21-November-2004 Dr. T. R. Bhadran 1
“Welcome”
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Presented by: Dr. T.R.Bhadran, MBBS; DTM&H; D.Ortho,.
Civil Surgeon & Orthopaedic Surgeon,Taluk Hospital, Cherthala.
First Aid
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―First aid is the initial care of a suddenly sick or injured person‖ ,
( pre-hospital care) the aims being
To preserve life
To prevent further harm
To relieve pain
Definition
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Immediate action
Don’t panic
Get help
Reassurance
What to do in an emergency?
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Immediate action
Fix priority
Remain calm & controlled
Think before acting
Actions should be deliberate
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Calling for help
Ambulance/fire/police/doctor/hospital
Stay on line until the called person gets
the proper message
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Information to be conveyed from remote area
Exact address or location City or town Nearest junction or street Landmarks Distance from Callers identity Caller’s phone number Explain the incidence Number and condition of casualties Explain aid available & urgency
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Explaining aid available &
urgency in a hospital casualty situation
Type & Time of accident
Number of casualties, age & sex
Did they walk in / were carried in?
First aid given
Body parts injured
Has an X-ray been taken?
Urgency:- Can the case wait until the called person completes more serious work at hand, while first aid is being given & an X-ray is being taken?
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Methods to call for help…………
Direct – Call aloud, Clapping, Drumming
Phone- land/mobile
Wireless set
Flag flares
Personal locator beacons
Medical alert devices
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Reassurance*:-
Emotional support
Keep the casualty informed
Comfort the casualty
Console relatives of the casualty
Get the relatives involved in helping
Explain the situation to the concerned
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First aid Kits*
Adhesive strips
Hand towels – 3
Adhesive tape – 1 roll
Non adhesive dressings
Alcohol swab
Plastic bag for amputations
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Combine dressings
Safety pins, blades, scissors
Crepe bandages 5 & 7.5 cms
Splints
Triangular bandages
Gauze swab
Wound dressings
Gloves disposable
CPR barrier devices
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Sorting and classification of casualties and
establishment of treatment priorities in
mass casualty situations.
Ask 3 questions Who can be saved?
Who will & who won’t benefit?
If I treat this case will the others suffer?
*Triage*(pronounced „tree-ahz‟)
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High priority!!!
Unconscious casualty on his back!
Severe bleeding!
Head & face injury!
Shock!
Chest, Abdominal & Pelvic injury!
Respiratory embarrassment!
Severe burns!
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“Approaching the scene”
Examine the scene
Control the scene with help
Assess the scene
How many casualties are there?
Gain access to the casualty
Assess the casualties
Triage the casualties
Attend to the casualty
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“GOLDEN HOUR”
Period during which all efforts are made to
save life before irreversible pathological
changes take place, period from time of
injury to getting definitive treatment
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„Platinum minutes‟
The first 10 minutes of golden hour
Assessment & injury survey – 1 min
Resuscitation & stabilization – 5 min
Immobilization & transport - 4 min
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Attending the casualty-assess
Shock
Respiration
Airway
Bleeding
Consciousness
Injuries
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Shock
Identify by
Cold limbs
Pale skin
Shallow breathing
Vomiting
Shivering
Lying on back
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Shock
What to do
Keep him lying down
Elevate the legs
Stop bleeding from wounds
IV line
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Bleeding from wounds
Have the injured person lie down
Remove any obvious dirt or debris from the wound
Apply pressure directly on the wound
Maintain pressure until the bleeding stops
Don't reposition displaced organs
Don't remove the gauze or bandage
Squeeze a main artery if necessary
Bind with tight bandage & immobilize the injured body part once the bleeding has stopped
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Bleeding from nose
Usually stops within a few minutes
Lean forward
Pinch the bridge of the nose & mouth-breathe
Apply a cool wet cloth to the face & nose
Apply ice covered with cloth on bridge
Don’t pick or blow nose after bleeding stops
Decongestant nasal sprays
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Respiratory arrest
No voluntary breathing movements
Clear the airway &/or Heimlich maneuver
Artificial respiration
Mouth to mouth
Intubations & Ambue bag / respirator
Tracheostomy (in expert hands only)
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Choking
Choking is often the result of inadequately chewed
food becoming lodged in the throat or windpipe.
