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Basic First Aid. Instructor Tim Winer Orange Coast College (714) 432-0202, Ext. 26677. The Key Emergency Principle. The key principle taught in almost all systems is that the rescuer, be they a lay person or a professional, should assess the situation for Danger .

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Basic First Aid

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    1. Basic First Aid Instructor Tim Winer Orange Coast College (714) 432-0202, Ext. 26677

    2. The Key Emergency Principle • The key principle taught in almost all systems is that the rescuer, be they a lay person or a professional, should assess the situation for Danger. • The reason that an assessment for Danger is given such high priority is that it is core to emergency management that rescuers do not become secondary victims of any incident, as this creates a further emergency that must be dealt with. • A typical assessment for Danger would involve observation of the surroundings, starting with the cause of the accident (e.g. a falling object) and expanding outwards to include any situational hazards (e.g. fast moving traffic) and history or secondary information given by witnesses, bystanders or the emergency services (e.g. an attacker still waiting nearby). • Once a primary danger assessment has been complete, this should not end the system of checking for danger, but should inform all other parts of the process. • If at any time the risk from any hazard poses a significant danger (as a factor of likelihood and seriousness) to the rescuer, they should consider whether they should approach the scene (or leave the scene if appropriate).

    3. Principles for assessing an emergency • Once a primary check for danger has been undertaken, a rescuer is then likely to follow a set of principles, which are largely common sense. These assessment principles are the types of information that the emergency services will ask when summoned. • This information usually includes number of Casualties, history of what's happened and at what time, location and access to the site and what emergency services are likely to be required, or that are already on scene. There are several mnemonics which are used to help rescuers remember how to conduct this assessment, which include CHALET (Casualties, Hazards, Access, Location, Emergency Services, Type of Incident) and ETHANE (Exact Location, Type of Incident, Hazards, Access, Number of casualties, Emergency services required) • For small scale medical incidents (one or two casualties), the rescuer may also conduct a first aid assessment of the patient(s) in order to gather more information. The most widely used system is the ABC system and it's variations, where the rescuer checks the basics of life on the casualty (primarily their breathing in modern protocols). • In larger incidents, of any type, most protocols teach that casualty assessment should not start until emergency services have been summoned (as multiple casualties are expected). • Accurate reporting of this important information helps emergency services dispatch appropriate resource to the incident, in good time and to the right place.

    4. Summoning Emergency Services • After undertaking a scene survey, the rescuer needs to decide what, if any, emergency services will be required. In many cases, an apparent emergency may turn out to be less serious than first thought, and may not require the intervention of the emergency services. • If emergency services are required, the lay person would normally call for help using their local emergency telephone number, which can be used to summon professional assistance. The emergency dispatcher may well give instructions over the phone to the person on scene, with further advice on what actions to take.

    5. Action whilst awaiting emergency services • The actions following the summoning of the emergency services are likely to depend on the response that the services are able to offer. In most cases, in a metropolitan area, help is likely to be forthcoming within minutes of a call, although in more outlying, rural areas, the time in which help is available increases. • Actions may include: • First Aid for casualties on scene • Obtaining further history on the incident to pass on the emergency services • Checking for further, previously unnoticed, casualties • Or in instances where emergency assistance is delayed, actions may include: • Moving any casualties away from danger • Undertaking more advanced medical procedures dependant on training

    6. Check the Patient • ABC (and extensions of this initialism) is a mnemonic for memorizing essential steps in dealing with an unconscious or unresponsive patient. It stands for Airway, Breathing and Circulation. Some protocols add additional steps, such as an optional "D" step for Disability or Defibrillation. It is a reminder of the priorities for assessment and treatment of many acute medical situations, from first-aid to hospital medical treatment. Airway, breathing and circulation are vital for life, and each is required, in that order, for the next to be effective.

    7. ABC’s • The key part of the mnemonic is made up of the first three letters of the alphabet — A, B and C. Together they are designed to remind practitioners of the correct procedure (including the order) in which to deal with a non-breathing patient. • A — Airway • If the patient's airway is blocked, oxygen cannot reach the lungs and so cannot be transported round the body in the blood. Ensuring a clear airway is the first step in treating any patient. Common problems with the airway involve blockage by the tongue or vomit. • Initial opening of the airway is often achieved by a "head tilt — chin lift" or jaw thrust technique, although further maneuvers such as intubation may be necessary. (See Airway) • B — Breathing • The patient is next assessed for breathing. Common findings during an assessment of breathing may include normal breathing, noisy breathing, gasping or coughing. The rescuer proceeds to act on these based on his/her training. Generally at this point it will become clear whether or not the casualty needs supportive care (such as the recovery position) or Rescue Breathing. • C — Circulation • Once oxygen can be delivered to the lungs by a clear airway and efficient breathing, there needs to be a circulation to deliver it to the rest of the body. This can be assessed in a number of ways, including a pulse check, ECG analysis, or Capillary refill time. Other diagnostic techniques include blood pressure checks or temperature checks on peripheral areas. • Circulation is the original meaning of the 'C' as laid down by Jude, Knickerbocker & Safar, but in some revised modern protocols, this step stands for Cardiopulmonary Resuscitation or more simply, Compressions, which is effectively artificial circulation. In this case, this step should only apply to those patients who are in Cardiogenic or other form of Shock, and therefore not breathing normally and with an unsatisfactory heart rhythm.

