11 FIRST AID First Aid is the aid that can be provided before one can get to a trained medical help.What you will learn in this chapter Page Number1. How to stop Bleeding 11-1 to 11-22. Wound Cleaning & Bandaging 11-3 to 11-43. Fractures 11-5 to 11-64. Burns 11--7 to 11-8
11-1 FIRST AID – BLEEDINGWhy We Should Not Lose Blood?A person has about 80 ml of blood for every kilo body weight. In other words, an adult of 60 kiloswill have 60 X 80 ml or 4.8 litres of blood. Similarly a child aged 1 year having a weight of eight kiloswill have 8 X 80 ml or 640 ml of blood.Blood is needed by the body to take oxygen and other important nutrients In Blood donation,like glucose and proteins from one part of the body to another. The body only 350 ml ofusually cannot face the loss of more than 40% of its blood, and such bleedings blood is takencan kill the person. As in the above example, we can see that an adult can from our body,face the loss of blood up to 2 litres (40% of 5 litres) but a one year old child which is easilycan die even if he / she loses 300 ml of blood. It is very important to thenknow how to immediately stop bleeding, especially in children. replaced in three months. TrulyExcept for blood donation and in flow of blood in women during normal speaking, we canmenstruation, all bleedings must be taken seriously. Bleedings from internal safely donateorgans - blood in vomiting, blood with shit and blood in urine –would blood once everymake it necessary for us to tell the patient to consult a doctor. six months.But apart from these more serious bleedings, we can stop most of thebleedings from injuries by simple first aid. The first aid for bleeding hasthree simple principles: 1. Pressure. 2. Elevation 3. Tying1. PressureIf there is bleeding, we should put firm pressure at the site ofinjury with bare hands or with a handkerchief. We should presshard on the bleeding spot continuously for at least five minutes.We can check if the bleeding has stopped by releasing the pressureevery five minutes. If the bleeding has not stopped, we shouldpress and start counting five minutes again. In a large number ofcases, this by itself can stop bleeding. 2. Elevation After having applied pressure, the injured part may be lifted (elevated) above the level of the heart. Since blood flows downwards, doing this would lessen the flow of blood down and would help the collapsed blood vessels to let blood pass through again. For injuries of the hand, elevating the part above the level of the heart may be easy. But for injuries of the thigh or leg, one can do so only if the person is asked to lie down and her leg lifted and kept on a couple of pillows. Of course, we will not be able to treat Injuries and bleeding of the abdomen or chest by this method and hence will need to depend on other methods.
11-23. TyingIf by putting pressure or by elevating the part or by doing both, yetthe bleeding does not stop, we need to try the tying method. We cantry to tie a string or shoelace above the level of the injury towardsthe heart. To be really effective, after having wrapped the stringaround the part, insert a pencil and keep twisting the pencil to seethat the string is firmly tied. The best way to find out if the pressureapplied is enough or not, check if the part is still bleeding. An effectivetie will be able to stop the blood from flowing.Be Careful In Such Tying Method !Such kind of ties – also called tourniquet (toor-ni-kay) – may stopthe bleeding but it also stops the flow of blood in the arteries. Henceit is important to open the tie every half an hour or else the wholepart may die due to a lack of oxygen and nutrients. As soon as youtie a tourniquet, NOTE THE TIME OF TYING and tell theaccompanying person to take care of the tie by opening it every halfan hour. Stopping Other Types Of Bleeding These three methods, either used singly or in combination will help simple health workers to stop almost all kinds of bleedings. Nosebleeds : For nosebleeds, applying pressure by pinching the nose – for that is where the bleeding usually starts - and asking the patient to sit up (unless she is having problems of heavy bleeding and showing anaemia, in which case she can lie down with the nose pinched.) Neck bleeding: For bleeding from the neck, we cannotput press hard on the neck as it may chock the person. Asking the person to sit up managesto elevate the bleeding point above the level of the heart and helps in decreasing thebleeding.How To Stop Bleeding On The Scalp Of The HeadOr On The Face?In injuries of the scalp on the head, it is often difficult to apply pressureat the bleeding site. This is because there are muscles that will pull theedges of the skin at the site of injury and will continue bleeding even ifwe put pressure on the bleeding spot. But it will help to know that in thescalp, the blood supply goes up from the sides. So, if we put pressurefirmly on the lower edge it may help stop the bleeding. In injuries of theface, the muscles may once again pull at the edges of the skin and hence For head wounds,pressure should be applied firmly on both the edges. press below the wound (on its lower edge)One may not be able to apply pressure at times of bleeding in the neckand of the eyes. Other methods of stopping bleeding may help.