Solid foods such as meat are frequently the cause
Talking while simultaneously chewing
Drinking alcohol while eating
Wearing dentures
Young children tend to put into their mouths
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Choking
Panic
An expression of fear or terror
The victim may turn purple
The eyes may bulge
May wheeze or gasp
Can speak if block is partial / no if not.
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Heimlich maneuver
-in a conscious adult
Stand behind him, wrap your arms around his waist, bend him slightly forward.
Make a fist with one hand and place it slightly above the person's navel, grasp your fist with the other hand
Press hard into the abdomen with a quick, upward thrust
Repeat this procedure until the object is expelled from the airway
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Heimlich maneuver
-in an unconscious adult
Position adult on his back, look inside the mouth
Sweep the area with your finger
See if you can remove the blockage.
If not, kneel over the person and apply upward
thrusts to the upper abdomen
Repeat the process as necessary to remove the
blockage
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Heimlich maneuver
-in a choking infant
Assume a seated position and hold the infant
facedown on your forearm, which is resting on
your thigh
Thump the infant gently but firmly five times on
the middle of the back using the heel of your hand
Repeat till breathing resumes
The combination of gravity and the back blows
should release the blocking object
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Heimlich maneuver
-in a pregnant woman & in obese
Position your hands a little bit higher than
with a normal Heimlich maneuver, at the base
of the breastbone, just above the joining of
the lowest ribs
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Cardiopulmonary resuscitation
Combination of mouth to mouth rescue
breathing and chest compression
Chest compression to move blood to vital organ
like brain,lungs and heart
Rescue breathing to oxygenate the blood
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CPR
Check signs of life
Position person on back on hard surface
Lift chin forward to open airway
Watch for spontaneous breathing, if nil
Pinch his nostrils
Breath into his mouth @ 12 breaths/min
Completely refill your lung after each breath
What if still there are no signs of life?
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No response,movement or breathing??
Begin chest compressions
Place heel of both hands on lower end of chest bone
Keep elbows straight
Lean forward and press making use of your weight
Push down 1.5 to 2 inches @ 80 –100 times/min
Between 15 each compressions breath into him twice
Check for signs of life after every four cycles of 15 compressions and 2 breaths: namely neck pulse, spontaneous breathing movement and/or cough.
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Head trauma
Signs
Severe head or facial bleeding
Changes in level of consciousness
Blue-black discoloration near eye or ear
Cessation of breathing
Confusion
Loss of balance
Weakness or inability to use arm or leg
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Head injury
What to do
Keep him lying down
Hold him still
Avoid moving the neck
Stop any bleeding
Watch out for respiratory &/or cardiac arrest
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Chest injury
What to do
Seal all penetrating wounds with occlusive
dressing & prevent pneumothorax
Clear the airway
Take care, avoid chest compression
Plaster strapping in flail chest
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Abdominal injury
What to do
Care of wounds
Don't reposition displaced organs
Abdominal binders
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Spine injuries
Assessment
? Other associated head injury
C/o pain in neck or back
Weakness, numbness or paralysis or loss of control over a)limbs,
b)bladder
c) bowel
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Spine injuries
What to do
Keep the person still
Stabilize the neck with a heavy towel
Never ever move the neck
Transport on hard board or wooden plank
Move with help of several people support
If alone, drag by his clothing, never turn him
Or, leave him in position he was found
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Crush Injury Syndrome
Why serious?
A casualty trapped by compressing force for prolonged period
Collection of large quantities of acid and electrolytes and toxins in the crushed muscle
On release of compressing force, the liberated blood carries the toxin in high quantities to the vital organs with fatal results
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Crush Injury Syndrome
Criteria for assessment:
Large muscle mass involved
Prolonged compression
Compromised blood circulation
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Crush Injury Syndrome
Signs and symptoms
Compression in excess of 60 min
Large muscle mass
Absent pulse or capillary distal to crush
Pale, cool, clammy skin
Weak rapid pulse
Absence of pain in the affected limb
Onset of shock
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Crush Injury Syndrome
Care and first aid
If < 1hr, release the crushing force
If > 1hr, do not relieve crush
Tourniquet- to or not to?
