AED - Automated External Defibrillator

An automated external defibrillator (AED) is used in cases of life threatening cardiac arrhythmias (an abnormal electrical signal in the heart) which lead to cardiac arrest. Symptoms of cardiac arrest are chest pain or loss of consciousness. The AED restores the heart's normal electrical signal, if the heart is not defibrillated in 3 minutes or less death or serious incapacitation will occur.

During sudden cardiac arrest, your brain and other vital organs are being starved of blood and oxygen which carries live saving nutrients. You can die in minutes and/or survive but sustain permanent damage to your brain and other organs. The heart's rhythm must be restored fast since every minute that passes is critical to your chance of survival and the amount of damage you sustain.

When the electrodes or pads of automated external defibrillator capable of automatic operation are attached to your chest, these electrodes can detect the heart's rhythm during cardiac arrest and automatically delivers an electric shock to get your heart beating again.

Sudden cardiac arrest happens when your heart's electrical activity is disrupted and the heartbeat gets dangerously fast (ventricular tachycardia) or chaotic (ventricular fibrillation). Your heart stops beating effectively and does not adequately pump blood because of these irregular heart rhythms (arrhythmia).

A non trained bystander that acts quickly and calls 911 to summon emergency medical services to the scene before using the AED can then grab an “automatic operation” defibrillator with voice prompts and easily connect it to your chest to allow the AED to evaluate your heart rhythm. If your heart rhythm can be treated with an electric shock, the AED automatically sends an electrical shock to get your heart back into a normal rhythm.

Only defibrillation can restore the heart's normal rhythm and ultimately save your life although cardiopulmonary resuscitation (CPR) is important to use to keep some blood flowing to your heart and brain.

Uncorrected, these cardiac conditions (ventricular tachycardia, ventricular fibrillation, asystole) rapidly lead to irreversible brain damage and death. After approximately three to five minutes, irreversible brain/tissue damage may begin to occur. For every minute that a person
in cardiac arrest goes without being successfully treated (by defibrillation), the chance of survival decreases by 10 percent



Requirements for Use
AEDs are designed to be used by laypersons who ideally should have received AED training. This is in contrast to more sophisticated manual and semi-automatic defibrillators used by health professionals, which can act as a pacemaker if the heart rate is too slow (bradycardia) and perform other functions which require a skilled operator able to read electrocardiograms.
Bras with a metal underwire and piercings on the torso must be removed before using the AED on someone to avoid interference.

Placement and Availability
Automated external defibrillators are generally either held by trained personnel who will attend events or are public access units which can be found in places including corporate and government offices, shopping centres, airports, restaurants, casinos, hotels, sports stadiums, schools and universities, community centers, fitness centers, health clubs, workplaces and any other location where people may congregate.

The location of a public access AED should take in to account where large groups of people gather, regardless of age or activity. Children as well as adults may fall victim to sudden cardiac arrest (SCA)
In many areas, emergency vehicles are likely to carry AEDs, with some ambulances carrying an AED in addition to manual defibrillators. Police or fire vehicles often carry an AED for first responder use. Some areas have dedicated community first responders, who are volunteers tasked with keeping an AED and taking it to any victims in their area. AEDs are also increasingly common on commercial airlines, cruise ships, and other transportation facilities.



An AED in airport

In order to make them highly visible, public access AEDs often are brightly colored, and are mounted in protective cases near the entrance of a building. When these protective cases are opened or the defibrillator is removed, some will sound a buzzer to alert nearby staff to their removal, though this does not necessarily summon emergency services; trained AED operators should know to phone for an ambulance when sending for or using an AED. In September 2008, the International Liaison Committee on Resuscitation issued a 'universal AED sign' to be adopted throughout the world to indicate the presence of an AED, and this is shown at the top of this page.

A trend that is developing is the purchase of AEDs to be used in the home, particularly by those with known existing heart conditions. The number of devices in the community has grown as prices have fallen to affordable levels. There has been some concern among medical professionals that these home users do not necessarily have appropriate training, and many advocate the more widespread use of community responders, who can be appropriately trained and managed.

Typically, an AED kit will contain a face shield for providing a barrier between patient and first aider during rescue breathing; a pair of nitrile rubber gloves; a pair of trauma shears for cutting through a patient's clothing to expose the chest; a small towel for wiping away any moisture on the chest, and a razor for shaving those with very hairy chests.

Preparation for operation
Most manufacturers recommend checking the AED before every period of duty or on a regular basis for fixed units. Some units need to be switched on in order to perform a self check; other models have a self check system built in with a visible indicator.All manufacturers mark their pads with an expiry date, and it is important to ensure that the pads are in date. This is usually marked on the outside of the pads. Some models are designed to make this date visible through a 'window', although others will require the opening of the case to find the date stamp.

Mechanism of operation
The rhythms that the AED will treat are usually limited to:
1. Pulseless Ventricular tachycardia (shortened to VT or V-Tach)
2. Ventricular fibrillation (shortened to VF or V-Fib)

In each of these two types of shockable cardiac arrhythmia, the heart is active, but in a life-threatening, dysfunctional pattern. In ventricular tachycardia, the heart beats too fast to effectively pump blood. Ultimately, ventricular tachycardia leads to ventricular fibrillation. In ventricular fibrillation, the electrical activity of the heart becomes chaotic, preventing the ventricle from effectively pumping blood. The fibrillation in the heart decreases over time, and will eventually reach asystole.

AEDs, like all defibrillators, are not designed to shock asystole ('flat line' patterns) as this will not have a positive clinical outcome. The asystolic patient only has a chance of survival if, through a combination of CPR and cardiac stimulant drugs, one of the shockable rhythms can be established, which makes it imperative for CPR to be carried out prior to the arrival of a defibrillator.


An AED is external because the operator applies the electrode pads to the bare chest of the victim, as opposed to internal defibrillators, which have electrodes surgically implanted inside the body of a patient. Automatic refers to the unit's ability to autonomously analyse the patient's condition, and to assist this, the vast majority of units have spoken prompts, and some may also have visual displays to instruct the user. When turned on or opened, the AED will instruct the user to connect the electrodes (pads) to the patient. Once the pads are attached, everyone should avoid touching the patient so as to avoid false readings by the unit. The pads allow the AED to examine the electrical output from the heart and determine if the patient is in a shockable rhythm (either ventricular fibrillation or ventricular tachycardia). If the device determines that a shock is warranted, it will use the battery to charge its internal capacitor in preparation to deliver the shock. This system is not only safer (charging only when required), but also allows for a faster delivery of the electrical current.
When charged, the device instructs the user to ensure no one is touching the victim and then to press a button to deliver the shock; human intervention is usually required to deliver the shock to the patient in order to avoid the possibility of accidental injury to another person (which can result from a responder or bystander touching the patient at the time of the shock). Depending on the manufacturer and particular model, after the shock is delivered most devices will analyze the victim and either instruct that CPR be given, or administer another shock.

Many AED units have an 'event memory' which store the ECG of the patient along with details of the time the unit was activated and the number and strength of any shocks delivered. Some units also have voice recording abilities[citation needed] to monitor the actions taken by the personnel in order to ascertain if these had any impact on the survival outcome. All this recorded data can be either downloaded to a computer or printed out so that the providing organisation or responsible body is able to see the effectiveness of both CPR and defibrillation.

AEDs available to the public may be semi-automatic or fully automatic. Fully automatic units are likely to have few buttons, often activating as soon as the case is opened, and possibly just one button to shock, or in some cases this will be performed automatically. The user has no input in the operation of the unit apart from attaching the pads and following the prompts. Health care professionals and other trained responders may use a semi-automatic defibrillator, which is likely to have an ECG readout display, and the possibility to override the rhythm analysis software. This allows trained personnel to provide a higher level of care.

