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First-aid 

| INTRODUCTION | | Asphyxiation | | Cardiopulmonary | | Severe bleeding | | FAINTING, SEIZURES, AND COMA | | POISONING AND DRUG OVERDOSE | |A burn | | ELECTRIC SHOCK | | ANIMAL BITES AND STINGS || HEAT ILLNESSES | | Exposure to cold | | Injuries to the head | | SPRAINS AND FRACTURES |

I INTRODUCTION  First Aid, emergency care for a victim of sudden illness or injury until more skillful medical treatment is available. First aid may save a life or improve certain vital signs including pulse, temperature, a patent (unobstructed) airway, and breathing. In minor emergencies, first aid may prevent a victimís condition from worsening and provide relief from pain. First aid must be administered as quickly as possible. In the case of the critically injured, a few minutes can make the difference between complete recovery and loss of life.

First-aid measures depend upon a victimís needs and the providerís level of knowledge and skill. Knowing what not to do in an emergency is as important as knowing what to do. Improperly moving a person with a neck injury, for example, can lead to permanent spinal injury and paralysis.

Despite the variety of injuries possible, several principles of first aid apply to all emergencies. The first step is to call for professional medical help. Determine that the scene of the accident is safe before attempting to provide first aid. The victim, if conscious, should be reassured that medical aid has been requested, and asked for permission to provide any first aid. Next, assess the scene, asking bystanders or the injured personís family or friends about details of the injury or illness, any care that may have already been given, and preexisting conditions such as diabetes or heart trouble. The victim should be checked for a medical bracelet or card that describes special medical conditions. Unless the accident scene becomes unsafe or the victim may suffer further injury, do not move the victim.

First aid requires rapid assessment of victims to determine whether life-threatening conditions exist. One method for evaluating a victimís condition is known by the acronym ABCs, which stands for:

A ó Airwayóis it open and unobstructed?

B ó Breathingóis the person breathing? Look, listen, and feel for breathing.

C ó Circulationóis there a pulse? Is the person bleeding externally? Check skin color and temperature for additional indications of circulation problems.

Once obvious injuries have been evaluated, the injured personís head should be kept in a neutral position in line with the body. If no evidence exists to suggest potential skull or spinal injury, place the injured person in a comfortable position. Positioned on one side, a victim can vomit without choking or obstructing the airway.

Before treating specific injuries, protect the victim from shockóa depression of the bodyís vital functions that, left untreated, can result in death. Shock occurs when blood pressure (pressure exerted against blood vessel walls) drops and the organs do not receive enough blood, depriving them of oxygen and nutrients. The symptoms of shock are anxiety or restlessness; pale, cool, clammy skin; a weak but rapid pulse; shallow breathing; bluish lips; and nausea. These symptoms may not be apparent immediately, as shock can develop several hours after an accident. To prevent shock, the victim should be covered with blankets or warm clothes to maintain a normal body temperature. The victimís feet should be elevated. Because of the danger of abdominal injuries, nothing should be administered by mouth.

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II ASPHYXIATION  
Asphyxiation occurs when air cannot reach the lungs, cutting off the supply of oxygen to circulating blood. This can cause irreparable damage to the brain. Among the causes of asphyxiation are drowning, gas poisoning, overdose of narcotics, electrocution, choking, and strangulation. Victims may collapse, be unable to speak or breathe, and have bluish skin. Most people will suffer brain death within four to six minutes after breathing ceases unless first aid is administered.

In the case of choking, a procedure known as the Heimlich maneuver can be used to clear the windpipe of food or other objects. In this procedure quick upward thrusts are applied to the victimís abdomen to eject the object blocking the windpipe. The first-aid provider stands behind the victim with both arms around the victimís waist. One fist is placed slightly above the navel and below the rib cage with the thumb against the victimís body. The other hand is used to hold the fist and apply pressure. The abdomen is then pressed quickly inward and upward, forcing air from the lungs to eject the object from the windpipe. If the victim is too large to hold while standing, or becomes unconscious, the maneuver can be accomplished by laying the person down face up and using the heel of one hand in the same manner as above. The person performing the maneuver must be careful not to apply pressure on the rib cage to avoid breaking ribs, especially in children and the elderly. For obese or pregnant choking victims, the providers hands should be placed over the lower half of the sternum (breastbone) and pressure applied as described above.