Reassure the casualty
Treat any other associated injuries
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Dislocations
―Injury to joint where the ends of bones are forced from their normal positions.‖
Splint the affected joint into its fixed position. Don't try to move a dislocated joint or force it back into place. This can damage the joint and its surrounding muscles, ligaments, nerves or blood vessels.
Put ice on the injured joint.
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FracturesDiagnosis
Pale, cool, clammy skin & rapid, weak pulse
Pain & Tenderness at the site
Loss of power to limb
Associated wound and blood loss
Associated organ damage
Deformity &/or Crepitus (never attempt to elicit)
If doubtful compare with opposite normal limb
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Fractures
Immobilize the part- why & how:
A splint stabilizes & reduces pain
Include the joints above and below the fracture in
the immobilization technique used & prevent
unwanted movement
Don't attempt to align the bone back into position
The splint should be longer than the bone it is
splinting and extend above and below the injury
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Fractures
Cont’d
Use a rigid material such as wood, plastic metal, tree branches or even rolled paper. Pad the splint
Fasten the splint to the limb with gauze, strips of cloth or string, or even a belt. Start wrapping from the extremity and work toward the body. Splint the limb firmly to prevent motion but not tight enough to stop blood flow
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Fractures
Ideal equipments
Arm sling
Elevated sling
Collar & cuff (clove hitch) sling
Triangular bandage
Thomas splint
Collars (hard/soft)
Foldable trolley with body straps
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Anatomical immobilization
Finger to finger
Forearm & arm to chest (use cuff button)
Leg-to-leg & Thigh-to-thigh
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Sprains
―Injury to a ligament caused by excessive stretching‖
Protect the injured limb from further injury
Rest the injured limb.
Ice the area.
Compress the area with an elastic wrap or bandage.
Elevate the injured limb
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*PAIN KILLERS*
―There is no better painkiller so good as
good immobilization of an injured limb‖
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Drowning
Without placing yourself at risk, remove the casualty from the water
Make sure that his/her head is kept low, this will discourage the threat of inhaling one's vomit
Once on land/pool-side perform mouth -to-mouth resuscitation
Wrap them as quickly as possible with a blanket
Look/Listen or Feel for signs of breathing
CPR
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Heart attack
Tell-tale symptoms & signs
Uncomfortable pressure, fullness or squeezing
pain in the center of chest, lasting more than a few
minutes
Pain spreading to shoulders, neck or arms
Lightheadedness, fainting, sweating, nausea or
shortness of breath
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Heart attack
Seat the casualty comfortably
Call for emergency medical assistance
Open windows and let fresh air in
Decide on the fastest method of transportation
Chew aspirin
IV line
Monitor breathing and pulse
CPR if need be
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Epilepsy
Allow the seizure to run its course
Place a soft padding around his/her head
Try and move objects away from the individual
Don’t attempt to put objects into epileptic's mouth
Don't restrain the epileptic
Wait for the jerking movements to cease
Place the casualty in the recovery position
Offer comfort and reassurance
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Stroke
Occurs when there's bleeding into brain, or normal
blood flow to brain is blocked.
Within minutes of being deprived of essential
nutrients, brain cells start dying — a process that
may continue over the next several hours.
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Stroke
Symptoms are sudden like bolt from the blue
Weakness or numbness in your face, arm or leg on one
side of your body
Dimness, blurring or loss of vision, particularly in one
eye
Loss or trouble of speech
Severe headache, disorientation
Unexplained dizziness, unsteadiness or fall
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Stroke
True emergency
Seek immediate medical assistance.
The faster treatment is given, the more likely damage can be minimized.
Every moment counts.
