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Source: First aid manual, Emergency procedures for everyone, athome, at work, at leisure, 8th edition(P.29)1.4.2. Problem identification (Diagnosis)The history of the incident must be taken in to consideration and anexamination made to determine the signs and symptoms and levelof consciousness.History:-The story of how the accident happened or the illnessbegan can be obtained from: The causality ( e.g. I slipped and fall down) A witness or a bystander(s) whether he/she saw the happeningsPoints to be considered during history taking:Any history of illness: Eg. Epilepsy, Diabetes mellitus,For history of ingested material E.g. Drug, Alcohol, type of food orfluidSymptoms:- Sensations and feelings that are described by thecasualtyE.g. I feel pain I feel cold my arm is numbSigns:- variations from normal ascertained by the first- aider.E.g. Pallor of the inner surface of the eyelids or nail beds;blueness (cyanosis) of face, lips, fingers and toes. Theremay be evidence of poisoning e.g. medications, alcoholicsmell, bottles and other containers beside the victims.5

Level of consciousness:Recognition of any change of level of consciousness is important. Full consciousness- the casualty is able to speak and answerquestions normally Drowsiness- the casualty is easily aroused but lapses in tounconscious state Stupor –the casualty can be roused with difficulty, aware ofpainful stimuli.E.g. pin prick, but not of other external elements like beingspoken to. Coma - cannot be roused by any stimuli.In general make full use of your senses to obtain maximuminformation (Look, smell, listen and touch).Action: - If the cause of the condition is still active, remove thecause.E.g. -a lodging of wood on the causalities leg, contaminated clothingor remove the causality from the cause, such as traffic, fire, water,poisonous fumes. etc.6

Table 1. Essential Points to be considered while giving first aidtreatmentTo sustainTo preventTo promote(preserve) life.worsening of thehealing andproblemrecovery.Finally(complication). Emergency resuscitationPrevent the Place the with out delay toconditioncasualty infromcorrectbecomingand worsecomfortabl (complicatioe positionhome or to hospitalTransport the victimIn a serious casesummon(inform)n) Convey the causalityahealth personalCoverwounds Immobilize Reassurebleedingfractures, Give anyand shocklargeotherwounds andtreatmentany injuredneededshould be sent to theRelievefamily if necessary topaintell the family4 whatControl par Handlethe causality A tactful messageandwas happened andcarefully atwhere he has beenall timestaken, unless it hasgently A brief written reportshould accompanyMoveasbeen done by thelittleaspolice or otherauthority.possibleProtect fromcold.7

1.5. Study Questions1. Define first aid2. Describe reasons why first aid is given3. What are the values of first aid?4. What are the general directions to be followed while givingfirst aid?5. In the case of occurrence of an injury to a victim if thecondition is still active, remove the cause or the victim fromthe cause.TrueFalse8

CHAPTER TWORESPIRATORY EMERGENCIES ANDARTIFICIAL RESPIRATION2.1. Learning ObjectivesAfter studying the material in this chapter, the student will be ableto:1.Define respiratory emergencies and artificial respiration.2.Explain the breathing process.3.Identify causes of respiratory failure4.Prevent respiratory accident, give artificial respiration andmanage respiratory accident.2.2. DefinitionRespiratory emergency is one in which normal breathing stops or inwhich breathing is reduced so that oxygen intake is insufficient tosupport life.Artificial respiration is a procedure for making air to flow into and outof a person’s lungs when his natural breathing is inadequate orceases.2.3. The breathing processNatural breathing is accomplished by increasing and decreasing thecapacity of the chest and the lung. Atmospheric air being under9

pressure, rushes in and out with the increase and decrease of chestspace.During the inhalation phase of breathing (inspiration), the muscles ofthe chest lift the ribs, expanding the chest. At the same time thediaphragm contracts and descends toward the abdomen. In thisway, the chest cavities increased in size and air flows in. When allmuscles relax, the ribs and diaphragm resume their normal position,the chest cavity becomes smaller, and air flows outward. In allmanual methods of artificial respiration, the objective is to cause analternate decrease and increase in size of the chest cavity. Whenthis is done, air flows in and out if there is no obstruction.2.3.1. Causes of Respiratory FailureA. Anatomical ObstructionThe most common cause of respiratory emergency is interferencewith breathing caused by the drooping of the tongue back andobstructing the throat. Other causes of obstruction that constrict theair passages are: Asthma Croup Diphtheria Laryngeal spasm Swelling after burns of the face Swallowing of corrosive poisons Direct injury caused by a blow10