For victims of other types of asphyxiation, the most practical method of artificial respiration is the mouth-to-mouth technique in which the first-aid provider forcefully exhales air into the victimís lungs after first clearing the airway of any obstruction. The provider tilts the victimís head backward by placing one hand under the victimís chin and lifting while the other hand presses down on the victimís forehead. At this point, the mouth and airway can be checked for foreign objects, which can be removed with the fingers. To begin mouth-to-mouth resuscitation, gently pinch the victimís nostrils together to prevent air from escaping out the nose. Take normal breaths, seal the victimís mouth with a pocket mask or mouth, and exhale into the mouth. When performed properly the victimís chest should rise visibly. The provider then listens for the victim to exhale; if using a pocket mask, it need not be removed. This process is repeated at a rate of about 12 times per minute (one breath every five seconds) for adults and about 20 times per minute for children, using less pressure and volume for children. Once beginning artificial respiration, the first-aid provider should continue until the victim begins to breathe or medical help arrives.

In cases of drowning, artificial respiration should be attempted even if the victim appears dead. People submerged in cold water for more than 30 minutes who appeared blue have responded to first-aid efforts and recovered with no brain damage.

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III CARDIOPULMONARY ARREST  
Cardiopulmonary resuscitation (CPR) is used to restore the heartbeat in a victim whose heart has stoppedóa condition known as cardiac arrest. Symptoms of this life-threatening condition may include crushing pain or pressure behind the breastbone; pain in the arms, neck, or shoulder; anxiety and a feeling of impending doom; difficulty breathing; heavy perspiration; weakness; nausea; and loss of consciousness. The American Red Cross recommends that CPR be performed only by individuals who have received special training in the recognition of cardiac arrest and proper performance of CPR skills.


CPR combines the techniques of artificial respiration with the application of external heart massage to keep blood flowing through the victimís body. The first-aid provider positions the victim face up on a firm surface and clears the airway of any obstructions. To maintain an open airway, the head is tilted back and the chin lifted forward. The provider then gives the victim two breaths by mouth or mask. If no pulse is detected at the carotid artery (located in groove beside windpipe in the neck), the first-aid provider kneels next to victim, placing the heel of one hand on top of the other over the lower half of the sternum. The provider depresses the chest about 5 cm (2 in), forcing blood from the heart through the victimís arteries. When the pressure is released, blood flows into the heart. The first-aid provider applies the pressure in short, rhythmic thrusts about 15 times every ten seconds. This cycle of two breaths followed by 15 chest compressions is repeated until the victim revives or professional medical help arrives.

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IV SEVERE BLEEDING  
The presence of blood over a considerable area of a personís body does not always indicate severe bleeding. The blood may ooze from multiple small wounds or be smeared, giving the appearance of more blood than is actually present. The rate at which blood is lost from a wound depends on the size and kind of blood vessel ruptured. Bright red, spurting blood indicates injury to an artery while welling or steadily flowing, dark red blood indicates injury to a vein.


Welling or spurting blood is an unmistakable sign of severe bleeding. If a major artery ruptures, a person may bleed to death within a minute. Injuries to veins and minor arteries bleed more slowly but may also be fatal if left unattended. Shock usually results from loss of fluids, such as blood, and must be prevented as soon as the loss of blood has been stopped.


To stop the bleeding, apply pressure directly over the wound and, when possible, elevate the bleeding body part. The first-aid provider should use bandages to hold a sterile dressing or clean cloth firmly over the wound. Dressings that become saturated with blood should not be removed but should be reinforced with additional layers. If an arm or leg wound bleeds rapidly and cannot be controlled by dressings and bandages, the first-aid provider can apply pressure to the artery at a point adjacent to the bleed called the pressure point. Arteries pass close to the skin at these points and can be compressed against underlying bone to stop arterial bleeding. The pressure point for the femoral artery, which supplies blood to the leg, is located on the front center of the legís hinge, the crease of the groin area where the artery crosses the pelvic bone. The pressure point for the brachial artery, which supplies blood to the arm, is located halfway between the elbow and armpit on the inner side of the arm.

