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EMERGENCY STATE. ADDICTION Introduction: Addiction has been defined as physical and physiological dependence on psychoactive substances (for example alcohol,

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Presentation on theme: "EMERGENCY STATE. ADDICTION Introduction: Addiction has been defined as physical and physiological dependence on psychoactive substances (for example alcohol,"— Presentation transcript:


2 ADDICTION Introduction: Addiction has been defined as physical and physiological dependence on psychoactive substances (for example alcohol, tobacco, heroine and other drugs) which cross the blood brain barrier once ingested, temporarily altering the chemical milieu of the brain.

3 FIRST AID 1. Check the victim's airway, breathing, and circulation. If necessary, begin CPR(2 breath and 30 heart compression) at once. If the victim is unconscious but breathing, carefully place him or her in the recovery position. If the victim is conscious, loosen the clothing, keep the person warm, and provide reassurance. Try to keep the victim calm. If an overdose is suspected, try to prevent the victim from taking more drugs. Call for immediate medical assistance. 2. Treat the victim for signs of shock, if necessary. Signs include: weakness, bluish lips and fingernails, clammy skin, paleness, and decreasing alertness. 3. If the victim is having convulsions, give convulsion first aid. 4. Keep monitoring the victim's vital signs (pulse, rate of breathing, blood pressure) until emergency medical help arrives.

4 Medical emergency: Teens on amphetamines who experience delusions and hallucination need anti-psychotic drug chlorpromazine and IV fluids if blood pressure is lowered. Cocaine can increase Blood pressure, which can cause a heart attack even in healthy young atheletes. Beta blockers are given to lower it. Opioid users (of codeine, morphine, pentacozine) requires ventilator and naloxene via IV.

5 ALCOHOL Alcohol causes several changes in a person's level of consciousness. Slurred speech, unstable gait, and confusion are the most common. Anyone who's seen an intoxicated person knows how intoxication can make a person act and sound. Those reactions are similar to signs of various brain injury and illness. Stroke, closed head injury, and hypoglycemia are common brain-related conditions that result in speech and gait disturbances, which may be confused with alcohol consumption.

6 Blood Alcohol Poisoning The level of alcohol in the blood stream is so high that the affect on the central nervous system. Unlike most foods or beverages that take time to digest, alcohol is absorbed directly into the bloodstream through the tissue lining of the stomach and the small intestine. The amount of alcohol it takes to affect a person's central nervous system depends on many factors, including size and weight, gender etc. How To Tell If Someone has Alcohol Poisoning : If the person is breathing less than twelve times per minute or stops breathing for periods of ten seconds or more. If the person is asleep and you are unable to wake them up Look at the person's skin. If it is cold, clammy, pale, bluish in colour

7 Other Important Factors: Stay with a person who is vomiting! Try to keep the person sitting up. If they must lie down, keep them on their side with their head turned to the side (the recovery position). Watch for choking; if the person begins to choke, get help immediately. If a person drinks alcohol in combination with any other drug, the combined effect could be fatal

8 ANAPHYLACTIC SHOCK A widespread and very serious allergic reaction. Symptoms include dizziness, loss of consciousness, labored breathing, swelling of the tongue and breathing tubes, blueness of the skin, low blood pressure, heart failure, and death. Immediate emergency treatment is required for this type of shock, including administration of antivenom in the case of bee or wasp stings.

9 Anaphylaxis First Aid: Recognize Anaphylaxis

10 FIRST AID: 1. First try to find out if the child has any known allergies or is carrying medication. This is usually an adrenaline injection which counteracts the reaction. 2. If they have, ideally this should be injected into the outside of the thigh or top of the bum. 3. Once you've given the injection, or if they haven't got any medication you must call for an emergency. 4. Lie them in the recovery position. If the child stops breathing or you can't find any medication, call for emergency and then start CPR(2 breaths and 30 chest compression).

11 MEDICAL EMERGENCY: Have a Anti –Histamine tablet(Allegra, Cetzine) and get an Epinephrine shot.

12 ASTHMA Introduction: Asthma is a common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm Symptoms include wheezing, coughing, chest tightness, and shortness of breath.