The first commercially available AEDs were all of a monophasic type, which gave a high-energy shock, up to 360 to 400 joules depending on the model. This caused increased cardiac injury and in some cases second and third-degree burns around the shock pad sites. Newer AEDs (manufactured after late 2003) have tended to utilise biphasic algorithms which give two sequential lower-energy shocks of 120 - 200 joules, with each shock moving in an opposite polarity between the pads. This lower-energy waveform has proven more effective in clinical tests, as well as offering a reduced rate of complications and reduced recovery time.

Simplicity of use

Unlike regular defibrillators, an automated external defibrillator requires minimal training to use. It automatically diagnoses the heart rhythm and determines if a shock is needed. Automatic models will administer the shock without the user's command. Semi-automatic models will tell the user that a shock is needed, but the user must tell the machine to do so, usually by pressing a button. In most circumstances, the user cannot override a "no shock" advisory by an AED. Some AEDs may be used on children - those under 55 lbs (25 kg) in weight or under age 8. If a particular model of AED is approved for pediatric use, all that is required is the use of more appropriate pads. Some organizations, such as the American Heart Association, recommend that if pediatric AED pads are not available, adult pads should be used to determine if the child is in a shockable rhythm. There is insufficient evidence to suggest that a child, in a shockable cardiac arrest, can be "hurt" by an adult defibrillation energy setting.

All AEDs approved for use in the United States use an electronic voice to prompt users through each step. Because the user of an AED may be hearing impaired, many AEDs now include visual prompts as well. Most units are designed for use by non-medical operators. Their ease of use has given rise to the notion of public access defibrillation (PAD), which experts agree has the potential to be the single greatest advance in the treatment of out-of-hospital cardiac arrest CPR.
since the invention of CPR.

Liability

Automated external defibrillators are now easy enough to use that most states in the United States include the "good faith" use of an AED by any person under the Good Samaritan laws. AEDs create little liability if used correctly; NREMT-B and many state EMT training and many CPR classes incorporate or offer AED education as a part of their program. In addition to Good Samaritan laws, Ontario, Canada also has the "Chase McEachern Act (Heart Defibrillator Civil Liability), 2007 (Bill 171 – Subsection N)", passed in June, 2007, "Good faith" protection under a Good Samaritan law means that a volunteer responder (not acting as a part of one's occupation) cannot be held civilly liable for the harm or death of a victim by providing improper or inadequate care, given that the harm or death was not intentional and the responder was acting within the limits of their training and in good faith. In the United States, Good Samaritan laws provide some protection for the use of AEDs by trained and untrained responders. which protects individuals from liability for damages that may occur from their use of an AED to save someone's life at the immediate scene of an emergency unless damages are caused by gross negligence.

