Sunday, January 20, 2008

First Aid

I attended a Training on Handling of Emergency Accidents & First Aid.Once again kudos to my company for helding this session.

I thought it will be a traditional one but to my surprise I was proved wrong.Dr.Mahesh Joshi from Apollo made it a worth-to-attend training.He is tall and full of life.His confidence and authority is itself a kind of first-aid to the patient.Congratulations to the doctor and his team.

I will mention the details in direct speech for ease of understanding.The doctor started with :

Hello Every one!Let us look at statistics.How many accidents/year occur in India?
Audience shouted variety of numbers ranging from 4000 to 4 lakhs.
What a value we have given to lives poor people met with accidents 4000 to 4 L !! (with an ironical tone).It is not your fault.It is the unfortunate scenario of our poor infrastructure.In any mishap prevention is better than cure but we are not always so lucky.Ok it is actually 1L.Do you know that India is the diabetes capital of the world?18 crore Indians are Diabetes-Prone.Do you know that the people of the Hyderabad are the sweetest (1 out of 8 people are suffering from diabetes)?Do you know that 2500 Indians die per year due to BP(BloodPressure)?

So there is high probability of finding people or your own parents or relatives suffering.What can you do so that you donot repent "If I would have done that "?First of all Don't Panic.Don't hurt yourselves.Call emergency helplines 108 or 1066 and then start first aid.How to give first aid ?Don't worry we will discuss.If there is some one else on the scene delegate them the task.I hope you guys are well equipped with "managerial" skills.How do you delegate the task?Call 108 tell them that person is unconscious at Gachibowli (with proper land marks) thats all and then you start doing the first aid.

Now let us dwell into first aid.What is first aid? It is the care given before emergency medical help arrives that can change morbidity or mortality.If done correctly it will decrease morbidity or mortality or else it will certainly increase.So do first-aid only if you know correctly but please do not further harm.

Let me tell you a funny instance happened at Numaish (exhibition).
I was handling a similar session.I wanted to know how does audience attend to a person suffering with fits.I was in the audience and suddenly started doing convulsions.Some of them were scared and ran away.But some responsible citizens started doing so-called first-aid.There were twenty of them surrounding me.They were making me (a fits patient) breathless.Twenty advices wer coming out.They debated among themselves and finally started acting (Thank God! they started doing some thing let us see what they did).Do you see my broken teeth?One of them took out his car keys and inserted into my mouth.In the process poor me's tooth was broken.Another one pour a bucket of water on me.Another one sacrificed his pav bhaji's onion to place them on my forehead.Two of them started thumping my ribs violently.Even today I feel the pain (My God!).Some of them took out their socks , chappal what not! I was afraid and stopped the drama.

Isn't it funny?If it were a real patient it would have been a torture for him rather than first-aid.Let us know about first-aid in case of some general accidents.
(2)Sudden Collapse
(6)Dog/Snake Bite
(7)Chest Pain (Heart Attack)
(8)Electric Shock

How many lifelines are there in KBC?Audience shouted 3,4 ...Ok but there are only 2 life lines for a human being.(1)Airway (2) Spine.First aid must ensure that they are fine.

With this thumb-rule let us start with these accidents one by one.

(1)Choking :-
It is speechless,breathless condition caused due to a foreign-body obstructing wind-pipe.
Obviously you cannot ask him questions as he cannot speak.Also donot give him water or tea.
(i)First of all let him know that you are doing first-aid.Make him believe you.
(ii)You can take help of his cough-reflex.Make him stand .
(iii)Go behind him place one of your leg in between his two legs.This will help you to balance his weight and save your spine if he suddenly becomes unconscious.
(iv)Now clasp your arms from behind around his abdomin above his navel.
(v)Give a blow so that it comes out due to his cough reflex or he becomes unconscious.
(vi)If he becomes unconscious using your leg's support lay him down and do the same blows till some medical help is arrived.