13 FIRST AID: 1) Make the person sit upright in a comfortable position. Speak calmly and be reassuring. 2) Use the persons own inhaler if possible. If not, use the first aid kit inhaler or borrow from someone else. Give 4 puffs of a reliever inhaler (puffer) – Ventolin, Airomir, Bricanyl, or Asmol.

14 3) Relievers are best given through a spacer, if available. Use 1 puff at a time and ask the person to take 4 breaths from the spacer after each puff. Wait for 4 minutes. If there is no improvement, give 4 more puffs. If you still find little or no improvement, call the ambulance immediately. Keep giving 4 puffs every 4 minutes until the ambulance arrives. For children, 4 puffs each time is a safe dose. For adults, 6-8 puffs every 5 minutes may be given for a severe attack while waiting for the ambulance.

15 MEDICAL EMERGENCY: A nebuliser of reliever medication is given to ease your breathing difficulties. If there is no improvement, cortisone may be given intravenously. It takes approximately 3 hours for cortisone to workfully. Blood oxygen levels may be monitored and if the attack is particularly severe than an arterial blood test is taken to see how much oxygen there is in the blood and how much carbon dioxide is building up. According to these figures the medical team may or may not put the asthmatic straight in intensive care and assist with ventilation

16 INTERNAL BLEEDING Internal bleeding is bleeding occurring inside the body. It can be a serious medical emergency depending on where it occurs (e.g. brain, stomach, lungs), and can potentially cause death and cardiac arrest if proper medical treatment is not received quickly.

17 FIRST AID 1. Treat for shock. Keep the casualty warm. Place him in a comfortable position, preferably lying down with the legs slightly raised. Reassure him. Treat any external bleeding or bleeding from orifices. 2. Call for an ambulance as soon as possible and explain what has happened. Monitor and record the person's pulse and breathing rates. This information will be useful for the medical staff in determining the extent of the injury. If the casualty becomes unconscious, place in the recovery position and monitor airway and breathing. Be prepared to resuscitate if necessary.

18 BURNS A burn is a type of injury to flesh caused by heat, electricity, chemicals, light, radiation or friction. Most burns only affect the skin (edidermal tissue and dermis). Rarely, deeper tissues, such as muscles, bone, and blood vessels can also be injured. Burns may be treated with first aid, in an out-of-hospital setting, or may require more specialized treatment such as those available at specialized burn centers.

19 Categories of burn: First, second and third degree Categorization depends on severity of tissue damage Check extent of burn before deciding self treatment Seek help if burn is over a couple of inches in diameter, or If it involves large sections of the hands, feet, face, groin or buttocks, or a major joint

20 First-degree burns: Injuries are superficial / mild Swelling& redness of the injured area Pain develops No blisters seen Burned area becomes white on touch Takes 3-6 days to heal Treatment: Remove patient from heat source Remove the burnt clothing Run cool water over burnt area Gently clean the injured area Gently dry Apply anti biotic such as Silver Sulphadiazine Use a sterile bandage to cover burns Take tetanus vaccination, if required

21 Second-degree burns: Burns extends to middle skin layer, dermis Swelling, redness and pain observed Burnt area may turn white on touch Blisters develop, that ooze a clear fluid Scars may develop Restricts movement, if injury occurs at joint Dehydration may occur Healing time varies, depends on extent of injury Treatment: Clean the affected area thoroughly Gently dry Apply antibiotic cream over affected area Make the patient lie down Keep burnt body part at a raised level Skin graft may be required Physical therapy may be essential to aid mobility Splints may be used to rest affected joints Hospitalization is essential

22 Third-degree burns: Damage occurs to all 3 skin layers Destroys adjacent hair follicles, sweat glands, nerve endings Lack of pain due to destroyed nerves Injured area does not turn white on touch No blisters observed Swelling occurs Skin develops leathery texture Discoloration of skin observed Scars develop Crusty surfaces (Eschars) develop-impairs circulation Dehydration occurs resulting in shock Symptoms may worsen with time Disfigurement may result Healing depends on extent of injury 90% body surface injury results in death 60% injury in elderly, fatal

23 Treatment: Requires immediate hospital care Dehydration treated through intravenous fluid supply Oxygen is administered Eschars are surgically opened Periodically run clean cool water over burns Nutritious diet helps to heal quickly Regular monitoring essential Mental Depression treated by anti-depressants

24 DIABETES Diabetes mellitus, often simply referred to as diabetesis a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced. This high blood sugar produces the classical symptoms of polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger).

