him what he wants to do-- most epileptics manage the condition very well and will have their own coping strategies.

INFANTILE CONVULSIONS (CAUSED BY HEAT)

Babies and young children may have seizures induced by a high temperature. This may be the result of an infection or because they are overwrapped and in a warm environment. The signs and symptoms are similar to a major epileptic seizure.

TREATMENT. Make sure that the child is protected from hitting himself on a bed or cot-- do not attempt to restrain. Cool down by removing bedclothes and clothing where possible. Sponge the head and under the arms with tepid flannel or sponge, re-soaking it regularly. When the convulsion is finished, check ABC and take action as appropriate. In most cases, the child will want to sleep. Dress him in dry clothes and let him sleep. Call a doctor for advice.

WHEN TO CALL AN AMBULANCE. Generally, neither epilepsy nor infantile convulsion are medical emergencies. However, you should be prepared to call an ambulance if:

• The victim is injured during the seizure.
• The seizure lasts for longer than 3 minutes.
• There are repeated seizures in a short period of time.
• The victim does not regain consciousness.

If it is the first time seizure, advise the victim to call his doctor or take him to hospital.

By: Unknown On 6:11 AM

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Heart problems and Stroke

The heart is a muscle that pumps blood around the body, which it does with the help of the thick-walled and muscular arteries and the other vessels of the circulatory system. The heart is controlled by regular electrical impulses that tell it when to contract. Like all other muscles, the heart needs its own blood supply  and this is provided by the coronary (heart) arteries. When this  blood supply fails to run smoothly, the body starts to experience problems, such as angina pectoris (angina) and heart attack. Either of these may lead to the heart stopping (cardiac arrest).

ANGINA. Throughout life, arteries are clogging up with fatty deposits. As these fatty deposits cause the coronary and other arteries to become narrower, it becomes increasingly difficult for blood to flow around the body. The clogged coronary arteries can just about supply blood to the heart when it is pumping at a normal rate but when the heart rate speeds up the arteries cannot cope with the demand. This leads to an angina attack, a frightening, severe, crushing chest pain that acts as a warning to the victim to calm down or to rest.

TREATMENT

1. Sit the victim down and reassure her. This reduce the demands being placed on the heart.
2. Angina sufferers may have medicine that will help relieve an attack. This is often in the form of a puffer or a pill that is placed under the tongue. The drug works by dilating the blood vessels, thereby increasing circulation to the heart. Help the victim to take this medication.
3. Call an ambulance if the pain does not appear to ease or if the victim is not a known angina sufferer.
4. If the victim has regular attacks, listen to what she wants to do next.

SIGNS AND SYMPTOMS OF ANGINA

• Evidence of recent exertion
• Previous history of angina attacks
• Gripping chest pain, often described by the sufferer as vise-like
• Pain spreading up into the jaw or down into the left arm
• Feeling of tingling down the arm
• Shortness of breath
• Dizziness and confusion
• Anxiety
• Pale skin which possible blue tinges
• Rapid, weak pulse

HEART ATTACK. If a coronary artery becomes completely blocked, the area of the heart being supplied by that particular blood vessel will be starved of oxygen and will eventually die. This blockage may be caused by a clot, a condition often referred to as a coronary thrombosis.

     The development of advanced cardiac care in hospital and good post-hospital care means that heart attack patients have a good chance of making a full recovery. This is important information to remember when you are reassuring somebody having a heart attack.

SIGNS AND SYMPTOMS OF HEART ATTACK

This signs and symptoms are generally the same as those of angina-- indeed, the patient may initially suffer an angina attack that becomes a heart attack. The key difference is that heart attacks do not always follow physical exertion. While angina sufferers will recover from their attack on resting, heart attack patients do not tend to improve without medical treatment.