First Aid Medications

Acetaminophen
  • Common Name : Tylenol
  • Use : Mild pain reliever, reduces fever. Good for headaches, muscle aches, and menstrual cramps. A good alternative to aspirin if person has an aspirin allergy. Acetaminophen will not upset the stomach. It does not, reduce inflammation.
  • Adult Dose : 325 to 500 mg every 3–4 hours, as needed. For short-term use the total daily dose should not exceed 4,000 mg.
  • Precautions : Do not drink alcoholic beverages if you are taking more than an occasional 1–2 doses. Individuals with liver disease should consult their physician before using this drug. Overdose can cause permanent liver damage and death. Treatment must be initiated within hours after overdose to be effective.
Aspirin
  • Common Name : Aspirin, Bufferin, Bayer, Anacin
  • Use : Mild pain relief. Fever reduction. Anti-inflammatory.
  • Adult Dose : 650 mg as needed with lots of water and food if possible
  • Precautions : May irritate stomach, cause vomiting, abdominal pain or bleeding. Do not use if you have a history of peptic ulcers or related disorders. Can cause allergic reaction: watch for skin rashes and asthma-like symptoms. Overdose will cause dizziness and confusion. If ringing in the ears is present, discontinue immediately. Aspirin is also an anticoagulant, so it can lead to bleeding.
  • Drug Interactions : Aspirin may interact with Diabinase or other diabetes drugs to cause a dangerous fall in blood sugar for diabetics.
  • Contraindications : People with aspirin allergies, bleeding stomach ulcers, anemia, high blood pressure, kidney disease, liver disease, gout, or hemophilia. Diabetics or people who have allergic sinusitis or asthma should contact physician prior to taking.
Tincture of Benzoin
  • Ingredients : Benzoin, alcohol 80%
  • Use : Use only as a topical solution on skin to provide a sticky surface for tape or moleskin to adhere to. Benzoin is not effected by wet or sweat. Not for internal use.
  • Directions for Use : Clean and dry the area. Apply a thin coating and let air dry until tacky, then apply tape or moleskin.
  • Precautions : Do not apply to open wounds. Do not take internally.
Diphenhydramine
  • Common Name: Benadryl
  • Use : Antihistamine, anti-allergy medication. Inactivates histamine produced by allergic reactions. Provides temporary relief of sneezing, watery and itchy eyes, and running nose due to allergies and hay fever. Also helps relieve upper respiratory allergies.
  • Adult Dose : 25 - 50 mg every 4-5 hours.
  • Precautions : May cause drowsiness. Avoid driving or hiking in dangerous terrain. Do not drink alcohol. Large doses may cause central nervous system depression or convulsions.
  • Contraindications : Antihistamines add to the effects of alcohol and other central nervous system depressants such as sedatives, tranquilizers and sleeping pills. Consult your physician before taking an antihistamine with these other drugs. Consult your physician before taking if you have asthma, glaucoma, liver disease, or difficulty in urinating due to enlargement of the prostate gland.
Epinephrine
  • Ingredient : Epinephrine 1:1000 solution (a synthetic form of adrenalin)
  • Use : This drug is used for emergency treatment of severe allergic reactions that cause respiratory distress. It is a fast-acting bronchodilator that also reduces swelling in the throat to allow breathing. It also serves to constrict the capillary bed to restore the circulating blood volume. After injection, bronchodilation may occur within 5-10 minutes, with maximum effects within 20 minutes.
  • Adult Dose : 0.5 ml. of epinephrine solution from the syringe in the kit, injected into the muscle of the shoulder (deltoid) or thigh. Dose may be repeated in 10–15 minutes as needed. See the kit itself for attached administration instructions.
  • Adverse Effects : Increased heart rate, heart flutters, increased blood pressure, trembling, dizziness, anxiety, weakness, paleness, nausea, vomiting, and headache. Excessive doses cause very high blood pressure, and cardiac irregularities.
  • Precautions : Use according to directions attached to the kit. Epinephrine is light sensitive and should be stored in the box provided. Store at room temperature. Periodically check contents of the syringe. The solution should be clear and colorless. If it appears brown or cloudy or contains a precipitate, do not use. The effects of epinephrine may be potentiated by tricyclic antidepressants or by some antihistamines.
  • Contraindications : Must not be given intravenously! It must be given into the muscle only. It should not be used on individuals in shock from blood loss. Epinephrine is a powerful cardiac stimulant. Use may be contraindicated in persons with high blood pressure, diabetes, thyroid disease, or heart disease.
Hydrocortisone Cream
  • Common Names : Cortaid, Lanacort
  • Use : Relieve redness, swelling, itching of skin. Use on skin rashes and irritations caused by eczema, insects, poison ivy/oak/sumac, soaps, detergents, cosmetics, genital and anal itching.
  • Dose : Apply cream to affected area not more than 3-4 times daily.
  • Precautions : External use only. Do not bandage or wrap the skin being treated unless directed to by a physician. Occlusive dressings increase the amount of medicine absorbed through the skin. Avoid contact in eyes. Do not use it for skin problems that are not listed on the package label without checking with a physician. Discontinue use after 7 days if itching is still present, and contact a physician. Do not use for external feminine itching if there is a vaginal discharge.
Ibuprofen
  • Common Names : Advil, Motrin
  • Use: Mild pain reliever, muscle relaxant, anti-inflammatory,. Good for menstrual cramps.
  • Adult Dose : 200 to 400 mg every 4–6 hours, as needed. Total daily non-prescription dose should not exceed 1,200 mg.
  • Precautions : Ibuprofen can irritate the stomach; take with food or milk. It should not be taken if there is a history of ulcers or severe indigestion. Ibuprofen can also produce gastrointestinal ulceration and bleeding. Ibuprofen also has a tendency to cause fluid retention, so care should be used in situations where fluid retention is a problem (ex. acute mountain sickness or high altitude pulmonary edema). Pregnant women should not take Ibuprofen without consultation with a physician.
  • Contraindications : Do not take if you are allergic to aspirin or salicylates.
Laxatives
  • Common Names : Ducolax
  • Use : Stimulant laxative for prolonged constipation, to encourage bowel movements
  • Dose : varies with specific preparation
  • Precautions : Do not take if there is abdominal pain, nausea, or vomiting. Discontinue if rash appears, or if there is rectal bleeding. Do not use if there is a history of kidney disease. Continued use can cause a dependence upon laxatives.
  • Contraindications : Do not use products with Bisacodyl if you are allergic to aspirin.
Triple Antibiotic Ointment
  • Common Name : Neosporin ointment
  • Active Ingredients : Polymyxin B sulfate, Bacitracin Zinc, Neomycin, in a white petrolatum base
  • Use : to prevent skin infection in minor cuts, scrapes, and burns..
  • Dose : apply a small amount (an amount equal to the surface area of a finger tip) on the area 1 to 3 times daily. To clear up the infection completely, use the medication for the full time of treatment (even if symptoms have disappeared).
  • Precautions : For external use only. Do not use in the eyes or apply over large areas of the body. There is a separate product specifically designed for use in the eye. Stop use and consult a physician if the condition persists or gets worse, or if a rash or other allergic reaction develops. Do not use this product if you are allergic to any of the active ingredients. Do not use longer than 1 week unless directed by a physician. In case of ingestion, seek professional medical care on contact the nearest poison control center.
Pepto-bismol
  • Use : Antacid, for upset stomach, heartburn, indigestion, nausea, and diarrhea. Neutralizes excess stomach acid and protects stomach lining. If you are having diarrhea, taking a dose before eating may help.
  • Dose : 2 tablets chewed or dissolved in mouth every 1/2 to 1 hour, as needed, to a maximum of 8 doses in 24 hours. Best to take an hour after meals, and every 2-3 hours thereafter.
  • Note : A darkened coating of the tongue or darkening of the stool may occur with use. Both conditions are harmless and temporary.
  • Precautions : May prevent the absorption of other drugs, so avoid taking when on other medications. Do not take more than 16 tablets in 24 hours. Do not use maximum dosage for more than 2 weeks. Consult physician prior to giving Pepto-bismol to teenagers during or after recovery from flu or chickenpox. If diarrhea is accompanied by high fever or continues more than 2 days, evacuate and contact physician.
  • Contraindication : Do not use this product if you are allergic to aspirin. Contact a physician prior to use if you are on anticoagulants (blood thinners), have diabetes, kidney disease, stomach ulcers, or gout.
Povidone-Iodine Solution and Ointment
  • Common Name : Betadine
  • Uses : Antiseptic (cleansing and sterilizing agent), topical antibiotic, water purification.
  • For cleaning and irrigation : Flush wound with povidone-iodine solution.
  • Mixing Solution : Mix about 1-1½ inches (2-4 centimeters) of povidone-iodine ointment with 1 liter of water (anywhere from 1:100 to 1:1000 concentration is acceptable). Allow to dissolve completely; wait 10-15 minutes. This solution can be safely stored in plastic bottles for extended periods, but may be slightly light sensitive.
  • For skin disinfection : Apply ointment directly to skin, or to sterile dressing to be placed over a wound.
  • Precautions : Individuals who are allergic to iodine. A chronic skin rash is the usual manifestation. Do not use directly in deep puncture wounds, on severe burns, and avoid contact with eyes.
Psuedoephedrine
  • Common Name : Sudafed
  • Use : Decongestant, for the common cold. Promotes sinus/nasal drainage. Relieves nasal congestion due to colds, hay fever, and upper respiratory allergies.
  • Doses : 60 mg tablets every 4-6 hours. Do not exceed 240 mg in 24 hours.
  • Adverse Effects : Acts as a mild stimulant and makes some individuals restless or jumpy, inhibiting restful sleep. Reducing dose of drug usually relieves these side effects. Taking the last dose of the day several hours before bedtime will help prevent trouble sleeping
  • Precautions : Do not exceed recommended dosage because at higher doses nervousness, dizziness or sleeplessness may occur. Do not take this product if you are presently taking a prescription anti-hypertensive or anti-depressant without consulting a physician first.
  • Contraindications: If you have high blood pressure, heart disease, diabetes, or thyroid disease consult your physician before taking this drug.
Sting Relief Swabs
  • Common Name : Sting-Eze
  • Use : Local immediate sting relief for non-allergic reactions
  • Directions : Remove swab from packet, squeeze mini-vial between fingers, and apply using sponge end directly to sting site, spreading with your finger.
  • Precautions : Do not use in eyes or nose. Not for prolonged use, or use over large areas of the body. If swelling or pain persists, discontinue use.
Zinc Oxide Ointment
  • Use : Skin protectant (total sun block). Apply liberally to desired area (especially face).
  • Precautions : Do not take internally. Avoid eye contact. Do not apply to open wounds.
[source : www.princeton.edu ]

First Aid For Animal, Human, or Insect Bites

 
Scorpion Bites
Scorpions are lobster-like arthropods in the arachnid class (the same class as spiders), with a curling stinger at the end of their tail, and are usually found in desert areas of the Southwest and Mexico. Scorpion stings are not likely to be fatal and are easy to treat, but are more dangerous to children and the elderly. Symptoms include immediate pain or burning, minor swelling, sensitivity to touch, and a numb or tingling sensation.
The steps below should be followed for treating scorpion bites:


  1. Wash the area with soap and water.
  2. Use a cold pack on the area for ten minutes, repeating as necessary at ten-minute intervals.
  3. Call the Poison Control Center for any severe symptoms.

Deadly Arizona Bark Scorpion, African King Scorpion and her sting

 
Tick Bites
People who live near wooded and grassy areas or who spend recreation time in these locations are most susceptible to tick bites. These tiny arachnids feed on the blood of mammals such as deer, rodents, and rabbits and are able to carry disease from animal to human. First aid for tick bites includes removing the tick immediately to avoid the bite reactions and reduce any possibility of developing one of the tick-borne infectious diseases such as Lyme disease, Colorado tick fever, and Rocky Mountain spotted fever.
To remove a tick:


  1. Use a pair of flat or curved forceps or tweezers and take hold of the head of the tick as close to the skin as possible, and gently remove it without squeezing the tick.
  2. Clean the area with soap and water and apply antihistamine or 1% hyrdrocortisone cream.
[Alert : Don’t put petroleum jelly, alcohol, or ammonia on ticks—they will make ticks bury deeper. If you live in a high-risk area and get a tick bite, always call your doctor for advice as you may need to get additional medical care including antibiotics]



Ticks, tick burrowing in skin and lyme disease bullseye rash

 

Spider Bites
Of the many spiders in the United States, only blackwidow spider and brown-recluse spider bites are dangerous or potentially life threatening to humans. Some species of tarantula can cause serious but not life-threatening local reactions. Identifying the type of spider that has caused the bite can often aid in the treatment and may even save the person’s life.

