Contusions

Contusions are caused by blunt violence: blows, punches, fails, crushing, trapping. The extent of the damage depends on the kind of tissue affected bruises of soft parts are usually harmless, but there may also be severe tissue damage. Contusions of organs however can be dangerous, when the impact of the force is transmitted to internal organs.

Symptoms and Signs

• Swelling
• Bluish purplish discoloration (hematoma)
• Pain

Danger

Bleeding and injuries of internal organs; severe contusions cause loss of blood into the tissue.

Fist Aid

• Consult a doctor in case of:
• Extensive hematomas
• Suspicion of internal injuries,
  

If the doctor does not diagnose any severe damage:

• Immobilize and raise the injured part.
• Apply cold compresses.

Hypothermia

Hypothermia is a condition by which the body temperature drops below 36^oC because of exposure to cold, moisture and wind.

 

In hypothermia the blood supply to the outer body layers (body shell) deteriorates because of the effect of cold, and circulation is maintained only in the inner part of the body (body core). This condition is called centralization. It is a protective reaction of the body to prevent the blood and thus the body core from cooling down too quickly. Apart from general hypothermia local damage tissue can occur too.

 

Symptom and Sign

The casualty initially feels:

·        Intense pain, then gets increasingly

·        Apathetic

·        Tired

·        Feel fine, and

·        Falls asleep

·        Pulse slow down and breathing slackens.

 

Danger

Unconsciousness, respiratory and circulatory failure owing to the drop in body core temperature below 30^oC.

 

Fist Aid

·        Wake the casualty and keep him awake

·        Keep him reclining and do not let him move or walk around

·        Wrap the casualty in a blanket or warm clothes.

·        Check breathing and circulation regularly, and if breathing stop, artificial respiration, and if circulation stop, chest compression (but only 40 compressions a minute).

 

If transport to hospital is impossible for the time being (mountain):

 

·        Seek shelter, i.e. take the casualty to a sheltered place or a warm room (mountain hut)

·        Remove cold, wet clothing and wrap the casualty in warm blankets.

·        Do not massage or rub the casualty with a towel, if feasible.

·        Dress frostbite with a sterile dressing.

·        Give hot drinks, but do not administer alcohol.

 

Help from Animal Bites

The consequences of external injuries, inflicted upon human by animals, vary to a great extent, depending on the circumstances. In general it can be said that animal bites quite often tend to heal poorly. They carry an acute risk of infection, unless treated swiftly and expertly.

The most frequent bites are dog-bites, but also other pets might bite. Normally, non-domesticated animals rarely bite, the exception is stray dogs. Careless behavior in zoos can also result in unpleasant contact with animals. Because of the ever-increasing spread of rabies bite wound are of great significance.

Danger!

Apart from a high risk of infection

- by pyococci

- by tetanus viruses

- of contracting rabies

Rabies is very often fatal for humans. The disease is transmitting through the saliva of infected animals.

First Aid

- Cleanse the wound immediately with hot soapy water (rabies viruses are sensitive to heat and soap).

- Disinfect the wound with a disinfectant

- Apply a sterile dressing

- Take the casualty immediately to a doctor or to hospital to establish whether or not the casualty needs an anti rabies vaccine.

- The animal that inflicted the bite, should, if possible, also be examined for rabies. If bitten by a pet, identify the owner (injury report).

Prevention:

Rabid animals, as a rule, display unusual behavior; they roam about, may be abnormally trustful, suddenly become vicious and bite unexpectedly. The saliva of infected animals is already contagious some days before they display strange behavior. Visibly diseased animals usually die within one week. Their cadavers remain contagious.

Do not touch an animal suspected to have rabies or any unfamiliar animal (nor any animal cadaver) or allow such an animal to lick you in a region known for the prevalence of rabies.

Particular caution is to be exercised with non-domesticated animals, who approach humans with unnatural friendliness. An attacking animal must be warded off with all means. Avoid any bodily contact. Quite often it helps to bait the infected animal with a stick in which it can sink its teeth into. Any living, dying or dead animal suspected of having rabies should be reported to the nearest police station or veterinarian indicating the exact location where it was sighted.

Help for Shock

The purpose of blood circulation is to provide the whole body, especially all vital organs, with blood and thus with oxygen. In circulatory malfunctions, caused, for instance, by blood loss, by serious injuries, extensive burns, poisonings, severe allergies and hearth rhythm disorders, the vital organs receive less blood which results in insufficient oxygen supply. Initially this lead to functional disorders, subsequently to permanent organ damage, resulting in organ failure, and eventually to death. Paint might enhance this circulatory disorder = shock. Shock is not an immediate reaction, but develops gradually and may rapidly become life-threatening. The earlier shock is treated, the better.

Consequently shock treatment should be performed as a preventive measure before the shock actually occurs.

Therefore it is necessary to treat every emergency patient for shock until the ambulance arrives.

