CHOCKING, FRACTURE, HEAT STROKE ,SUN STROKE, CPR, RECOVERY POSITION

 CHOCKING

A foreign object that is stuck at the back of the throat causing Chocking

Sign & Symptoms:

> Difficulty in breathing and speaking.
> Congested face initially.
> Grey blue skin (Cyanosis ) later.
> Distressed signs from the casualty, who may point to the throat, or grapes the neck.

YOUR AIMS ARE : 

> To remove the obstruction and so restore normal breathing.
> To arrange urgent removal to hospital if necessary.

TREATMENT: (FOR CONSCIOCS PERSON )

Ask the casualty to cough, if cannot cough, do not ask to do so.

Bend the casualty well forward at the west and give up to five sharp slaps between the shoulder

blades with the flat of your hand.

IT back slaps fail. try up to five abdominal thrust ( Hemlich's manoeuvre ).

Continue alternating back slaps and abdominal thrust.

TREATMENT: (FOR UNCONSCIOUS PERSON )

> Asses the casualty following the ABC of resuscitation.

> Turn the casualty on to his side and give up to five sharp slaps with. lat of your hand between the

    shoulder blades. Check the mouth and use a finger to hook out any obvious obstruction.

> If back slaps fail, kneel Astrid or alongside the casualty. Place the heel of one hand below his

    ribcage and cover it with your other hand. Press sharply inwards up to five times.

> If casualty begins to breath normally. place him in the recovery position.

C. Deal with simple fracture of collar Bone, Upper arm, Fore arm, Hip & Lower leg. 

Fracture

A fracture is a break or crack in a bone. Generally, considerable force is needed to break a bone, unless it is diseased or old. However, bones that are still growing are supple and may split, bend, or crack hence the term green stick fracture. A fracture is the partial or complete bend, crack or breakage of a bone.

Cause of Fractures

a. Direct Force

The bone breaks at the spot of application of the force e.g. bullet passing into

bones: severe fall on a projecting stone or a wheel passing over the body etc.

b. Indirect Force

The bone breaks away from the spot of application of force e.g. collar-bone-

fracture when the fall is on outstretched hands etc.

c. Muscular Force

Occurs when there is a violent contraction of a group of muscles; happens very

rarely e.g. fracture of ribs on violent cough.

Types of Fracture

Simple (closed) Fracture

The broken ends of the bone do not cut open the skin and i show on the outside.

Compound (open) Fracture

When the fractured bone is in contact with outside air as a result of an injury (so that dirt, dust and germs get into the protruding bone and the wound)

Complicated Fracture

In addition to the fracture, an important internal organ like the brain or major blood vessels, the spinal cord, lung, liver, spleen etc. may also be Furthermore a complicated fracture may be simple or compound.

The other types of Fractures are:-

a) Impacted b) Comminute

c) Depressed d) Green Stick

Sign and Symptoms

1. Pain at the spot of fracture and/or around it.

2. Tenderness i.e. pain on gentle pressure over the injured spot (Do not press hard).

3. Swelling of the area and discoloration

4. Loss of normal movements of the part.

5. Deformity of limb: The limb may lose its normal shape. Sometimes the muscles will pull up the lower free ends causing apparent shortening ot the limb.

6. Irregularity of the bone: If as in the leg bone. the break is under the Skin, the iregular outline of the bone can be felt easily.

LIP DUST

Loss of power 

Irregularity

Pain 

Deformity

Unnatural movement

Swelling or bruising

Tenderness

Management :-

The aim of first aid:

i. To prevent further damage

ii. To reduce pain

iii. To make the patient comfortable and manage shock.

iv. To get medical aid as soon possible.

1. Fractures often occur in major accidents. Therefore it is common to find other injuries also. They First Aider must decide which is more urgent. Heavy bleeding and severely wounded parts are more urgent and should be treated first.

