First Aid – Page 5

In sensitive people, anaphylaxis can occur within minutes, but may also occur up to several hours after exposure to a specific allergy-causing substance. A wide range of substances — including insect venom, pollen, latex, and certain foods and drugs — can cause anaphylaxis. Some people have anaphylactic reactions from unknown causes.

If you’re extremely sensitive, you might break out in hives and your eyes or lips might swell severely. The inside of your throat might swell as well, even to the point of causing difficulty breathing and shock. Your blood pressure drops, and your internal organs can be affected. Dizziness, mental confusion, abdominal cramping, nausea, vomiting or diarrhea also may accompany anaphylaxis.

How you can be ready:
If you’ve had an anaphylactic reaction in the past, carry medications with you as an antidote. Epinephrine is the most commonly used drug for severe allergic reactions. It comes only as an injection that must be prescribed by your doctor. You can self-administer epinephrine with an auto-injector, such as the EpiPen. Be sure to read the injection instructions as soon as you receive an auto-injector, and have your household members read them as well.

You should also carry an antihistamine pill, such as diphenhydramine (Benadryl, others), because the effects of epinephrine are only temporary. Seek emergency medical attention immediately after taking these medications.

If you observe someone having an allergic reaction with signs of anaphylaxis:

1. Call 911 or your local medical emergency number.
2. Check for special medications that the person might be carrying to treat an allergic attack, such as an auto-injector of epinephrine (for example, EpiPen). Administer the drug as directed — usually by pressing the auto-injector against the person’s thigh and holding it in place for several seconds. Massage the injection site for 10 seconds to enhance absorption. After administering epinephrine, have the person take an antihistamine pill if he or she is able to do so without choking. Look for a medical emergency ID bracelet or necklace.
3. Have the person lie still on his or her back with feet higher than the head.
4. Loosen tight clothing and cover the person with a blanket. Don’t give anything else to drink.
5. If there’s vomiting or bleeding from the mouth, turn the person on his or her side to prevent choking.
6. If there are no signs of circulation (breathing, coughing or movement), begin CPR.

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

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.

For other cases of severe bleeding, follow these steps:

1. Have the injured person lie down. If possible, position the person’s head slightly lower than the trunk or elevate the legs. This position reduces the risk of fainting by increasing blood flow to the brain. If possible, elevate the site of bleeding.
2. While wearing gloves, remove any obvious dirt or debris from the wound. Don’t remove any large or more deeply embedded objects. Don’t probe the wound or attempt to clean it at this point. Your principal concern is to stop the bleeding.
3. Apply pressure directly on the wound. Use a sterile bandage, clean cloth or even a piece of clothing. If nothing else is available, use your hand.
4. Maintain pressure until the bleeding stops. Hold continuous pressure for at least 20 minutes without looking to see if the bleeding has stopped. You can maintain pressure by binding the wound tightly with a bandage (or even a piece of clean clothing) and adhesive tape.
5. Don’t remove the gauze or bandage. If the bleeding continues and seeps through the gauze or other material you are holding on the wound, don’t remove it. Instead, add more absorbent material on top of it.
6. Squeeze a main artery if necessary. If the bleeding doesn’t stop with direct pressure, apply pressure to the artery delivering blood to the area of the wound. Pressure points of the arm are on the inside of the arm just above the elbow and just below the armpit. Pressure points of the leg are just behind the knee and in the groin. Squeeze the main artery in these areas against the bone. Keep your fingers flat. With your other hand, continue to exert pressure on the wound itself.
7. Immobilize the injured body part once the bleeding has stopped. Leave the bandages in place and get the injured person to the emergency room as soon as possible.

If you suspect internal bleeding, call 911 or your local emergency number. Signs of internal bleeding may include:

• Bleeding from body cavities (such as the ears, nose, rectum or vagina)
• Vomiting or coughing up blood
• Bruising on neck, chest, abdomen or side (between ribs and hip)
• Wounds that have penetrated the skull, chest or abdomen
• Abdominal tenderness, possibly accompanied by rigidity or spasm of abdominal muscles
• Fractures
• Shock, indicated by weakness, anxiety, thirst or skin that’s cool to the touch

Ideally, CPR involves two elements: chest compressions combined with mouth-to-mouth rescue breathing. (A complete description of how to do both follows farther down in this article.)

However, what you as a bystander actually should do in an emergency situation really depends on your knowledge and comfort level.

The bottom line is that it’s far better to do something than to do nothing at all if you’re fearful that your knowledge or abilities aren’t 100 percent complete. Remember, the difference between your doing something and doing nothing could be someone’s life.

Here’s the latest advice from the American Heart Association:

• Untrained. If you’re not trained in CPR, then provide hands-only CPR. That means uninterrupted chest presses of about two per second until paramedics arrive (described in more detail below). You don’t need to try rescue breathing.
• Trained, and ready to go. If you’re well trained, and confident in your ability, then you can opt for one of two approaches: 1. Alternate between 30 chest compressions and two rescue breaths, or 2. Just do chest compressions. (Details described below.)
• Trained, but rusty. If you’ve previously received CPR training, but you’re not confident in your abilities, then it’s fine to do just chest compressions.

