Aruna Asaf Ali Govt Hospital
Government of NCT of Delhi

Wounds and Bleeding

      Emergency care in case of bleeding

• Expose the wound by removing clothes to see where the blood is coming from.
• Place a cloth on the wound and apply pressure on the wound.
• If bleeding persists, use elevation to help reduce blood flow. It must be combined with direct pressure over the wound.
• If the bleeding does not stop, apply pressure on a nearby artery.
• Check the patient for shock-weakness, rapid pulse, low BP and confusion.

Bites and Stings

      Animal bites rarely cause lethal bleeding but they can produce significant damage.

• If a wound is not bleeding heavily, wash it with soap and water for 5-10 minutes. Don't scrub.
• Allow the wound to bleed.
• Rinse the wound with running water and antiseptic solution.
• Control the bleeding.
• Cover the wound with a sterile gauze / cloth.
• Seek medical attention.

Insect Sting

     Stinging insects include honey bees, yellow jacket wasps and fire ants.

• Check the wound for a stinger embedded in slum
• Remove the sting by scraping.
• Wash area with soap and water.
• Apply an ice pack for 15-20 minutes over the sting site.
• Seek medical attention.

Snake Bite

• Get the victim away from the snake.
• Keep the victim quiet. Lay the victim on the ground.
• Gently wash the bitten area with soap and water.
• Tie a tight cloth around the wound so that the poison does not mix with other blood.
• Seek medical attention immediately.
• Don't give anything to eat and drink.

Foreign Bodies

Small foreign bodies (wood splinters) usually cause minor puncture wounds with little or no bleeding. Foreign bodies deeply embedded in a wound should not be removed by a 'First Aider'. You can cause further injury.

Foreign Bodies in the Eye          

Sand particles, dust, small pieces of glass, coal and metal usually enter the eye as foreign bodies.

First Aid

The first aider should try to take out only those foreign bodies which are only on the surface area of the eyes.

• If the foreign body gets stuck on the middle portion of cornea, do not try to take it out, because it can lead to great harm.
• The eye then should be closed, padded and the person should be sent to the hospital.
• If the foreign body is stuck on the inner portion of the lower eyelid and is not seen on the round portion of the eye and if the feeling of irritation continues, slide the lower eyelid under the upper one and then open the eye. The foreign body sometimes comes out when the hair of the lower eyelid rubs against the under part of the upper eyelid.

Remember the following points

• Do not rub the eyes vigorously
• Wash hands before touching the eye
• Examine the eye carefully with soft hands
• Don't try to take out the foreign body with a toothpick or knife
• Don't try to take out the embedded foreign body under any condition. In such cases, the patient should be sent to the doctor

Foreign bodies in the Ear

Solid substances like peas, buttons can enter the ear. Some substances like peas and other seeds absorb moisture, swell up and obstruct the ear and it then becomes difficult to remove. Flies, mosquitoes or bed bugs can also enter the ear.

First Aid

• Never use a pin or piece of wire to take out foreign bodies from the ear because by using them the ear drum may rupture.
• Mosquitoes, bed bugs or flies die by putting olive oil or soda bicarb in lukewarm water into the ear. When the sound from these insects stops, send the person to the hospital.

Foreign bodies in the Nose

Certain foreign bodies like pieces of betel nut, grams or peas and other seeds can enter the nose

• By putting olive oil or any other oil in the nose either the foreign body comes out or the irritation in the nose subsides.
• Don't sneeze forcefully in an effort to take out the foreign body. Don't close the unaffected nostril and try to sneeze out through the affected nostril because by doing so there is a danger of cessation of respiration.

Burns                          

Burns are wounds caused by excessive exposure of the body to heat, such as a flame, hot liquids, chemicals, electricity or radiation.

Causes of Burns

• Dry Heat : Direct contact with a flame or hot object.
• Scalds : Moist heat such as boiling water, steam, etc.
• Friction : Contact with a moving wheel, rope. Wire or asphalt.
• Chemical : Acids and alkalis.
• Electrical : Direct passage of current through the body and lightning injuries.
• Radiation : Over exposure to the sun and radiant heat sources.

Management of the burns

• Stop the burning process.
• Immediately cool the burn wound.
• Burn blisters should be left untouched as they protect the wound from contamination.
• All articles like rings, bangles, belt and boots which may become constricting agents after edema develops, should be removed.
• Following cooling procedures, the burns should be covered with a clean sheet over which a blanket can be placed to maintain body heat to avoid hypothermia.
• Oils, ointments, lotions and other preparations should not be applied and adherent clothing not removed.
• The burn area must be covered with a moist, sterile or clean material to exclude air. Cling film is an excellent first-aid dressing. Face burns may be covered with a clean handkerchief.
• Non-burn areas are covered with warm dry covers.
• While awaiting transportation, the patient should be rested.
• Give warm fluids to drink if the casualty can take it, and restrict the movement and handling.