In case of babies cough-reflex is not well developed.Giving back-blows between shoulder blades with our hurting the baby helps.

(2)Sudden Collapse :-
It can occur due to variety of reasons.One that occurs due to cardiac arrest is discussed later.Here it occurs due to stress,low blood-sugar levels,low BP and so on.
(i)Oxygen and Blood-Supply should be maintained.Donot pour a bucket of water on his face as shown in Bollywood movies.
To maintain the supply of oxygen and blood
(i)Lay down the patient
(ii)Elevate his legs.If you don't have anything else to do :) you can hold his/her legs or raise his/her an support them against a chair or a wall.Why Elevate ?You are taking the advantage of gravity.By elevating you are letting blood & oxygen flow freely to and fro between heart and various parts of the body.
(iii)Please don't feed him with tea or coffee .It is another side-effect of Bollywood movies.

(3)Fits (Convulsions/Epilepsy):-
Let us understand them.Our brain has an electric circuit.It gets disturbed at times due to various reasons.This leads to repeated contractions in the circuit which causes convulsions.It is a scary sight but don't fear.The patient is already suffering.He is going to do nothing to you.It is your job to prevent secondary losses to him.
In this situtation his tongue falls back and closes one lifeline i.e., airway.
(i)As mentioned in "Sudden Collapse" case lay him down but in a lateral position.This is to avoid the tongue from falling back.
(ii)The patient needs immediate medical attention.As aforementioned you might have already called for medical help.

One quick tip :- Lateral position is known as recovery position when a patient is unconscious.

(4)Bleeds :-
What happens when a person bleeds?People gather around and make variety of hissing sounds as if someone has thrown water on a hot pan.Instead ,re-assure the person.
(i)Irrigate the wound but don't use your saliva or dust as shown in the movies.
(ii)Do pressure Compression.Take a cloth press on the injure part for 5-10 minutes with out break.This helps in the formation of the clot.Do not apply high pressure in such a way that it cuts the blood flow to the entire organ below the wound.
(iii)Applying Ice helps because it reduces temperature and quickens clot formation.
Bleeding from Nose :-
I generally happens in summer or due to high BP.
(i)Put the patient in 45degree posture but do not let him lay down as usual.
(ii)Do pressure compression on nose.If you are busy take cotton place it on nose then put a clip(the one you use for drying clothes) on the cotton.
(iii)Leave it for some time.

(iv)As usual the medical help might reach by this time.

(5)Sprains/Fractures :-
High Heels! Wonderful Stairs ! ooh! aah! ouch!

Sprains occur due to unfamiliar surface or insufficient lighting.They are injuries which occur to ligaments because of sudden overstretching. whereas in the case of fracture a bone is broken into pieces.Extreme pain is the main symptom of fracture.

For these use RICE principle : R(Rest)I(Ice)C(Compression)E(Elevation)
(i)Do not move the injured site.Generally people tend to move and twist and do all sorts of experiments on the injured site.Please avoid doing that.It will intensify the problem.

(ii)In the case of fracture do not use sling to support.Use your other hand or a card board(available in market) to support.Sling may aggravate the problem.What happens in the case of fracture?Your bone is broken say part1 and part2 and gap between the parts.The sling tends to settle in the gap and thus increasing the gap which is the only thing we do not want to happen.

(iii)If you feel that it is a fracture,insist on an X-ray even if the doctor claims that it is not a fracture.

(6)Dog/Snake Bite :-
Quick Statistics: Rabies(caused due to virus) is 100% mortal barring very few exceptions.Again India ranks first in it.A 17yr brilliant student in AP died because of rabies.
Dog Bite:
To attend to the patient make sure that the dog is not around.Then :-
(i)Clean the wound effectively with running soap water for 15-20 minutes.
(ii)Cover it with a cloth
(iii)Take the patient to a hospital with good facility.The hospital must contain Rabies Immunoglobin.The student mentioned above died because of not taking to a hospital with a good facility.The student was given TT and was sent.Poor boy! he suffered a brutal death.
(iv)Knowing whether the dog is vaccinated or not helps in the further treatment.