Symptoms of black-widow spider bites can appear one to twenty-four hours after the bite and include numbness at the bite site, dizziness, sweating, skin rash, intense muscle and chest pain and muscle spasms, severe abdominal cramps, nausea and vomiting, and difficulty breathing and tightness of the chest. You may also have pain at the bite site, white blisters that sometimes form painful ulcers (craters), rash, swelling and tenderness, weakness, stomach and joint pain, and fever.



Black Widow Spider and her bites



brown-recluse spider and her bites

The following steps should be taken for spider bites:

  1. When bitten by a suspected nonpoisonous spider, wash and treat the bite site as outlined for cuts and lacerations, cover the bite with a clean dressing, and consult a doctor if any signs of infection develop.
  2. For all black-widow or brown-recluse spider bites, call 911 or go immediately to an emergency department in order to receive treatment, and in the case of blackwidow bites to receive antivenom.
  3. Monitor the person’s ABCs and place them in a sitting position.

Snakebites 
Rattlesnakes, copperhead, cottonmouth (water moccasin), coral snake, and cobras are some of the many poisonous snakes. Symptoms of a snakebite include:
  • Fang marks in the skin
  • Bleeding
  • Blurred vision
  • Warmth and burning at the sight of the bite
  • Seizures
  • Diarrhea
  • Dizziness
  • Sweating
  • Fainting
  • Fever
  • Increased thirst
  • Loss of muscle coordination
  • Weakness
  • Nausea and vomiting
  • Numbness and tingling
  • Rapid heart rate
  • Severe pain at the site of the bite
  • Skin discoloration and swelling
A nonpoisonous snakebite will usually produce a horseshoe-shaped ring of tooth marks on the person’s skin, producing mild pain and possibly swelling. First-aid treatment of a nonpoisonous snake bite includes:
  1. Washing the bite with soap and water
  2. Covering the site with a sterile bandage or dressing
If you are unsure of the date of your last tetanus shot, consult with your doctor about a booster shot. Bites that begin to swell and change color are usually indicative of a poisonous snake. Take the following steps for a poisonous snakebite:
  1. Call 911 and the Poison Control Center immediately so that antivenom can be ready when the person arrives at the emergency department.
  2. Calm the person, limit movement, and keep the affected area below heart level to reduce circulation of venom.
  3. Remove jewelry or other constricting items and apply a loose splint to help restrict movement.
  4. Monitor temperature, pulse, rate of breathing, and blood pressure if you are able. Manage signs of shock
Do not bring the dead snake in unless it can be done safely, and know that snakes can bite for up to an hour after they are dead. Don’t allow the person who has been bitten to exert himself; carry him if you have to transport him. Don’t apply a tourniquet or any cold compresses to the bite. Never cut into a bite or try to suction the venom by mouth. Don’t allow any medications unless instructed by a doctor and don’t give the person any food or drink.

 
Insect Stings
Insect stings only produce a mild reaction in most people. Multiple stings, stings in the mouth and throat, and stings to persons with adverse allergic reactions to the venom, however, can produce anaphylactic shock and must be treated immediately. (click here for anaphylactic shock treatment)
First aid for stings includes:
  1. Wash the sting site with soap and water.
  2. Use a cold pack if needed to reduce swelling.
  3. Keep the site of the sting below the person’s heart if possible.
Additionally, using calamine lotion and Benadryl (diphenhydramine hydrochloride) can relieve itching and swelling. Also a paste of baking soda and water, or uncoated aspirin, will help reduce the stinging pain and reduce inflammation.

If the person has received a bee sting:
  1. Quickly and carefully scrape the stinger away with a knife, credit card, or fingernail without touching the sack that’s attached; this sack will still be pumping venom into the wound.
  2. Do not use tweezers or squeeze the sack, as this may inject even more venom into the person.
  3. Wash the site with soap and water and apply a cold pack, keeping the sting site below the level of the person’s heart if possible.

Yellow-Jacket Wasp Bee and his sting

You can use a credit card to scrape stinger out

Watch for signs of an allergic reaction that can develop up to twenty-four hours after a bee sting. If the site becomes infected, seek medical attention. In case of allergic reaction, anaphylactic shock, or sustained multiple stings, call 911 or go to an emergency department for treatment and observation. Multiple stings can produce life-threatening reactions in otherwise healthy people.

Bugs Bites
 
Head lice bites
They like to hide in the neck and behind the ears. If you have lice, you likely got it from sharing a hat, brush, or other item with a person who has lice. Lice are itchy, but scratching can lead to infection. In severe cases, hair may fall out. To kill lice and their eggs (called nits), use lotions, creams, or shampoos from the drug store or prescribed by your doctor. Wash clothing, bedding, and brushes to prevent the spread of lice. Check all household members, and treat everyone who has nits or lice.


head lice and the scratch infection

Flea bites 
Fleas are small, wingless, agile insects that live off the blood of their host – and they don't just bite pets. They dine on people, too. Some people are very sensitive to flea bites — but scratching can cause a wound or infection. The best solution is to get rid of fleas on pets and in your home. Keep pets out of your bed and be sure to vacuum rugs daily. Spray insecticides on infested areas. Consider using a once–a–month insecticide on your pet.


Flea and their bites

Fire Ants bites
Fire ants look much like ordinary ants — and are found in most of the Southeastern states. They produce large mounds in open areas and are aggressive when disturbed. During an attack, the fire ant latches onto the skin with its jaw, then stings from its abdomen. It may inject venom many times. The fire ant sting typically causes red hive–like lesions that burn and itch. Painful pus–filled lesions can also occur. Cold packs, pain relievers, and antihistamines can help relieve the discomfort. A large number of stings may trigger a toxic or severe life–threatening allergic reaction. Get emergency care.


Fire Ant and her bites


Bedbugs bites
Their name tells the tale, as these tiny insects tend to hide in bedding. They are often found in hotels, shelters, and apartment complexes — and can hitch a ride into your home aboard luggage, pets, and boxes. Bedbugs leave itchy, red bites on the skin, usually on the arms or shoulders. More of a nuisance than a health hazard, it is possible to develop an infection from scratching. If you have an allergic skin reaction, use creams with corticosteroids and take oral antihistamines and see your doctor.


Bedbug and her bites


Puss-Caterpillars sting

The most poisonous caterpillar in the U.S., puss caterpillars, can be found in Southern states where they feed on shade trees like elm, oak, and sycamore. The poison is hidden in hollow spines among the hairs. When a puss caterpillar stings, you may get waves of intense pain, rash, fever, vomiting, and muscle cramps. Remove the broken-off spines by using cellophane tape or a commercial facial peel and call your doctor.


Puss-caterpillar and her sting


Animal Bites

Cats and dogs cause most animal bites. Cat bites can cause very deep puncture wounds and present a serious risk of infection because punctures cause bacteria to be forced deep into the skin and tissues. Dog bites also carry a risk of infection and increased incidence of damage to affected tissues. These bites usually produce marks that have broken the skin and sometimes bleeding, depending upon the severity and location of the bites. Redness and swelling typically occur within twenty-four to forty-eight hours. For animal bites, check with a veterinarian for related health risks and have the wounds looked at by a physician. Your doctor may want to administer a tetanus shot and in some cases antibiotics. Keep the pet safe and secured in your custody until a doctor has evaluated the bite and the proper health authorities have ruled out any transmittable diseases. For severe bites or when the injured person loses consciousness, check for airway, breathing, and circulation and begin CPR, call 911, and manage for shock until help arrives. For minor bites, take the following steps:

  1. Wash your hands with soap and water and wash the bite under running water for at least five minutes.
  2. Clean the bite with soap and water, saline solution, or povidone-iodine.
  3. Stop bleeding with direct pressure and treat the bite as outlined for cuts and lacerations.
  4. For unbroken skin, apply a cold pack.
  5. Raise the wounded limb above the level of the person’s heart (if possible) to reduce any swelling.
  6. Check the bite site daily for signs of infection such as increased swelling, redness, or discharge.
Large and deep puncture wounds require medical attention. Always seek medical help for bites involving the neck, face, and hands due to the risk of serious infection and/or scarring.