    8. Recovery position • The recovery position or semi-prone position is a first aid technique recommended for assisting people who are unconscious, or nearly so, but are still breathing. It is frequently taught as part of classes in CPR (cardiopulmonary resuscitation) or first aid. • When an unconscious person is lying face upwards, there are two main risks factors which can lead to suffocation: • The tongue can fall to the back of the throat, due to loss of muscular control. The back of the tongue then obstructs the airway. • Fluids, possibly blood but particularly vomit, can collect in the back of the throat, causing the person to drown. When a person is lying face up, the esophagus tilts down slightly from the stomach towards the throat. This, combined with loss of muscular control, can lead to the stomach contents flowing into the throat, called passive regurgitation. As well as obstructing the airway, fluid which collects in the back of the throat can also then flow down into the lungs; stomach acid can attack the inner lining of the lungs and cause a condition known as aspiration pneumonia. • Many fatalities occur where the original injury or illness which caused unconsciousness is not itself inherently fatal, but where the unconscious person suffocates for one of these reasons. This is a common cause of death following unconsciousness due to excessive consumption of alcohol. • To a limited extent, it is possible to protect against risks to the airway from the tongue by tilting the head back and lifting the jaw. However, an unconscious person will not remain in this position unless held constantly, and crucially it does not safeguard against risks due to fluids. If the person is placed in the recovery position, the action of gravity will both keep the tongue from obstructing the airway and also allow any fluids to drain. Also the chest is raised above the ground, which helps to make breathing easier.

    9. Recovery position

    10. When to use the Recovery Position • The recovery position is recommended for unconscious people, those who are too inebriated to assure their own continued breathing, victims of drowning, and also for victims of suspected poisoning (who are liable to become unconscious). It is suitable for any unconscious person who does not need CPR.

    11. Putting a victim in the Recovery Position • Before using the Recovery Position, perform the preliminary first aid steps. First assess whether the scene is safe for the rescuer. If not, leave. Assess whether the person is responsive to your voice by asking something like "hey, buddy, are you OK?". If not, assess whether the person responds to painful stimulus by rubbing their sternum with your knuckles (this is not accepted practice in some countries). Assess whether the victim has an open airway, is breathing and has a pulse ("airway, breathing, and circulation" or "ABC") . If the victim is alert and an adult, obtain consent before performing first aid. For children, attempt to obtain consent from a parent, guardian, or other responsible caregiver. If the victim is not alert, and is not breathing, check for a pulse. If there is no pulse, perform cardiopulmonary resuscitation. If there is circulation, perform Rescue breathing. The initial assessment should be done quickly, in a minute or less. Next, alert trained emergency medical personnel. Call the emergency telephone number or other emergency services.

    12. Putting a victim in the Recovery Position • If no spinal or neck injury is indicated • The correct position is called the "lateral recovery position."[1] Start with the victim lying on the back and with the legs straight out. Kneel on one side of the victim, facing the victim. Move the arm closest to you so it is perpendicular to the body, with the elbow flexed (perpendicular). Move the farthest arm across the body so that the hand is resting across the torso. • Bend the leg farthest from you so the knee is elevated. Reach inside the knee to pull the thigh toward you. Use the other arm to pull the shoulder that is farthest from you. Roll the body toward you. Leave the upper leg in a flexed position to stabilize the body. • Victims who are left in this position for long periods may experience nerve compression. Still, that is a more desirable outcome for the victim than choking to death. • If spinal or neck injuries are possible • When the injury is apparently the result of an accidental fall, collision or other trauma, the risk of spinal or neck injuries should be assumed. Normally, only trained medical personnel should attempt to move a victim with neck or spinal injuries.[2] Such movements run the risk of causing permanent paralysis or other injuries. • Movement of spinal-injured victims should be minimized. Such victims should only be moved to a recovery position when it is necessary to drain vomit from the airway. • In such instances, the correct position is called the "HAINES modified recovery position." HAINES is an acronym of High Arm IN Endangered Spine. In this modification, one of the patient's arms is raised above the head (in full abduction) to support the head and neck.[3][4] • There is less neck movement (and less degree of lateral angulation) than when the lateral recovery position is used, and, therefore, HAINES use carries less risk of spinal-cord damage.[5]