B. Mechanical Obstruction Solid foreign objects lodging in the respiratory passage e.g.choking of food Accumulation of fluids in the back of the throat (mucous ,bloodor saliva) Aspiration (Inhalation of any solid or liquid substance)C. Air Depleted of Oxygen or Containing Toxic Gases Asphyxia – Is a condition in which there is a lack of oxygen inthe blood and the tissue do not receive an adequate supply ofoxygen. It may occur due to decreased oxygen in the air orincreased carbon monoxide (CO) or other toxic gases e.g.,mining area, sewer etc. Explosion hazard -Combustible gases that accumulate inconfined spaces where natural or manufactured gases are freein the air, and are explosive in certain concentrations. Theexplosion may result if a flame is introduced, if static electricity isdischarged or if an electric switch doorbell, telephone or otherdevice is used.D. Additional Causes of Respiratory Failure are: Drowning Circulatory collapse (shock) Heart disease11

Strangulation Lung disease e.g. pneumonia Poisoning by alcohol, barbiturate, codeine etc. Electrical shock Compression of the chest e.g. accident2.4. Artificial Respiration and Management ofRespiratory AccidentsA. Objectives:1. To maintain an open air way through the mouth and nose (orthrough the stoma)2. To restore breathing by maintaining an alternating increaseand decrease in the expansion of the chest.B. General Information The average person may die with in 4- 6 minutes if his/heroxygen supply is cut off. Recovery is usually rapid except in case of carbon monoxidepoisoning, over dosage of drugs or electrical shock. In suchcases, it is often necessary to continue artificial respiration for along time. When a victim revives he/she should be treated for shock. A physician’s care is necessary during the recovery period. Artificial respiration should always be continued until :¾The victim begins to breath by himself12

¾He/she is pronounced dead by a doctor or he/she is deadbeyond any doubtC.Mouth- to- mouth (mouth- to- nose) method or” kissof life”Steps in mouth- to- mouth or mouth- to- noserespiration Determine consciousness by tapping the victim on shoulder andasking loudly ''Are you OK''? Tilt the victim’s head back so that his/her chin is pointingupward. In this case the two procedures can be applied, i.e.head tilt- neck lift and head tilt and chin lift. (fig.1). Place your cheek and ear close to the victim’s mouth and nose.Look at the victim’s chest to see if it rises and falls; listen andfeel for air to be exhaled for about 5 seconds. If there is no breathing, pinch the victim’s nostrils shut with thethumb and index finger of your hand i.e. pressing on the victim’sforehead. Blow air in to the victim’s mouth.13

Figure 1 Steps of mouth to mouth respiration (steps of opening air way)Steps for mouth to mouth respiration. Open your mouth wide. Take a deep breath. Seal your mouth tightly around the victim’s mouth and with yourmouth forming a wide open circle and blow into the victim’smouth (fig.2). Initially give four quick full breaths without allowing the lungs tofully deflate (empty) between each breath. Maintain the head tilt and again look, listen, and feel forexhalation of air and check the pulse for at least 5 seconds butnot more than 10 seconds. If no pulse and breath docardiopulmonary resuscitation (CPR). If there is pulse and no breath, provide at least one breath every5 seconds or 12 per minute for adults and this provides sufficientair. If the airway is clear only moderate resistance to blowing will befelt.14

Figure 2Mouth- to- mouth respiration Watch the victim’s chest to see when it rises. Stop blowing when the victim’s chest is expanded and check forexhalation Watch the chest to see that it falls. Repeat the blowing cycle. For the mouth -to -nose method maintain the backward head -tiltposition with the hand on the victim’s forehead and use yourother hand to close the victims mouth. (fig.3).15

