AIRWAY OBSTRUCTION

AIRWAY OBSTRUCTION

The airway may be obstructed by food, vomit, by swelling of the throat after injury, or , in an unconscious casualty, by the tongue. The child may inhale a foreign body that can block the lower air passages, or swell within the lung, possibly resulting in a collapsed lung or pneurmonia.

General signs of an obstructed airway

• Noisy, laboured breathing.

• Reversing movement of the chest and abdomen: the chest wall will suck in and the abdomen will push out.

• Blueness of the skin (cyanosis).

• Flaring of the nostrils.

• Drawing in of the chest wall between the ribs and the soft spaces above the collar bone and breastbone.

• Also see Burns to the mouth and throat, Inhaled foreign body, Opening the airway, Unconsciousness.

SUFFOCATION

This occurs when air is prevented from reaching the lungs, either because there is a physical barrier that prevents air entering the nose and mouth, or because the air the casualty breathes is full of fumes or smoke.

TREATMENT

Your aims are:

• To restore the supply of fresh air to the casualty’s lungs.

• To seek medical aid.

1. Remove any obstruction to breathing, or move the casualty into fresh air.

If she is unconscious, check breathing and pulse, and be prepared to resuscitate. Dial 999 for an ambulance, and place her in the recovery position.

2. If she is conscious, reassure her, but keep her under observation. Call a doctor or an ambulance.

A foreign object sticking at the back of the throat may either block throat, or induce muscular spasm. This is known as choking. The adults may choke on a piece of food that has been inadequately chewed and hurriedly swallowed. Young children like putting objects inside their mouths and boiled sweets are a particular danger.

RECONGNITION

There will be:

• Difficulty in speaking and breaking.

There may be:

• Blueness of the skin (cyanosis).

• Signs from the casualty – pointing to the throat, or grasping the neck.

TREATMENT

Your aim is:

To remove the obstruction and restore normal breathing.

FOR AN ADULT

1. Reassure the casualty. Bend her forwards so that her head is lower than her chest.

2. Give up back to five sharp blows to her back, between the shoulder blades, with the flat of your hand

3. If backslaps fail, try abdominal thrusts. The sudden pull up against the diaphragm compresses the chest, and may expel the obstruction. If this does not free the blockage, try again four times, then alternate five back blows with five thrusts. If the casualty becomes unconscious, treat as described opposite.

FOR A CHILD

Place the child over your knee, head down. Slap him between the shoulder blades, using less force than for an adult . If back blows fail, use the abdominal thrust only if you have been trained to do so on a child. Otherwise, begin resuscitation.

FOR A BABY

Lay the body along your forearm. Slope her between the shoulder blades, using less force than for a child. If the baby becomes unconscious, begin resuscitation. Do not use the abdominal thrust.

If she starts to breathe normally, place her in the recovery position, and call an ambulance. Check and record breathing and pulse rate every 10 minutes. If she does not start to breathe again, dial 999 for an ambulance, and begin resuscitation.

THE RESPIRATORY SYSTEM

THE RESPIRATORY SYSTEM

We breathe air in and out in order to take oxygen into the lungs, and to expel the waste gas carbon dioxide, a by product of respiration. Breathing is not quite the same as respiration, which is the process whereby oxygen and carbon dioxide are exchanged in the lungs, and in the cells of the body. The process of gas exchange within the body tissues is described in the Circulatory System. When we breathe in, air is drawn in at the nose and mouth, and then passes down the main airway to the lungs, Within the lungs, it travels along a broadening network of air passages that finally open into tiny air sacs (alveoli). Here, the oxygen is taken up by the blood. Carbon dioxide-bearing air is then expelled as we breathe out, enabling fresh oxygen-bearing air to be drawn in with the next breath.

HOW WE BREATHE

Breathing consists of three phases: breathing in (inspiration), breathing out (expiration, and a pause. When we breathe in, muscles in the chest work to expand its volume, drawing air into the lungs, When we breathe out, the elastic chest wall regains its resting position, and the air is pushed out, Some air is always left in the lungs so that oxygen is constantly available to the blood. 