    13. Choking • Choking is the mechanical obstruction of the flow of air from the environment into the lungs. Choking prevents breathing, and can be partial or complete, with partial choking allowing some, although inadequate, flow of air into the lungs. Prolonged or complete choking results in asphyxiation which leads to hypoxia and is potentially fatal. • Choking can be caused by: • Introduction of a foreign object into the airway, which becomes lodged in the pharynx, larynx or trachea. • Respiratory diseases that involve obstruction of the airway. • Compression of the laryngopharynx, larynx or trachea in strangles.

    14. Choking • Foreign objects • The type of choking most commonly recognized as such by the public is the lodging of foreign objects in the airway. This type of choking is often suffered by small children, who are unable to appreciate the hazard inherent in putting small objects in their mouth. In adults, it mostly occurs whilst the patient is eating. • Symptoms and Clinical Signs • The person cannot speak or cry out. • The person's face turns blue (cyanosis) from lack of oxygen. • The person desperately grabs at his or her throat. • The person has a weak cough, and labored breathing produces a high-pitched noise. • The person does any or all of the above, and then becomes unconscious.

    15. Choking • Treatment • Choking can be treated with a number of different procedures, with both basic techniques available for first aiders and more advanced techniques available for health professionals. • Many members of the public associate abdominal thrusts, also known as the 'Heimlich Maneuver' with the correct procedure for choking, which is partly due to the widespread use of this technique in movies, which in turn was based on the widespread adoption of this technique in the USA at the time, although it also produced easy material for writers to create comedy effect. • Most modern protocols (including those of the American Heart Association and the American Red Cross, who changed policy in 2006[1] from recommending only abdominal thrusts) involve several stages, designed to apply increasingly more pressure. • The key stages in most modern protocols include: • Encouraging the victim to cough • This stage was introduced in many protocols as it was found that many people were too quick to undertake potentially dangerous interventions, such as abdominal thrusts, for items which could have been dislodged without intervention. Also, if the choking is caused by irritating liquids (alcohol, spice, mint, gastric acid, etc.) or anything without a solid shape, and if conscious, the patient should be allowed to drink water on their own to try to clear the throat. Since the airway is already closed, there is very little danger of water entering the lungs. Coughing is normal after most of the irritant has cleared, and at this point the patient will probably refuse any additional water for a short time.

    16. Choking • Abdominal thrusts • A demonstration of abdominal thrusts • Abdominal thrusts, also known as the Heimlich Maneuver (after Henry Heimlich, who first described the procedure in a June 1974 informal article entitled "Pop Goes the Cafe Coronary," published in the journal Emergency Medicine. Edward A. Patrick, MD, PhD, an associate of Heimlich, has claimed to be the uncredited co-developer of the procedure, and has been quoted calling it the Patrick maneuver.[4] Heimlich has objected to the name "abdominal thrusts" on the grounds that the vagueness of the term "abdomen" could cause the rescuer to exert force at the wrong site.[citation needed] • Performing abdominal thrusts involves a rescuer standing behind a patient and using their hands to exert pressure on the bottom of the diaphragm. This compresses the lungs and exerts pressure on any object lodged in the trachea, hopefully expelling it. This amounts to an artificial cough. • Due to the forceful nature of the procedure, even when done correctly it can injure the person on whom it is performed. Bruising to the abdomen is highly likely and more serious injuries can occur, including fracture of the xiphoid process or ribs.[5] • Self treatment with abdominal thrusts • A person may also perform abdominal thrusts on themselves by using a fixed object such as a railing or the back of a chair to apply pressure where a rescuers hands would normally do so. As with other forms of the procedure, it is likely that internal injuries may result.

