First Aid and Emergency Information

1 Fundamental Criteria for First Aid
2 Basic Measures for First Aid
3 First Aid for Special Wounds
4 First Aid for Fractures
5 First Aid for Climatic Injuries
6 First Aid for Bites and Stings
7 First Aid in Toxic Environments
8 First Aid for Psychological Reactions

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2-12. Airway Obstructions
In order for oxygen from the air to flow to and from the lungs, the upper airway must be unobstructed.
a. Upper airway obstructions often occur because—
(1) The casualty’s tongue falls back into his throat while he is unconscious as a result of injury, cardiopulmonary arrest, and so forth. (The tongue falls back and obstructs, it is not swallowed.)
(2) Foreign bodies become lodged in the throat. These obstructions usually occur while eating (meat most commonly causes obstructions). Choking on food is associated with—
• Attempting to swallow large pieces of poorly chewed food.
• Drinking alcohol.
• Slipping dentures.
(3) The contents of the stomach are regurgitated and may block the airway.
(4) Blood clots may form as a result of head and facial injuries.
b. Upper airway obstructions may be prevented by taking the following precautions:
(1) Cut food into small pieces and take care to chew slowly and thoroughly.
(2) Avoid laughing and talking when chewing and swallowing.
(3) Restrict alcohol while eating meals.
(4) Keep food and foreign objects from children while they walk, run, or play.
(5) Consider the correct positioning/maintenance of the open airway for the injured or unconscious casualty.
c. Upper airway obstruction may cause either partial or complete airway blockage.
*(1) Partial airway obstruction. The casualty may still have an air exchange. A good air exchange means that the casualty can cough forcefully, though he may be wheezing between coughs. You, the rescuer, should not interfere, and should encourage the casualty to cough up the object on his own. A poor air exchange may be indicated by weak coughing with a high pitched noise between coughs. Additionally, the casualty may show signs of shock (for example, paleness of the skin, bluish or grayish tint around the lips or fingernail beds) indicating a need for oxygen. You should assist the casualty and treat him as though he had a complete obstruction.
(2) Complete airway obstruction. A complete obstruction (no air exchange) is indicated if the casualty cannot speak, breathe, or cough at all. He may be clutching his neck and moving erratically. In an unconscious casualty a complete obstruction is also indicated if after opening his airway you cannot ventilate him.

2-13. Opening the Obstructed Airway-Conscious Casualty (081-831-1003)
Clearing a conscious casualty’s airway obstruction can be performed with the casualty either standing or sitting, and by following a relatively simple procedure.

WARNING
Once an obstructed airway occurs, the brain will develop an oxygen deficiency resulting in unconsciousness. Death will follow rapidly if prompt action is not taken.

a. Step ONE. Ask the casualty if he can speak or if he is choking. Check for the universal choking sign (Figure 2-18).
Figure 2-18
b. Step TWO. If the casualty can speak, encourage him to attempt to cough; the casualty still has a good air exchange. If he is able to speak or cough effectively, DO NOT interfere with his attempts to expel the obstruction.
c. Step THREE. Listen for high pitched sounds when the casualty breathes or coughs (poor air exchange). If there is poor air exchange or no breathing, CALL for HELP and immediately deliver manual thrusts (either an abdominal or chest thrust).

NOTE
The manual thrust with the hands centered between the waist, and the rib cage is called an abdominal thrust (or Heimlich maneuver). The chest thrust (the hands are centered in the middle of the breastbone) is used only for an individual in the advanced stages of pregnancy, in the markedly obese casualty, or if there is a significant abdominal wound.

• Apply ABDOMINAL THRUSTS using the procedures below:
º Stand behind the casualty and wrap your arms around his waist. Make a fist with one hand and grasp it with the other. The thumb side of your fist should be against the casualty’s abdomen, in the midline and slightly above the casualty’s navel, but well below the tip of the breastbone (Figure 2-19).
Figure 2-19
º Press the fists into the abdomen with a quick backward and upward thrust (Figure 2-20).
Figure 2-20
o Each thrust should be a separate and distinct movement.

*NOTE
Continue performing abdominal thrusts until the obstruction is expelled or the casualty becomes unconscious.

o If the casualty becomes unconscious, call for help as you proceed with steps to open the airway and perform rescue breathing (See task 081-831-1042, Perform Mouth-to-Mouth Resuscitation.)
• Applying CHEST THRUSTS. An alternate technique to the abdominal thrust is the chest thrust. This technique is useful when the casualty has an abdominal wound, when the casualty is pregnant, or when the casualty is so large that you cannot wrap your arms around the abdomen. To apply chest thrusts with casualty sitting or standing:
o Stand behind the casualty and wrap your arms around his chest with your arms under his armpits.
o Make a fist with one hand and place the thumb side of the fist in the middle of the breastbone (take care to avoid the tip of the breastbone and the margins of the ribs).
o Grasp the fist with the other hand and exert thrusts (Figure 2-21).
Figure 2-21
º Each thrust should be delivered slowly, distinctly, and with the intent of relieving the obstruction.
o Perform chest thrusts until the obstruction is expelled or the casualty becomes unconscious.
o If the casualty becomes unconscious, call for help as you proceed with steps to open the airway and perform rescue breathing. (See task 081-831-1042, Perform Mouth-to-mouth Resuscitation.)

