Essential First Aid

2. Severe bleeding Someone bleeding severely will probably have an uncontrolled wound. The area affected needs to be attended to in order to prevent the patient from going into shock and losing consciousness. In the first instance, your aim should be to stop the patient from bleeding profusely and get them medical help as soon as possible. Assessment for bleeding comes after checking the patient is breathing. First, identify where the wound is and cut away any clothing covering it then, using a dressing or a clean, non-fluffy pad, place direct pressure on to the wound. If there is nothing available for you to use then ask the casualty to place direct pressure themselves (eg with their hand). If there is an object in the wound, leave it in place and apply pressure around it. Keep exerting pressure to control the bleeding and raise and support the injured limb above the patient's heart. This will help to reduce the flow. Place some blankets or anything comfortable, like a coat, on the ground and ask the patient to lie down so that if they lose consciousness they won't fall. Raise the patient's legs by propping them up with a chair or something similar. Call 999 or 112 for emergency help and monitor the patient's condition until help arrives.

3. Choking Adults If an object gets stuck in a patient's airway, they won't be able to breathe and, ultimately, will die unless it is removed. If the patient has a mild obstruction, then they may still be able to cough, breathe and speak; if it's severe, they won't be able to do any of the above. First, ask the person if they are choking - this will prevent you from carrying out first aid unnecessarily. If they are, encourage them to cough out the obstruction. If they are unsuccessful and the airway is still blocked, bend them forward and give them up to five back blows between their shoulder blades using the heel of your hand. If this fails, give the patient up to five abdominal thrusts. To do this, stand behind the casualty and put both arms around the upper part of their abdomen. Clench your fist and place it between the navel and the bottom of their breastbone, then grasp your fist firmly with your other hand and pull sharply inwards and upwards up to five times as necessary. Continue this cycle of back blows and abdominal thrusts until the obstruction is dislodged. If the casualty becomes unconscious and stops breathing, start CPR (see C+D, June 16, p18, for more information). Call 999 or 112 for emergency help if the blockage hasn't cleared after three cycles of back blows and abdominal thrusts or if the person falls unconscious.

Infants An infant needs to be treated differently for choking. Signs of choking in younger patients include: * difficulty coughing and breathing * a purple/red/blue colour around the face and neck * blueness to the lips. If assistance is required, lay the infant face down on your forearm, supporting their back and chin with their head lowered. Give up to five back blows between the shoulder blades with the heel of your hand. Check the infant's mouth and remove any obvious obstructions with your fingertips. Do not feel blindly down the throat, as this may cause the obstruction to descend further. If the choking persists, turn the infant on their back and, using two fingers, give up to five thrusts in an upward direction to the centre of the chest. Do not use abdominal thrusts on an infant. Check the infant's mouth again and remove anything obvious with your fingertips. If the infant is still choking, repeat the back blows and chest thrusts. After three cycles, take the infant with you and call 999 or 112 for emergency assistance. Continue the back slaps and thrusts until help arrives. 4. Anaphylactic shock Severe allergic reactions can be fatal and develop within minutes of being exposed to the substance causing the reaction. A patient experiencing an allergic reaction may have:

* wheezy breathing * swelling of the throat and tongue * puffy eyes * a rash * lost consciousness * a cardiac arrest. If you suspect a patient has had an allergic reaction and requires emergency assistance, call 999 or 112 for emergency help and tell ambulance control the situation. The patient may already have an auto-injector with them, which gives a fixed dose of adrenaline to counteract the allergy. To administer a dose, pull off the safety cap and, holding the auto-injector with your fist, place the tip firmly against the casualty's thigh to release the adrenaline; some devices may work in other ways. You can inject through clothing. Once adrenaline has been administered, get the patient into a sitting position and keep them comfortable by using any padding such as cushions or coats. Monitor the patient's breathing and pulse and reassure them. If their condition gets worse, lie them down and raise their legs. Auto-injectors can be given in five minute intervals if you find there is no improvement in the patient's condition. If the casualty becomes unconscious and is breathing normally, place them in the recovery position. If they stop breathing, start CPR. 5. Concussion Concussion occurs when there has been a blow to the head, impairing consciousness for a short period. Patients should recover from concussion without medical attention, but if they start to develop symptoms such as headaches and blurred vision then they will need medical aid.

Symptoms of concussion may include: * dizziness * nausea * loss of memory or confusion. If you suspect a concussion, you need to check the patient's level of response using the AVPU test: A Is the patient alert? Are they responding to questions and are their eyes open? V Does the patient respond to your voice? Is he able to answer your questions? P Does the patient respond to pain. If you gently pinch them, do they respond? U Is the patient unresponsive to the previous checks? Make a note of your assessment. If the patient responds to sounds or pain then support them in a comfortable position and call 999 or 112 for emergency help. Monitor their condition while you're waiting for help to arrive. If the patient is unconscious, check their airway and breathing and place them in the recovery position.