    17. Choking • Other uses of abdominal thrusts • Dr. Heimlich also advocates the use of the technique as a treatment for drowning[6] and asthma[7] attacks, but Heimlich's promotion to use the maneuver to treat these conditions resulted in marginal acceptance. Criticism of these uses has been the subject of numerous print and television reports which resulted from an internet and media campaign by his son, Peter M. Heimlich, who alleges that in August 1974 his father published the first of a series of fraudulent case reports in order to promote the use of abdominal thrusts for near-drowning rescue.[8] • Modified chest thrusts • A modified version of the technique is sometimes taught for use with pregnant women and obese casualties. The rescuer places their hand in the center of the chest to compress, rather than in the abdomen. • CPR • In most protocols, once the patient has become unconscious, the emphasis switches to performing CPR, involving both chest compressions and artificial respiration. These actions are often enough to dislodge the item sufficiently for air to pass it, allowing gaseous exchange in the lungs. • Finger Sweeping • Some protocols advocate the use of the rescuer's finger to 'sweep' foreign objects away once they have reached the mouth. However, many modern protocols recommend against the use of the finger sweep as if the patient is conscious, they will be able to remove themselves, or if they are unconscious the rescuer should simply place them in the recovery position (where the object should fall out due to gravity). There is also a risk of causing further damage (for instance inducing vomiting) by using a finger sweep technique. • Direct vision removal • The advanced medical procedure to remove such objects is inspection of the airway with a laryngoscope or bronchoscope, and removal of the object under direct vision, followed by CPR if the patient does not start breathing on their own. Severe cases where there is an inability to remove the object may require cricothyrotomy.

    18. Heart Attack • Acute myocardial infarction (AMI or MI), more commonly known as a heart attack, is a medical condition that occurs when the blood supply to a part of the heart is interrupted, most commonly due to rupture of a vulnerable plaque. The resulting ischemia or oxygen shortage causes damage and potential death of heart tissue. It is a medical emergency, and the leading cause of death for both men and women all over the world.[1] Important risk factors are a history of vascular disease such as atheroscleroticcoronary heart disease and/or angina, a previous heart attack or stroke, any previous episodes of abnormal heart rhythms or syncope, older age—especially men over 40 and women over 50, smoking, excessive alcohol consumption, the abuse of certain drugs, high triglyceride levels, high LDL (low-density lipoprotein, "bad cholesterol") and low HDL (high density lipoprotein, "good cholesterol"), diabetes, high blood pressure, obesity, and chronically high levels of stress. Chronic kidney disease[2] and a history of heart failure[3] are also significant risk factors which may also predict fatality from MI.

    19. Heart Attack • Risk factors • Risk factors for atherosclerosis are generally risk factors for myocardial infarction: • Older age • Male sex • Tobacco smoking • Hypercholesterolemia (more accurately hyperlipoproteinemia, especially high low density lipoprotein and low high density lipoprotein) • Hyperhomocysteinemia (high homocysteine, a toxic blood amino acid that is elevated when intakes of vitamins B2, B6, B12 and folic acid are insufficient) • Diabetes (with or without insulin resistance) • High blood pressure • Obesity[14] (defined by a body mass index of more than 30 kg/m², or alternatively by waist circumference or waist-hip ratio). • Stress Occupations with high stress index are known to have susceptibility for atherosclerosis. • Many of these risk factors are modifiable, so many heart attacks can be prevented by maintaining a healthier lifestyle. Physical activity, for example, is associated with a lower risk profile.[15] Non-modifiable risk factors include age, sex, and family history of an early heart attack (before the age of 60), which is thought of as reflecting a genetic predisposition.[13]

    20. Heart Attack • Symptoms • Rough diagram of pain zones in myocardial infarction (dark red = most typical area, light red = other possible areas, view of the chest). • Back view. • The onset of symptoms in myocardial infarction (MI) is usually gradual, over several minutes, and rarely instantaneous.[44]Chest pain is the most common symptom of acute myocardial infarction and is often described as a sensation of tightness, pressure, or squeezing. Chest pain due to ischemia (a lack of blood and hence oxygen supply) of the heart muscle is termed angina pectoris. Pain radiates most often to the left arm, but may also radiate to the lower jaw, neck, right arm, back, and epigastrium, where it may mimic heartburn. Levine's sign, in which the patient localizes his chest pain by clenching his fist over the sternum, has classically been thought to be predictive of cardiac chest pain, although a prospective observational study showed that it had a poor positive predictive value.[45] • Shortness of breath (dyspnea) occurs when the damage to the heart limits the output of the left ventricle, causing left ventricular failure and consequent pulmonary edema. Other symptoms include diaphoresis (an excessive form of sweating), weakness, light-headedness, nausea, vomiting, and palpitations. These symptoms are likely induced by a massive surge of catecholamines from the sympathetic nervous system[46] which occurs in response to pain and the hemodynamic abnormalities that result from cardiac dysfunction. Loss of consciousness (due to inadequate cerebral perfusion and cardiogenic shock) and even sudden death (frequently due to the development of ventricular fibrillation) can occur in myocardial infarctions. • Women often experience markedly different symptoms than men. The most common symptoms of MI in women include dyspnea, weakness, and fatigue. Fatigue, sleep disturbances, and dyspnea have been reported as frequently occurring symptoms which may manifest as long as one month before the actual clinically manifested ischemic event. In women, chest pain may be less predictive of coronary ischemia than in men.[47] • Approximately half of all MI patients have experienced warning symptoms such as chest pain prior to the infarction.[48] • Approximately one fourth of all myocardial infarctions are silent, without chest pain or other symptoms.[49] These cases can be discovered later on electrocardiograms or at autopsy without a prior history of related complaints. A silent course is more common in the elderly, in patients with diabetes mellitus[50] and after heart transplantation, probably because the donor heart is not connected to nerves of the host.[51] In diabetics, differences in pain threshold, autonomic neuropathy, and psychological factors have been cited as possible explanations for the lack of symptoms.[50] • Any group of symptoms compatible with a sudden interruption of the blood flow to the heart are called an acute coronary syndrome.[

