Amaresh Jha: March 2014

First aid

Definition

First aid is the initial basic treatment of an injured or ill person. First aid requires an observer first to evaluate the injured or ill person and then to intervene, using a small amount of supplies.

Purpose

First aid is provided to a person immediately following an accident or onset of illness to decrease complications and to offer psychological (emotional) and physical comfort. It is performed to decrease the individual's pain and suffering until emergency medical technicians (EMTs) or other health care givers arrive on the scene.

Precautions

The provision of first aid should never postpone the initial contact with the emergency medical system. The bystander should wear disposable latex gloves if available, in case of contact with blood or body fluids. If gloves are not available, plastic bags or wrap can be used as a protective barrier.
Description

First aid is a universal term that encompasses many general concepts for rapid assessment of health crises and intervention. The sections listed above present the most common injuries and illnesses requiring first aid, and the interventions appropriate in these situations.

First-aid kit

A well-stocked first-aid kit can help you respond effectively to common injuries and emergencies. Keep at least one first-aid kit in your home and one in your car. Store your kits in easy-to-retrieve locations that are out of the reach of young children. Children old enough to understand the purpose of the kits should know where they are stored. Contents of a first-aid kit should include:

Basic supplies

ü Adhesive tape

ü Antibiotic ointment

ü Antiseptic solution or towelettes

ü Bandages, including a roll of elastic wrap (Ace, Coban, others) and bandage strips (Band-Aid, Curad, others) in assorted sizes

ü Instant cold packs

ü Cotton balls and cotton-tipped swabs

ü Disposable latex or synthetic gloves, at least two pairs

ü Duct tape

ü Gauze pads and roller gauze in assorted sizes

ü Eye goggles

ü First-aid manual

ü Petroleum jelly or other lubricant

ü Plastic bags for the disposal of contaminated materials

ü Safety pins in assorted sizes

ü Save-A-Tooth storage device containing salt solution and a travel case

ü Scissors, tweezers and a needle

ü Soap or instant hand sanitizer

ü Sterile eyewash, such as a saline solution

ü Thermometer

ü Triangular bandage

ü Turkey baster or other bulb suction device for flushing out wounds

Medications

ü Activated charcoal (use only if instructed by your poison control center)

ü Aloe vera gel

ü Anti-diarrhea medication

ü Over-the-counter oral antihistamine (Benadryl, others)

ü Aspirin and nonaspirin pain relievers (never give aspirin to children)

ü Calamine lotion

ü Over-the-counter hydrocortisone cream

ü Personal medications that don't need refrigeration

ü If prescribed by your doctor, drugs to treat an allergic attack, such as an auto-injector of epinephrine (EpiPen)

ü Syringe, medicine cup or spoon

Emergency items

ü Cell phone and recharger that uses the accessory plug in your car dash

ü Emergency phone numbers, including contact information for your family doctor and pediatrician, local emergency services, emergency road service providers and the regional poison control center

ü Medical consent forms for each family member

ü Medical history forms for each family member

ü Small, waterproof flashlight and extra batteries

ü Candles and matches for cold climates

ü Sunscreen

ü Mylar emergency blanket

ü First-aid instruction manual

Give your kit a check-up Check your first-aid kits regularly, at least every months, to be sure the flashlight batteries work and to replace supplies that have expired. Prepare children for medical emergencies in age-appropriate ways. The American Red Cross offers a number of helpful resources, including classes designed to help children understand and use first-aid techniques.

Anaphylaxis

A life-threatening allergic reaction (anaphylaxis) can cause shock, a sudden drop in blood pressure and trouble breathing. In people who have an allergy, anaphylaxis can occur minutes after exposure to a specific allergy-causing substance (allergen). In some cases, there may be a delayed reaction or anaphylaxis may occur without an apparent trigger.

If you are with someone having an allergic reaction with signs of anaphylaxis:

1. Immediately call 108, 102, or your local medical emergency number.

2. Ask the person if he or she is carrying an epinephrine auto injector to treat an allergic attack (for example, EpiPen[AJ1] , Twinject).

3. If the person says he or she needs to use an auto injector, ask whether you should help inject the medication. This is usually done by pressing the auto injector against the person's thigh.

4. Have the person lie still on his or her back.

5. Loosen tight clothing and cover the person with a blanket. Don't give the person anything to drink.

6. If there's vomiting or bleeding from the mouth, turn the person on his or her side to prevent choking.

7. If there are no signs of breathing, coughing or movement, begin CPR. Do uninterrupted chest presses of about two a second until paramedics arrive.

8. Get emergency treatment even if symptoms start to improve. After anaphylaxis, it's possible for symptoms to recur. Monitoring in a hospital setting for several hours is usually necessary.