25 Hyperglycaemia (BS too high): Recognition: Recent history of eating excessively. Casualty is thirsty but not hungry, may vomit and may urinate excessively. Breathing is rapid. Breath smells fruity/sweet Pulse rapid and weak. Skin warm and dry. Casualty does not usually have a seizure. Casualty appears drowsy. Symptoms usually develop gradually. Aim: Arrange urgent medical treatment for the casualty. Treatment: Dial for an ambulance immediately. Monitor the casualty's breathing, pulse and level of responsiveness. Be prepared to resuscitate if the casualty stops breathing.

26 Hypoglycaemia (BS too low): Recognition: History of under eating, missed or irregular meals. Casualty is thirsty but not hungry, doesn't (usually) vomit and urinates normally. Casualty is disoriented and acts unusually. Breath smells normal. Pulse rapid and strong. Skin pale, cold and clammy. Casualty may have a seizure. Casualty rapidly loses consciousness. Aims: To raise the casualty's BS. To get medical help if necessary.

27 Treatment: Help the casualty to sit or lie comfortably. Give him/her a sugary drink, sugar lumps or anything else sweet. Alternatively, some diabetics carry a glucose gel for use in a 'hypo' - help them to use this. If the casualty responds quickly give more food and advise the casualty to rest until they feel better. Advice him/her to see their own doctor even if they feel fully recovered. If they do not respond look for alternative causes. Monitor the casualty's airway, breathing and responsiveness. If the casualty is unconscious place them in the recovery position and dial for an ambulance. Be prepared to resuscitate if the casualty stops breathing.

28 SEVERED FINGERS & TOES This is a serious injury, and if bleeding is not stanched, can be fatal. But with proper and quick response, the severed digit might even be reattached. Here is what to do. FIRST AID The first thing to do is to call for emergency. Then get clean cotton cloths - towels, washcloths, gauze pads, even tee shirts - and water. You want to stop the bleeding, prevent infection if possible, save the digit if possible, and avoid shock.

29 Get the patient to lie down, then position him or her with his head lower than his heart, and elevate the bleeding hand or foot. Gently run water over the wound, then apply a clean cloth with gently pressure. If the cloth becomes drenched and there is still bleeding, do not remove the cloth, but apply another on top of it. If you cannot stop the bleeding, apply a tourniquet at the wrist. Though this has dangers, it can save a life.

30 FALLS ON HEAD Head injuries fall into two categories: External (usually scalp) injuries Internal head injuries, which may involve the skull, the blood vessels within the skull, or the brain. EXTERNAL (SCALP) INJURIES Call the doctor if your child is an infant; has lost consciousness, even momentarily; or if a child of any age has any of these symptoms: won't stop crying complains of head and neck pain vomits repeatedly difficult to awaken becomes difficult to console isn't walking normally

31 If your child is not an infant, has not lost consciousness, and is alert and behaving normally after the fall or blow: Apply an ice pack or instant cold pack to the injured area for 20 minutes every 3 to 4 hours. Observe your child carefully for the next 24 hours. If you notice any of the signs of internal injury call your doctor immediately. If the incident has occurred close to bedtime or naptime check for disturbances in color or breathing. If color and breathing are normal, and you observe or sense no other abnormalities, let your child sleep. There's no need to keep a child awake after a head injury.

32 Suspected Internal Injury Call for an emergency if your child shows any of these symptoms after a head injury: unconsciousness for more than a few minutes abnormal breathing obvious serious wound bleeding or clear fluid from the nose, ear, or mouth disturbance of speech or vision pupils of unequal size weakness or paralysis neck pain or stiffness. seizure

33 MEDICAL EMERGENCY The doctor will assess the injury, perhaps with an X-ray or CT scan.

34 FRACTURE What is fracture? A broken or cracked bone Occurs when pressure is applied to bone Occurs with / without displacement of bone fragments FIRST AID 1.Try to maintain the patient still and composed. Prevent unnecessary movement arising out of anxiety or fear. 2.Examine the person closely for the presence of other injuries and call for medical help. If medical help is quickly available, handover the patient to them for further treatment.