The above advice applies only to adults needing CPR, not to children.

CPR can keep oxygenated blood flowing to the brain and other vital organs until more definitive medical treatment can restore a normal heart rhythm.

When the heart stops, the absence of oxygenated blood can cause irreparable brain damage in only a few minutes. Death will occur within eight to 10 minutes. Time is critical when you’re helping an unconscious person who isn’t breathing.

To learn CPR properly, take an accredited first-aid training course, including CPR and how to use an automatic external defibrillator (AED).

Before you begin
Assess the situation before starting CPR:

• Is the person conscious or unconscious?
• If the person appears unconscious, tap or shake his or her shoulder and ask loudly, "Are you OK?"
• If the person doesn’t respond and two people are available, one should call 911 or the local emergency number and one should begin CPR. If you are alone and have immediate access to a telephone, call 911 before beginning CPR — unless you think the person has become unresponsive because of suffocation (such as from drowning). In this special case, begin CPR for one minute and then call 911.
• If an AED is immediately available, deliver one shock if advised by the device, then begin CPR.

Remember the ABCs
Think ABC — Airway, Breathing and Circulation — to remember the steps explained below. Move quickly through Airway and Breathing to begin chest compressions to restore circulation.

AIRWAY: Clear the airway

1. Put the person on his or her back on a firm surface.
2. Kneel next to the person’s neck and shoulders.
3. Open the person’s airway using the head-tilt, chin-lift maneuver. Put your palm on the person’s forehead and gently tilt the head back. Then with the other hand, gently lift the chin forward to open the airway.
4. Check for normal breathing, taking no more than five or 10 seconds: Look for chest motion, listen for breath sounds, and feel for the person’s breath on your cheek and ear. Gasping is not considered to be normal breathing. If the person isn’t breathing normally and you are trained in CPR, begin mouth-to-mouth breathing. If you believe the person is unconscious from a heart attack and you haven’t been trained in emergency procedures, skip mouth-to-mouth rescue breathing and proceed directly to chest compressions to restore circulation.

BREATHING: Breathe for the person
Rescue breathing can be mouth-to-mouth breathing or mouth-to-nose breathing if the mouth is seriously injured or can’t be opened.

1. With the airway open (using the head-tilt, chin-lift maneuver) pinch the nostrils shut for mouth-to-mouth breathing and cover the person’s mouth with yours, making a seal.
2. Prepare to give two rescue breaths. Give the first rescue breath — lasting one second — and watch to see if the chest rises. If it does rise, give the second breath. If the chest doesn’t rise, repeat the head-tilt, chin-lift maneuver and then give the second breath.
3. Begin chest compressions to restore circulation.

CIRCULATION: Restore blood circulation with chest compressions

1. Place the heel of one hand over the center of the person’s chest, between the nipples. Place your other hand on top of the first hand. Keep your elbows straight and position your shoulders directly above your hands.
2. Use your upper body weight (not just your arms) as you push straight down on (compress) the chest 2 inches (approximately 5 centimeters). Push hard and push fast — give two compressions per second, or about 120 compressions per minute.
3. After 30 compressions, tilt the head back and lift the chin up to open the airway. Prepare to give two rescue breaths. Pinch the nose shut and breathe into the mouth for one second. If the chest rises, give a second rescue breath. If the chest doesn’t rise, repeat the head-tilt, chin-lift maneuver and then give the second rescue breath. That’s one cycle. If someone else is available, ask that person to give two breaths after you do 30 compressions.
4. If the person has not begun moving after five cycles (about two minutes) and an automatic external defibrillator (AED) is available, apply it and follow the prompts. The American Heart Association recommends administering one shock, then resuming CPR — starting with chest compressions — for two more minutes before administering a second shock. If you’re not trained to use an AED, a 911 operator may be able to guide you in its use. Trained staff at many public places are also able to provide and use an AED. Use pediatric pads, if available, for children ages 1 to 8. Do not use an AED for infants younger than age 1. If an AED isn’t available, go to No. 5 below.
5. Continue CPR until there are signs of movement or until emergency medical personnel take over.

To perform CPR on a child
The procedure for giving CPR to a child age 1 through 8 is essentially the same as that for an adult. The differences are as follows:

• If you’re alone, perform five cycles of compressions and breaths on the child — this should take about two minutes — before calling 911 or your local emergency number or using an AED.
• Use only one hand to perform heart compressions.
• Breathe more gently.
• Use the same compression-breath rate as is used for adults: 30 compressions followed by two breaths. This is one cycle. Following the two breaths, immediately begin the next cycle of compressions and breaths.
• After five cycles (about two minutes) of CPR, if there is no response and an AED is available, apply it and follow the prompts. Use pediatric pads if available. If pediatric pads aren’t available, use adult pads.