2-14. Open an Obstructed Airway—Casualty Lying or Unconscious (081-831-1042)
The following procedures are used to expel an airway obstruction in a casualty who is lying down, who becomes unconscious, or is found unconscious (the cause unknown):
• If a casualty who is choking becomes unconscious, call for help, open the airway, perform a finger sweep, and attempt rescue breathing (paragraphs 2-2 through 2-4). If you still cannot administer rescue breathing due to an airway blockage, then remove the airway obstruction using the procedures in steps a through e below.
• If a casualty is unconscious when you find him (the cause unknown), assess or evaluate the situation, call for help, position the casualty on his back, open the airway, establish breathlessness, and attempt to perform rescue breathing (paragraphs 2-2 through 2-8).
a. Open the airway and attempt rescue breathing. (See task 081-831-1042, Perform Mouth-to-mouth Resuscitation.)
b. If still unable to ventilate the casualty, perform 6 to 10 manual (abdominal or chest) thrusts. (Note that the abdominal thrusts are used when casualty does not have abdominal wounds; is not pregnant or extremely overweight.) To perform the abdominal thrusts:
(1) Kneel astride the casualty’s thighs (Figure 2-22).
Figure 2-22
(2) Place the heel of one hand against the casualty’s abdomen (in the midline slightly above the navel but well below the tip of the breastbone). Place your other hand on top of the first one. Point your fingers toward the casualty’s head.
(3) Press into the casualty’s abdomen with a quick, forward and upward thrust. You can use your body weight to perform the maneuver. Deliver each thrust slowly and distinctly.
(4) Repeat the sequence of abdominal thrusts, finger sweep, and rescue breathing (attempt to ventilate) as long as necessary to remove the object from the obstructed airway. See paragraph d below.
(5) If the casualty’s chest rises, proceed to feeling for pulse.
c. Apply chest thrusts. (Note that the chest thrust technique is an alternate method that is used when the casualty has an abdominal wound, when the casualty is so large that you cannot wrap your arms around the abdomen, or when the casualty is pregnant.) To perform the chest thrusts:
(1) Place the unconscious casualty on his back, face up, and open his mouth. Kneel close to the side of the casualty’s body.
o Locate the lower edge of the casualty’s ribs with your fingers. Run the fingers up along the rib cage to the notch (Figure 2-23A).
o Place the middle finger on the notch and the index finger next to the middle finger on the lower edge of the breastbone. Place the heel of the other hand on the lower half of the breastbone next to the two fingers (Figure 2-23B).
• Remove the fingers from the notch and place that hand on top of the positioned hand on the breastbone, extending or interlocking the fingers (Figure 2-23C).
• Straighten and lock your elbows with your shoulders directly above your hands without bending the elbows, rocking, or allowing the shoulders to sag. Apply enough pressure to depress the breastbone 1½ to 2 inches, then release the pressure completely (Figure 2-23D). Do this 6 to 10 times. Each thrust should be delivered slowly and distinctly. See Figure 2-24 for another view of the breastbone being depressed.
Figure 2-23 Figure 2-24
(2) Repeat the sequence of chest thrust, finger sweep, and rescue breathing as long as necessary to clear the object from the obstructed airway. See paragraph d below.
(3) If the casualty’s chest rises, proceed to feeling for his pulse.
d. Finger Sweep. If you still cannot administer rescue breathing due to an airway obstruction, then remove the airway obstruction using the procedures in steps (1) and (2) below.
(1) Place the casualty on his back, face up, turn the unconscious casualty as a unit, and call out for help.
(2) Perform finger sweep, keep casualty face up, use tongue-jaw lift to open mouth.
• Open the casualty’s mouth by grasping both his tongue and lower jaw between your thumb and fingers and lifting (tongue-jaw lift) (Figure 2-25). If you are unable to open his mouth, cross your fingers and thumb (crossed-finger method) and push his teeth apart (Figure 2-26) by pressing your thumb against his upper teeth and pressing your finger against his lower teeth.
Figure 2-25 Figure 2-26
• Insert the index finger of the other hand down along the inside of his cheek to the base of the tongue. Use a hooking motion from the side of the mouth toward the center to dislodge the foreign body (Figure 2-27).
Figure 2-27

WARNING
Take care not to force the object deeper into the airway by pushing it with the finger.

Continue to Stop the Bleeding and Protect the Wound

 

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