Human Bites
Human bites can be more dangerous than animal bites because of the high levels of bacteria and viruses contained in the human mouth. Human bites also have a high risk of infection. Even in minor wounds, infections can lead to complications such as severe joint infections. In the case of human bites, avoid putting the wound in your mouth because this adds bacteria to the wound. Take the following steps for human bites:

  1. Use soap and water or saline to wash the wound thoroughly if the skin around the wound is not broken— never attempt to clean a wound from a human bite that is actively bleeding.
  2. Apply an antibiotic ointment to the wound, cover with a nonstick bandage, and continue to watch the area carefully.
  3. Seek medical attention if there is numbness or if the fingers cannot be straightened or bent.
  4. If the skin is broken and bleeding, apply direct pressure with a clean, dry cloth to stop any bleeding. Elevate the area, cover the wound with a clean or sterile dressing, and seek medical help.
  5. Get medical attention within twenty-four hours of being bitten in order to prevent complications from any deep wounds.
Seek medical attention for any signs of infections including warmth around the wound, swelling, pain, pus discharge, or signs of tendon or nerve damage such as inability to bend or straighten a finger and loss of sensation over the fingertip.

[ source : The Everything First Aid Book by Nadine Saubers, R.N. , www.webmd.com ]


Related Post:
TOMCAT Bites

First Aid For Allergic Reactions

An allergic reaction is an acquired, abnormal inflammatory reaction to a substance (allergen) that is usually mild to moderate in most people. Pollens, medications, certain foods, insect stings and bites, dust mites, pet dander, perfumes, and detergents may cause an allergic reaction. Allergies are common in all age groups and reactions to allergens range in severity from mild to severe to a life-threatening allergic reaction called anaphylaxis. Even though a person may previously have experienced no reactions or only very mild reactions to an allergen for many years, in some cases repeated exposures (sensitization) may eventually lead to a more severe reaction without warning. As you become more sensitized to an allergen, even a mild exposure may at some point trigger a potentially life-threatening reaction.

Allergies occur when your body’s defensive system, the immune system, comes into contact, by eating, touching, breathing, or injecting, with something it interprets as a foreign substance and a threat. Sometimes the immune system works to protect your body but other times it has difficulty distinguishing between the actual threats and substances that are not a threat. Those hyper-reactive systems tend to react with an inflammatory response to substances that aren’t actually harmful, such as certain foods. Allergic reactions can range from mild to severe reactions
requiring immediate medical attention. Sometimes symptoms are localized and immediate, but they can also be general (systemic) and delayed.


Allergens and modes of contact

Signs and Symptoms
Most allergic reactions are mild, and although they are normally not serious or life threatening, it’s a good idea to advise your doctor of the condition if it is new or unique to your medical history. The following are common symptoms of mild allergic reactions:
  • Itchy skin
  • Itchy, watery eyes
  • Itchy, runny nose with clear nasal discharge
  • Sneezing
  • Rashes and hives
  • Minor swelling
Mild Allergic Reactions
A localized itchy rash (contact dermatitis) can be prevented by avoiding contact with the allergen. Wash off any known allergens immediately with soap and water, keep the area clean and dry, and if needed treat with calamine lotion. For all allergy symptoms, check with your
family doctor to see whether prescription or OTC allergy medication is advised, such as antihistamines, decongestants, or a combination of both. Your doctor may tell you to treat rashes with antihistamine cream or 1% hydrocortisone cream. As always, determining what is causing
the allergic reaction and avoiding it is the best course of action.

Sinus irrigation is a method of rinsing out and irrigating the inside of your nose and the sinuses to remove any allergens. It also helps clear any areas of infection that may be forming in your nasal passages, making breathing easier, as well as moisturizing your sinuses. It’s necessary
to use a salt concentration similar to that of your body, or isotonic, to prevent nasal-tissue swelling and damage to the tissues. You can buy commercial products or you can make your own solution (½ teaspoon salt, ½ teaspoon baking soda, and 1 pint warm water) and store it in the
refrigerator for up to two weeks. Use the following method of sinus irrigation for relief of nasal congestion due to allergies:
  1. Use a soft rubber-tip bulb syringe to irrigate the nose.
  2. Stand over a sink or in the shower with head forward, mouth open, and chin out.
  3. Insert the tip of the bulb syringe filled with solution in the nose, stop breathing, and squeeze the solution into nose, being careful not to swallow. If you need to swallow, stop and bend your head forward and allow solution to run out of your nose.
  4. Repeat on the other side, then blow your nose very gently, closing off one side at a time and blowing with the mouth open.
If you are bothered with allergens in the air, irrigate your sinuses twice daily at first and then every day to every third day or after activities that involve being outside among allergens. You may also use a pulsating system according to the manufacturer’s instructions.

Severe Allergic Reactions
Severe allergic reactions are less common, and can be life threatening if not treated immediately. If a person is exhibiting any of the symptoms below, take them to a hospital emergency room, or call 911 for emergency transport immediately:
  • Flushed face, neck, chest, arms, hands, feet, or tongue
  • Swelling of the face, eyes, tongue, or lips
  • Rapid breathing
  • Signs of panic or anxiety
  • A feeling of tightness in the chest and throat
  • Abdominal cramping or pain
  • Nausea and/or vomiting
  • Dizziness or weakness
  • Pale and damp skin
  • Difficulty swallowing
  • Difficulty breathing and wheezing
  • Lips turning blue
  • Feeling faint or loss of consciousness (LOC)
Swelling of the airway during a severe allergic reaction can result in loss of oxygen to the brain and other vital organs. If someone is experiencing these symptoms, call 911 and follow emergency-response steps (CPR) as it is critical that they get immediate attention.

Anaphylactic Shock
Anaphylaxis is a sudden severe systemic (wholebody) allergic reaction that can potentially kill a person in less than fifteen minutes unless emergency measures are taken. Anaphylaxis is a constellation of symptoms including:
  • Difficulty breathing
  • Wheezing
  • Confusion
  • Abnormal breathing sounds
  • Weak or rapid pulse
  • Heart palpitations(missed beats)
  • Blueness of the skin(including the lipsand nail beds)
  • Slurred speech
  • Fainting
  • Lightheadedness
  • Dizziness
  • Hives Itching and skin redness
  • Anxiety
  • Nausea and vomiting
  • Diarrhea
  • Nasal congestion
  • Cough
[Doctors will prescribe an Epinephrine Auto-Injector for patients with severe allergies.If someone in your family has a prescription and is experiencing a severe allergic reaction in which the throat is constricting and breathing is becoming increasingly difficult, you need to usethe injector immediately as instructed by their doctor]

These symptoms develop rapidly in response to an allergen, often within seconds or minutes, and without proper intervention may result in anaphylactic shock including dangerously low blood pressure, respiratory arrest (the person stops breathing), and cardiac arrest
(when the heart stops beating). Try your best to remain calm. For all severe allergic
reactions, follow the steps outlined below:
  1. Call 911 immediately.
  2. Check for ABCs (airway, breathing, and circulation) and perform CPR.
  3. If the person has received a bee sting, quickly and carefully scrape the stinger away with a knife, credit card, or fingernail without touching the sack that’sattached . Wash the site with soap and water and apply a cold pack, keeping the sting site below the level of the person’s heart if possible.
  4. To prevent shock, if able to breathe easily, lay the person flat with head tilted up (do not use a pillow, as this will restrict breathing) and raise the feet eight to twelve inches. Use a blanket to keep the person warm. If the person is having difficulty breathing, place them in a sitting position and keep them calm until EMS arrive.
  5. Do not give the person any food or drink if they are having difficulty breathing, swallowing, or if they are wheezing.
[ source : The Everything First Aid Book by Nadine Saubers, R.N. ]

First Aids For Common In-Home Incident

Cuts and Abrasion Wound
Cuts and abrasions of all kinds can happen every day, from scraped knees on a patio to deep cuts on fingers and hands in the kitchen and workshop. Cuts are skin wounds that involve separation of the skin and are usually caused by a sharp object like a knife or a piece of glass.