35 3.If there is a break in the skin surface, it can be rinsed to remove any visible dirt or other potential contamination. However, vigorous flushing or scrubbing of the wound should be avoided. 4.The broken bones can be immobilised with either a splint or string. Rolls of newspaper or strips of wood can be used. It is important to immobilize the area both above and below the injured bone. 5.Ice packs can be applied to reduce pain and swelling (Not to be placed directly over the wound. NOTE: DO NOT move the person if a head, neck, or back injury is suspected as this can worsen the injury, leading to life threatening complications.

36 HEAT EXHAUSTION Heat exhaustion is a warning that the body is getting too hot. With a heat stroke, body organs start to overheat. They will stop working if they get hot enough. If it is not treated, a heat stroke can result in death

37 Sun burn Symptoms: Skin redness and pain, possible swelling,blisters, fever, headaches First Aid: Take a shower using soap to remove oils that may block pores, preventing the body from cooling naturally. Apply dry, sterile dressings to any blisters, and get medical attention. Heat Cramps Symptoms Painful spasms, usually in legs and abdominal muscles; heavy sweating First aid Get the victim to a cooler location. Lightly stretch and gently massage affected muscles to relieve spasms. Give sips of up to a half glass of cool water every 15 minutes.(Do not give liquids with caffeine or alcohol) Discontinue liquids, if victim is nauseated.

38 Heat Exhaustion Symptoms Heavy sweating but skin may be cool,pale or flushed. Weak pulse. Normal body temperature is possible, but temperature will likely rise. Fainting or dizziness, nausea, vomiting, exhaustion and headache are possible. First Aid Get victim to lie down in a cool place. Lossen or remove clothing Apply cool or wet clothes. Fan or move victim to air-conditioned place. Give sips of water if victim is conscious. Be sure water is consumed slowly. Give half glass of cool water every 15 minutes. Discontinue water if victim is nauseated. Seek immediate medical attention if vomiting occurs.

39 Heat stroke(a severe medical emergency) Symptoms High blood temperature (105+);hot, red, dry skin, rapid weak pulse and rapid shallow breathing. Victim will probably not sweat unless victim was sweating from recent strenuous activity. Possible unconsciousness. First Aid Call emergency service, or get the victim to a hospital immediately. Delay can be fatal. Move victim to a cooler environment. Removing clothing. Try a cool bath, sponging, or wet sheet to reduce body temperature. Watch for breathing problems. Use extreme caution. Use fans and air conditioners.

40 HEART ATTACK A heart attack occurs when blood flow to a section of heart muscle becomes blocked. If the flow of blood isn t restored quickly, the section of heart muscle becomes damaged from lack of oxygen and begins to die. FIRST AID Immediately place the palm of your hand flat on the patient's chest just over the lower part of the sternum (breast bone) and press your hand in a pumping motion once or twice by using the other hand. This may make the heart beat again. If these actions do not restore a pulse or if the subject doesn't begin to breathe again:

41 call for help, stating that the casualty is having a cardiac arrest but stay with the patient. find out if any one else present knows CPR. provide artificial respiration immediately. begin CPR immediately. MEDICAL EMERGENCY Electrocardiogram (EKG) be done within 10 minutes of the patient's arrival in the hospital. Medications are used to try to restore blood supply to the heart muscle. If it wasn't taken prior to arrival in the ER, aspirin will be used for its anti-platelet action. Nitroglycerin will be used to dilate blood vessels. Heparin or enoxaparin (Lovenox) will be used to thin the blood. Morphine can also be used for pain control. Antiplatelet medications such asclopidogrel (Plavix) or prasugrel (Effient) are also recommended.