2. There may be more than one fracture in the same patient or even in the same limb.

3. If there is no immediate danger to life, temporary attention to fracture is enough.

4. Support the fracture on the spot, so that the fractured ends are established and patient is ready for transport.

5. Handle very gently; avoid all unnecessary movements of the injured parts.

5. Send for medical aid or send the patient to hospital as quickly as possible. Also inform party's relatives.

7. Treat for shock.

3. If the broken ends of the bones are shown out, do not wash the wound or apply antiseptics to the ends of the bone. Do not handle the fracture unnecessarily.

Fracture Treatment

1. Provide support to the injured area

2. Expose the site of the injury

3. Treat any wounds

4. Immobilise effectively

5. Reassure and monitor

Fracture of the Collar Bone :-

The collar bone is broken when the person falls on the tip of the shoulder or the palm ofthe outstretched hand.

Signs and Symptoms

1. The arm on the injured side is partially helpless. The casualty usually supports it at the elbow with the other hand.

2. His head is inclined towards the injured side.

3. The broken ends can be seen and felt. They overlap the outer end being lower.

Management

1. Support the arm of the injured side with the help of the casualty him self or an assistant.

2. Do not remove the coat or shirt.

3. Place a pad in the arm-pit.

4. Leaving the forearm free and bandage the upper arm to the side of the chest with a broad bandage.

5. Support the upper limb in the triangular sling.

6. Feel the pulse to make sure that circulation in the limb is free.

7. Shock is not usually severe; the casualty may be transported even as a walking case to the nearest hospital.

Fracture of the UpperLimb :- 

1. Fractures of the Arm-Bone (Humerus) 

This is a difficult fracture as the spasm of muscles produce bending and overlapping of ends that are broken.

Fracture Sites:

1. Close to the shoulder 

2. In the middle part 

3. At lower end near the Elbow, including the elbow joint. 

Place a pad of rolled handkerchief in the axilla  lightly tie the arm to the chest. 

Bend the elbow and place the hand on the opposite shoulder and apply a triangular sling 

Management

Place a pad of rolled handkerchief in the axilla lightly tie the arm to the chest. Bend the elbow and the hand, place on the opposite and apply a triangular sling. For all injuries of arm and elbow, always feel the pulse of the injured limb before the splintage and after the splintage. If the pulse weakens after splintage

relax the bandage till the pulse comes back.

5. Fracture of the lower end of the radius :- 

Care must be taken not to mistake it for a sprain of the wrist.

Do not mobilise or bend the elbow forcefully

Support the forearm with triangular bandage

Strap the upper arm with roller bandage before mobilizing the casualty to hospital.

Casualty can be moved in a sitting posture or lying down Position in

stretcher

Splints in fractures of the forearm :- 

Forearm fractures are the only fractures where external splint is necessary.

1. Place the forearm at right angles to the upper arm, and place it across the chest with the thumb facing upwards and the palm over the chest. 

2. Roll folded newspaper or other magazine around the forearm. The paper magazine should be from the elbow to the fingers.

3. Apply one bandage above the fracture and the other over the wrist first around it and then as a figure of eight including the wrist and hand.

4. Support the limb by a broad arm sling.

Fracture of the Pelvis :- 

This is mostly due to direct force like fall of beams crush accident etc. Indirect force very rarely results in fracture of the pelvis, (as by a fall from a great height on the feet with lower limbs stiff). The bladder and urinary passages may also be injured producing grave complications.

Signs and Symptoms

1. Pain in the hip and joints increased by cough and/ or movement.

2. Although the lower limbs are not injured the casualty will be unable to stand.

3. Internal bleeding is possible.

4. There will be difficulty in passing urine. Urine may be mixed with blood. 

Management :- 

1. Allow the casualty to lie in the position most comfortable to him preferably on his back with lower limbs stretched.

2. Ask him to avoid passing urine.

3. a. If a hospital is near, transport on stretcher in the most comfortable position. No need to bandage.

b. If the journey is long and on rough roads:-

i. Place centre of the broad bandage on the hip joint of the injured side, pass one end round the pelvis and tie on the other side. Tie another broad bandage so that it overlaps the first by half its breadth and tie similarly. The bandage should be firm but not too tight, avoid pressing the broken parts more inwards.

ii. Put pads between knees and ankles.

iii. Apply figure-of-eight bandage around the ankles and the knees with a broad bandage if needed.

d) Treat for Heat Stroke and Sun Stroke:

HEAT STROKE

As the name implies this dangerous condition may come on suddenly or it may follow heat exhaustion.