Take the following steps to care for simple cuts and abrasions:
  1. Wash your hands with soap and water and then wash the wound under running water. For wounds that are bleeding, apply direct pressure with a sterile cloth or bandage and elevate the wound.
  2. Apply antibiotic cream, but avoid using iodine or hydrogen-peroxide solutions, as they can cause further damage to injured tissues and may cause allergic reactions in people reactive to iodine and shellfish.
  3. Dress the wound with a sterile gauze, preferably nonstick, bandage to protect the wound from infection and water loss until a scab forms.
  4. Keep the area around the wound clean and change any dirty dressings promptly.
Change most dressings daily and replace dressings when any fluids soak through, to decrease any chance that the wound will dry and stick to the dressing. Cleaning open wounds can sometimes cause bleeding, which can be easily stopped with direct pressure using a sterile
gauze pad.

In the case of lacerations that are deep enough to see fatty tissue:
  1. Pull the edges of the wound together and use butterfly closures to secure them.
  2. Apply antiseptic or antibiotic ointment over butterfly closures, cover with a bandage, and seek medical attention.
See a doctor :
  1. For cuts that don’t stop bleeding after ten minutes or applying pressure
  2. If there is a chance that nerves or tendons have been affected
  3. If there is something embedded in the cut
  4. If the cut is caused by an animal or human bite or was punctured by anything dirty that may cause infection
  5. If the cut is on the mouth, face, hand, or genitals
If stitches are needed, keep the wound closed with butterfly closures until you can get professional care. If the wound is very dirty or is likely to be so, such as with human or animal bites, you only have about six hours before the wound is too contaminated to stitch. Other
wounds may go as long as eight hours after the injury before being stitched, but the longer you wait, the less likely that stitches will be possible and any scarring can be minimized. For any signs of complications such as numbness or decreased movement; tenderness, inflammation,
swelling, or red streaks around the wound; or fever seek immediate medical attention.

Puncture Wounds
A puncture wound is a small but deep hole caused by such things as fangs, pins, sticks, staples, nails, or any object capable of penetrating the skin deeply. Puncture wounds don’t usually bleed a lot, but can cause internal injury, and it’s difficult to estimate how deep the wound may be. First aid for puncture wounds are :
  1. Wash your hands with soap and water and wear gloves.
  2. Clean the wound under a stream of running water, using soap followed by povidone-iodine.
  3. Bandage loosely and monitor the wound daily for signs of infection suh as increased swelling, redness, or discharge.
Never seal the puncture wound and do not use antibiotic ointments because sealing the wound may actually increase the chance of infection. Don’t attempt to clean a major puncture wound as this may cause more serious bleeding. Never try to remove an imbedded object from a puncture wound. Depending on where the wound is located, this can cause further damage, bleeding, and
even immediate death. Never probe or remove debris from a wound, attempt to push body parts back in, or breathe on a wound or dressing because doing so may cause serious infection later. Call 911 immediately for any serious puncture wound. If the wound is bleeding heavily, apply direct pressure until help arrives.

Localized infections taking the following steps:
  1. Wash the area daily with soap and water.
  2. Apply antibiotic ointment or cream and cover the infected area lightly with a dry gauze, nonstick bandage.
  3. Watch for signs of a more serious infection such as increased redness, pain, swelling, or pus.
Handle Accidental Tooth Loss
A knocked-out or partially dislodged tooth can usually be reinserted in the socket within thirty minutes of an injury. Adults should hold the tooth in place with clean gauze, trying not to touch the root of the tooth. You may handle the tooth with a sterile gauze or pad and rinse it with water if it has become very dirty, but it is best not to clean a dislodged tooth. If you are not able to hold the tooth in place for any reason or you cannot reach a dentist or emergency room within thirty minutes, the tooth may be placed in a container with fresh whole milk or the person’s own saliva for transport. For an empty bleeding socket, place a fold of sterile gauze or pad over the socket and bite down on it. Maintain this pressure for twenty minutesor until bleeding stops.

Handle Broken Teeth
Rinse the mouth with water and cover the broken tooth with a sterile gauze pad. Hold a cold pack against the face to reduce pain and swelling. Keep the broken portion and call your dentist, as the dentist may be able to reattach it. Do not eat or drink anything before receiving dental care.

First Aid for Toothache
If your tooth starts to become sensitive to cold or heat and progresses in level of pain, it’s an indication that there may be gum disease or a problem related to the nerve inside the tooth. Sensitive teeth can be treated daily using a toothpaste that is designed for sensitive teeth, but if you really have a toothache you need to see a dentist.
  • In the early stages of a toothache, astringent mouthwashes are antiseptic and help to shrink swollen tissue.
  • Use a cold pack on the face and take aspirin, ibuprofen, or acetaminophen for pain and swelling.
  • (Remember, never give aspirin to children younger than sixteen due to the risk of a life-threatening condition called Reye’s syndrome.)
  • Rub ice on your hands. According to a Canadian study, rubbing an ice cube on your hands kills tooth pain because the cold, rubbing sensation travels the same pathway to the brain as tooth pain, and overrides the signals from your mouth about half of the time. Try wrapping a cube and rubbing it where the bones of your thumb and index finger meet.
  • See a dentist if the pain persists. An abscessed tooth with swelling and inflammation that is progressing from your tooth to other parts of your face is life threatening and needs immediate medical or dental care.
Diabetic Emergencies
When a person has diabetes, her body doesn’t produce and properly use insulin, the hormone required by the body to convert sugar, starches, and other food into energy. Prolonged blood-sugar extremes in diabetics can cause loss of consciousness known as a diabetic coma. Symptoms of high blood sugar or low blood sugar often appear gradually and some or all of the following symptoms can signal the onset of a diabetic coma:
  • Fruity-smelling breath
  • Frequent urination
  • Fast heart rate
  • Deep and rapid breathing
  • Extreme thirst
  • Dry mouth
  • Warm, dry, red skin
  • Drowsiness
  • Nausea with upper abdominal pain
  • Vomiting
  • Loss of consciousness
  • Agitation, behavior changes, irritability
In the case of hypoglycemia or hyperglycemia, take the following steps:
  1. If you know the person is diabetic, or if you find a Medic Alert bracelet stating the person is diabetic, ask if she has taken her required insulin. If she has not or you are unsure, call 911 for help.
  2. In the case of low blood sugar, or hypoglycemia, give her some form of sugar such as fruit juice. Don’t give hard candy to someone who is very ill or in an altered state because of the risk of choking.
Many people are aware of how to treat their diabetes and how to test their blood-glucose levels. If tested blood remains below 60 mg/dL or if the person continues to have symptoms of severe hypoglycemia, hyperglycemia, or insulin reaction, call 911 and get to an emergency department.