What controls breathing?

Breathing is controlled by the respiratory centre in the brain. No conscious effort is required to breathe, though in normal circumstances we can change the depth and rate of breathing voluntarily. An adult normally breathes about 16 times per minute; children breathe 20 to 30 times per minute. The rate may be altered (usually increased) by the respiratory centre as a response to stress, exercise, injury, or illness.

The composition of air

Air is a mixture of gases, of which 80 per cent is nitrogen and 20 per cent is oxygen. Only some of this oxygen is used up by respiration, so the air we breathe out still contains 16 per cent oxygen, in addition to a small amount of carbon dioxide. The oxygen level in exhaled air is thus adequate to resuscitate another person.

THREATMENT AND AFTERCARE

THREATMENT AND AFTERCARE

Relaxed way and efficiently, treat each condition found. Pay attention to the casualty’s remarks or requests. Reassure the casualty constantly, but do not pester him or her with questions.

Establishing treatment priorities Follow this order as applicable; your own common sense and judgement will distance modifications.

• Follow the ABC of resuscitation.

• Control bleeding.

• Treat large wounds, burns, and fractures.

• Look for and treat other injuries or condition

• Treat for shock.

While giving the necessary treatment, help the casualty into a correct and comfortable position. Do not let people crowd around, Use your judgement to decide whether the casualty needs medical treatment and, if so, what level of attention is required. If you have to summon help, send someone else to do so whenever possible, in case the casualty’s condition alters or worsens. Stay with the casualty until the doctor or ambulance arrives.

• Don’t give anything by mouth to a casualty who is unconscious, who may have internal injuries, or who may require hospital treatment.

• Do not send anyone home who has been unconscious for longer than three minutes, has had severe breathing difficulty, or has displayed the features of shock.

Dealing with the casualty’s belongings

If you have to search a casualty’s personal belongings, do so only in the presence of a reliable witness. Take care of any property found, and hand it over to the police or ambulance personnel. Make sure someone accepts responsibility for getting a message to the casualty’s home, If involved, the police will do this – if not, volunteer your help.

Arranging for further care

Depending on your assessment of the casualty’s condition, you may:

• Dial 999 for an ambulance.

• Arrange transport to hospital by ambulance or other suitable vehicle.

• Hand over the casualty to the care of a doctor, nurse, or ambulance officer.

• Take the casualty to a nearby house or shelter to await medical help.

• Call the casualty’s doctor or any doctor for advice.

• Allow the casualty to go home, accompanied if possible, Ask the casualty if someone will be at home to meet him or her, or if you can help arrange this. Advise the casualty to see a doctor.

PASSING ON INFORMATION

Having summoned medical aid, make notes, if possible, so that you can pass on all the information you have gathered about the casualty. Always include a record of the casualty’s pulse, breathing, and level of response, made at least every 10 minutes for as long as he or she remains in your care. You may wish to check more frequently if the casualty is in a critical condition, The observation chart overleaf, which is recommended for use by all three Voluntary Aid Societies, will enable you to note your findings clearly.

Make a brief written report to accompany your observations. A record of the timing of events is particularly valuable to medical personnel. Note carefully, for example, the length of a period of unconsciousness, the duration of a fit, the time of any changes in the casualty’s condition, and the time of any intervention or treatment. If possible, stay with the casualty until help arrives, or accompany him or her to hospital, so the you can hand your notes over personally.

Making a report

Your report should include;

• The casualty’s name and address.
• History of the accident or illness
• A brief description of any injuries.
• Any unusual behaviour.
• Any treatment given, and when.
• The following observations, recorded every 10 minutes:

Pulse Take the pulse at the wrist (the radial pulse, or on a baby’s upper arm. Note the rate over one minute, and whether it is weak or strong, regular or irregular.

Breathing Count the number of times the casualty breathes over one minute, and note whether breathing is quiet and easy, or noisy and difficult.

Level of response Measure and record the responses the casualty makes to certain stimuli in the three categories given on the chart overleaf.