Note :- Rabies vaccine is not the only answer to Rabies because vaccine is nothing but milder version of virus.Lot of clinical care is required.

Snake Bite:
AS mentioned above make sure that the snake is not around.Although 90% of the snakes are non-poisonous it is safe to assume that the snake is poisonous.
As shown in movies Snake - Bite cannot kill so rapidly .It takes time for the poison to mix with blood and finally collapse the heart.We take advantage of this time to save the patient.
(i)Do not touch the wound with bare hands
(ii)Do not cut the affected part.It may cause gangrene.
(iii)Clean the wound .Immobilise the injured part using a cloth so that blood does not flow freely.
(iv)Every minute is important . Rush the patient to a hospital that is likely to contain polyvalent anti-venom .

In case of scorpion bite/bee stings also clean the wound and rush the patient to the hospital.

(7)Chest Pain (Heart Attack) :-
Heart attack may occur in variety of forms
(a)Chest Pain
(b)Shooting Pain in Shoulders
(c)Left Jaw Pain
and so on so forth.

Let me tell you an example of a bank executive who died because of neglecting the symptoms.His spouse applied amrutanjan on his chest all the night.Infact it enraged his problem.The next morning he died in his office.

What I want to say is You,me and most of the employees in India belong to the blessed citizens of the country i.e., they have Health Insurance Policy.So please get ECG done immediately . Go for treatment with out any delay.

Let us understand cardiac arrest.The heart does not beat and breathing ceases, which starves the body of oxygen. Brain damage is likely if cardiac arrest lasts for more than 5 minutes, and death is likely if cardiac arrest lasts for more than 10 minutes.

How can we help a person suffering from cardiac arrest?
(i)Act immediately.
(ii)If the person is conscious ,give him aspirin or sorbitrate5mg.Do not Let him exert.Call for immdediate help.
(iii)If the person is unconscious (in fact if you feel that the person is unconscious),
Ask loudly, "Are you OK?" "Are you OK?" .If there is no response Place two fingers on one or other side of the person's voice box in their throat to feel if they have a carotid pulse.
(iv)If the patient has a pulse but is not breathing it could be because of suffocation? Feel inside the mouth with a finger to see if there is anything blocking it or the windpipe and remove any food or other objects. Provided that dentures are not broken, it is better not to remove them.Call for help immediately,and provide resuscitation (discussed below) until the patient begins to breathe or the ambulance arrives.

If there is no breathing or pulse, the patient has had a cardiac arrest.

(v)If possible, raise the legs up to allow more blood to flow towards the heart.Immediately place the palm of your hand flat on the patient's chest just over the lower part of the sternum (breast bone) and press your hand in a pumping motion once or twice by using the other hand. This may make the heart beat again.

(vi)If these actions do not restore a pulse or if the subject doesn't begin to breathe again:
Use an automated external defibrillator (AED),a device that can start the heart beating again if available.The device is easy to use.Shamshabad airport is supposed to be installed with AED's around.
(vii)If the person has not resumed breathing or an AED is not available cardiopulmonary resuscitation (CPR) should be started.CPR combines artificial respiration (mouth-to-mouth resuscitation, rescue breathing), which supplies oxygen to the lungs, with chest compressions, which circulate oxygen to the brain and other vital organs by forcing blood out of the heart.CPR needs practice Refer this .

(8) Electric Shocks/Burns :
Ensure Scene safety.Shut off Electric supply.In case of burns use water.Get immediate mental attention.

(9)Paralysis :
Symptoms (i)Facial Droop (ii) Unable to Speak (iii)Cannot stretch both the arms one of them sways.
It needs immediate medical attention with good facility.

Ok friends.I will close . Happy Living.Let us all practice CPR.

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