TREATMENT

1. Move the victim into semi-sitting position head and shoulders supported and knees bent, as this is generally the best position to breathe in.
2. Reassure the victim and do not let her move, as this will place an extra strain on the heart.
3. Call for an ambulance as soon as possible because the victim needs hospital care.
4. If the victim has angina medication, let her take this. If you have an ordinary aspirin, give her one to chew (without water).
5. Keep a continual check on the breathing and pulse and be prepared to resuscitate in necessary.

STROKE

A stroke occurs when a blood clot or bleeding cuts off the blood supply, and therefore the oxygen, to part of the brain. The affected area of the brain will eventually die. The effect of a stroke depends on how much of the brain is affected and where the clot or bleeding is. Different parts of the brain control different functions, so a clot in the part of the brain that controls speech, for example, will result in slurred or confused speech. Often the signs will be confined to one side of the body.

EFFECTS OF STROKE. If the bleeding or clot is in one of the larger blood vessels supplying a large area of the brain, then the stroke will often be immediately fatal. However, many people do survive, with some making a full recovery. Others may need extensive periods of rehabilitation and support to manage stroke-related problems such as reduced mobility.

TREATMENT. Monitor airway and breathing and be prepared to resuscitate if necessary. Place the person in the recovery position if she becomes unconscious. If she is conscious, help her to lie down with the head and shoulders slightly raised. Provide support and reassurance. The person will often be disoriented and may be speaking nonsense if the speech center is affected. Equally, she may hear what you are saying but not understand it. Speak in a reassuring tone with confidence. Call an ambulance. Wipe any dribbling away from the side of the face and be prepared for the person to vomit.

SIGNS AND SYMPTOMS
Any combination of the following may be present. In minor strokes, the signs and symptoms may be very limited.

• History-- the sufferer may have a history of smaller strokes over previous years, or may have been feeling unwell for some days with no known cause.
• Headache
• Blurred vision, partial loss of sight, or seeing flashing lights.
• Confusion and disorientation, often mistaken for drunkenness.
• Signs of paralysis or weakness, often only down one side of the body (confirm by asking the patient to hold out both arms in front of her and look for drooping or shaking).
• Difficulty speaking; drooping mouth or smile (caused by minor paralysis).
• Dribbling from one side of the mouth
• Loss of consciousness (this can be gradual or sudden).
• Sometimes the pulse will be full and throbbing, the person's breathing noisy, and the skin flushed.

By: Unknown On 7:05 AM

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Breathing Difficulties and Asthma

In a first aid situation you are likely to encounter a victim who has breathing difficulties. Psychological stress may trigger breathing problems that affect the blood's chemical composition, causing a range of symptoms that make the victim feel unwell. Accidents that include a heavy impact to the chest can cause injuries that result in severe breathing difficulties.

HYPERVENTILATION. This is a breathing difficulties that may be triggered by the stress of an accident or some other form of emotional shock. The person over-breathes, causing the level of carbon dioxide in the blood to drop. This leads to a combination of the signs and symptoms listed below:

• Fast, shallow breathing
• Feeling of tangling in the limbs
• Dizziness
• Cramps
• Panic attacks

TREATMENT

1. If the victim is otherwise uninjured, remove her from the scene of the accident to a quite place where there is no audience. People who are hyperventilating often subconsciously react to onlookers, making themselves worse.
2. Reassure the victim but remain calm and speak firmly. Encourage the victim to regain control of her breathing.
3. If the situation persists, and you are certain that there is no other underlying condition such as asthma or chest injury, let the victim inhale her own breathed-out air from a paper bag. This air contains more carbon dioxide, which will help restore the balance of oxygen and carbon dioxide in the blood.
4. Call a doctor or ambulance if symptoms do not disappear. Do not slap the victim-- she may become violent and attack you, and you run the risk of being charged with assault.

CHEST INJURIES. Serious injuries following an accident, or the aftermath of any illness causing problems with breathing can lead to the lung collapsing. Air enters the space between the lung and the chest wall, making breathing very difficult. In severe cases, the pressure affects the uninjured lung and the heart, causing a tension pneumothorax, a condition requiring urgent medical attention if the victim is to survive.