Should speak clearly and directly, close to the casualty’s ear. Apply a painful stimulus by pinching the skin, or by squeezing the Achilles tendon at the back of the heel.

REMOVING CLOTHING

REMOVING CLOTHING

Removing shoes

Support the ankle as you carefully remove the shoe. Long boots with no zip may need to be carefullu slit down the back seam with a sharp knife.

Removing Socks

If socks are difficult to pull off, insert two fingers between the sock and the lag. Raise the sock and cut alongside your fingers with scissors.

Removing Trousers

Pull them down from the waist to reveal the thigh, or pull up the trouser leg to expose the calf and knee, If necessary, slit up the seam.

Removing a Coat or Shirt

• Raise the casualty, and pull the garment off his shoulders.

• Bend his arm on the uninjured side, and remove the coat from that side first.

• Then slip the injured arm out of its sleeve, keeping the arm straight if possible,

Try not to cause too much damage.

REMOVING CRASH-HELMETS

A protective helmet, such as a motorcycle crash—helmet, is best left on, and should only be removed if absolutely necessary (for example, if it prevents you form performing artificial ventilation). Any helmet should always, if possible, be removed by the casualty. Do not remove a full-face helmet )that encloses the head and face) unless it obstructs breathing, or the casualty is vomiting, or there are server head injuries. Removal ideally requires two persons, so the the casualty’s head and neck are constantly supported.

FOR AN OPEN—FACE HELMET OR RIDING HAT

Do not remove the helmet unless it is absolutely necessary.

• Unfasten the buckle, or cut through the chinstrap.

• Force the sides of helmet apart to take pressure off the head, then lift the helmet upwards and backwards,

FOR A FULL—FACE HELMET

Do not remove the helmet unless it is absolutely necessary

• Working from the base of the helmet, ease your fingers underneath the rim. Support the neck and hold the lower jaw firmly, with your fingers spread.

• Ask a helper to tilt the helmet (not the head) back, and gently lift it until it is clear of the chin.

• While you continue to support the neck and jaw, your helper should tilt the helmet forwards to pass over the base of the skull, then lift it straight off.

TOP – TO – TOE SURVEY

TOP – TO – TOE SURVEY

Having taken any vital action, carefully examine the casualty. Always start at the head and work down; the “top–to–toe” routine is both thorough and easily remembered. You may need to move or remove clothing, but bear in mind that, during every stage of your examination, you should try not to move the casualty more than is absolutely necessary. They use both hands, and always compare one side of the body with the other, since any swelling or deformity may be revealed much more clearly.

SYMPTOMS AND SIGNS

SYMPTOMS AND SIGNS

Each injury and illness manifests itself in distinctive ways that may help your diagnosis. These clues are divided into two groups: symptoms and sighs. Some will be obvious, but other valuable ones may be overlooked unless you examine the casualty thoroughly form head to toe. A conscious casualty should be examined, wherever possible, in the position found, or with any obvious injury comfortably supported; an unconscious casualty’s airway must first be opened and secured. Use you sense – look, listen, fell. And smell. Be quick and alert, but be thorough, and do not skimp or make assumptions. Ask the casualty to describe any sensations your touch causes as the examination proceeds. Though you should handle the casualty gently, your touch must be firm enough to ensure that you will feel any swelling or irregularity, or detect a tender spot.

CHECKING FOR SYMPTOMS

These are sensations that the casualty feels or experiences, and may be able to describe. You may need to ask questions to establish their presence or absence. Ask a conscious casualty if there is any pain and exactly where it is felt. Examine that part particularly, and then any other sites where pain is felt; severe pain in one place can mask a more serious, but less painful injury at another. Other symptoms that may help you include nausea, giddiness, heat, cold, weakness, and impaired sensation. All symptoms should be assessed and confirmed, wherever appropriate, by an examination for signs of injury or illness.

LOOKING FOR SIGNS

These are details discovered by applying your senses—sight, touch, hearing, and smell – often in the course of an examination. It’s common sighs of injury include bleeding, swelling, tenderness, or deformity; signs of illness that are very often evident are a pale or flushed skin, sweating, a raised body temperature, and a rapid pulse.