First Aid for Earache
In the case of a high fever or discharge from the ear canal, get immediate medical attention, as antibiotics are necessary if the cause of the earache is an infection. Take the following steps:
  • Children should always be seen by a doctor.
  • Take the entire course of any prescribed antibiotics.
  • Use OTC painkillers such as ibuprofen, acetaminophen, and aspirin (adults only), eardrops, and hot packs to help alleviate pain.
  • To help prevent ear infections, wash hands often.
  • Use a bulb syringe to suction mucus gently out of the nose of infants and toddlers and keep baby’s head tilted up during feeding.
  • Elevate the head of a child’s bed a few inches (place item under the mattress, not on top where it could lead to suffication) to help drain the fluid that collects behind the eardrums and use a humidifier in your child’s room at night.
  • Never place cotton-tipped swabs, matches, hairpins, or anything else in the ear. This can push wax further into the ear canal or perforate the eardrum, resulting in severe
    ear damage.
Treating an Ear Injury
Ear injuries are typically accompanied by pain, dizziness, hearing loss, and bleeding from inside the ear canal. Take the following steps to treat an ear injury:
  1. Cover the outside of the ear loosely with a bandage or dressing to soak up blood and drainage, but do not attempt to plug the ear or try to stop any flow.
  2. Place the person on the injured side with the injured ear facing down to drain the blood, and call 911 or go to an emergency department immediately.
First Aid for Food Poisoning
Use the following guidelines for treating food poisoning:
  • Anyone who is experiencing short episodes of vomiting and small amounts of diarrhea that last less than twentyfour hours can be cared for at home by abstaining from solid food during the nausea and vomiting phase and drinking plenty of fluids, ideally clear liquids.
  • Try to avoid alcoholic, caffeinated, or sugary drinks, and use over-the-counter rehydration products that are made specifically for children, such as Pedialyte and Rehydralyte, and sports drinks like Gatorade and Powerade diluted with water (full-strength energy drinks contain too much sugar and may worsen diarrhea) for adults.
  • After nausea and vomiting have stopped and you have been able to tolerate fluids, resume eating regular food slowly beginning with plain foods such as rice, wheat cereals and breads, potatoes, bland cereals, lean meats, and baked chicken that are easy on the stomach. Unless you have lactose intolerance you can safely drink milk also.
Most of the time, you do not need an OTC medicine to stop diarrhea, but they are usually safe if used as directed and only by adults. If you have any concerns or symptoms of dehydration or nausea, vomiting, and diarrhea that last longer than twenty-four hours, bloody diarrhea and/or
high fever, seek medical attention.

[ source : The Everything First Aid Book by Nadine Saubers, R.N. ]

Cardio-Pulmonary Resuscitation (CPR)



History
The origins of cardiopulmonary resuscitation (CPR) can be traced back to 1740, when the Paris Academy of Sciences first formally recommended mouth-to-mouth resuscitation for near-drowning victims. Over a hundred years later in 1891, the first documented and effective chest compression in humans was performed by Dr. Friedrich Maass. Through the years the use of external chest compressions in human resuscitation was attempted and analyzed, and it was proven that expired air by a rescuer is sufficient to oxygenate an unresponsive person. CPR was then officially developed and instituted in 1960, and a program by the American Heart Association (AHA) provided CPR training and encouraged the use of CPR by the general public. The American Red Cross and other agencies came on board to institute performance standards, standardized training, and certification for CPR for intervention of sudden cardiac arrest and acute life-threatening cardiopulmonary problems.

The ABCs of First Aid
There are three critical steps in emergency first aid. A person needs all three common denominators to live, and basic life support or CPR, together with early defibrillation, is proven to improve long-term survival after a cardiac arrest. The ABCs of first aid is a mnemonic that stands for airway, breathing, and circulation:
  • Airway : Is the airway unobstructed? Use measures to clear the airway.
  • Breathing : Is the person breathing? Start rescue breathing.
  • Circulation : Is the person’s heart beating? Start chestcompressions.
The steps for performing CPR are:
  1. Open the airway using the head-tilt, chin-lift method—one hand on the forehead, fingers of the other hand under the bony part of the lower jaw, near the chin. Tilt the head back, gently lift the jaw, making sure not to close the mouth or push on soft parts beneath the chin. Avoid lifting the neck in the case of spinal injury.
  2. Check for normal breathing by putting your ear to the person’s mouth and turning your head to look for chest movement, while listening for air flowing through the mouth or nose and trying to detect breath on your cheek. A person with periodic gasping is most likely in cardiac arrest and needs CPR.
  3. If there are no signs of breathing, pinch the nose; make a seal over the mouth with yours and give the person a breath strong enough for you to see the chest rise. When the chest falls, repeat the rescue breath once more for a total of two breaths. If available, use a CPR mask as a barrier between your mouth and the person’s mouth that you are rescuing. These first three steps are called “rescue breathing.”
  4. Begin chest compressions by placing the heel of your hand in the middle of the chest, over the lower half of the breastbone at the nipple line. Place your other hand on top and lace your fingers together (heel of one hand on chest, heel of the other hand on top of that hand) and compress the chest about one to two inches. Allow the chest to recoil completely, and then perform thirty compressions, at a rate of 100 compressions per minute.
  5. After thirty chest compressions, immediately repeat the two rescue breaths. Open the airway with headtilt, chin-lift again. This time, go directly to rescue breaths without checking for breathing again. Give one breath, making sure the chest rises and falls, then give another.
  6. Perform the cycle of thirty compressions followed by two breaths for about two minutes. Then stop and recheck for breathing. If the person is not breathing, continue chest compressions and rescue breaths.
Steps of CPR

The AHA now recommends that a series of thirty compressions followed by two breaths (compressionventilation ratio of 30:2) be given to all persons, regardless of age. Continue the cycle of compressions and rescue breathing until professional help arrives or until the person
recovers and begins breathing. In children age one to eight, use one or two hands as necessary to compress the chest one-third to one-half the depth of the chest. For the unresponsive infant or child, perform five cycles of thirty compressions and two breaths for about two minutes
before leaving the child to call 911 and get an AED if one is available.

CPR for Newborns and Infants
Newborn CPR has different recommendations than those for infants. But the recommendations for newborn CPR only apply to newborns in the first hours after birth until the newborn leaves the hospital, so the general public needs only to be concerned with infant CPR guidelines
that apply to babies less than approximately one year of age. The rescue-breathing rate for infants with pulses is about forty to sixty breaths per minute, with chest compression to one-third the depth of the chest. Deliver ninety compressions and thirty ventilations per minute. Compress the infant chest just below the nipple line (on lower half of sternum) using two fingers (rather than a whole hand) to compress the chest with a compression-ventilation ratio
of 30:2.

Problems Associated with CPR
Some of the problems the AHA has identified regarding performing CPR are excessive ventilation given during CPR and compressions that are interrupted too frequently and that are often too slow and too shallow. It’s believed that bystanders may be reluctant to perform CPR because it seems too complicated and difficult to remember. That’s why in recent updates the AHA has made attempts to simplify the steps by making the compression-ventilation ratio used the same for infants, children, and adults. The same update has been issued for chest compressions in children and adults. While it’s been surmised that the public is afraid of contracting diseases and is therefore reluctant to perform mouth-to-mouth resuscitation, the data illustrates that transmission of infection is very low; nonetheless, use of a barrier device (CPR mask) while giving ventilations is still encouraged. If you are still reluctant to give mouthto-mouth ventilations, at least call for help and start chest compressions immediately.

Recovery Position
The recovery position is a technique used in first aid for all unconscious people who are breathing. This includes anyone over the age of one year old who has started breathing after being given CPR, those who may be unconscious or nearly unconscious but are still breathing, those who are too inebriated to assure their continued breathing, persons of near drowning, and in cases of suspected poisoning. An unconscious person who is lying face up is in a position that may result in obstruction to the airway. When a person is laying face up, the tongue may relax to
the back of the throat and fluids such as blood or vomit can pool in the back of the throat and obstruct the airway. Also, in the face-up position, the esophagus is tilting down slightly from the stomach toward the throat, and when combined with loss of muscular control that occurs
when someone is unconscious, this can lead to what is called passive regurgitation—when the stomach contents flow up into the throat. Aside from airway obstruction, any fluid collecting in the back of the throat can flow down into the lungs and the acid from the stomach that is in that fluid can damage the lungs, a condition known as aspiration pneumonia. In many instances, the actual injury or illness that caused unconsciousness will not be fatal, but the resulting passive regurgitation or aspiration pneumonia will be.