42 POISONING Poisoning is caused by swallowing, injecting, breathing in, or otherwise being exposed to a harmful substance. Most poisonings occur by accident. First Aid Seek immediate medical help. For poisoning by swallowing: Check and monitor the person's airway, breathing, and pulse. If necessary, begin rescue breathing and CPR. Try to make sure that the person has indeed been poisoned. It may be hard to tell. Some signs include chemical-smelling breath, burns around the mouth, difficulty breathing, vomiting, or unusual odors on the person. If possible, identify the poison.

43 If the person vomits, clear the person's airway. Wrap a cloth around your fingers before cleaning out the mouth and throat. If the person has been sick from a plant part, save the vomit. It may help experts identify what medicine can be used to help reverse the poisoning. Keep the person comfortable. The person should be rolled onto the left side, and remain there while getting or waiting for medical help. If the poison has spilled on the person's clothes, remove the clothing and flush the skin with water. For inhalation poisoning: Call for emergency help. Never attempt to rescue a person without notifying others first. If it is safe to do so, rescue the person from the danger of the gas, fumes, or smoke. Open windows and doors to remove the fumes.

44 Take several deep breaths of fresh air, and then hold your breath as you go in. Hold a wet cloth over your nose and mouth. Do not light a match or use a lighter because some gases can catch fire. After rescuing the person from danger, check and monitor the person's airway, breathing, and pulse. If necessary, begin rescue breathing and CPR. If necessary, perform first aid for eye injuries (eye emergencies) or convulsions ( convulsion first aid). If the person vomits, clear the person's airway. Wrap a cloth around your fingers before cleaning out the mouth and throat. Even if the person seems perfectly fine, get medical help.

45 Stroke is also called 'Cerebrovascular Accident' It is an acute neurological injury It may be due to blood clot (ischemic) or bleeding (hemorrhagic) Leads to stoppage of blood supply to a part of brain Oxygen supply is decreased This initiates 'ischemic cascade'-causes brain cell death/damage This results in a cerebral stroke STROKE

46 First Aid If you suspect stroke, call emergency medical help Reassure the patient Lay the patient down with head and shoulders slightly elevated If patient is not breathing well do a CPR Place the patient on the left side if breathing/not responsive Keep the chin slightly extended

47 Medical Treatment If you are tested for diabetes, bleeding tenderness and abnormal blood clotting. Other tests are an ECG, CT scan or MRI, CSF(Spinal Tap) Brain Angiography. Thrombolytic therapy is given if the stroke is due to a blood vessel blockage. A tissue plasminogen activator (tPA) busts clots and must be administered within 3 hours of onset of symptoms. This push up your chances of survival, returning to normal or having a very mild disability by 30%. However there is a risk of suffering brain haemmorhage as a result. Further treatment will follow in ICU or room.

48 URINARY RETENTION The inability to urinate, called acute urinary retention Self-Care at Home Try sitting in a bathtub full of warm water or running the water in the bathroom to stimulate the flow of urine. Medical Treatment You will probably have a Foley catheter inserted through your urethra into your bladder. This is a small, flexible rubber or silicone tube. Once it has reached your bladder, urine will drain out into a bag.

49 WOUND Cuts or tears in tissue (lacerations), scrapes (abrasions), and puncture wounds can be caused by bites or other injuries. First-Aid Treatment The first step in treating a cut is to stop the bleeding. Visible bleeding can almost always be stopped by firmly compressing the bleeding area with a finger or hand for at least 5 minutes. Whenever possible, the bleeding part is elevated above the level of the heart-for example, by raising a limb. Because tourniquets shut off all blood flow to a body part and deprive it of oxygen, they are used only for very severe injuries (such as combat casualties).

50 Medical assistance is needed under the following circumstances: If a cut is longer than about 1 / 3 inch (¾ centimeter), is on the face, appears deep, or has edges that separate If bleeding does not stop on its own or within several minutes after pressure is applied If there are symptoms of a nerve or tendon injury, such as loss of sensation, loss of movement, or numbness If a scrape is deep or has dirt and particles that are difficult to remove If there is a puncture wound, particularly if foreign material in the wound is likely If the person has not had a tetanus vaccination within the past 5 years.

