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First-Aid Techniques Everyone Should Know
A Step-by-Step Illustrated Guide
While learning first aid might seem a daunting task, there is really only a handful of simple techniques that everyone should be familiar with. These techniques form the basis of almost all first-aid treatments and will prove invaluable if you're someday faced with an emergency situation. Although a book is a good place to start, it's always best to get instruction from a qualified health-care provider before trying any of these techniques. In addition, always remember the most important rule of medicine: First, do no harm.
It is strongly recommended that you contact your local chapter of the American Heart Association (AHA) to find out more about training and certification in CPR in your area. The following CPR information is meant as a guide only.
CARDIOPULMONARY RESUSCITATION (CPR)
CPR is performed when someone's breathing or pulse (or both) stops. When both stop, sudden death has occurred. Sudden death has many possible causes — poisoning, drowning, choking, suffocation, electrocution, smoke inhalation — but the most common is heart attack.
Everyone should know the signs of heart attack and the actions for survival. Everyone should also have a plan for emergency action.
The warning signs of a heart attack are:
* Uncomfortable pressure, fullness, squeezing, or pain in the center of the chest that lasts more than a few minutes.
* Pain in the shoulders, neck, arms, back, jaw, or stomach.
* Shortness of breath with or without chest discomfort.
* Lightheadedness, fainting, sweating, nausea, or vomiting.
Not all these signs occur in every heart attack. Additional symptoms are listed on here. If some start to occur, don't wait. Get help fast.
If you feel you might be having a heart attack, recognize the warning signs. Stop whatever you're doing and sit or lie down. Stay calm and relaxed. If the symptoms last more than a few minutes, call the local emergency number (usually it is 911 in the United States and Canada). If that's not possible, ask for help getting to the nearest hospital emergency room with emergency cardiac care. Do not attempt to drive yourself to the hospital.
Never practice CPR on a healthy person — it can be harmful!
The Basics of CPR
CPR is a procedure that's as simple as assessing the situation, determining if the victim is breathing or has a pulse, giving chest compressions, opening the airway, and giving rescue breaths if necessary. (A helpful acronym to remember this is C-A-B: compressions, airway, breathing.) If you see a person collapse or come upon someone who is already lying unconscious, take immediate action.
Since incorrect chest compressions can cause internal injuries, CPR should be performed only by someone who has taken a professional course. CPR requires training, practice, and skill. This information is presented for the purpose of review for one who is trained. Keep in mind that anyone who performs CPR should pull on a pair of gloves if they're available. Using a CPR mask or face shield is also strongly recommended, to help prevent the spread of any possible contagions.
ASSESSMENT AND ACTIVATION
First verify that the scene is safe for you to perform CPR. Pinch the victim's shoulder and shout, "Are you OK?" If the victim does not respond, shout for help. Call your emergency medical service (911 or local number).
If an automatic emergency defibrillator (AED) and emergency equipment are available, either get it yourself if you are alone or send someone else to retrieve it, then begin CPR. Most AEDs will have an automated prompt to instruct you on the correct procedure and on continuing to give chest compressions while the device charges.
ASSESSING FOR BREATHING AND PULSE
To begin CPR as quickly as possible, check breathing at the same time you check the pulse. This should take at most 10 seconds.
Breathing. To check for breathing, scan the victim's chest for a maximum of 10 seconds, looking for the chest to rise and fall. If the victim is breathing, stay with them until additional help arrives. If the victim is not breathing or is only gasping, begin chest compressions.
SEEK IMMEDIATE MEDICAL ATTENTION IF:
* The victim is not breathing.
* Breathing is noisy.
* Froth appears around the lips or nose.
* A bluish color appears around the lips and ears.
Pulse. Check the person's carotid artery pulse to see if the heart is still beating. Do so by first locating the person's Adam's apple (voice box) using two or three fingers. Slide these two or three fingers down the groove beside the Adam's apple and feel for the pulse (see illustration below).
Feel for a pulse, ideally in the victim's neck, for at least 5 seconds. If you cannot find a pulse within 10 seconds, begin administering chest compressions. If the victim is breathing normally and has a pulse, continue to monitor the victim. If the victim has a pulse but is not breathing adequately, provide rescue breathing.
The foundation of CPR is chest compressions. External chest compressions provide artificial circulation. When you apply rhythmic pressure on the lower half of the victim's breastbone, you force the heart to pump blood.
First position yourself at the victim's side. If the victim is lying facedown, carefully roll him or her as a unit, moving the whole body at once, while keeping the neck stable. If it's possible that the victim may have a neck or spinal injury, extreme caution is needed, and the victim should only be moved by someone with appropriate training.