     Chest injuries with more than one broken rib will often result in the victim having difficulty in breathing as the chest wall is unable to move effectively. There may also be an open break on the chest wall where ribs have sprung out. Remember that the ribs extend around the back and there may be injuries here as well as on the front.

     Chest injuries may be accompanied by a sucking wound to the chest. Here there is a direct passage between the outside and the lungs, often caused by a puncture injury from a sharp object pushing through the chest wall.

SIGNS AND SYMPTOMS OF COLLAPSED LUNG AND OTHER CHEST INJURIES

• History of chest impact or recent illness affecting breathing
• Chest rises as the person breathes out (paradoxical breathing)
• Swelling or indentation along the line of the ribs
• Open fractures
• Difficulty in breathing
• Pain on breathing
• Shock, as there is likely to be some degree of internal bleeding
• Bright red, frothy blood coming from the mouth and/or nose. (This is an indication of punctured lung because oxygenated blood is escaping from the respiratory system. There may or may not be associated sucking wound to the chest.)
• Sucking wound to the chest

TREATMENT. Ensure that an early call for emergency medical help has been made. If the victim is conscious, she will often find it easier to breathe if sitting up. Help her into a sitting-up position if possible and provide support to remain in this position comfortably. If you can determine the side of the injury, lean the victim to breathe a little easier.

     If there is an open sucking wound to the chest, cover this up as soon as possible. The best cover comes from using plastic sealed on three sides over the wound area. Help the victim remove blood from her mouth. If the person becomes unconscious, place into the recovery position on the injured side and monitor breathing carefully. Treat any open wound once the person is in the recovery position. Treat any broken ribs.

ASTHMA
Asthma attacks cause the muscle of the air passages to go into spasm, making it very difficult for the asthmatic to breathe, particularly to exhale. Attacks may be triggered by an allergy or by stress; for example, being involved in an accident. Sometimes the cause of the attacks for a particular sufferer is never identified. There is evidence to suggest that asthma appears to be increasing in frequency, or at least in diagnosis.

TREATMENT
An asthma attack should not be underestimated. While the preventive treatments are very effective, and the drugs to relieve attacks usually work very well, left untreated, a serious attack can be fatal. The strain of a serious asthma attack can cause the breathing to stop or the heart to cease beating. You should be prepared to resuscitate if necessary.

1. Reassure the victim as this will have a positive effect on his breathing.
2. Help the victim into a sitting position, leaning slightly forward, as most people with asthma find this an easier position for breathing.
3. If the victim has medication, enable him to use it. Inhalers are the main form of treatment.

If this is the first attack, the medication does not work within 5 minutes, or the victim is in severe distress, then call an ambulance. Help the victim to take medication every 5 to 10 minutes.

     If the attack ease and the person finds it easier to breathe, he will not need immediate medical attention but should advise a doctor of the attack. A person will often be very tired following an attack so it is best to ensure that he is accompanied home to rest.

SIGNS AND SYMPTOMS

• History of the condition (although some people may not realize that they are asthmatic and the first attack may be a very severe one).
• Difficulty in breathing, particularly breathing out
• Wheezing or otherwise noisy breathing 
• Inability to speak
• Pale skin and potential blueness, particularly around the lips, caused by lack of oxygen
• Distress, dizziness, and  confusion as it becomes harder to get oxygen into the body
• Unconsciousness and then breathing stopping

USING AN INHALER

Known asthmatics are usually prescribed an inhaler, a device that administers a measured dose of drugs inhaled directly into the lungs, where it will have a near-instant effect.

     Young children may find it hard to use an ordinary aerosol inhaler and will need a spacer instead. Medication is put into the end of the spacer and the child breathes normally to take this in.

     Children under the age of four will usually require a face mask to use with the spacer as they cannot coordinate their breathing to inhale the drugs.

     If a member of your family is an asthmatic, make sure that everyone understands the importance of knowing where the inhaler is and that there is always enough medication in the house.