51 SNAKE BITES If a snake bites your child, for goodness' sake, don't get inspired by Hindi movies and start sucking venom from the wound! There's a lot else you can do to prevent the poison from spreading and reaching the heart.

52 First aid Make her lie down on a bed or mattress. She should move as little as possible. The more she moves, the quicker the venom will spread through the body. It is important to remember that most snakes are not poisonous, and it is likely that your child has been bitten by a non-poisonous snake. However, if fang marks are visible, the snake was probably of the poisonous variety. Keep the bitten limb below the level of the heart. This slows down the spread of the poison to the heart. So if your child has been bitten on the leg, she could lie down with her leg on a lower level than the mattress, perhaps on a stool.

53 Don't apply ice to the bite. Tie a band or cloth about two inches away from the wound. If there has been swelling, tie the band about two inches from the swelling. The band should be at least an inch thick, and it should be tied within 20 minutes of the bite, if it is to have any effect. The band should be firm and tight, but not so tight that it completely blocks blood flow. A good rule of thumb is that the bandage should be loose enough for a finger to slip through. Some advise that you should wash the bite with soap and water, and then apply an antiseptic, while others advise that it is better not to wash the bite. The doctor will be able to treat your child much better if he has traces of the venom. It is a good idea to wipe the area clean with an antiseptic and retain the wipe for venom traces.

54 Keep bandaging as much of the area as possible, depending on the amount of bandage you have. You could even bandage around the torso to prevent any poison which may have already started to move towards the heart. As far as possible, DO NOT LET YOUR CHILD WALK. Remember, the limb should be moved as little as possible. Get your child to a hospital as soon as possible.

55 Medical emergencies Antivenins,i.e. Crotalidae polyvalent immune FAB(ovine) is used intravenously to neutralize toxins from snakebites. To achieve maximum efficacy, administer within 4-6 hours of bites. Antibiotics i.e. Ceftriaxone (Rocephin) are often given upon arrival to hospital. Immunization i.e. Tetanus prophylaxis is recommended if the patient is not immunized.

56 DENTAL INJURIES Given below are a few common dental emergencies and injuries along with First Aid tips for each. 1. Toothaches : - First you need to thoroughly rinse your mouth with warm saline water and floss your teeth to remove any food particles that may be stuck in between them. In case of a swelling, apply cold compress outside the affected area. Never put any medicine like, aspirin or clove directly against the gums as they may cause tissue burns. Take a painkiller, if you have any, and visit the dentist as soon as possible.

57 2. Knocked Out Tooth :- Teeth can get knocked out of their sockets in case of a trauma and immediate action in this case can save the tooth. First you need to retrieve the tooth and rinse it with water gently without scraping its root surface. Also take care to hold the tooth with its crown (the part that is usually exposed in the mouth) and NOT the root. Rinse the mouth with warm saline water and remove any debris that may be present. Try to insert the tooth back into the socket, if it is clearly visible and there are no other broken fragments near or in the socket. However, if that is not possible, then the other best alternative is to place the tooth in the mouth between the cheek and gum to keep it moist. The tooth should not be allowed to dry out. The third alternative is placing the tooth in milk or saline water in a container and take it to the dentist as soon as possible along with the patient.

58 3. Chipped or broken teeth : - Teeth can get chipped or broken due to accidents or trauma. Rinse the mouth with warm saline water and also rinse the broken pieces. In case there is any bleeding, place a wet gauze on the area and bite on it hard for 10 minutes to stop the bleeding. You can also apply cold compress to the outside of the mouth, cheek, or lip near the broken or chipped tooth to keep any swelling down and relieve pain. Visit the dentist as soon as possible. 4. Lost Fillings :- A sugarless gum can be stuck into the cavity as a temporary measure before you visit the dentist, which should be as soon as possible. Leaving the cavity open for long can cause sensitivity.