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V FAINTING, SEIZURES, AND COMA  
Fainting, a sudden, temporary loss of consciousness, occurs when the brain does not receive enough blood. Just before fainting, a personís skin may appear pale and clammy or sweaty. To restore blood flow to the brain, a first-aid provider should elevate the unconscious personís feet or position the individualís head below the level of the heart. The victimís airway and breathing should be closely monitored. A fainting victim must also be kept warm to prevent shock. If the victim does not fully recover after five minutes, medical help should be requested.

Seizures, sudden brief episodes of intense neurological activity, may result from a variety of causes, including epilepsy, a neurological disorder, and head injuries. First aid for seizures consists of protecting the victim from accidental injury during the seizure. The first-aid provider should not put any objects in a seizing personís mouth or try to hold the tongue. If the victim has medical identification indicating epilepsy, an ambulance need not be called unless the person experiences multiple seizures or one seizure lasts more than five minutes. Otherwise, once the seizure stops, question the person about the need for a hospital evaluation. If no medical identification exists the first-aid provider should request medical assistance.

A deep state of unconsciousness due to illness or injury is known as a coma. Comatose individuals cannot be awakened. Heart failure, stroke, epilepsy, diabetes, or traumatic brain injury can cause comas and a medical alert tag on the victim may identify a possible cause of the coma. If the person is breathing, first aid is limited to providing comfort until medical assistance arrives. If the victim is not breathing, the first-aid provider should administer mouth-to-mouth or mask-to-mouth resuscitation.

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VI POISONING AND DRUG OVERDOSE  A poisonous substance introduced into the body through the mouth or nose causes symptoms such as nausea, cramps, and vomiting. Poisons include toxic medications, herbicides, insecticides, rodenticides, household disinfectants, and noxious gases.

In a case of poisoning, the first-aid provider should remove the victim from a toxic environment, then contact the poison control center listed in most United States phone books. If the number is unavailable, the provider should call a physician or hospital emergency department. If possible, the provider should try to identify the poison, either by questioning the victim or searching for suspicious containers. Containers of many poisonous substances list the antidote, or remedy, on the label. Burns or stains on the skin or a characteristic odor on the breath may also help the first-aid provider recognize the poison.

Unless instructed to do so by the poison control center, the first-aid provider should never give a poisoning victim anything to eat or drink. Vomiting should not be induced unless the poison control center recommends it. If the victim vomits, the first-aid provider should turn the individual on the side and clear the airway. Before clearing the victimís mouth of any obstructions, however, the provider should first put on clean first-aid gloves or wrap a cloth around his or her fingers. If the person who ingested the poison is unconscious, the airway, breathing, and circulation should be checked and CPR started if necessary.

A drug overdose occurs when an individual takes too large a dose of a drug or takes a dose that is stronger than the person can tolerate. A drug overdose can be difficult to diagnose because the signs and symptoms vary widely and often mimic other illnesses or injuries. Symptoms of a drug overdose include unusually dilated or contracted pupils, vomiting, difficulty in breathing, hallucinations, and in severe cases unconsciousness and slow, deep breathing. If an overdose is not treated, the individual may die. Victims of overdose should be taken immediately to a hospital emergency room.

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VII BURNS  A burn is an injury to the skin caused by exposure to fire, hot liquids or metals, radiation, chemicals, electricity, or the sunís ultraviolet rays. Burns are classified according to the depth of tissue damage and extent of the burn. A first-degree, or superficial, burn, which involves only the surface of the skin, is characterized by reddening. A second-degree burn extends beneath skin surface and causes blistering and severe pain while a third-degree, or full-thickness, burn causes charring and destruction of the cell-producing layer of skin. The severity of a burn depends also on the area involved, expressed as a percentage of the total body surface area. Severe burns cause shock and loss of body fluids. A person suffering third-degree burns over more than 10 percent of body surface area should be hospitalized as soon as possible.