A very common cause of death is excessive consumption of alcohol that leads to unconsciousness followed by all or some of these events. While in the recovery position, the force of gravity keeps the tongue from obstructing the airway and prevents fluids from flowing the wrong way.
This, coupled with raising the chest above the ground, protects the person while aiding breathing.

As in all first-aid situations, assess the area for safety before approaching the unconscious person. Next, assess the person for the ABCs. If there is no need to perform CPR or if you already have performed CPR and the person begins breathing, then put the person into the recovery position. If there is no suspicion of spinal or neck injury, you want to place the person into what is called the lateral recovery position:
  1. With the person lying on his back with legs straightout, kneel on one side, facing him. Position the person’sarm that is closest to you perpendicular to hisbody, with his elbow flexed. Then position the otherarm across the body, resting the hand across thetorso.
  2. Bend the leg that is farthest from you up; the kneeelevated, reach behind the knee and pull the thightoward you.
  3. Use your other arm to pull the shoulder farthest from you while rolling the body toward you. Maintain theupper leg in a flexed position so that the body isstabilized.
Lateral recovery position

Because people who stay in this position for an extended period of time may experience nerve compression, you may move the person from side to side every thirty minutes if emergency rescue is taking a long time to arrive. In case of spinal injury, any other movement of the unstabilized neck will carry a risk of causing permanent paralysis or other injuries, so movement should be minimized. The only reason to move a person with a suspected spinal injury into a recovery position is if you must drain vomit from the airway. And then you should use what is
called HAINES modified recovery position (High Arm IN Endangered Spine). In this modified position, raise one of the injured person’s arms above the head (in full abduction) while turning the person’s body in order to support the head and neck for less neck movement.

In a suspected spinal or neck injury, your first priority is keeping the airway open, so if the person is breathing, leave them in the position you found them. But if breathing stops, regardless of potential for increased injury to the person, you must continue ABCs: airway, breathing, and circulation. Breathing is the first priority; everything else is second.An unconscious pregnant woman should always be positioned in the recovery position on her left side, and anyone with wounds to the torso should be placed with the wounds closest to the ground to decrease any
chance of blood pooling in the lungs. Place a baby less than a year old in a modified recovery
position by holding the infant in your arms, head tilted downward, in order to prevent the tongue from obstructing the airway or the infant from inhaling vomit. In all cases, continue to monitor the person’s level of response, pulse, and breathing until help arrives.

Signs of Heart Attack
Sometimes heart attacks are sudden and there is no doubt what is happening, but those are the minority. Most heart attacks begin slowly with very mild discomfort and pain. The biggest mistake is when people aren’t sure and they wait too long to seek help. If you or anyone you know has the following symptoms, seek help immediately:
  1. Chest discomfort such as uncomfortable pressure, squeezing, fullness, or pain in the center of the chest lasting more than a few minutes, or that comes and goes
  2. Discomfort in other areas of the upper body including pain or discomfort in one or both arms, the back, neck, jaw, or stomach
  3. Shortness of breath
  4. A cold sweat, nausea, or lightheadedness
Women are more likely to have some of the other common symptoms, in particular back or jaw pain, shortness of breath, nausea, and vomiting. Even if you are not sure, it’s wise to call 911. If you are not able to access Emergency Medical Services (EMS), have someone else drive you to the hospital immediately. Never drive yourself unless there is no other option.

Are the symptoms of a heart attack the same for both men and women?
Women have the same symptoms as men but, are more prone to also have back or jaw pain, shortness of breath, nausea, and vomiting. You need to seek immediate medical help for any symptoms, not just the “classic” symptoms of a heart attack.

What Is Happening In Heart Attack?
The heart functions both mechanically and electrically. It pumps blood by contracting, which you are able to feel as a pulse—the mechanical function. The heart also has cells that regulate the mechanical system by transmitting electrical signals through conduction pathways, stimulating the muscle tissue to contract—the electrical function. The rate of electrical stimulation or pulses
normally correlates with the rate of heart-muscle contractions or beats, and should be between sixty and eighty times per minute at rest, increasing with exertion. The pumping chambers of the heart are the ventricles. If they suddenly stop effectively contracting and pumping blood into the body, Sudden Cardiac Arrest (SCA) occurs. The heart then has a disorganized and abnormal rhythm and spasmodic twitching called “ventricular fibrillation” (VF) that is ineffective in pumping blood to the body. The person in VF or V fib usually has no pulse because the heart is not pumping blood, and they will then become unresponsive, stop breathing, and die within minutes without intervention.

Choking
Choking occurs when an object gets stuck in the throat and partly or completely blocks the airway. Signs of choking include:
  • Pointing to throat, hands crossed on throat (universalsign of choking)
  • Gasping or coughing
  • Signs of panic
  • Difficulty speaking
  • Red face that steadily turns blue
  • Loss of consciousness
When you suspect someone is choking, ask her, “Are you choking?” If the person is able to answer you, don’t do anything because it’s likely that she will free the food or object on her own. In the case of actual choking, the person will not be able to talk and you need to help them.
Call 911 if the person can’t talk, make noise, or breathe well or is unconscious, then perform the Heimlich maneuver as outlined below. If the person is unconscious, lay her on her back. Check the person’s mouth for any visible obstruction and try to dislodge it using a finger sweep.
If you are unable to do so, begin mouth-to-mouth resuscitation and CPR. Continue to check inside the person’s mouth for any signs of the foreign body as the chest compressions of CPR may dislodge it.

Heimlich Maneuver
The Heimlich maneuver (pronounced Hi-mlick) is a technique whereby you administer abdominal thrusts to yourself or to a person who is choking. The Heimlich maneuver is recommended for use in clearing a blocked airway in conscious adults and children over the age of one; it is not meant to be used for choking infants under age one. The act of abdominal thrust lifts the diaphragm and forces air from the lungs, similar to a coughing action, so that the foreign body in an airway may be moved and expelled. (Click here for Heimlich Maneuver steps)

Managing Shock
Preventing and managing shock is a matter of life and death in emergencies. When the circulatory system stops working to deliver blood to the body, shock occurs. If the heart beats irregularly, if blood vessels become too dilated, or if a person is losing too much blood, shock may occur. The symptoms of shock are a weak and rapid pulse; disorientation; dizziness or confusion; cold, clammy skin and hands and pale skin; extreme thirst; nausea and vomiting; high level of anxiety; and fingernails that do not blanch with applied pressure (turn white when pressed and color does not return within two seconds).

If someone is in shock, elevate her legs, keep her warm,
and turn her head to one side if neck injury is not suspected

In emergency situations you must guard the person against shock. Call 911 for help immediately, because you cannot manage shock alone for long, and the person is likely to go into cardiac arrest. Check the ABCs continually while waiting for help and begin CPR if needed. If the head, neck, back, hips, or legs are not injured, lay the person on the ground facing up and elevate the legs to keep critical blood flow to vital organs. Use a towel, a sanitary napkin, or a piece of clothing to apply pressure to open wounds to slow bleeding. Keep the person calm, comfortable,
and warm, but never give the person water, even if they claim to be very thirsty. Monitor the person for consciousness and ABCs continually until help arrives.

[ source : The Everything First Aid Book by Nadine Saubers, R.N. ]