Making a diagnosis form signs

Many signs are immediately obvious, but others may be discovered only in the course of thorough physical examination. If the casualty is not conscious, confused or otherwise unreliable, your diagnosis may have to be formed purely on the basis of the circumstances of the incident, information obtained from onlookers, and the signs you discover.

SYMPTOMS AND SIGNS OF INJURY OR ILLNESS

The casualty may tell you these symptoms:
• Pain
• Apprehension
• Heat
• Cold
• Loss of normal movement
• Loss of sensation
• Abnormal sensation
• Thirst
• Nausea
• Tingling
• Faintness
• Stiffness
• Momentary unconsciousness
• Weakness
• Memory loss
• Dizziness
• Sensation of broken bone


You may see these signs
• Anxiety and painful expression
• Unusual chest movement
• Sweating
• Wounds
• Bleeding from orifices
• Response to touch
• Response to speech
• Bruising
• Abnormal skin colour
• Muscle spasm
• Swelling
• Deformity
• Foreign bodies
• Needle marks
• Vomit
• Incontinence
• Containers and other circumstantial evidence


You sense of touch may reveal these signs

• Dampness
• Abnormal body temperature
• Tenderness to touch or pressure
• Swelling
• Deformity
• Irregularity
• Grating bone ends


You may hear these signs

• Noisy or weakness of breathing
• Groaning
• Sucking sounds (chest injury)
• Response to touch
• Response to speech


Your sense of smell may detect these signs. Remember to smell the casualty’s breath

• Acetone
• Alcoholic liquors
• Burning
• Gas or fumes
• Solvents or glue
• Incontinence

THE SEQUENCE OF CARDIOPULMONARY RESUSCITATION (CPR)

THE SEQUENCE OF CARDIOPULMONARY RESUSCITATION (CPR)

When a casualty has no pulse and is not breathing, you must combine artificial ventilation with chest compression.. This is the sequence known as CPR. You must, if alone, call for help before you star CPR. With a helper – ideally, a second. First Aider – the situation become easier. In every case, you must persevere with resuscitation attempts until either a pulse returns, professional help arrives and takes over, or physical exhaustion forces you to stop.

FOR ONE FIRST AIDER

1. Immediately dial 999 for an ambulance. 

 2. Open the casualty’s airway by tilting the head and lifting the chin, and give two breaths of artificial ventilation. 

 3. Move your hands to the casualty’s chest, and give 15 chest compressions. 

4. Return to the head and give two more ventilation.

5. Give 15 further compressions.

6. Continue to give two ventilations every 15 compressions until professional help arrives. It is very unlikely that you will be rewarded by the heart re-starting before expert assistance is given. Do not interrupt CPR to make pulse checks unless there is any sign of a retuning circulation. With a pulse confirmed, check breathing and, if it is still absent, continue with artificial ventilation. Please check the pulse after every 10 breaths, and be prepared to re-start chest compressions if it disappears. If the casualty start to breathe unaided, place him or her in the recovery position. Re-check breathing and pulse every three minutes.

FOR TWO FIRST AIDERS

One person should go to summon help while the other immediately starts CPR. Then, either puoceed as above, each person taking it in turn, or while one of you gives chest compressions, the other can give one breath of artificial ventilation after every five compressions. Pause to ensure that the casualty’s chest rises, but do not wait for the chest to fall before continuing with chest compression.

MAKING A DIAGNOSIS

Once, it’s safe to start giving treatment, you must first identify what is wrong with the casualty. The process by which you recognise what is wrong is called diagnosis; this will often involve suspicion rather than certainty. Your diagnosis will be a conclusion, probability, on which you should be prepared to act. Making a diagnosis often requires a thorough physical examination. Factors that will help you include history and clues to any medical condition, and symptoms and signs. Throughout this chapter, the probable history, symptoms and signs of specific illnesses and injuries are grouped under the heading Recognition.

EXTERNAL CLUES

1. Pointers to diabetes An insulin syringe (which may look like a pen) and/or sugar lumps tell you that the casualty is a Diabetic.