59 5. Extruded Teeth (teeth pushed out of position) : - In case of an extruded tooth, you can try to push the tooth back gently by applying finger pressure on the tooth or by biting on it. But take care not to force the tooth. You may experience pain and so may not be able to touch the tooth, in that case just rush to the dentist as soon as you can. You can apply a cold compress to the area to relieve pain. You can also take a painkiller in the meantime. 6. Objects Caught Between Teeth :- Usually a toothpick or a floss can dislodge any objects or food particles that get caught between teeth. But, if you are not able to do so then visit the dentist as soon as possible and do not use any sharp instruments like pins as they may injure your gums or soft tissues.

60 7. Soft Tissue Injuries (Bitten Lip or Tongue) :- Any injury to the soft tissues like the lips, tongue, cheek or gums can result in bleeding. To control bleeding first rinse mouth with mild salt-water solution then use a moistened piece of gauze and hold it over the area by applying pressure for minutes. You can also use cold compress on the outside for a few minutes to help stop the bleeding. If the bleeding still doesnt stop, then rush to the dentist immediately. The dentist will control the bleeding and evaluate the need for any stitches to be given. It is always best to be prepared for any kind of emergencies and you can prepare yourself for any dental emergencies by packing a Dental First Aid Kit. The dental first aid kit should contain the phone number of your dentist (both home and office), saline solution, clean handkerchief, some gauze and or cotton balls (preferably sterile), a small clean container with a lid, Ibuprofen tablets (not Aspirin as it is an anticoagulant and it may cause excessive bleeding in case of a dental emergency).

61 ROAD ACCIDENT Some basic steps to take which could help at road accidents. In the event of a road accident whether it is a car accident, cyclist accident, pedestrian accident or any other accident there are a number of things you can do to help, even if you have not received any training. First aid Deal with the immediate danger. Fire and further collisions are the immediate dangers after a crash. Any vehicles involved in the crash should be approached with care. If it is safe to do so, turn off all engines, and alert oncoming traffic to the danger ahead. Do not allow anyone to smoke; there could be inflammable substances present. Get Assistance. Attempt to get the help of any bystanders.

62 Do not move casualties who remain in their vehicles, unless they are in danger by doing so. Never remove a motorcyclist s helmet unless deemed necessary. Casualties may be suffering from shock so must not be given food or drink. Try and keep them warm and comfortable but avoid unnecessary movements. Try not to leave them alone they may wander off, and give them plenty of reassurance. Provide the necessary emergency care. Before caring for the casualties you should ensure you are not putting yourself in danger. Ensure the relevant emergencies services are called as soon as possible. They will require the precise location and the number of casualties and vehicles involved in the incident. Help for those involved.

63 Is the casualty responsive, ask them questions and if necessary shake them gently by the shoulders. Ensure normal breathing and that their airways are not blocked and are kept open. If necessary place a hand on their forehead and two fingers from the other hand under the chin and gently tilt the head backwards. Check to ensure breathing normally for up to 10 seconds if necessary. If they are not breathing correctly compressions should be administered to keep circulation going. This is done by placing both hands in the centre of the chest and pressing down approximately 4cm to 5cm at a rate of about 100 compressions per minute. This should be done for about 30 compressions then the head should be tilted back gently, the casualty's nostrils pinched together and two breaths of about one second administered with your mouth over theirs. Then repeat the process until normal breathing resumes. If the casualty is a child it may only be necessary to use one hand for the compressions, and use gentler breaths for small children.

64 If the casualty is breathing but unconscious, place them in the recovery position if safe to do so until medical assistance arrives. If there is bleeding, first check if there are any objects in the wound. If the wound is clear of objects apply firm pressure over the wound. If there are objects embedded in the wound do not press them, and build up padding around the object. If a first aid kit is available fasten a pad to the wound with a bandage. If not using the cleanest materials available fasten a makeshift pad to the wound with cloth, this may mean ripping up clothing. If limbs are not broken but are bleeding, lift them above the level of the heart to reduce blood loss. If blood circulation is restricted for more than a short length of time long-term injuries could occur. If there are burns do not remove anything that may be stuck to it. The burn should be cooled if possible by dousing it in clean cold water for at least 10 minutes

65 EPILEPSY Epilepsy is a disease, often involving the young, where the patient has repeated episodes of convulsions. Epilepsy patients are in danger of hurting themselves when they fall down, when they bite their tongue or may either aspirate or even asphyxiate during the episode. How to identify a seizure or convulsion? Minor Seizure Here the patient may become pale, the eyes become fixed and staring and he may become unconscious for a few seconds. He soon resumes his work as though nothing has happened. Here the only precaution to be taken is to observe if the patient is progressing into a major epileptic attack and to treat as for a fainting spell.