If you're with someone having signs of anaphylaxis, don't wait to see whether symptoms get better. Seek emergency treatment right away. In severe cases, untreated anaphylaxis can lead to death within half an hour. An antihistamine pill, such as diphenhydramine (Benadryl, others), isn't sufficient to treat anaphylaxis. These medications can help relieve allergy symptoms, but work too slowly in a severe reaction to help.

Signs and symptoms of anaphylaxis include:

* Skin reactions including hives, itching, and flushed or pale skin

* Swelling of the face, eyes, lips or throat

* Constriction of the airways, leading to wheezing and trouble breathing

* A weak and rapid pulse

* Nausea, vomiting or diarrhoea

* Dizziness, fainting or unconsciousness

Some common anaphylaxis triggers include:

* Medications (especially penicillin)

* Foods such as peanuts, tree nuts, fish and shellfish

* Insect stings from bees, yellow jackets, wasps, hornets and fire ants

Animal Bites

If an animal bites you or your child, follow these guidelines:

ü For minor wounds. If the bite barely breaks the skin and there is no danger of rabies, treat it as a minor wound. Wash the wound thoroughly with soap and water. Apply an antibiotic cream to prevent infection and cover the bite with a clean bandage.

ü For deep wounds. If the animal bite creates a deep puncture of the skin or the skin is badly torn and bleeding, apply pressure with a clean, dry cloth to stop the bleeding and see your doctor.

ü For infection. If you notice signs of infection, such as swelling, redness, increased pain or oozing, see your doctor immediately.

ü For suspected rabies. If you suspect the bite was caused by an animal that might carry rabies — including any wild or domestic animal of unknown immunization status — see your doctor immediately.

Doctors recommend getting a tetanus shot every 10 years. If your last one was more than five years ago and your wound is deep or dirty, your doctor may recommend a booster. You should have the booster as soon as possible after the injury.

Domestic pets cause most animal bites. Dogs are more likely to bite than cats are. Cat bites, however, are more likely to cause infection. Bites from nonimmunized domestic animals and wild animals carry the risk of rabies. Rabies is more common in raccoons, skunks, bats and foxes than in cats and dogs. Rabbits, squirrels and other rodents rarely carry rabies.

Black Eye

The so-called black eye is caused by bleeding beneath the skin around the eye. Sometimes a black eye indicates a more extensive injury, even a skull fracture, particularly if the area around both eyes is bruised (raccoon eyes) or if there has been a head injury.

Although most black eye injuries aren't serious, sometimes there is an accompanying injury to the eyeball itself sufficient to cause bleeding inside the eye. Bleeding in the front part of the eye, called a hyphema, is serious and can reduce vision and damage the cornea — the clear, protective "window" at the front of the eye. In some cases, abnormally high pressure inside the eyeball (glaucoma) also can result. For this reason, it's advisable to have an eye specialist examine your eyeball if there has been enough of an injury to cause a black eye.

To take care of a black eye:

* Using gentle pressure, apply a cold pack or a cloth filled with ice to the area around the eye. Take care not to press on the eye itself. Apply cold as soon as possible after the injury to reduce swelling, and continue using ice or cold packs for 24 to 48 hours.

* Be sure there's no blood within the white and colored parts of the eye.

* Seek medical care immediately if you experience vision problems (double vision, blurring), severe pain, or bleeding in the eye or from the nose.

Blisters

Common causes of blisters include friction and burns. If the blister isn't too painful, try to keep it intact. Unbroken skin over a blister provides a natural barrier to bacteria and decreases the risk of infection. Cover a small blister with an adhesive bandage, and cover a large one with a porous, plastic-coated gauze pad that absorbs moisture and allows the wound to breathe. If you are allergic to the adhesive used in some tape, use paper tape. Do not puncture a blister unless it is painful or prevents you from walking or using one of your hands. If you have diabetes or poor circulation, call your doctor before considering the self-care measures below.

To relieve blister-related pain, drain the fluid while leaving the overlying skin intact. Here's how:

ü Wash your hands and the blister with soap and warm water.

ü Swab the blister with iodine or rubbing alcohol.

ü Sterilize a clean, sharp needle by wiping it with rubbing alcohol.

ü Use the needle to puncture the blister. Aim for several spots near the blister's edge. Let the fluid drain, but leave the overlying skin in place.

ü Apply an antibiotic ointment to the blister and cover with a bandage or gauze pad.

ü Cut away all the dead skin after several days, using tweezers and scissors sterilized with rubbing alcohol. Apply more ointment and a bandage.