Remember: The longer a stroke goes untreated, the greater the damage and potential disability. Success of treatment may depend on how soon you receive care
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Food poisoning
Avoid milky drinks or anything acidic such as
soft drinks
Drink plenty of fresh, boiled water constantly
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Poison ingested
Call emergency services immediately
Do not force the individual to vomit
If the casualty has taken corrosive poison , it would be best to give the person sips of water or milk
Use the A B C technique and be prepared to carry out resuscitation
Be sure to place a conscious or unconscious individual in the recovery position until help arrives
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Burns
Superficial Burn (First Degree)
Involves only the top layer of skin.
The skin is red and dry and usually painful.
The burned area may also swell.
The underlying skin is healthy.
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Burns
What to do
Treat immediately with cool water. Keep the burn
under the water until there is little or no pain.
Then apply a moist dressing, and bandage loosely.
Where water is not available, apply a clean, dry
dressing.
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Burns
Partial-thickness Burn (Second Degree)
Involves the partial layers of skin
The skin is red with blisters
May open and weep clear fluid
Giving the skin a wet appearance
The area may also appear mottled
Usually painful and often swells
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Burns
What to do
Do not break the blisters - this will compound the
injury by causing an open wound.
If the blisters are not open, place in cool water until
the pain lessens,
Then apply a moist dressing, and bandage loosely.
Do not apply creams, ointments, or sprays.
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Burns
Full-thickness Burn (Third Degree)
Destroys all layers of skin
Destroys any or all of the underlying structures
The burn appears brown or black (charred) with
the tissues underneath sometimes appearing white.
Extremely painful or relatively painless if the
burn destroys the nerve endings.
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Burns
What to do
Do not apply creams, ointments, or sprays.
Wrap a clean sheet around the victim and,
If the weather is cool, cover them with blankets.
The victim should be rushed to hospital because
their life is at stake.
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Burns
Chemical Burns
Remove the chemical immediately
Flush the area with large amounts of cool running
water
Remove any clothes with chemicals on them
Be careful not to spread the chemical to other
body parts or to yourself.
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BurnsElectrical Burns
The power source has been turned off.
If the victim is unconscious, check breathing and pulse.
Check for other injuries
Do not move the victim because he may have spinal injuries.
Cover an electrical burn with a dry, sterile dressing.
Do not cool the burn. There may be two wounds, one where the current entered the body and one where it left, and they may be deep.
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Cuts & scrapes
Wear latex gloves & avoid direct contact with body fluids
Stop the bleeding.
Clean the wound.
Apply an antibiotic.
Cover the wound.
Change the dressing.
Get stitches for deep wounds.
Tetanus toxoid
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Part of body torn off
Find the part
Wrap it in clean dressing
Put the bag on ice, but don’t freeze
Take the part to the hospital
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Bruise
Forms when a blow breaks small blood vessels near
the skin's surface
A small amount of blood leaks out under the skin
The trapped blood appears as a black-and-blue mark
Sometimes, there are tiny red dots or red splotches
The skin isn't broken
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Bruise
First aid measures
Doesn't need a bandage.
Elevate the injured area.
Apply ice or a cold pack for 30 to 60 minutes
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Muscle cramps
Symptoms & signs
Painful, involuntary muscle spasms that usually
occur during heavy exercise in hot environments.
Inadequate fluid intake often contributes to this
problem
Muscles most often affected include calves,
arms, abdomen and back
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Muscle cramps
Rest briefly and cool down
Drink water or an electrolyte-containing
sports drink
Practice gentle, range-of-motion
stretching and gentle massage of the
affected muscle group
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Foreign object in the skin
If not deeply embedded
Use tweezers to remove slivers of wood or
fiberglass, small pieces of glass or other foreign
objects projecting from your skin.
Clean the area well with soap and water and
apply alcohol to the wound.
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Foreign object in the skin
If deeply embedded
Clean the area well with soap and water.
Break the skin over the object with the Sterile needle.
Use tweezers to remove the object. A magnifying glass may help you see the object better.
Apply antibiotic ointment to the area.
If the particles don't come out easily, cover with sterile pad and seek medical help
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Foreign body in ear
First aid procedures
Don't probe your ear with a tool.