In case of extensive burns if the person goes into shock then first aid for shock be given and person rushed to a nearby hospital as fast as possible.

Poisoning

Poison

Poison is a substance which if taken into the body in sufficient quantity may cause temporary or permanent damage. Poison may be swallowed, inhaled or absorbed through the skin, splashes into the eye or injected.

Household Poisons

Almost every household contains potentially poisonous substances, such as bleach, dishwasher detergent, paint and weed killer. These can result in chemical burns. Children in particular are at high risk from poison.

Treatment

• Check and if necessary clear the casualty's air passages.
• If the casualty becomes unconscious, check breathing and pulse and be prepared to resuscitate if necessary.
• Place the casualty in a recovery position.
• If needed give mouth to mouth resuscitation and if there are chemicals on the casualty's mouth, use a plastic face shield to protect yourself.

 Alcohol Poisoning

Alcohol is a drug that depresses the activity of the central nervous system. Prolonged intake can badly impair all physical and mental abilities.

Treatment

• Check the causality's level of consciousness.
• Gently shake the shoulders and speak to them loudly and clearly to see if they respond.
• If the causality is unconscious, open the air passages, check breathing and pulse and be prepared to resuscitate if necessary.

Food Poisoning

This may be caused by eating food that is contaminated by bacteria or by toxins.

Treatment

• Help the casualty to lie down and rest.
• Seek medical attention immediately
• Give the casualty plenty to drink and a bowl to use if they should need to vomit.

Fever

A sustained body temperature above the normal level of 37 degree Celsius (98.6 degree Fahrenheit) is usually caused by bacterial or viral infection and may be associated with influenza, measles, sore throat or a local infection such as an abscess.

• Make the casualty comfortable in cool surroundings, preferably in bed with a light cover. Allow to rest.
• Give the casualty cool bland drinks to replace lost fluid.
• An adult may take two paracetamol tablets. Give children the recommended dose of paracetamol syrup (not Aspirin).

If condition does not improve seek medical attention immediately.

Headache

A headache may accompany any illness, particularly a feverish ailment such as 'flu' but it may be the most prominent symptom of a serious condition such as meningitis or stroke.

Headaches may develop for no apparent reason, but can often be traced to tiredness, nervous tension, stress or emotional distress.

Treatment

• Help the casualty to sit or lie down comfortably in a quiet place. If possible, remedy any likely cause of the headache, such as loud noises, bright lights or lack of fresh air.
• An adult may take two paracetamol tablets or their own painkillers. Give a child the recommended dose of paracetamol syrup (not aspirin).

If the pain does not ease within two hours, seek medical attention immediately.

Abdominal Pain

Pain in the abdomen often has a relatively trivial cause, but can indicate serious problems, such as perforations or an obstruction of the intestine.

Abdominal pain may be accompanied by vomiting also.

Treatment

• Make the person comfortable.
• Give the casualty a hot water bottle to place against the abdomen.
• Do not give the casualty any medicines or anything to eat or drink.

If the pain is severe, or does note ease within 30 minutes seek medical attention immediately.

Vomiting and Diarrhoea

The causes of vomiting and diarrhea are most likely to be food poisoning, contaminated water, allergies or unusual or exotic foods.

Treatment

• Reassure the casualty while he or she is being sick. Afterwards, give the casualty a warm damp cloth with which to wash him or herself.
• Give the casualty lots of bland fluids to slip slowly and if the appetite returns, give them bland, starchy or sugary food for the first 24 hours.

Ear Ache

An infection of the middle ear is the most common cause of ear aches, particularly in children. It often accompanies a cold, tonsillitis or flu. This allows pus and other matter to be discharged from the outer ear which may bring temporary relief from pain.

Treatment

• If there is discharge, fever or marked hearing loss, call a doctor immediately.
• An adult may take two paracetamol tablets or their own painkiller. Give children the recommended dose of paraetamol syrup (not aspirin).
• Give the casualty a source of heat (such as a hot water bottle wrapped in a towel) to hold against the affected ear.
• Let them sit up if lying flat makes the pain worse.
• Advise the casualty to see their doctor.

If not treated seek medical attention immediately.