Continue until the child moves or help arrives.

To perform CPR on a baby
Most cardiac arrests in infants occur from lack of oxygen, such as from drowning or choking. If you know the infant has an airway obstruction, perform first aid for choking. If you don’t know why the infant isn’t breathing, perform CPR.

To begin, assess the situation. Stroke the baby and watch for a response, such as movement, but don’t shake the child.

If there’s no response, follow the ABC procedures below and time the call for help as follows:

• If you’re the only rescuer and CPR is needed, do CPR for two minutes — about five cycles — before calling 911 or your local emergency number.
• If another person is available, have that person call for help immediately while you attend to the baby.

AIRWAY: Clear the airway

1. Place the baby on his or her back on a firm, flat surface, such as a table. The floor or ground also will do.
2. Gently tip the head back by lifting the chin with one hand and pushing down on the forehead with the other hand.
3. In no more than 10 seconds, put your ear near the baby’s mouth and check for breathing: Look for chest motion, listen for breath sounds, and feel for breath on your cheek and ear.

If the infant isn’t breathing, begin mouth-to-mouth breathing immediately.

BREATHING: Breathe for the infant

1. Cover the baby’s mouth and nose with your mouth.
2. Prepare to give two rescue breaths. Use the strength of your cheeks to deliver gentle puffs of air (instead of deep breaths from your lungs) to slowly breathe into the baby’s mouth one time, taking one second for the breath. Watch to see if the baby’s chest rises. If it does, give a second rescue breath. If the chest does not rise, repeat the head-tilt, chin-lift maneuver and then give the second breath.
3. If the chest still doesn’t rise, examine the mouth to make sure no foreign material is inside. If the object is seen, sweep it out with your finger. If the airway seems blocked, perform first aid for a choking infant.
4. Begin chest compressions to restore circulation.

CIRCULATION: Restore blood circulation

1. Imagine a horizontal line drawn between the baby’s nipples. Place two fingers of one hand just below this line, in the center of the chest.
2. Gently compress the chest to about one-third to one-half the depth of the chest.
3. Count aloud as you pump in a fairly rapid rhythm. You should pump at a rate of about 100 to 120 pumps a minute.
4. Give two breaths after every 30 chest compressions.
5. Perform CPR for about two minutes before calling for help unless someone else can make the call while you attend to the baby.
6. Continue CPR until you see signs of life or until a professional relieves you.

A puncture wound — such as results from stepping on a nail or being stuck with a tack — can be dangerous because of the risk of infection. The object that caused the wound may carry spores of tetanus or other bacteria, especially if the object has been exposed to the soil. Puncture wounds resulting from human or animal bites, including those of domestic dogs and cats, may be especially prone to infection. Puncture wounds on the foot are also more vulnerable to infection.

If the bite was deep enough to draw blood and the bleeding persists, seek medical attention. Otherwise, follow these steps:

1. Stop the bleeding. Minor cuts and scrapes usually stop bleeding on their own. If they don’t, apply gentle pressure with a clean cloth or bandage. If bleeding persists — if the blood spurts or continues to flow after several minutes of pressure — seek emergency assistance.
2. Clean the wound. Rinse the wound well with clear water. A tweezers cleaned with alcohol may be used to remove small, superficial particles. If larger debris still remains more deeply embedded in the wound, see your doctor. Thorough wound cleaning reduces the risk of tetanus. To clean the area around the wound, use soap and a clean washcloth.
3. Apply an antibiotic. After you clean the wound, apply a thin layer of an antibiotic cream or ointment (Neosporin, Polysporin) to help keep the surface moist. These products don’t make the wound heal faster, but they can discourage infection and allow your body to close the wound more efficiently. Certain ingredients in some ointments can cause a mild rash in some people. If a rash appears, stop using the ointment.
4. Cover the wound. Exposure to air speeds healing, but bandages can help keep the wound clean and keep harmful bacteria out.
5. Change the dressing regularly. Do so at least daily or whenever it becomes wet or dirty. If you’re allergic to the adhesive used in most bandages, switch to adhesive-free dressings or sterile gauze and hypoallergenic paper tape, which doesn’t cause allergic reactions. These supplies are generally available at pharmacies.
6. Watch for signs of infection. See your doctor if the wound doesn’t heal or if you notice any redness, drainage, warmth or swelling.

If the puncture is deep, is in your foot, is contaminated or is the result of an animal or human bite, see your doctor. He or she will evaluate the wound, clean it and, if necessary, close it. If you haven’t had a tetanus shot within five years, your doctor may recommend a booster within 48 hours of the injury.

If an animal — especially a stray dog or a wild animal — inflicted the wound, you may have been exposed to rabies. Your doctor may give you antibiotics and suggest initiation of a rabies vaccination series. Report such incidents to county public health officials. If possible, the animal should be confined for 10 days of observation by a veterinarian.