By: Unknown On 5:46 PM

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Shock and Drowning

The word shock can be used in a range of ways, but when used in a first aid context it describes a physical condition that results from a loss of  circulating body fluid. It should not be confused with emotional shock that might occur when a person has received bad news (although the external signs are very similar).

WHAT HAPPENS IN CASES OF SHOCK. A severe loss of body fluid will lead to a drop in blood pressure. Eventually the blood's circulation through the body will deteriorate and the remaining blood flow will be directed to the vital organs such as the brain. Blood will therefore be directed away from the outer areas of the body, so the victim will appear pale and the skin will feel cold and clammy. As blood flow slows, so does the amount of oxygen reaching the brain. The victim may appear to be confused, weak, and dizzy, and may eventually deteriorate into unconsciousness. To try to compensate for this lack of oxygen, the heart and breathing  rates both speed up, gradually becoming weaker, and may eventually cease.

POTENTIAL CAUSES OF SHOCK INCLUDE: severe internal or external bleeding; burns; severe vomiting and diarrhea, especially in children and the elderly; problems with the heart.

TREATMENT

• Warmth
• Air
• Rest
• Mental rest
• Treatment
• Help

SIGNS AND SYMPTOMS

• Pale, cold, and clammy skin
• Fast, weak pulse
• Fast, shallow breathing
• Dizziness and weakness
• Confusion
• Unconsciousness
• Breathing and heartbeat stopping

Shock kills, so it is vital that you can recognize these signs and symptoms. With internal bleeding in particular, shock can occur some time after an accident, so if a person with a history of injury starts to display these symptoms of internal bleeding, advise her to seek urgent medical attention, or take or send her to hospital.

Warmth. Keep the victim warm but do not allow her to get overheated. If you are outside, try to get something underneath her if you can do so easily. Wrap blankets and coats around her, paying particular attention to the head, through which much body heat is lost.

Air. Maintain a careful eye on the victim's airway and be prepared to turn her into the recovery position if necessary, or even to resuscitate if breathing stops. Try to keep back bystanders and loosen tight clothing to allow maximum air to the victim.

Rest. Keep the victim still and preferably sitting or lying down. If the victim is very giddy, lay her down with her legs raised to ensure that maximum blood and therefore maximum oxygen is sent to the brain.

Mental rest.  Reassure the victim but keep your comments realistic. Do not say that everything is going to be fine when it is obvious that there is something seriously wrong. Let the victim know that everything that can be done is being done and that help has been called for it. If she has other concerns, try to resolve this.

Treatment.  Treat the cause of the shock and aim to prevent further fluid loss.

Help.  Ensure that appropriate medical help is on the way.

DROWNING
When a person is drowning, the air passages flows to prevent water entering the lungs. This is also prevents air from entering the lungs, thus depriving, the victim of oxygen and eventually leading to unconsciousness and death. Usually, only if the victim has been unconscious in the water for some time to the lungs fill up with water. More commonly, the water goes into the stomach. A secondary risk for the rescued person is that he or she choke on vomit as water in the stomach forces the stomach contents upward. A near drowning person also faces the risk of hypothermia. Children and young adults are the greatest risk of drowning.

RESCUING A DROWNING PERSON. As in all first aid, the key rule is to protect yourself. A person who is drowning will strike out and pull down even the most competent swimmer; dirty water can hide dangers such as metal rubbish with sharp edges; and cold water can cause muscles to cramp very quickly.
     If possible, reach to the person from the safety of solid ground using a pole, rope, or buoyancy aid to enable him to help himself out of the water. If in doubt about your ability to rescue the person safety, call for emergency help.