11-3 WOUND CLEANING & BANDAGINGa. Cleaning of wounds 1. What to Clean With? If possible, use a stream of water from a jug or bottle from a height of few inches to remove any dust or broken skin pieces from the wound. Use water which is as clean as possible. It should be at least as clean as drinking water. Preferably use pre-boiled clean water or diluted Chlorhexidine solution. Application of Spirit although is good to clean germs, hurts the person besides delaying healing. Use a clean cloth or cotton dipped in clean water to clean the wound. The cloth should be washed and sun-dried before using. 2. How to clean a wound? Clean from inside of the wound outwards: As the skin carries a lot of germs, if the wound is cleaned from outwards to inwards, germs may enter the wound. Hence, while cleaning wounds, go around the wound in circles starting from the centre of the wound and ending outside the edges of the wound. Cleaning Big Wounds: If the wound is very big, more than one piece of cloth or cotton may be required. In such cases, one can cover the wound with one piece and clean the surroundings with the other. Now use the other piece to clean the wound itself. The wounds must be cleaned Rub the piece of cloth, gauze or cotton firmly enough to remove any from inside outwards in a pus or other material. At the end of the cleaning the base of the wound circular way should look pink. Do not worry if a few drops of blood come out from the wound at the end of the cleaning.If such cleaning can be taught to the patient or her relative, the cleaning can be done at nightand the wound left open, free of dust and flies.
11-4BandagingBandaging a wound is as much an art as it is a science. A cleanand tidy bandage is very reassuring to the patient and is seen asa competence of the health worker. Not all wounds will requirebandaging.When Bandaging Is Needed?Þ The wound is likely to get too much of dust, as in cases of wounds of the feet.Þ Too many flies will sit on the wounds, as in wounds on the face or of someone who cannot move his arms.Þ Wound on the hands of someone who is handling food or water that is going to be eaten by others need to be bandaged properly. Even a small drop of pus that falls while cooking can poison the food and anyone eating this food could die within hours.Þ DO NOT bandage animal bites - they must be left open.Steps in Bandaging 1. Clean the wound well before applying the bandage. If necessary, cover the wound with neem or turmeric paste or an antiseptic cream. If the wound is full of pus, the health worker should put a dressing without any paste or cream. This is called a dry bandage. When the patient comes back for dressing the wound again, the older bandage can be wetted with clean water and pulled off. This helps in cleaning away the dead and unclean skin from a healing wound. 2. Place a piece of clean cloth or gauze on the wound. We usually get two types of bandages – the close weave and the loose weave. The loose weave allows more air and helps in healing of wounds. We should use the close weave where the bandage is needed to support the part or soak excess blood and pus. 3. Wrap the end of the bandage once or twice at a place above (or below) the wound. This is called the fixing turn. Now keep opening the bandage roll and wrapping it downward (or upward) by overlapping each layer for at least one-third of the width of the previous one. 4. Keep wrapping the length of the bandage until there are at least two layers covering the wound. 5. When this is done, cut the edge of the bandage lengthwise neatly into two halves, and tie a knot with the two flaps around the wound. Take care not to tie the knot right over the wound site. Þ At times, in case of a big wound on an uneven part of the body like the calf, the lower edge of the bandage may feel loose. Twisting the bandage each time we wrap it around the uneven part can prevent it becoming loose. Þ If the wound is over or near a joint, it may be necessary to tie the bandage across the joint. In that case, after the fixing turn, it is important to wrap the bandage in the shape of a figure – of – eight. Practice and perfect bandaging... You never know when you will require it !
11-5 FIRST AID – FRACTURESWhy Bones Break? The First Aid of Fractures aimsBones in children are softer than in adults. This is at:because with age calcium keeps piling up in our 1. Decreasing painbones and makes them hard and brittle. So, older 2. Preventing the sharp ends ofpeople suffer more “fractures” – bones breaking the broken bone to pierce– even from the simplest of falls. On the other end, and burst close by bloodchildren may fall from the second storey of a house tubes and nerves.without more than a bending of a bone. 3. Preventing wrong alignment of the broken ends of theMoreover, the fractures that we saw in olden days were bone during healing.different from the fractures that we get to see nowadays. 4. Preventing germs fromNowadays, with modern cars and vehicles that move at high getting into the site ofspeeds and cause accidents, machinery and tall buildings, we fracture and delayingcan see complicated and compound fractures. Yet, what can healing in case of openbe given as First Aid can make a lot of difference in decreasing fractures.the deformity and complications after the fracture.Some simple Steps need to be remembered as First Aid of Fractures: I. Do not allow the broken ends to move. II. Provide a splint support III. Do not massage/reset the bone unless you have special training for the same.I. Do not allow the broken ends of the bones to move. By carrying out this step, you willdecrease the pain. It also decreases the chances of one of the broken ends damaging important tissueslike the neighbouring muscles, blood tubes or nerves.II. Provide a splint support. A support tied to the broken ends of the bone will help to preventthem from moving. The best way to do so is to prevent the joint above and the joint below frommoving.III. Do not massage : If you suspect that a bone might be fractured, do not massage or allowothers to massage that part. While healing, new bone sets around the blood that has come out ofthe broken site. Massaging may spread the blood all around and this may spread hard Calcium tothe muscles and other areas. This would stop the parts from functioning. Massaging may sometimescause lifelong deformity!