Signs and Symptoms:

• Unconsciousness comes on rapidly but may be preceded by headache, irritability and vomiting. The face is flushed, the skin hot and dry.

• The pulse is full and bounding.

• The temperature which rises rapidly may be very high.

• The casualty will die in a short time if it is not lowered quickly.

Treatment :- 

• Place the casualty in the coolest place and remove outer clothing.

• Sprinkle him/her with water or wrap him/her in a wet sheet and fan him/her.

• Care must be taken not to lower the temperature too far. When the temperature is lower wrap him/her in a dry sheet and continue fanning, If the temperature rises again, repeat ne treatment.

• On recovery continue as for heat exhaustion and keep under observation.

SUNSTROKE

Sunstroke is an unsatisfactory term fora condition which arises as a result of the combined effects of the direct light and heat rays of the sun on, or through, insufficiently protected surfaces of the body.

Treatment:

This is largely preventive. Skin surfaces should be protected by suitable clothing. Sun helmets and spine pads should be worn when exposure to the sun is necessary or expected. Tinted glasses protect the sensitive nerve tissues of the eyes from glare. Superficial effects of sunburn can be alleviated by the use of cooling lotions and cold creams. 

With deeper seated effects such as delayed headache and vomiting send for a doctor and apply ice cap to the top of the head, after removing the patient to cool shaded surrounding-

e)  Demonstrate CPR (Cardio Pulmonary Resuscitation). 

Reviving someone who is unconscious and/or not breathing or not breathing normally is called resuscitation.

Chest compressions with or without rescue breathings are performed by an individual during cardio pulmonary resuscitation (CPR) in an attempt to restore spontaneous circulation.

For untrained or minimally trained first aid providers treating an adult victim, compression-only CPR is recommended. These chest compressions ensure a small but crucial supply of blood to the heart and brain. 

CPR: HOW TO GIVE CHEST COMPRESSIONS?

1. Turn the casualty on his back on a hard surface, if not already.

2. Kneel next to the casualty, beside his upper arm.

3. Place the heel of one hand in the center of the person’s chest.

4. Place the heel of the other hand on top of your first hand.

5. Lock your fingers of both hands together.

6. Make sure your shoulders are directly above the person’s chest.

7. With outstretched arms, push five to maximum six centimetres downwards.

8. Release the pressure and avoid leaning on the chest between compressions to allow full chest recoil. The compression and release should be of equal duration.

9. Do not allow your hands to shift or come away from the breastbone.

10. Give 30 chest compressions in this way at a rate of 100 compressions a minute (you may go faster, but not more than 120 compressions a minute). This equates to just fewer than two compressions a second.

If the person’s age is below puberty, only use one hand.

If the victim is a baby, do not use this technique but apply the technique of CPR for babies and children under the age of one year.

CPR: HOW TO GIVE RESCUE BREATHS?

If for some reason you cannot or do not want to give rescue breaths, you can just continue giving chest compressions (five to maximum six centimetre deep at a rate of 100 compressions a minute).

1. Put one hand on the person’s forehead and tilt back his head.

2. Put your other hand on the bony part of the chin and lift the chin.

3. Then pinch the person’s nose with one hand that is on his forehead.

5. Take a normal breath and then put your mouth completely over the person’s mouth and seal with your lips. Calmly blow your air into the mouth of the person’s for one second. Check if the person’s chest rises.

6. If the chest does not rise, take the following steps:

a. Check if anything is in the person’s mouth.  If so, remove any visible items that may block the             airway.

b. Check that the head is well tilted and the chin is lifted properly.

In any case, make no more than two attempts to blow air into the person.

7. Start another series of 30 chest compressions prior to trying to blow air into the person’s mouth again.

   To ensure that the quality of the chest compressions remains optimal, the rescuers should switch every two minutes:

   
   The first rescuer gives 30 chest compressions followed by two ventilations and another set of 30 chest compressions and two ventilations.