Place the heel of one hand in the center of the victim's chest, at the bottom half of his or her sternum or in between the nipples. Place your other hand on top of your bottom hand. Keep your arms and elbows straight and lean forward to use your upper body weight to begin chest compressions.
Press straight down at least 2 inches (5 cm) and not more than 2.4 inches (6 cm) with each compression. Give chest compressions at a rate of 100 to 120 compressions per minute (the beat of the classic disco song "Stayin' Alive").
At the end of each compression, completely relax the pressure on the sternum. Don't remove your hands from the victim's sternum, but do let the chest rise to its normal position between compressions. Relaxation and compression should take equal amounts of time.
Maintain chest compressions with minimal interruptions. If rescue breathing is necessary (helpful mostly for drowning victims), the best rate is 30 chest compressions followed by 2 breaths, and repeat.
IF YOU DON'T HAVE CPR TRAINING
Even if you have no CPR training and do not have access to a defibrillator, there is a simple way you can give immediate CPR to help save a life. If you see an adult or teenager suddenly collapse, first call 911, then place the heel of one hand in the center of the chest and another hand on top of the first, interlocking the fingers. Push down straight, hard, and fast, to a depth of about 2 inches and to the rate of 100 to 120 compressions per minute (to the beat of the classic disco song "Stayin' Alive"). Continue giving chest compressions until help arrives.
The victim's airway must be open for breathing to be effective. To open the airway, perform a head tilt — chin lift or a jaw thrust (see warning, opposite). To do a head tilt — chin lift, gently lift the chin with one hand while pushing down on the forehead with your other hand. You want to tilt the head back.
If opening the airway doesn't cause the person to spontaneously start breathing, you'll have to provide rescue breathing.
IF YOU SUSPECT A NECK INJURY
If you suspect that the victim may have a neck injury (such as might occur in a diving or automobile accident, for example), you must open the airway differently, using a jaw thrust without tilting the head. To perform a jaw thrust, place one hand on each side of the victim's head, with your fingers under the victim's lower jaw (see illustration below). Lift up with both hands, moving the jaw forward. If the lips close, open them by pushing the lower lip.
Some first-aid kits may have an artificial airway that can be used to open the airway with minimal movement.
Mouth-to-mouth breathing is a quick, effective technique to provide oxygen. First hold the victim's airway open or reapply the jaw thrust. Apply a CPR mask or face shield if one is available. If there is blood, vomit, or other fluid around the victim's mouth, wipe clean with water. Using the thumb and index finger of your hand that's on the victim's forehead, pinch the nose closed.
Create an airtight seal with your lips around the victim's mouth, or use the CPR mask or face shield. Deliver a breath of normal volume over 1 second. Watch to be sure the chest rises as you deliver the breath. If the victim's chest does not rise with the breath, then air is not reaching the lungs, and you must reapply the head tilt — chin lift or the jaw thrust.
Repeat another rescue breath. If air is not getting into the victim's lungs despite repeated attempts, return to chest compressions.
CPR for Infants and Children
Cardiopulmonary resuscitation for infants (birth to 1 year) and children (1 to 8 years) is similar to that for adults, but there are a few important differences. Infants and children in cardiac arrest need to be given both chest compressions and breaths so that their heart and brain receive adequate oxygenated blood. Other important differences are given below.
For infants, check for a pulse by feeling on the inside of the upper arm midway between the elbow and the shoulder. Feel for a pulse for at least 5 seconds. If you do not definitely feel a pulse within 10 seconds, begin CPR, starting with chest compressions.
For children, check for a pulse in the femoral artery by pressing two fingers to the inner thigh, midway up the edge of the groin. Feel for a pulse for at least 5 seconds. If you do not definitely feel a pulse within 10 seconds, begin CPR, starting with chest compressions.
For infants, the use of only two fingers is appropriate for chest compressions, and extra care is required not to injure the infant. With the infant on a firm and flat surface, place two fingers at the center of the chest, just below the nipple line, and give quick compressions for a depth of only 11/2 inches (4 cm). Give compressions at the rate of 2 per second, or about 100 to 120 per minute.
For children, chest compressions are similar as for an adult: two hands, with the heel of one hand on the chest and the other hand atop the bottom hand. For a very small child, one-handed compressions are appropriate for the smaller chest compression depth. Compress the chest about 2 inches with each compression. Give compressions at a rate of 100 to 120 per minute.
Be careful when handling an infant. Don't tilt the head back too far. An infant's neck bends so easily that if the head is tilted back too far, the breathing passages may be blocked instead of opened.