Symptoms and Signs:
The following symptoms do not all appear and not at the same time, because shock develops gradually:

• Apathy or, on the contrary, conspicuous restlessness.
• Pulse is rapid and shallow
• Pallor and moist, clammy skin
• Muscle tremor

Danger!
When the shock becomes life-threatening, the casualty turns ashen and becomes increasingly listless. He is only semi-conscious, no pulse is left at his wrist, unconsciousness, impaired breathing (gasping) sets in, and eventually death may occur due to circulatory failure.

First Aid
Shock treatment aims at supporting and maintaining the vital functions (breathing and circulation) by:

• swift, exact control of bleeding
• treatment of wounds (e.g. application of cold water on burns or chemical burns)
• Placing the casualty of patient in a position causing as little pain as possible, depending on his condition (e.g. flat on his back, legs raised, half-sitting, etc.)
• loosening tight clothing
• keeping the casualty warm
• providing fresh air, if indoors
• making the casualty breathe slowly and deeply
• shielding the casualty from excitement
• reassuring and comforting the casualty
• emergency call

Severe Bleeding

Bleeding means that blood is escaping from blood vessels. We distinguish between visible external bleeding (from wound), only this type of bleeding can be controlled, and internal bleeding. When invisible bleeding can be caused by violence or by certain diseases. Blood loss may cause circularly disturbance.

Symptoms and signs:

• Severe bleeding: blood spurts from a wound or escapes in gushes and a considerable quantity of blood is lost within a very short period of time.
• A pool of blood (on an impermeable surface) could be evidence for considerable blood loss.
• Blood soaked clothing.

Danger:

Severe bleeding, if not stopped or controlled in time, likewise coupled with symptoms of severe shock (= circulation failure) can be fatal.

First Aid:

Controlling bleeding is an essential life-saving measure. All other measures of first aid are pointless, if circulation fails due to uncontrolled blood loss.

The method of controlling bleeding depends on the severity or the bleeding and thus the blood loss, not on the type of bleeding. Almost every visible strong bleeding can be stopped by sufficiently strong external pressure on the source of the bleeding. Avoid direct contact with the blood (use disposable gloves).

Stop the bleeding by finger pressure:

• Sit or lay the casualty down.
• Press a sterile dressing onto the severity bleeding wound.
• Maintain pressure until the ambulance arrives.

Stop the bleeding with a pressure bandage:

Only where the shape of the body permits it, it suitable dressing and bandaging material is available and the first aider has learn and practical how to apply a pressure bandage, finger pressure can be replaced by a pressure bandage.

• Raising or elevation of the attached limb will increase the effect of the pressure bandage.
• If severe bleeding continuous, place a second dressing and bandage on top of the first and/or exert finger pressure.
• Keep a constant check on the effect of the pressure bandage.

Next to Stop Bleeding by means of tourniquet

Circulatory Standstill

Circulation has stopped when the person does not respond to external stimuli and when neither breathing nor circulation can be detected.

When circulation fails the heart is no longer capable of supplying the vital organs with blood (oxygen).

Causes
Conditions that cause unconsciousness and respiratory failure may also lead to circulatory arrest.

Further causes are:

• Electrical accident
• Cardiac rhythm disturbances
• Severe blood loss
• Hypothermia
• Allergic shock

Assessment

Check Consciousness

• Look to Respiratory Standstill

Check Breathing

• Look to Unconsciousness

Check Circulation

• Look to Crash Helmet

Danger!

Circulatory arrest will be fatal, unless artificial respiration and external chest compression is applied within a few minutes.

First Aid

• If the casualty is not breathing begin artificial respiration.
• In case of circulatory standstill start external chest compression!

What to do:

• Place the emergency patient on a hard, unyielding surface.
• Kneel beside the emergency patient and place the heel of one hand on the lower half of his breastbone (pressure point), keeping your fingers off the rib cage. Cover your hand with the heel of the other hand.
• Keep your arms straight while you exert vertical pressure on the beast bone. Press down 3 to 4 cm. Perform the compressions rhythmically, not jerkily, i.e. press and release the chest evenly.
• Do not lift your hands off the chest while you are messaging.
• Perform heat massage in an even rhythm at a rate of 80 to 100 compressions a minute.

When applying the one-helper method give 2 breaths of mouth to mouth followed by 15 compressions, continue with 2 breath, 15 compressions.

Check circulation every minute.

Emergency call.

• If there is no carotid pulse, continue respiration and external chest compression until the ambulance arrives.
• When you feel the carotid pulse, stop compressing but continue mouth-to-mouth (no more compressions) and check circulation in regular intervals.
  

Respiratory Standstill

Respiratory standstill means that a person has stopped breathing. He does not respond to external stimuli and does not breathe despite a clear airway and intact circulation. When breathing has stopped the respiratory center is unable to from the impulses required to maintain breathing, or the impulses cannot reach the respiratory muscles.

Causes
Conditions that lead to unconsciousness may also lead to respiratory failure.

Other Causes:
Obstruction of the airway of an unconscious person (foreign matter; vomit, tongue)
Obstruction of the airway due to swelling (insect sting, allergy, etc.).

The casualty is trapped or buried: drowning.