11-6Use Splints To Stop MovementTo prevent the bones of a fractured forearm from damaging nearby tissues, one should use a splint– short for splinter: a thin strip of wood or iron – to support and prevent the joints from moving. Apencil can be used to splint the fracture of a finger bone; a flat wooden board or cot splints a fracturedbackbone; a big stick splints a leg from the knee to the ankle while one finger can also act as a splintfor the other. finger which splint for fractured backbone broken acts like splint finger Resetting of a broken bone in the hands of an un- trained person may create disaster. It may not only be painful, but may also damage nearby muscles, blood tubes and nerves permanently. Only try to make the person comfortable and decrease chances of damage till one can reach the person to a person who is experienced and knows how to set bones.Bandaging Arm FracturesMost fractures of the shoulder and arm require a simple support of a big folded cloth tiedto one of the shoulders in such a manner that the arm can restfully hang in it. I II. III. • Fold square peice of Pull one end of cloth • Gently pull up the from behind the neck & broken arm to rest in the cloth into triangle. the other in front of the fold of the cloth. • Keeping pointed end arm. of cloth towards • Tie a knot with both the elbow, pull cloth ends at the shoulder. between arm and chest.
11-7 FIRST AID – BURNSBurnsBurns are a common event in our households. One can see so many scars on the hands of housewivescreated by hot oil splashing while cooking. Burns are also common in villages because of thatchedhouses, and because of bamboo and other wooden material used in housing that easily catch fire.Some time or the other, we will face the problem of offering help in some case of burns, whethersimple or severe burns. We should know the correct and scientific way of providing first aid. Thiswill not only decrease the chances that someone dies of serious burns, but will also ensure that minimumpain and scarring takes place.If A Person Has When A Part Is BurntCaught Fire Wherever the skin has burnt, if possible dip the part for at least half an hour in clean cold water – as clean as possible When person has caught fire, and as cold as possible. If dipping is not possible, pour such cover her with woollen water continuously as much as possible. This helps to blanket etc tightly so that no prevent the heat from continuing to burn the tissues inside air reaches the fire and roll the skin. This action not only decreases pain very fast but her on the ground. This also, has saved the lives of many people. should finish the fire. If water is not available readily –this must be a rare occasion If the clothes have got stuck — milk, buttermilk, ink or other clean and cold fluids can to the skin, try to cut them off be used. DO NOT USE KEROSENE or chemicals though. or put water immediately. One can apply some edible oil like coconut oil with turmeric Simply rolling the person on (haldi) on the wound. If available, any antiseptic cream can also the ground can also put off be used. This helps to avoid any infection from coming into the fire if no blanket is the open wound. available.Treating Simple BurnsOther simpler burns can be treated as below: 1. Dip in Cold water or pour cold water at the earliest for half an hour. 2. Antiseptic dressing – turmeric with oil or market preparation 3. Unless the wound is likely to attract too many flies or dust, DO NOT cover the wound. If dressing is required, use the lightest and simplest dressing. 4. Painkiller pills may help to bear the pain, but would delay healing and care must be taken not to give too much. 5. If the burns have already got germs and infection, germ killers like Doxycycline or Cotrimoxazole may be required.
11-8Are blisters harmful?Do not be scared of blisters being formed on the burns. The fluid inside is a defence mechanism of thebody to help in healing the skin. Skin is the best dressing - as long as the skin is intact, the burnt partwill not get infected. However if it is likely that the blisters may burst by themselves as they are on theback or other such place and even if accidently rubbed, it will brust. Else, we can even puncture theblister with a fine needle whose tip has been kept in a flame until red hot. Once the fluid is pressedout, the punctured point can then be touched with turmeric paste in oil, neem paste or with an antisepticcream to avoid infection from getting inside the blister.If the burns are not serious, the person can have normal meals and more than normal fluids of alltypes to drink. If there are serious burns, the person SHOULD NOT be allowed to eat or drink. Thisincreases his chances of vomiting blood.Are The Burns Serious?To find if the burns are serious, the figure below can be used to calculate as a guide: Head and neck – 9% (front 4.5% and back 4.5%) For ages 8 to 60 years – more than 20% burns should be considered Serious and Chest — 18% referred to a hospital. (front 9% and back of chest For children less than 8 9%) years and people above 60 years, even 10% of burns may be serious enough to require fluids by Intra Venous drip Trunk - 18% and should be referred to a (front 9% and hospital. Explain why they back 9%) should not eat or drink until Private parts – 1% they are in a doctor’s care. Thighs, legs and feet – 18% (front 9% and back 9%; divide 50% for above and below knee) That makes it 9% + 18% + 18% + (2 X 9%) + (2 X 18%) + 1% = 100% for the entire body.