VOMITING. A person who is nearly drowned is very likely to vomit. Maintain a close watch for this. If the victim vomits while you are resuscitating him, turn him toward you, and clear out the mouth before turning him onto the back and resuming rescue breathing. If the victim vomits while in the recovery position, clear out the mouth and keep close eye on breathing to ensure that it has not stopped. If the victim is conscious and becomes sick, encourage him to lean forward and support while he is vomiting.
     Don not make any effort to remove water from the lungs by applying chest compressions or abdominal thrusts. The risk of water in the lungs is minimal, while compressing the chest or stomach will increase the risk of the victim choking on his own vomit.

TREATMENT OF A NEAR-DROWNING VICTIM

1. Open the airway by tilting the head, checking the mouth, and lifting the chin. Check for breathing for up to 10 seconds.
2. If the victim is breathing, place into the recovery position.
3. If the victim is not breathing, provide rescue breathing before moving on to an assessment of circulation and full CPR as necessary.

HYPOTHERMIA. Hypothermia is a lowering of the body's core temperature and is very common secondary problem of near-drowning. If untreated, hypothermia leads to the breathing and heart rate slowing down and eventually stopping.

     To reduce the risks of hypothermia in a case of near-drowning, place the victim on a blanket or layer of coats to insulate him from the ground. Remove wet clothing if you are able to replace it quickly with warm and dry clothing; if not, then cover the wet clothing with blankets and coats. Cover the head to prevent heat loss. Warm the external environment if possible.

     Even in a conscious person, hypothermia can be a risk. Seek medical help as soon as possible.

ANAPHYLACTIC SHOCK
An allergy is hypersensitivity to a substance (allergen) that is not normally considered to be harmful. Allergies are triggered by the immune system, which reacts to the allergen as though it were a harmful substance invading the body. The most extreme response is anaphylaxis, which may result in anaphylactic shock which, if untreated, can kill.

CAUSES OF ANAPHYLAXIS. This extreme allergic reaction has an intense effect on the body, causing a sudden drop in blood pressure and narrowing of the airways that can be fatal. Anaphylactic shock can be caused by anything, but among the most common triggers are: nuts (for those who are particularly sensitive, even touching the trace of a nut can be potentially fatal), seafood, insect stings and bites, and drugs (some people have a very extreme reaction  to penicillin, for example).
     As with asthma, the number of people suffering allergic reactions appears to be increasing. Whether this is because people are becoming more sensitive to allergens (the substances that cause allergic reactions) or whether we are just becoming better at detecting allergies, nobody is really sure.

SIGNS AND SYMPTOMS
One of the main effects of severe anaphylaxis is a constriction of the air passages in a similar way to asthma but generally more severe, preventing the intake of any oxygen at all. There may be a history of contact with a particular allergen, the thing that triggers the attack. Anaphylaxis can happen very quickly, within seconds. Signs and symptoms include:

• Difficulty breathing
• Pale skin and blue lips
• Blotches on the skin
• Rapid pulse
• Breathing and heartbeat stopping

TREATMENT

1. Call an ambulance immediately. The victim needs  epinephrine to counteract the reaction
2. If the victim is a known sufferer she may have an epinephrine injection. Help her to administer this. if you have been trained and the victim is unable to do so, you may give the injection.
3. Place the victim in the most comfortable position and reassure her.
4. If the victim becomes unconscious, place in the recovery position. Monitor the victim's breathing and circulation and be prepared to resuscitate if necessary.

SKIN PRICK TEST FOR ALLERGIES

Skin prick test are simple procedures carried out to find out what substances (allergens) cause allergic reactions in an affected person. Extracts of allergens that commonly cause allergic reaction, such as food, pollen, and dust are made into dilute solution and are then placed on the skin. The skin is pierced to allow the substance to be absorbed.

1. Dilute solutions of substances that a person is thought to be allergic to are placed on the skin, usually the arm, and the skin is then pricked with a needle. Several different allergens can be tested on the skin at the same time.
2. An allergic reaction usually takes place within 30 minutes of the test. If the person is allergic to the substance a red weal, indicating a positive reaction, appears at the site where the needle pricked the skin.

By: Unknown On 4:49 AM

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