Call your doctor if you see signs of infection around a blister — pus, redness, increasing pain or warm skin.

To prevent a blister, use gloves, socks, a bandage or similar protective covering over the area being rubbed. Special athletic socks are available that have extra padding in critical areas. You might also try attaching moleskin to the inside of your shoe where it might rub, such as at the heel.

A blister unless it's painful or prevents you from walking or using one of your hands. If you have diabetes or poor circulation, call your doctor before considering the self-care measures below.

To relieve blister-related pain, drain the fluid while leaving the overlying skin intact. Here's how:

ü Wash your hands and the blister with soap and warm water.

ü Swab the blister with iodine or rubbing alcohol.

ü Sterilize a clean, sharp needle by wiping it with rubbing alcohol.

ü Use the needle to puncture the blister. Aim for several spots near the blister's edge. Let the fluid drain, but leave the overlying skin in place.

ü Apply an antibiotic ointment to the blister and cover with a bandage or gauze pad.

ü Cut away all the dead skin after several days, using tweezers and scissors sterilized with rubbing alcohol. Apply more ointment and a bandage.

ü Call your doctor if you see signs of infection around a blister — pus, redness, increasing pain or warm skin.

To prevent a blister, use gloves, socks, a bandage, or similar protective covering over the area being rubbed. Special athletic socks are available that have extra padding in critical areas. You might also try attaching moleskin to the inside of your shoe where it might rub, such as at the heel.

Bruise

A bruise forms when a blow breaks blood vessels near your skin's surface, allowing a small amount of blood to leak into the tissues under your skin. The trapped blood appears as a black-and-blue mark.

If your skin isn't broken, you don't need a bandage, but you enhance bruise healing with these simple techniques:

ü Elevate the injured area.

ü Apply ice or a cold pack several times a day for a day or two after the injury.

ü Rest the bruised area, if possible.

ü Consider acetaminophen (Tylenol, others) for pain relief, or ibuprofen (Advil, Motrin, others) for pain relief and to reduce swelling.

See your doctor if:

ü You have unusually large or painful bruises — particularly if your bruises seem to develop for no known reasons.

ü You bruise easily and you're experiencing abnormal bleeding elsewhere, such as from your nose or gums, or you notice blood in your eyes, stool or urine.

ü You have no history of bruising, but suddenly experience bruises.

These signs and symptoms may indicate a more serious problem, such as a blood-clotting problem or blood-related disease. Bruises accompanied by persistent pain or headache also may indicate a more serious underlying illness and require medical attention.

Burns

To distinguish a minor burn from a serious burn, the first step is to determine the extent of damage to body tissues. The three burn classifications of first-degree burn, second-degree burn and third-degree burn will help you determine emergency care:

First-degree burn

The least serious burns are those in which only the outer layer of skin is burned, but not all the way through. The skin is usually red, with swelling, and pain sometimes is present. Treat a first-degree burn as a minor burn unless it involves substantial portions of the hands, feet, face, groin or buttocks, or a major joint, which requires emergency medical attention.

Second-degree burn

When the first layer of skin has been burned through and the second layer of skin (dermis) also is burned, the injury is called a second-degree burn. Blisters develop and the skin takes on an intensely reddened, splotchy appearance. Second-degree burns produce severe pain and swelling.

If the second-degree burn is no larger than 3 inches (7.6 centimeters) in diameter, treat it as a minor burn. If the burned area is larger or if the burn is on the hands, feet, face, groin or buttocks, or over a major joint, treat it as a major burn and get medical help immediately.

For minor burns, including first-degree burns and second-degree burns limited to an area no larger than 3 inches (7.6 centimeters) in diameter, take the following action:

ü Cool the burn. Hold the burned area under cool (not cold) running water for 10 or 15 minutes or until the pain subsides. If this is impractical, immerse the burn in cool water or cool it with cold compresses. Cooling the burn reduces swelling by conducting heat away from the skin. Don't put ice on the burn.

ü Cover the burn with a sterile gauze bandage. Don't use fluffy cotton, or other material that may get lint in the wound. Wrap the gauze loosely to avoid putting pressure on burned skin. Bandaging keeps air off the burn, reduces pain and protects blistered skin.

ü Take an over-the-counter pain reliever. These include aspirin, ibuprofen (Advil, Motrin, others), naproxen (Aleve) or acetaminophen (Tylenol, others). Use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 2, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. Talk to your doctor if you have concerns.

Minor burns usually heal without further treatment. They may heal with pigment changes, meaning the healed area may be a different color from the surrounding skin. Watch for signs of infection, such as increased pain, redness, fever, swelling or oozing. If infection develops, seek medical help. Avoid re-injuring or tanning if the burns are less than a year old — doing so may cause more extensive pigmentation changes. Use sunscreen on the area for at least a year.