    21. Bleeding and Wound Care • Basic external wound management • The type of wound (incision, laceration, puncture etc.) will have a major effect on the way a wound is managed, as will the area of the body affected and the presence of any foreign objects in the wound. The key principles of wound management are:[1] • Elevation - Keeping the wound above the level of the heart will decrease the pressure at the point of injury, and will reduce the bleeding. This mainly applies to limbs and the head, as it is impractical (and in some cases damaging) to attempt to move the torso around to achieve this. Most protocols also do not use elevation on limbs which are broken, as this may exacerbate the injury. • Direct Pressure - Placing pressure on the wound will constrict the blood vessels manually, helping to stem any blood flow. When applying pressure, the type and direction of the wound may have an effect, for instance, a cut lengthways on the hand would be opened up by closing the hand in to a fist, whilst a cut across the hand would be sealed by making a fist. A patient can apply pressure directly to their own wound, if their consciousness level allows. Ideally a barrier, such as sterile, low-adherent gauze should be used between the pressure supplier and the wound, to help reduce chances of infection and help the wound to seal. Third parties assisting a patient are always advised to use protective latex or nitrilemedical gloves to reduce risk of infection or contamination passing either way. Direct pressure can be used with some foreign objects protruding from a wound, and to achieve this, padding is applied from either side of the object to push in and seal the wound - objects are never removed.

    22. Bleeding and Wound Care • Pressure points • In situations where direct pressure and elevation are either not possible or proving ineffective, and there is a risk of exsanguination, some training protocols advocate the use of pressure points to constrict the major artery which feeds the point of the bleed. This is usually performed at a place where a pulse can be found, such as in the femoral artery. There are significant risks involved in performing pressure point constriction, including necrosis of the area below the constriction, and most protocols give a maximum time for constriction (often around 10 minutes). There is particularly high danger if constricting the carotid artery in the neck, as the brain is sensitive to hypoxia and brain damage can result within minutes of application of pressure. Other dangers in use of a constricting method include rhabdomyolysis, which is a build up of toxins below the pressure point, which if released back in to the main bloodstream may cause cardiogenic shock

    23. Bleeding and Wound Care • A bandage is a piece of material used either to support a medical device such as a dressing or splint, or on its own to provide support to the body. Bandages are available in a wide range of types, from generic cloth strips, to specialized shaped bandages designed for a specific limb or part of the body, although bandages can often be improvised as the situation demands, using clothing, blankets or other material. • In common speech, the word "bandage" is often used to mean a dressing, which is used directly on a wound, whereas a bandage is technically only used to support a dressing, and not directly on a wound.

    24. Shock • Shock may result from trauma, heatstroke, allergic reactions, severe infection, poisoning or other causes. Various signs and symptoms appear in a person experiencing shock: • The skin is cool and clammy. It may appear pale or gray. • The pulse is weak and rapid. Breathing may be slow and shallow, or hyperventilation (rapid or deep breathing) may occur. Blood pressure is below normal. • The eyes lack luster and may seem to stare. Sometimes the pupils are dilated. • The person may be conscious or unconscious. If conscious, the person may feel faint or be very weak or confused. Shock sometimes causes a person to become overly excited and anxious. • If you suspect shock, even if the person seems normal after an injury: • Dial 911 or call your local emergency number. • Have the person lie down on his or her back with feet higher than the head. If raising the legs will cause pain or further injury, keep him or her flat. Keep the person still. • Check for signs of circulation (breathing, coughing or movement). If absent, begin CPR. • Keep the person warm and comfortable. Loosen belt(s) and tight clothing and cover the person with a blanket. Even if the person complains of thirst, give nothing by mouth. • Turn the person on his or her side to prevent choking if the person vomits or bleeds from the mouth. • Seek treatment for injuries, such as bleeding or broken bones.