Figure 3Steps in mouth -to -nose respirationNote: Mouth- to- mouth and -nose resuscitation are administeredfor infants and children as described above except that thebackward head tilt should not be as extensive as that ofadult. Both the mouth and nose of the infant or child shouldbe sealed off by your mouth. Blow in to the infant’s mouthand nose once every 3 seconds (about 20 times perminutes). But in the case of children blow once every 4seconds (about 15 times per minute). The amount of air isdetermined by the size of the victim.16

NB: - Nowadays this practice is questioned by many people as tothe possibility of transmission of HIV/ AIDS and needs maximumcare or needs alternative procedure to save life in both cases (thevictim and the first aider). Therefore this needs recent information forbetter practice.D. Obstructed airway - unconscious victim If you are not getting air exchange, reposition the head andagain attempt to ventilate. If you still do not get an air exchange immediately turn the victimon his side towards you, resting his chest against your kneesand administer four sharp blows between the shoulder blades(fig.4). Place the victim on his back (supine) and spread legs wideapart, straddle his hips or one thigh. This position gives comfortfor the first -aider.17

Figure 4First aid measure for obstructed air way Open the victim’s airway and sweep with the fingers. If the procedures are ineffective, you must repeat the sequence. Attempt to ventilate. Perform four rapid back blows Perform four thrusts (push on the chest ) Do finger sweep If the stomach is building gastric distention, turn the adultvictim to one side and clear the mouth after pressing yourhand briefly and firmly over the upper abdomen between therib margin and the navel. This procedure will force air out ofthe stomach. But it may also cause regurgitation.E. Obstructed Air Way - Conscious Victim: The urgency of thissituation can not be over emphasized. Immediate recognitionand proper action are essential if the victim has good air18

exchange with only partial obstruction and is still able to speakor cough effectively. Do not interfere with his attempts to expel aforeign body. If the victim can not speak or cough, shows adistress signal, appears cyanotic or reveals an exaggeratedeffort to breathe, you must intervene appropriately.F. Ingested and Inhaled Objects (Choking)A small piece of food or a bone (foreign body), may be inhaledin to the wind pipe when eating. Most people on such occasionsare able to cough it up at once. Some times, however, this maynot be possible and help is needed.Do not try to hook the foreign body out with your fingers; this is likelyto push it further down. Do the following at once.19

Figure 5 First aid measure during choking for adults and children’sFor babies and small children (under one year) Hold the baby up side down by the feet and smack him firmlybetween his shoulder blades three to four sharp slaps (fig.5).GIVE UP TO FIVE BACKSLAPS Check the mouth andremove any obviousobstruction.If the obstruction is stillpresentGIVE UP TO FIVECHEST THRUSTS Check the mouthand remove anyobviousobstruction.If the obstruction doesn’tclear after three cyclesof back slabs and rivesFor Children (1-7 years) Lie the child face down over your knee or arm and smack themsharply between their shoulder blades three to four sharp slaps.Iftheobstructionisstill present orthechildisgetting weakerGIVE UP TOFIVEBACKSLAPS Check themouth andremoveanyIftheobstructionisstill presentGIVE UP TOFIVECHESTTHRUSTS Check themouth ll presentGIVE UP TOFIVEABDOMINALTHRUSTS Check themouth andremoveanyobvious20If theobstructiondoesn’t clearafter threecycles of backslabs, chestthrusts, andabdominalthrustsDIALL FOR ANAMBULANCEContinue until

For AdultsMethod - AStand behind the patient and grasp them around the chest justunder the chest bone (sternum). Give a sharp bear hug (fig.6).If the obstruction is stillpresent or the causalityis getting weakerGIVE UP TO FIVEBACK SLAPS Check the mouthand remove anypreviousobstructionIf the obstruction isstill presentGIVE UP TO FIVEABDOMENALTHRUST CheckthemouthandremoveanypreviousIf the obstruction doesn’t clearafter three cycles of backslabs and abdominal thrustsDIALL FOR AN AMBULANCEContinue until help arrivesMethod - BTell the patient to lean over the back of the chair holding on to theseat and then bang him sharply three or four times between hisshoulder blades.Whichever method you use, the foreign body should be coughedout. When a very soft food, drink, blood or vomitus has beenbreathed in, place the patient in the recovery position and clear hismouth off any food or vomitus with your finger (wrapped in a softclean cloth). If the breathing has stopped begin mouth-to -mouthrespiration.21