66 Major Seizure This kind of seizure may follow headache, restlessness or a feeling of dullness. The patient may be aware that he is likely to have a fit soon. The fit itself is divided into four phases: Phase I - Sudden loss of consciousness which causes the patient to fall to the ground. The patient may cry or scream. Phase II - The body becomes rigid for a few seconds and the face becomes flushed. Phase III - The fits begin in full force. The patient may injure himself by striking himself hard against nearby objects. There is frothing at the mouth and the tongue may be bitten. The patient may pass urine or motion during this phase. Phase IV - The attack lasts for a few minutes and then the convulsion stops. The patient appears dazed and confused. He may act in a strange manner for a few hours without knowing the exact nature of his actions. After a few hours he becomes normal again.

67 FIRST AID Try to keep the patient under control. Do not use force to stop the convulsions. Remove any objects in the vicinity that may cause injury to the convulsing patient. Prevent the biting of the tongue by inserting a spoon wrapped in a handkerchief near the back teeth, when the jaws are relaxed. Wipe the froth from the mouth. Follow the general rules for treating an unconscious patient. Watch for recurrence, if any. Do not leave the patient until you are sure that he is aware of his surroundings. Advise the patient to see a doctor soon.

68 Medications The mainstay of treatment of epilepsy is anticonvulsant medications. Often, anticonvulsant medication treatment will be lifelong and can have major effects on quality of life.


70 How do I perform CPR (cardiopulmonary resuscitation)? See if there is breathing if not, start artificial respiration. Checking for a pulse in the neck (carotid artery) may waste valuable time if the rescuer is inexperienced in this check. The procedure is: place your fingers in the groove between the windpipe and the muscles of the side of the neck. Press backwards here to check for a pulse. If there is no pulse, or if you are unsure, then proceed without delay thus: look at the person's chest and find the 'upside-down V' shaped notch that is made by the lower edge of the ribcage. Place your middle finger in this notch and then place your index finger beside it, resting on the breastbone. Take the heel of your other hand and slide it down the breastbone until it is touching this index finger. The heel of your hand should now be positioned on the middle of the lower half of the breastbone.

71 now place the heel of your other hand on top of the first. Keep your fingers off the chest, by locking them together. Your pressure should be applied through the heels of the hands only. keep your elbows straight, and bring your body weight over your hands to make it easier to press down. press down firmly and quickly to achieve a downwards movement of 4 to 5cm, then relax and repeat the compression. do this 15 times, then give artificial respiration twice, and continue this 15:2 procedure until help arrives. aim for a rate of compression of about 100 per minute. You can help your timing and counting by saying out loud 'one and two and three and four...' etc.

72 How to give artificial respiration Tilt the head back and lift up the chin. Pinch the nostrils shut with two fingers to prevent leakage of air. Take a deep breath and seal your own mouth over the person's mouth. Breathe slowly into the person's mouth – it should take about two seconds to adequately inflate the chest. Do this twice. Check to see if the chest rises as you breathe into the patient. If it does, enough air is being blown in. If there is resistance, try to hold the head back further and lift the chin again. Repeat this procedure until help arrives or the person starts breathing again.

73 Artificial respiration and CPR should both be performed at the same time If possible, get someone else to help – one person to perform artificial respiration and the other to perform CPR. (This is not easily done without prior practice and it is well worth attending sessions on CPR training to become familiar with the technique.) The ratio of chest compressions to breaths is 15:2 for both one-person and two-person CPR. Continue until the ambulance arrives or the patient gets a pulse and starts to breathe again. If the pulse returns and breathing begins but the person remains unconscious, roll them gently onto their side into the recovery position. This way mucus or vomit can get out of the mouth and will not obstruct the patient's breathing. It also prevents the tongue from falling back and blocking the air passage.




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