    25. Burns • The most common system of classifying burns categorizes them as first-, second-, or third-degree. Sometimes this is extended to include a fourth or even up to a sixth degree, but most burns are first- to third-degree, with the higher-degree burns typically being used to classify burns post-mortem. The following are brief descriptions of these classes:[4] • First-degree burns are usually limited to redness (erythema), a white plaque and minor pain at the site of injury. These burns only involve the epidermis. • Second-degree burns manifest as erythema with superficial blistering of the skin, and can involve more or less pain depending on the level of nerve involvement. Second-degree burns involve the superficial (papillary) dermis and may also involve the deep (reticular) dermis layer. • Third-degree burns occur when most of the epidermis is lost with damage to underlying ligaments, tendons and muscle. Burn victims will exhibit charring of the skin, and sometimes hard eschars will be present. An eschar is a scab that has separated from the unaffected part of the body. These types of burns are often considered painless, because nerve endings have been destroyed in the burned area. Hair follicles and sweat glands may also be lost due to complete destruction of the dermis. Third degree burns result in scarring and may be fatal if the affected area is significantly large.

    26. Burns • For minor burns, including first-degree burns and second-degree burns limited to an area no larger than 3 inches (7.5 centimeters) in diameter, take the following action: • Cool the burn. Hold the burned area under cold running water for at least five minutes, or until the pain subsides. If this is impractical, immerse the burn in cold water or cool it with cold compresses. Cooling the burn reduces swelling by conducting heat away from the skin. Don't put ice on the burn. • Cover the burn with a sterile gauze bandage. Don't use fluffy cotton, which may irritate the skin. Wrap the gauze loosely to avoid putting pressure on burned skin. Bandaging keeps air off the burned skin, reduces pain and protects blistered skin. • Take an over-the-counter pain reliever. These include aspirin, ibuprofen (Advil, Motrin, others), naproxen (Aleve) or acetaminophen (Tylenol, others). Never give aspirin to children or teenagers. • Minor burns usually heal without further treatment. They may heal with pigment changes, meaning the healed area may be a different color from the surrounding skin. Watch for signs of infection, such as increased pain, redness, fever, swelling or oozing. If infection develops, seek medical help. Avoid re-injuring or tanning if the burns are less than a year old — doing so may cause more extensive pigmentation changes. Use sunscreen on the area for at least a year. • Caution • Don't use ice. Putting ice directly on a burn can cause frostbite, further damaging your skin. • Don't apply butter or ointments to the burn. This could prevent proper healing. • Don't break blisters. Broken blisters are vulnerable to infection.

    27. Burns • Third-degree burnThe most serious burns are painless, involve all layers of the skin and cause permanent tissue damage. Fat, muscle and even bone may be affected. Areas may be charred black or appear dry and white. Difficulty inhaling and exhaling, carbon monoxide poisoning, or other toxic effects may occur if smoke inhalation accompanies the burn. • For major burns, dial 911 or call for emergency medical assistance. Until an emergency unit arrives, follow these steps: • Don't remove burnt clothing. However, do make sure the victim is no longer in contact with smoldering materials or exposed to smoke or heat. • Don't immerse large severe burns in cold water. Doing so could cause shock. • Check for signs of circulation (breathing, coughing or movement). If there is no breathing or other sign of circulation, begin cardiopulmonary resuscitation (CPR). • Elevate the burned body part or parts. Raise above heart level, when possible. • Cover the area of the burn. Use a cool, moist, sterile bandage; clean, moist cloth; or moist towels.

    28. Fractures • A fracture is a broken bone. It requires medical attention. If the broken bone is the result of major trauma or injury, call 911 or your local emergency number. Also call for emergency help if: • The person is unresponsive, isn't breathing or isn't moving. Begin cardiopulmonary resuscitation (CPR) if there's no respiration or heartbeat. • There is heavy bleeding. • Even gentle pressure or movement causes pain. • The limb or joint appears deformed. • The bone has pierced the skin. • The extremity of the injured arm or leg, such as a toe or finger, is numb or bluish at the tip. • You suspect a bone is broken in the neck, head or back. • You suspect a bone is broken in the hip, pelvis or upper leg (for example, the leg and foot turn outward abnormally). • Take these actions immediately while waiting for medical help: • Stop any bleeding. Apply pressure to the wound with a sterile bandage, a clean cloth or a clean piece of clothing. • Immobilize the injured area. Don't try to realign the bone, but if you've been trained in how to splint and professional help isn't readily available, apply a splint to the area. • Apply ice packs to limit swelling and help relieve pain until emergency personnel arrive. Don't apply ice directly to the skin — wrap the ice in a towel, piece of cloth or some other material. • Treat for shock. If the person feels faint or is breathing in short, rapid breaths, lay the person down with the head slightly lower than the trunk and, if possible, elevate the legs.

