First Aid ~ Priorities In An Emergency.
In an emergency, regardless of the cause, you must first follow the following:
- Look for danger to yourself, the casualty and bystanders.
- Take action to ensure safety, or await trained rescuers.
- Only move casualty if in danger.
- Quickly assess the state of consciousness of the casualty.
- Shake firmly but gently and shout.
- Clear and open the airway.
- Check for breathing.
- Check the neck pulse.
If the casualty has stopped breathing, after clearing the airway you must breathe for him. If the casualty’s heart has stopped beating, you must provide artificial circulation. The techniques of resuscitation enable you to do this.
Problems with airway breathing and circulation are all separate problems dealt with individually. However, they must also be considered collectively as part of a total package. Any casualty may need management of only one or maybe all three of these areas.
- State the objective of resuscitation.
- State the reasons for immediate action.
- Define effective resuscitation.
- Define successful resuscitation.
- Describe the order of priorities of action in an emergency.
The Objective Of Resuscitation Techniques .
Resuscitation techniques aim to preserve life and to maintain an adequate supply of oxygen to the brain, thus preventing irreversible brain damage.
Clear the airways of any obstructions.
Immediate Action.
Resuscitation must be started immediately. Death or serious brain damage may result after 3 minutes without breathing and circulation.
Effective resuscitation maintains an adequate supply of oxygen to the brain.
Successful resuscitation restores breathing and circulation (pulse). Consciousness may also return.
It must be understood that effective resuscitation may sometimes not be successful, such as when:
- The illness or injury is too great to allow recovery.
- Brain death has occurred before effective.
- Resuscitation was started.
If the casualty is not breathing, but still has a pulse, then attempts to restore breathing will be necessary. But if circulation has also ceased, then attempts to restore both breathing and circulation must be carried out.
Airway.
After studying this article you should be able to:
- Describe the structure of the airway.
- Clear, open and maintain a clear and open airway.
- State the common causes of a blocked airway
- Describe the course of action if the airway is blocked.
- Describe the procedure if the casualty is unconscious and trapped.
- State the problems of regurgitation and vomiting and perform the actions necessary to prevent airway blockage.
The first aid recovery position or coma position
Mucus: sticky fluid from some parts of the body, for example the nose, the bronchi.
Regurgitation: backward flowing of stomach contents into the throat and mouth area.
Saliva: secretions in the mouth.
Vomiting: the forceful ejection of stomach contents (vomitus).
Structure Of The Airway.
The entry of air to the lungs is through the airway. It includes the:
- Mouth, nose and throat.
- Voice box (larynx).
- Windpipe (trachea).
- Bronchi.
The airway is the passage through which air is drawn into and breathed out of the lungs.
In the lungs, oxygen is then transferred from the air to the blood for distribution throughout the body, and in a reverse process carbon dioxide is transferred from the blood to the air and breathed out. If the airway is blocked, air will not reach the lungs. The supply of oxygen to the blood will be cut off. The brain cells will begin to die. After 3 minutes without oxygen irreversible brain damage will begin and very soon death will result. However, if the circulation is still present, even though breathing has stopped, the casualty will survive for a longer period, until all available oxygen in the lungs has been used.
Many unconscious casualties have died from blockage of the airway alone. They could have been saved by simple first aid measures.
Common Causes Of Airway Blockage.
In an unconscious casualty:
- The muscles relax and allow the tongue to fall backwards. If the casualty is lying on his back, the tongue will block the airway.
- The ability to swallow and cough is lost, so that the natural methods of clearing fluids or foreign material (such as blood, vomitus, etc.) from the throat can no longer occur.
Positioning the casualty so that fluid can flow away
- Quickly turn the casualty on to the side.
- Tilt the head backwards with head turned slightly downward (this allows the tongue to fall forward and fluid to drain from the mouth).
- Open the mouth.
- Check the mouth for foreign objects or matter
- If these are present, clear these, using the fingers if necessary.
- Remove dentures only if they are loose or broken.
Clear the air ways of a child.
Turn the child on the side and clean the mouth of foreign material. If this fails to clear the blockage, place the child with the head down and give several firm blows between the shoulder-blades.
Hold the infant upside down. Clear the airway if necessary with your little finger.
To open the airway, proceed as follows:
- With the casualty lying on the back, kneel beside the head of the casualty.
- Place the palm of one hand high on the forehead, support the chin with the other hand and firmly but gently tilt the head backwards. The chin is supported with the thumb along the front of the lower jaw just above the point of the chin. The index finger lies along the jaw and with the other three fingers curled into the palm, press up on the bony part of the jaw with the knuckle of the middle finger under the point of the chin. Keep the other two fingers curled under and well clear of the soft tissues of the jaw and throat.
- Lift the jaw forward and support whilst opening the casualty’s mouth slightly.
Where difficulty is experienced in gripping the casualty’s chin or in opening the airway using the above method, the jaw thrust method should be tried.
- With the casualty on the back, kneel beside the head.
- Place one hand on the forehead and press the head into a backward tilt and, at the same time.
- Place your other hand under the angle of the lower jaw and lift the jaw upwards and forwards.
- If the airway is still obstructed use both hands, one behind each angle of the jaw.
Opening airways
Maximum jaw thrust may minimise the amount of head tilt needed when neck injury is suspected.
A further method of opening the airway is the neck lift. This is less effective and should only be used where it is too difficult for the First Aider to use the other two methods, for example a child attempting to open a thickset adult’s airway.
- With the casualty on the back, kneel beside the head.
- Place the palm of one hand high on the forehead and the other under the neck.
- Press the head firmly but gently into backward tilt while lifting the neck upwards.
- Check to see whether breathing begins.
While it is more efficient to open the airway with the casualty on the back, if the casualty is trapped or is on the side the airway can be opened by the above methods.
Jaw thrust and neck lift
Where difficulty is experienced in gripping the casualty’s chin or in opening the airway using the above method, the jaw thrust method should be tried.
- With the casualty on the back, kneel beside the head.
- Place one hand on the forehead and press the head into a backward tilt and, at the same time.
- Place your other hand under the angle of the lower jaw and lift the jaw upwards and forwards.
- If the airway is still obstructed use both hands, one behind each angle of the jaw.
If the casualty is unconscious, the airway must be constantly kept clear and open. If the casualty is not breathing, expired air resuscitation must be started.
If the casualty is breathing, place in the coma position.
In infants it can be very difficult to maintain a clear airway. The head should be kept horizontal without head tilt. The lower jaw should be supported without pressure on the soft tissues of the neck.
A Partially Blocked Airway.
The airway of the unconscious casualty could be partially blocked.
The casualty may:
- Breathe heavily and noisily, like snoring.
- Wheeze.
- Choke.
- Cough.
- Become blue, about the face, lips, fingers, nails etc.