First aid for burns involves removing the source of the burn as soon as possible. The burn should be cooled immediately with cold water. A clean, cold wet towel or dressing can be placed on less serious burns to ease pain and protect the burn from contamination. Continuously bathe chemical burns with running water for at least 20 minutes to dilute the substance. Any powder should be carefully brushed off with gloved or protected hands before washing. Wet dressings or ointments should never be used for burns. Instead, the first-aid provider should gently apply dry, sterile dressings held in place by bandages and seek immediate medical attention.

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VIII ELECTRIC SHOCK  Contact with electrical current is potentially fatal. Electricity passing through the body can cause injury to the skin and internal organs. If electricity passes through the heart, the heart muscle may be damaged and the heartís rhythm interrupted, leading to cardiac arrest. The signs and symptoms of electric shock include tingling, burns on the skin where the current entered or exited, muscle pain, headache, loss of consciousness, irregular breathing or lack of breathing, and cardiac arrest. The severity of the injury depends on the strength of the electric current and the path the current takes through the body. The person providing first aid to a victim of electric shock should not touch the individualís body until the source of the shock is turned off. Because of the potential for internal injuries, victims of electrical injury should not be moved unless they are in immediate danger. The first-aid provider should monitor the victim for symptoms of shock. If the victim has stopped breathing and has no pulse, CPR should be performed after the airway, breathing, and circulation have been checked. When the victimís vital signs are stable, the site of the burn should be treated using the same methods used for other burns.

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IX ANIMAL BITES AND STINGS  Animals such as snakes, dogs, cats, small rodents like squirrels, certain insects, and spiders may bite humans with dangerous consequences. Many snakebites are caused by nonvenomous (nonpoisonous) snakes and do not require treatment beyond cleaning the wound. Bites inflicted by venomous snakes require immediate first-aid measures. The victim should be taken as soon as possible to the nearest emergency medical facility. In the interim, the first-aid provider should not cut the area around the bite, attempt to suck out the venom, or apply ice to the wound. The focus of first aid should be to prevent the venom from spreading rapidly through the individualís bloodstream. The victim should be kept quiet to avoid stimulating circulation of the venom. In addition, the bite area should be kept at a lower level than the rest of the body. The wound should be washed thoroughly with soap and water, blotted dry, and loosely covered with a sterile dressing.

Bites from other animals should be thoroughly washed, treated with an antibiotic ointment, and bandaged. The victim should seek medical attention if the bite is severe, if rabies (an infectious viral disease) is suspected, or if the bite becomes infected. Bites from other humans are particularly prone to serious bacterial infection and should be treated by a medical professional. Victims of any animal or human bite whose immunizations are not current may need a shot for tetanus, an often fatal infectious disease affecting the muscles of the neck and jaw.

Biting insects include fleas, mosquitoes, bedbugs, lice, chiggers, and gnats. Bites from these insects should be washed to prevent infection, and cold compresses or topical medications applied to alleviate itching and pain. Bites from some species of ticks can cause serious illnesses including lyme disease and Rocky Mountain spotted fever. When a tick bites a person, it may attach itself to the body by burrowing into the skin. As a result, a tick should be removed by carefully pulling it straight out with tweezers so as not to leave its head behind. The tick should not be squeezed when it is removed. Bites from most spiders can be treated like those of other biting insects. Bites from black widow spiders, tarantulas, scorpions, and other poisonous spiders require medical help. They are treated similarly to poisonous snakebites.

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X HEAT ILLNESSES  Exposure to excessive heat may cause heat exhaustion or heatstroke. Heat exhaustion results from excessive loss of body fluids and body salts. Symptoms include pale and clammy skin, heavy perspiration, a weak pulse, and shallow breathing. Headache and vomiting may also occur. In heat exhaustion the internal body temperature remains close to normal.

Heatstroke, a malfunction of the heat-control centers in the body, occurs less frequently than heat exhaustion and is much more serious. It commonly affects the elderly. The symptoms of heatstroke are hot and flushed skin, absence of perspiration, a rapid but weak pulse, rapid breathing, and a high body temperature. The affected person may feel dizzy and lose consciousness.