   
   Then another rescuer takes over and repeats the above steps and switch again.

   The switches should happen with minimal interruption and as quickly and smoothly as possible.

8. Do not interrupt the resuscitation until: 
   
   
   
   

   01. the victim starts to wake up, moves, opens his eyes and breathes normally; help (trained in 02. (CPR) arrives and takes over;

   03. you become too exhausted to continue; or

   04. the area becomes unsafe for you to continue. 

f)  Place an unconscious victim in the Recovery position. 

1. Put the person on the floor if he is not there already.

2. Remove the person’s spectacles if necessary.

3. Kneel down by the side of the casualty.

4. Make sure both of his legs are outstretched.

5. Place the nearest arm (the one on the side you are kneeling next to) at right angles to his body.

6. Bend the forearm upwards with palm facing up.

7. Lay the person’s other arm across his chest. 

    8. Hold the back of this hand against his cheek on the side at which you are kneeling.

    9. Keep that hand in that position.

10. With your other free hand, grasp the leg on the other side of the person’s body under the knee.

11. Raise that leg, but leave the person’s foot on the ground.

    

12. Pull the raised leg towards you.

13. In the meantime, keep the back of the person’s hand held against his cheek. Roll the person towards you so he turns on his side.

    
    
    

14. Position the person’s upper leg in such a way that his hip and knee are at right angles.

16. The person is now in a turned position and will not turn on his back.

    
    
    

17. Tilt the head of the person backwards to keep the airway open.

18. Make sure the mouth is angled towards the ground. This will prevent the risk of choking on blood or vomit.

    
    
    

19. Adjust the hand under the cheek if necessary so that the head remains tilted backwards and the mouth remains at a downward angle.

    A casualty lying position is commonly referred to in the ‘recovery position’

20. Do not leave a casualty alone and continue observing his condition and monitoring his breathing. If the person stops breathing, start resuscitation (see resuscitation). 

1. g) Transportation of victim - One Rescuer & two Rescuers 

2. Transportation of victim - One Rescuer

3. 
   a) Cradle: Lift the casualty by passing one of your arms well beneath his/her two knees and the other round his/her back. This method is only possible, if the casualty is light weight or in case of children.

b) Human Crutch: Standing on his/ her injured side, when there is injury to an upper limb, assist the casualty by putting your arm round his / her waist, grasping the clothing at his / her hip and placing his / her arm round your neck, holding his / her hand with your free hand. The casualty can place his her injured foot on your foot.

c) Pick-a-back : If the casualty is conscious and able to hold on, he / she may be carried in the ordinary “Pick-a-back" fashion.

d) Fireman's lift and carry :- Help the casualty to rise to the upright position. Grasp his / her right waist with your left hand. Your right shoulder is in level with the lower part of his / her abdomen and place your right arm between or round his / her Bend down with your head under his / her extended right arm so that her legs. Taking his / her weight on your right shoulder rise to the erect position. Pull the casualty across both shoulders and grasp his / her right wrist with your right hand, so leaving your left hand free.

1. Transportation of victim - two Rescuers

2. 

1) The Four Hand Seats: This method is used when the casualty can assist the bearers. 

a) Two bearers face each other behind the casualty and grasp their left wrists with their right hands and each other's right wrists with their left hands.

b) The casualty is instructed to place one arm round the neck of each bearer, so that he / she may raise

himself/ herself to sit on their hands.

c) The bearers rise together and step off.

2) The two handed seat-

a) Two bearers face each other and stop one on each side of the casualty. Each bearer passes his / her

forearm nearest to the casualty's head under his /her back just below the shoulders. They slightly raise the casualty's back and then pass their other forearms, the middle of his / her thighs and clasp their hands.

b) The bearers rise together and step off.

3) The Fore and Aft method:

One bearer stands between the casualty's legs, facing the feet, bends down and grasps the casualty under his / her knees. The other bearer takes a position behind the casualty and after raising his / her trunk passes his / her hands under the casualty's armpit and grasps his / her own wrists across the casualty's chest. The

casualty is then lifted. The bearers walk in step.