2. Warning bracelet This example gives a telephone number for information about the casualty’s medical history.

3. Inhaler These ”puffer” aerosols are frequently carried by asthmatics and angina sufferers.

4. Medicines Glyceryl trinitrate is taken for angina, for example; phenobarbitone or phenytoin for epiletsy. Simpler remedies may give clues—indigestion tablets could indicate a stomach ulcer.

Resuscitation for Children

Resuscitation for Children

Fortunately, it is rare for a child’s heart to stop, but there are dangers in airway blockage and inadequate breathing. Artificial ventilation and chest compression can be performed on older children just as for adults, but they must be done slightly faster, and with lighter pressure. The techniques require some modifications for small children and babies.

CHECKING FOR A BABY’S BREATHING

Open the airway by gently lifting the chin and tilting the head. It helps to support the head slightly. You must look, listen, and feel for breathing.

Do Not, if clearing an obstruction with a finger, you have to touch the back of a young child’s throat. If the child is suffering from an infection of the airway, this can cause swelling and, possibly, total blockage.

CHECKING FOR A BABY’S CIRCULATION

It is difficult to feel the carotid pulse in an infant so, instead, use the brachial pulse. This is located on the inside of the upper arm, midway between shoulder and elbow. Place your index and middle fingers on the inside of the arm, and then press lightly towards the bone. It may help to place your thumb on the outside of the arm. Feel for 5 seconds before deciding there is no pulse.

ARTIFICIAL VENTILATION FOR A BABY

Babies should be given artificial ventilation at twice the rate used for adults and children, using the mouth to mouth and nose technique. Make a tight seal around the baby’s mouth and nose with your mouth, and nose with your mouth, and breathe into the lungs until the chest rises. Let the chest fall. Continue giving breaths at a rate of 20 per minutes.

CHEST COMPRESSION

If you cannot detect a pulse or, in infants, if it is very slow (less than 60 beats per minute), apply chest compressions to the lower half of the breastbone. Use the adult technique for a child of school age; for babies and small children, modify the technique and rate as below. Remember that, in the absence of a pulse, chest compression must be combined with artificial ventilation.

FOR A BABY

Lay the baby on a firm surface. To locate the correct position, imagine a line joining the baby’s nipples. Place the tips of two fingers just below the mid-point of this line, and press at a rate of 100 compressions per minute, to a depth of 1.5 to 2.5cm. Combine with artificial ventilation giving five compressions to one breath.

FOR A CHILD BELOW SCHOLL AGE

Find the correct position on the chest as you would for an adult. Using one hand only, and you press at a rate of 100 compressions per minute, depressing the chest by 2.5 to 3.5cm. Combine with artificial ventilation, giving five compressions to one breath

RESTORING THE CIRCUALATION

RESTORING THE CIRCUALATION

If there is no pulse, the heart has stopped. You will have to provide an artificial circulation by performing chest compression, in which will send blood to the brain. To be of any use to the brain, this supply of blood must be oxygenated, therefore chest compression must be combined with artificial ventilation in the way laid out in The Sequence of CPR (Cardio Pulmonary Resuscitation).

CHEST COMPRESSION

1. With the casualty lying flat on his back on a firm surface, kneel beside him, and find one of his lowest ribs using your index and middle fingers. Slide your fingers upwards to the point on the middle where the rib margins join at the breastbone. Place your middle finger over this point (the xiphistemun) and your index finger on the breastbone (stemum) above.

2. Place the heel of your other hand on the breastbone, and then slide it down until it reaches your index finger. This is the point at which you will apply pressure.

3. Place the heel of your first hand on top of the other hand, and interlock the fingers.

4. Leaning well over the casualty, with your arms straight on the chest, and press down vertically on the breastbone to depress it approximately 4 to 5 cm, then release the pressure without removing your hands. 

5. Repeat the compressions, aiming for a rate of approximately 80 compressions per minute. To combine with artificial ventilation, follow the sequence.

IF THE CHEST DOES NOT RISE

IF THE CHEST DOES NOT RISE

If you cannot get breaths into the casualty’s chest, check that:

• The head is tilted sufficiently for back.