For infants, keep the head tilted to maintain an open airway. Place your mouth over the infant's mouth and nose and create an airtight seal. Blow gently into the infant's nose and mouth, giving just enough air to make the chest rise. Deliver each breath over 1 second and pause to inhale between breaths. Keep in mind that an infant's lungs are much smaller. Excessive volume and pressure can cause severe lung damage. If you can't cover the infant's nose and mouth with your mouth, use the mouth-to-mouth technique instead.
For children, pinch the nose, cover the mouth, and breathe the same as for an adult.
Perform rescue breathing after every 30 compressions. Open the airway with either a head tilt — chin lift or jaw thrust and give 2 breaths, each over 1 second. Make sure the chest rises with each breath. Call emergency services as soon as possible and retrieve an AED if one is available. Continue CPR at a ratio of 30 compressions to 2 rescue breaths until the AED is activated or first responders take over.
Periodic practice in CPR is essential to keep your skills at the level they need to be. Someone's life may depend on how well you remember — and apply — the steps in CPR. Have your CPR skills and knowledge tested at least once a year. It could enable you to save a life.
WAITING FOR HELP
If an individual doesn't regain consciousness, keep CPR going for as long as you are safely able to, whether it's a child or an adult. In a group, take turns, switching every 2 minutes.
ABDOMINAL THRUSTS (HEIMLICH MANEUVER)
Abdominal thrusts are used to aid an individual who is choking. In effect, the under-the-diaphragm series of thrusts forces enough air from the lungs to artificially create a cough, which is intended to move or expel a foreign object that is obstructing the victim's breathing. After performing abdominal thrusts, have the victim examined by a medical professional.
The technique should be performed only when the victim's airway is completely obstructed by a foreign object. Abdominal thrusts are not recommended if he or she can cough or speak. So before beginning, encourage the person who is choking to cough, as this may be enough to dislodge any blockage.
If the victim is having trouble coughing or breathing, however, ask if he is choking:
* If he can cough or speak, let him try to expel the blockage on his own.
* If he can't cough but is breathing, his airway is only partially obstructed. Arrange for immediate transport to an emergency medical facility to remove the blockage.
* If he cannot speak or cough, his airway is obstructed. Get someone to call for medical help while you perform lifesaving abdominal thrusts.
The universal sign for chocking is clutching the throat.
An Illustrated Guide to Abdominal Thrusts
IF THE VICTIM IS CONSCIOUS:
1. Ask, "Are you choking?" If the victim can speak, cough, or breathe, do not interfere.
2. If the victim cannot speak, cough, or breathe, give abdominal thrusts until the foreign object is expelled or the victim becomes unconscious.
Note: If the victim is extremely obese or in the late stages of pregnancy, give chest thrusts.
3. Be persistent. Continue uninterrupted until the obstruction is relieved or advanced life support is available. In either case, the victim should be examined by a physician as soon as possible.
IF THE VICTIM BECOMES UNCONSCIOUS:
1. Activate the emergency medical system (911 or local number).
2. Perform a tongue-jaw lift followed by a finger sweep to try to remove the foreign object.
3. Open the airway and try to give 2 slow rescue breaths. If unsuccessful, reposition the head and try again.
4. If unsuccessful, give up to 5 abdominal thrusts.
5. Repeat steps 5 through 7 until effective. If the victim resumes effective breathing, place the person in the recovery position.
6. After the obstruction is removed, begin the C-A-B of CPR if necessary.
7. Be persistent. Continue uninterrupted until the obstruction is relieved or advanced life support is available. When successful, have the victim examined by a physician as soon as possible.
Abdominal Thrusts for Infants and Children
When there are signs of choking in an infant (birth to 1 year) or child (1 to 8 years):
* If the infant or child is breathing and continues to be able to speak or cough, do not interfere, but take to an advanced life support facility.
* If the infant or child has a fever or history of illness, the air passages may be swollen. Take him or her to an emergency care facility.
* If the infant or child has ineffective coughing and high- pitched inspirations and is unable to speak or cry, immediately begin to clear the airway.
IF AN INFANT IS CONSCIOUS:
1. Support the infant's head and neck with one hand firmly holding the jaw. Place the infant facedown on your forearm, keeping the head lower than the trunk.
2. With the heel of your free hand, deliver up to 5 back blows forcefully between the infant's shoulder blades.
3. Supporting the head, sandwich the infant between your hands and arms and turn the infant on his or her back, keeping the head lower than the trunk. Using two fingers, deliver up to 5 thrusts over the lower half of the breastbone (sternum).
Excerpted from "The Natural First Aid Handbook"
Copyright © 2017 Brigitte Mars.
Excerpted by permission of Storey Publishing.
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