Victims of heat exhaustion should rest in a cool area with their feet elevated. Further cooling can be achieved with cool water compresses and a fan. The victim should never be given medications used to treat fever, such as aspirin. The person suffering from heat exhaustion may feel nauseous at first, but after resting for a period, he or she may be able to sip minimally salty water or an electrolyte solution to replenish salt lost from perspiration. In serious cases, medical care is required. First-aid measures for heatstroke are similar to those for heat exhaustion, but the victim should be more aggressively and rapidly cooled, should not be given anything by mouth, and the feet should not be raised if breathing difficulties are observed. The heatstroke victim must be taken immediately to an emergency care center.

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XI COLD INJURIES  Exposure to cold can lead to hypothermia, a condition in which the bodyís internal temperature drops below normal. The first-aid provider should seek medical help first, if possible, and rewarm a hypothermic individual by whatever means available, including body warmth. If the victim is alert, warm, sweet fluids may be given. If the victim is breathing at a rate less than six breaths per minute, mouth-to-mouth or mask-to-mouth resuscitation can be started. CPR should not be performed because a hypothermic person may have a heartbeat even when the pulse is undetectable and any CPR may cause cardiac arrest.

Frostbite is is a condition in which the skin freezes, initially causing pain and redness in the affected area, which may develop into numbness and whiteness. The first-aid provider should rewarm frozen areas (usually extremities) of the victimís body slowly by using skin to skin contact, immersing frozen part in warm, not hot, water, or using warm compresses. Avoid massaging the affected area, which may cause tissue damage. The first-aid provider should not thaw frozen areas that may refreeze before the victim reaches a medical facility.

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XII HEAD, EYE, AND NOSE INJURIES  Injuries to the head may involve the scalp, skull, or brain. If the victim has a head wound, the first-aid provider should not apply pressure to it, as this may damage the brain. The victimís airway should be kept clear from obstructions, such as vomitus, which is common in cases of head injury. If the victim has a seizure, a sudden spasm of the body, the head must be protected with cushions to prevent further injury. All individuals with head injuries should be evaluated by a physician.

Medical attention should be sought for all eye injuries as well. In the case of foreign material in the eye, especially caustic substances, or those that can burn, corrode, or dissolve tissues, the eye should be flushed immediately with a cool, sterile saline solution, if available, or plain tap water for 15 to 30 minutes. The first-aid provider should not attempt to remove embedded objects from the eye.

The most common injuries to the nose involve nosebleeds, objects lodged in the nasal passages, and broken nasal bones. The victim of a simple nosebleed should sit down, lean forward, and gently pinch together the soft part of the nose for 15 minutes. A cold compress can also be placed on the bridge of the nose. If material lodged in the nose cannot be forced out by gently blowing the nose, the victim should request medical help. In the case of a broken nose, the first-aid provider should apply a cold compress to the bridge of the nose and seek medical attention.

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XIII SPRAINS AND FRACTURES  A sprain, the painful stretching or tearing of ligaments (tissues that connect bones at joints), occurs when a bone is suddenly wrenched at the joint. A fracture, a break or crack in a bone, is caused by sudden, violent pressure against the bone. Great pain and swelling characterize both a sprain and a fracture, but inability to move the affected part, a deformed appearance, and pain or tenderness at a specific point usually indicate a fracture. Sprains and fractures should be treated in the same way by a first-aid provider since it can be difficult to diagnose a fracture without an X ray of the affected bone.

Because the slightest movement of the affected part may cause the injured person great pain and increase the damage, no attempt should be made to straighten or move sprained or broken limbs until medical help arrives. If the injured person must be transported to a hospital, rigid splints should be used to immobilize the broken part and adjacent joints or bones. Splints can be improvised from light, smooth boards or folded cardboard and tied to the broken part with wide strips of cloth or improvised material.

If a person is found with the head or body in an unnatural position, a fracture of the spinal column may have occurred. Other signs of a broken spinal column are severe pain in the back or neck and lack of movement of the lower extremities. The first-aid provider should not attempt to straighten or move the injured personís body as this may cause permanent paralysis or death. If the victim must be transported, his or her body should be immobilized by placing it on a flat board. However, moving such a victim should not be attempted without prior training.

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