Remove the object if possible.
Try using gravity.
Try using oil for an insect.
Don't use oil to remove any object other than an insect.
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Foreign body in nose
Don't probe at the object with any tool
Don't try forcefully breathing in & inhale the object
Breathe through mouth until the object is removed
Blow nose gently to try to free the object
If the object is visible and you can easily grasp it with
tweezers, gently remove it
Or else call for emergency medical assistance
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Foreign body in eye
What to do
Seat the person in a well-lighted area.
Try to locate the object
If the object is floating in the tear film or on the surface of the eye, you may be able to flush it out or remove it manually
If the object is large . Don't remove the object cover the eye and the object with a paper cup
Seek emergency medical assistance
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Corneal abrasion
Extremely painful, because the cornea is very
sensitive
Feeling of sand in eye
Tears
Blurred vision
Increased photo sensitivity
Redness around the eye
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Corneal abrasion
Rinse the eye with lukewarm clean tap water over
the eye or splash the eye with clean water. This may
wash out the offending foreign body. Blink several
times. This movement may remove small particles
of dust or sand.
Pull the upper eyelid over the lower eyelid. The
lashes of the lower eyelid can brush the foreign
body from the undersurface of the upper eyelid.
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Black eye
Bleeding beneath the skin around the eye
Sometimes indicates a more extensive injury,
even a skull fracture, particularly if the area
around both eyes is bruised or if there has been
head trauma.
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Black eye
Using gentle pressure, apply ice or a cold pack to the
area around the eye for 10 to 15 minutes
Do not to press on the eye itself.
Apply cold as soon as possible after the injury to
reduce swelling.
Be sure there's no blood in the white and colored
parts of the eye.
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Tooth loss
Handle the tooth by the top only, not the roots.
Don't rub it or scrape it to remove dirt.
Gently rinse the tooth in a bowl of tap water
Try to replace the tooth in the socket. Then bite
down gently on gauze to help keep it in place. If
you can't, immediately place it in milk, or , saline
Apply sterile gauze in the gap left by lost tooth
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Fainting
Occurs when the blood supply to the brain is
momentarily inadequate, causing one to lose
consciousness for a brief spell.
Position the person on his or her back.
Watch the airway carefully
Check for breathing
Help restore blood flow
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Motion Sickness
It can strike suddenly, progressing from a feeling of restlessness to a cold sweat, dizziness and then
vomiting
By ship:request a cabin in the middle of the ship, near the waterline
By plane:ask for a seat over the front edge of a wing. Once aboard, direct the air vent to your face
By train:take a seat near a window and face forward
By road:drive or sit in the front passenger's seat
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Motion Sickness
Focus on the horizon or on a distant, stationary
object. Don't read.
Keep your head still, resting against a seat back.
Don't smoke or sit near smokers.
Avoid spicy foods and alcohol. Don't overeat.
Take anti-emetics on eve of journey
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Snake bite
Poisonous
Fright & fear +
Fang marks +
Local reaction + / --
Systemic signs +
Non-poisonous
Fright & fear +
Fang marks nil
Local reaction nil
Systemic signs nil
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Snake bite
Remain calm & don't try to capture the snake
Immobilize the bitten arm or leg and try to stay as quiet as possible
Don't cut the wound or attempt to remove the venom
Don't use a tourniquet or apply ice
Seek medical attention as soon as possible, especially if the bitten area changes color, begins to swell or is painful.
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Insect stings
Move to a safe area to avoid more stings
Scrape off the stinger with a straight-edged object
Don't try to pull out the stinger doing so may release
more venom.
To reduce pain and swelling, apply ice or a cold pack
Apply 0.5 percent or 1 percent hydrocortisone cream,
calamine lotion or a baking soda paste
Antihistamine
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“ All‟s well that ends well ”
The clean up
Take a break, relax and breathe easy
Talk about the incidence with peers
Clean up the scene
Clean equipment and restock your first aid kit
Replace all items used
Complete any documentation needed
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“The purpose of life is to serve and show compassion and the
will to help others”
So,
“Help…………………………”Thank you