    29. Strains and Sprains • For immediate self-care of a sprain or strain, try the P.R.I.C.E. approach — protection, rest, ice, compression, elevation. In most cases beyond a minor strain or sprain, you'll want your doctor and physical therapist to help you with this process: • Protection. Immobilize the area to protect it from further injury. Use an elastic wrap, splint or sling to immobilize the area. If your injury is severe, your doctor or therapist may place a cast or brace around the affected area to protect it and instruct you on how to use a cane or crutches to help you get around, if necessary. • Rest. Avoid activities that cause pain, swelling or discomfort. But don't avoid all physical activity. Instead, give yourself relative rest. For example, with an ankle sprain you can usually still exercise other muscles to prevent deconditioning. For example, you could use an exercise bicycle, working both your arms and the uninjured leg while resting the injured ankle on a footrest peg. That way you still exercise three limbs and keep up your cardiovascular conditioning. • Ice. Even if you're seeking medical help, ice the area immediately. Use an ice pack or slush bath of ice and water for 15 to 20 minutes each time and repeat every two to three hours while you're awake for the first few days following the injury. Cold reduces pain, swelling and inflammation in injured muscles, joints and connective tissues. It also may slow bleeding if a tear has occurred. If the area turns white, stop treatment immediately. This could indicate frostbite. If you have vascular disease, diabetes or decreased sensation, talk with your doctor before applying ice. • Compression. To help stop swelling, compress the area with an elastic bandage until the swelling stops. Don't wrap it too tightly or you may hinder circulation. Begin wrapping at the end farthest from your heart. Loosen the wrap if the pain increases, the area becomes numb or swelling is occurring below the wrapped area. • Elevation. To reduce swelling, elevate the injured area above the level of your heart, especially at night. Gravity helps reduce swelling by draining excess fluid. • Continue with P.R.I.C.E. treatment for as long as it helps you recover. Over-the-counter pain medications such as ibuprofen (Advil, Motrin, others) and acetaminophen (Tylenol, others) also can be helpful. If you want to apply heat to the injured area, wait until most of the swelling has subsided. • After the first two days, gently begin to use the injured area. You should see a gradual, progressive improvement in the joint's ability to support your weight or your ability to move without pain. • Mild and moderate sprains usually heal in three to six weeks. If pain, swelling or instability persists, see your doctor. A physical therapist can help you to maximize stability and strength of the injured joint or limb.

    30. Poisoning • Many conditions mimic the signs and symptoms of poisoning, including seizures, alcohol intoxication, stroke and insulin reaction. So look for the signs and symptoms listed below if you suspect poisoning, but check with the poison control center at 800-222-1222 (in the United States) before giving anything to the affected person. • Signs and symptoms of poisoning: • Burns or redness around the mouth and lips, which can result from drinking certain poisons • Breath that smells like chemicals, such as gasoline or paint thinner • Burns, stains and odors on the person, on his or her clothing, or on the furniture, floor, rugs or other objects in the surrounding area • Empty medication bottles or scattered pills • Vomiting, difficulty breathing, sleepiness, confusion or other unexpected signs

    31. Poisoning • When to call for help: • Call 911 or your local emergency number immediately if the person is: • Drowsy or unconscious • Having difficulty breathing or has stopped breathing • Uncontrollably restless or agitated • Having seizures • If the person seems stable and has no symptoms, but you suspect poisoning, call the poison control center at 800-222-1222. Provide information about the person's symptoms and, if possible, information about what he or she ingested, how much and when. • What to do while waiting for help: • If the person has been exposed to poisonous fumes, such as carbon monoxide, get him or her into fresh air immediately. • If the person swallowed the poison, remove anything remaining in the mouth. • If the suspected poison is a household cleaner or other chemical, read the label and follow instructions for accidental poisoning. If the product is toxic, the label will likely advise you to call the poison control center at 800-222-1222. Also call this 800 number if you can't identify the poison, if it's medication or if there are no instructions. • Follow treatment directions that are given by the poison control center. • If the poison spilled on the person's clothing, skin or eyes, remove the clothing. Flush the skin or eyes with cool or lukewarm water, such as by using a shower for 20 minutes or until help arrives. • Take the poison container (or any pill bottles) with you to the hospital. • What NOT to do • Don't administer ipecac syrup or do anything to induce vomiting. In 2003, the American Academy of Pediatrics advised discarding ipecac in the home, saying there's no good evidence of effectiveness and that it can do more harm than good.