• You have a firm seal around the casualty’s mouth.

• You have closed the nostrils completely

• The airway is not obstructed by vomit, blood or a foreign body.

CLEARING AN OBSTRUCTION

1. Providing the jaw is relaxed, sweep a finger around inside the mouth. Be very careful to avoid the back of the throat if doing this to a young child. 

2. If this fails, give backslaps and abdominal thrusts

Other forms of artificial ventilation

In situations such as rescue form water, or where mouth injuries make a good seal unpassable, you may choose to use the mouth-to-nose method of artificial ventilation. While it is usually easy to blow air into the nose, it is not so easy for the air to escape, the soft part of the noses may flop back like a valve. To give mouth-to-nose ventilation:

1. Wish the casualty’s mouth closed, form a tight seal with your lips around the casualty’s nose, and blow. 

2. Open the mouth to let the breath out. Babies should be given artificial ventilation using the mouth to mouth and nose method.

Mouth-to stoma ventilation

A laryngectomies is someone whose voice box (larynx) has been surgically removed, leaving a permanent a permanent opening (stoma in the front of the neck through which breathing takes place. Artificial ventilation must be given through the stoma. If the chest fails to rise and your air escapes from the casualty’s mouth, he or she may be a “partial neck breath”; you will have to close off the mouth and nose with your thumb and fingers while giving mouth-to-stoma ventilation.

The Recovery Position

The Recovery Position 

Any unconscious casualty should be placed in the recovery position. This position prevents the tongue form blocking the throat, and because the head is slightly lower than the rest of the body, it allows liquids to drain from the mouth, reducing the risk of the casualty inhaling stomach contents. The head, neck, and back are kept in a straight line, while the bent libs keep the body propped in a severe and comfortable position. If you must leave an unconscious casualty unattended, he or she can safely be left in the recovery position while you get help. The technique for turning shown below assumes that the casualty is lying on her back from the start. Not all the steps will be necessary if a casualty is found lying on his or her side or front. Before turning a casualty, remove his or her spectacles, if worn, and any bulky objects from pockets. 

METHOD

1. Kneeling beside the casualty, open her airway by tilting the head and lifting the chin. Straighten her lags. Place the arm nearest you out at right angles to her body elbow, and with the hand palm uppermost.

2. Bring the arm furthest from you across the chest, and hold the hand, palm outwards, against the casualty’s nearer cheek. 

3. With your other hand, group the thigh furthest from you and pull the knee up, keeping the foot flat on the ground. 

4. Keeping her hand pressed against her cheek, pull at the thigh to roll the casualty towards you and on to her side.

5. Tilt the head back to make sure the airway remains open. Adjust the hand under the cheek, if necessary, so that the head stays in this tilted position. 

6. Adjust the upper leg, if necessary, so that both the hip and the knee are bent at right-angles. 

7. Dial 999 for an ambulance. Check breathing while waiting for help to arrive.

ARTIFICIAL VENTILATION 

Expired air still contains 16 per cent oxygen, so you can use it to “breathe” for a casualty by blowing it into his or her lungs. The way this is done depends on the casualty’s condition:

• If a casualty has stopped breathing but still has a pulse, give 10 breaths of artificial ventilation, telephone for help, then continue at a rate of 10 breaths per minute until the casualty starts to breathe on his or her own, or until help arrives. Check for a pulse after every 10 breaths.

• If the casualty’s breathing and pulse have stopped, you must first phone forhelp, then combine artificial ventilation with chest compression

Using face shields

1. With the casualty lying flat on his back, please first remove any obvious obstruction, including broken or displaced dentures, from the mouth. Leave well-fitting dentures in place

2. Open the airway by tilting the head and lifting the chin

3. Close the casualty’s nose by pinching it with your index finger and thumb. Please take a full breath, and place your lips around his mouth, making a good seal.

4. Please blow into the casualty’s mouth until you see the chest rise. Take about two seconds for full inflation.

5. Remove your lips and allow the chest to full fully. Deliver subsequent breaths in the same manner.