Figure 6. First aid measure during choking for adults2.5.DrowningIt is the fourth leading cause of accidental death in the active agegroups. Major drowning ranks second in fatality only to motor vehicleaccidents; the majority occurs in the recreational play or leisure timeactivities in developed countries.The aim of giving first aid for drowning is:To restore adequate breathingTo keep the casualty warmTo arrange urgent removal to hospitalFirst aid measure.22

1. If you are rescuing the casualty from the water to safety, keep thehead lower than the rest of the body to reduce their risk of inhalingwater.2. Lay the casualtyPrevention of accidental drowning involves: Supervision during swimming. Protection of the swimming area and the swimmer. Training of the swimming person and life savers.2.6. Mechanical suffocation (Strangulation)If pressure is exerted on the outside of the neck, the air way issqueezed and the flow of air to the lung is cut off. The main causesof such pressure are: Hanging- suspension of the body by rope around the neckor throat. Strangulation- constriction or squeezing around the neck orthroat.Sometimes, hanging or strangulation may occur accidentally- forexample, by ties or clothing becoming caught in machinery.Hanging may cause a broken neck; for this reason, a casualty in thissituation must be handled extremely carefully.Recognition (signs) A constricting article around the neck Marks around the casualty’s neck Rapid, difficult breathing; impaired consciousness; grey-blueskin (cynosis).23

Congestion of the face, with prominent veins and, possibly,tiny red spots on the face or on the whites of the eyes.Caution Do not move the casualty unnecessarily, in case of spinalinjury. Do not destroy or interfere with any material that has beenconstricting the neck, such as knotted rope; police may needit as evidence.First aid aim and interventions:The aims are: To restore adequate breathing. To arrange urgent removal to the hospitalFirst aid measures are:1. Quickly remove any constriction from around the casualty’s neck.Support the body while you do so if it is still hanging. Be awarethat the body may be very heavy.2.Lay the casualtyon the ground. Open the airway and checkbreathing. If he/she is not breathing, be prepared to give rescuebreaths and chest compressions if necessary. If he/she isbreathing, place her in the recovery position.Never give an infant plastic material to play with and be certain thatmattress covers securely anchored to the bed.24

2.7.Inhalation of fumesThe inhalation of smoke, gases (such as carbon monoxide), or toxicvapors can be lethal. A casualty who has inhaled fumes is likely tohave low levels of oxygen in his/her body tissues and thereforeneeds urgent medical attention. Do not attempt to carry out a rescueif it is likely to put your own life at risk; fumes that have built up in aconfined space may quickly overcome anyone who is not wearingprotective equipment.Smoke inhalationAny person who has been enclosed in confined space during a fireshould be assumed to have inhaled smoke. Smoke from burningplastics, foam padding, and synthetic wall coverings is likely tocontain poisonous fumes. Casualties should also be examined forother injuries due to the fire.Inhalation of carbon monoxideCarbon monoxide is a poisonous gas that is produced by burning. Itacts directly on red blood cells, preventing them from carryingoxygen to the body tissues. If the gas is inhaled in to the body inlarge quantities- for example, from smoke or vehicle exhaust fumesin a confined space- it can very quickly proves fatal. However,lengthy exposure to even a small amount of carbon monoxide- foreexample, due to a leakage of fumes from defective heater or fluemay also result in sever, or possibly fatal, poisoning.25

Carbon monoxide has no test or smell, so take care if you suspect aleak.Table 2: Effects of fumes InhalationGasSourceEffectsCarbonExhaust fumes of motor vehicles.Prolonged exposure from lowmonoxide Smoke from most fireslevels: Head ache Back-draughts from blocked Confusion,Aggressi

1. Define first aid 2. Recognize the reasons why first aid is given 3. Appreciate values of first aid 4. Identify general directions for giving first aid 1.2. Definition First aid is the immediate care given to a person who has been injured or suddenly taken ill. It includes hom