    32. Heat Exhaustion • Heat exhaustion is one of the heat-related syndromes, which range in severity from mild heat cramps to heat exhaustion to potentially life-threatening heatstroke. • Signs and symptoms of heat exhaustion often begin suddenly, sometimes after excessive exercise, heavy perspiration and inadequate fluid intake. Signs and symptoms resemble those of shock and may include: • Feeling faint or dizzy • Nausea • Heavy sweating • Rapid, weak heartbeat • Low blood pressure • Cool, moist, pale skin • Low-grade fever • Heat cramps • Headache • Fatigue • Dark-colored urine • If you suspect heat exhaustion: • Get the person out of the sun and into a shady or air-conditioned location. • Lay the person down and elevate the legs and feet slightly. • Loosen or remove the person's clothing. • Have the person drink cool water. • Cool the person by spraying or sponging him or her with cool water and fanning. • Monitor the person carefully. Heat exhaustion can quickly become heatstroke. • If fever greater than 102 F (38.9 C), fainting, confusion or seizures occur, dial 911 or call for emergency medical assistance.

    33. Heatstroke • Heatstroke is the most severe of the heat-related problems, often resulting from exercise or heavy work in hot environments combined with inadequate fluid intake. • Young children, older adults, people who are obese and people born with an impaired ability to sweat are at high risk of heatstroke. Other risk factors include dehydration, alcohol use, cardiovascular disease and certain medications. • What makes heatstroke severe and potentially life-threatening is that the body's normal mechanisms for dealing with heat stress, such as sweating and temperature control, are lost. The main sign of heatstroke is a markedly elevated body temperature — generally greater than 104 F (40 C) — with changes in mental status ranging from personality changes to confusion and coma. Skin may be hot and dry — although if heatstroke is caused by exertion, the skin may be moist. • Other signs and symptoms may include: • Rapid heartbeat • Rapid and shallow breathing • Elevated or lowered blood pressure • Cessation of sweating • Irritability, confusion or unconsciousness • Feeling dizzy or lightheaded • Headache • Nausea • Fainting, which may be the first sign in older adults • If you suspect heatstroke: • Move the person out of the sun and into a shady or air-conditioned space. • Dial 911 or call for emergency medical assistance. • Cool the person by covering him or her with damp sheets or by spraying with cool water. Direct air onto the person with a fan or newspaper. • Have the person drink cool water, if he or she is able.

    34. Cold Emergencies • Under most conditions your body maintains a healthy temperature. However, when exposed to cold temperatures or to a cool, damp environment for prolonged periods, your body's control mechanisms may fail to keep your body temperature normal. When more heat is lost than your body can generate, hypothermia can result. • Wet or inadequate clothing, falling into cold water, and even having an uncovered head during cold weather can all increase your chances of hypothermia. • Hypothermia is defined as an internal body temperature less than 95 F (35 C). Signs and symptoms include: • Shivering • Slurred speech • Abnormally slow breathing • Cold, pale skin • Loss of coordination • Fatigue, lethargy or apathy • Confusion or memory loss • Signs and symptoms usually develop slowly. People with hypothermia typically experience gradual loss of mental acuity and physical ability, so they may be unaware that they need emergency medical treatment. • Older adults, infants, young children and people who are very lean are at particular risk. Other people at higher risk of hypothermia include those whose judgment may be impaired by mental illness or Alzheimer's disease and people who are intoxicated, homeless or caught in cold weather because their vehicles have broken down. Other conditions that may predispose people to hypothermia are malnutrition, cardiovascular disease and an underactive thyroid (hypothyroidism).

    35. Cold Emergencies • To care for someone with hypothermia: • Dial 911 or call for emergency medical assistance. While waiting for help to arrive, monitor the person's breathing. If breathing stops or seems dangerously slow or shallow, begin cardiopulmonary resuscitation (CPR) immediately. • Move the person out of the cold. If going indoors isn't possible, protect the person from the wind, cover his or her head, and insulate his or her body from the cold ground. • Remove wet clothing. Replace wet things with a warm, dry covering. • Don't apply direct heat. Don't use hot water, a heating pad or a heating lamp to warm the victim. Instead, apply warm compresses to the neck, chest wall and groin. Don't attempt to warm the arms and legs. Heat applied to the arms and legs forces cold blood back toward the heart, lungs and brain, causing the core body temperature to drop. This can be fatal. • Don't give the person alcohol. Offer warm nonalcoholic drinks, unless the person is vomiting. • Don't massage or rub the person. Handle people with hypothermia gently, because they're at risk of cardiac arrest.

    36. Acknowledgements • Thank you to: • Wikipedia and for the information provided in this handout.