Assessment:
Check consciousness

• Talk to the motionless casualty/emergency patient
• Rouse him by tapping
• Apply gentle pain stimuli

If he/she does not respond adequately, he/she is without consciousness.
Call for help (Help! Can somebody help me?)

*Check Breathing
Clear the airway (upper respiratory tract):

• Loosen tight clothing and remove strangling objects.
• Inspect the oral cavity; if vomit, blood, mucus, broken or dislocated dentures are to be removed from the oral cavity, turn the casualty’s or emergency patient’s head to the side (use disposable gloves or a fabric handkerchief).
• Tilt the casualty’s or emergency patient’s head backward keeping his neck arched and lift his tongue if it has fallen back, thus enabling unobstructed breathing.

How to check breathing: Click Here Check Breathing

* Check Circulation
How to check circulation: Click here Check Circulation.

Danger Condition
Since the brain can survive without oxygen for only a short time, lack of oxygen would within a few minutes cause circulatory standstill and shortly lead to a person’s death. Therefore oxygen must be supplied immediately through artificial respiration.

First Aid This Condition

Unconsciousness

An individual, who is unresponsive to speech, touch or pain stimuli despite normal breathing and circulation, is unconscious. The casualty lacks consciousness, muscle tension and vital defense reflexes. A person in this condition is helpless and defenseless.

Causes:

Head and brain injuries:

• Concussion
• Contusion
• Cerebral pressure caused by swelling of the brain and cerebral bleeding.

Poisoning:

• By toxic gases
• By poisons

Other causes:

• Sunstroke, heatstroke
• Stroke
• Brain diseases (epilepsy, meningitis, etc.)
• Metabolic diseases (diabetes, etc.)

Assessment:

Check consciousness:

• Talk to the motionless casualty
• Rouse the casualty by tapping
• Apply light pain stimuli

If the casualty does not respond adequately, he is without consciousness:

Call for help (Help! Can somebody help me?) then

Check breathing

Clear the airway (upper respiratory tract):

• Loosen tight clothing and remove strangling objects.
• Inspect the oral cavity: it vomit, blood, mucus, broken, or dislocated dentures are to be removed from the oral cavity, turn the casualty’s head to the side (use disposable gloves or a fabric handkerchief).
• Tilt the casualty’s head backwards keeping his neck arched and lift his tongue it has fallen back, thus enabling unobstructed breathing: then

Check breathing i.e. listen for the casualty’s breath. Watch his chest and your ear close to the casualty’s mouth to feel the breaths. Continuous to check the casualty’s breathing for about 10 seconds. If you feel and hear the casualty breathe, and see his chest move, his breathing is intact: then,

Check circulation:

Feel the carotid pulse:

Gently pull the casualty’s head backwards and with several fingertips feel for the neck artery pulse for 5-10 second on each side). If the carotid pulse can be felt, circulation is still functioning.

If the casualty is without consciousness, but breathing and circulation are apparent, there is the emergency case of unconsciousness.

Danger

Any unconscious casualty is in danger of dying while lying face upwards, as the airway might be blocked by foreign matter, vomit or curled-back tongue, which could cause death by suffocation.

First Aid

Keep the breathing passage clear by turning the casualty into a stable lateral position, the so-called “recovery position”.

Realization:

1. Place the arm nearest to you by the casualty’s side.
2. Take the opposite arm at the wrist and the far leg at the hollow of the knee; bend the knee so that arm and leg form a stable triangle with the body.
3. Turn the casualty gently to a lateral position.
4. Tilt the casualty’s head back and turn the face towards the ground to prevent the tongue from blocking the airway and to make blood, secretions or vomit drain off from the mouth.

Important Point:

• Check breathing and circulation in one minute intervals.
• Emergency call
• Further shock treatment

Crash Helmet

The crash helmet protects the casualty’s head from injuries, but does however transmit the force of the collision to the cervical vertebral column (injury of the cervical vertebrae).

Danger!

You have to remove the helmet to check the breathing of an unconscious casualty, and to eliminate danger of suffocation in case he has vomited. Unskilled removal of the helmet can cause additional injuries to the vertebral column.

First Aid

• If the casualty is conscious, you can help him to remove the helmet carefully.
• If the casualty is without consciousness, you must remove the helmet to check the casualty’s breathing.

Helmet Removal by two First-Aiders

One first-aider kneels at the free side of the casualty’s head and grasps the helmet both hands in order to fix the head, thereby exerting gentle traction, and the second first aider proceeds as follows:

1. Open the visor.
2. Open the chin strap. While the helmet is removed, the second helper holds the casualty’s head in place and the first helper proceeds as follows:
3. Tilt the helmet, until the nose appears under the chin strap.
4. Remove the helmet cautiously.

It is now the first helper’s turn to hold the casualty’s head in place, and to put it down cautiously with careful traction.

When the helmet has been removed, make an emergency diagnosis and take immediate life saving measures.

Accident Prevention:

Cyclists, moped-riders, motorcyclists:

Wear suitable clothing and head gear (crash helmet)!

A full visor helmet offers best possible protection.

Note: Motorcyclists are obliged by law to wear helmets (since 1986 also moped-riders)!