Caution

ü Don't use ice. Putting ice directly on a burn can cause a burn victim's body to become too cold and cause further damage to the wound.

ü Don't apply butter or ointments to the burn. This could cause infection.

ü Don't break blisters. Broken blisters are more vulnerable to infection.

Third-degree burn

The most serious burns involve all layers of the skin and cause permanent tissue damage. Fat, muscle, and even bone may be affected. Areas may be charred black or appear dry and white. Difficulty inhaling and exhaling, carbon monoxide poisoning, or other toxic effects may occur if smoke inhalation accompanies the burn.

For major burns, call 108 or 102 or emergency medical help. Until an emergency unit arrives, follow these steps:

1. Don't remove burned clothing. However, do make sure the victim is no longer in contact with smoldering materials or exposed to smoke or heat.

2. Don't immerse large severe burns in cold water. Doing so could cause a drop in body temperature (hypothermia) and deterioration of blood pressure and circulation (shock).

3. Check for signs of circulation (breathing, coughing or movement). If there is no breathing or other sign of circulation, begin CPR.

4. Elevate the burned body part or parts. Raise above heart level, when possible.

5. Cover the area of the burn. Use a cool, moist, sterile bandage; clean, moist cloth; or moist towels.

Get a tetanus shot. Burns are susceptible to tetanus. Doctors recommend you get a tetanus shot every 10 years. If your last shot was more than five years ago, your doctor may recommend a tetanus shot booster.

Cardiopulmonary resuscitation (CPR)

Cardiopulmonary resuscitation (CPR) is a lifesaving technique useful in many emergencies, including heart attack or near drowning, in which someone is breathing or heartbeat has stopped. In 2010, the American Heart Association updated its guidelines to recommend that everyone — untrained bystanders and medical personnel alike — begin CPR with chest compressions.

It is far better to do something than to do nothing at all if you are fearful that your knowledge or abilities are not 100 percent complete. Remember, the difference between you are doing something and doing nothing could be someone's life.

Here is advice from the American Heart Association:

ü Untrained. If you are not trained in CPR, then provide hands-only CPR. That means uninterrupted chest compressions of about 100 a minute until paramedics arrive (described in more detail below). You do not need to try rescue breathing.

ü Trained, and ready to go. If you are well trained and confident in your ability, begin with chest compressions instead of first checking the airway and doing rescue breathing. Start CPR with 30 chest compressions before checking the airway and giving rescue breaths.

ü Trained, but rusty. If you have previously received CPR training but you are not confident in your abilities, then just do chest compressions at a rate of about 100 a minute. (Details described below.)

The above advice applies to adults, children, and infants needing CPR, but not new-borns.

CPR can keep oxygenated blood flowing to the brain and other vital organs until more definitive medical treatment can restore a normal heart rhythm.

When the heart stops, the absence of oxygenated blood can cause irreparable brain damage in only a few minutes. A person may die within eight to 10 minutes.

Before starting CPR, check:

ü Is the person conscious or unconscious?

ü If the person appears unconscious, tap or shake his or her shoulder and ask loudly, "Are you OK?"

ü If the person doesn't respond and two people are available, one should call 108 or 102 or the local emergency number and one should begin CPR. If you are alone and have immediate access to a telephone, call 108 or 102 before beginning CPR — unless you think the person has become unresponsive because of suffocation (such as from drowning). In this special case, begin CPR for one minute and then call 108 or 102 or the local emergency number.

ü If an AED is immediately available, deliver one shock if instructed by the device, then begin CPR.

Remember to spell C-A-B (circulation, airway, breathing)

In 2010, the American Heart Association changed its long-held acronym of ABC to CAB — circulation, airway, breathing — to help people remember the order to perform the steps of CPR. This change emphasizes the importance of chest compressions to help keep blood flowing through the heart and to the brain.

Circulation: Restore blood circulation with chest compressions

1. Put the person on his or her back on a firm surface.

2. Kneel next to the person's neck and shoulders.

3. Place the heel of one hand over the center of the person's chest, between the nipples. Place your other hand on top of the first hand. Keep your elbows straight and position your shoulders directly above your hands.

4. Use your upper body weight (not just your arms) as you push straight down on (compress) the chest at least 2 inches (approximately 5 centimetres). Push hard at a rate of about 100 compressions a minute.

5. If you haven't been trained in CPR, continue chest compressions until there are signs of movement or until emergency medical personnel take over. If you have been trained in CPR, go on to checking the airway and rescue breathing.

Airway: Clear the airway

1. If you're trained in CPR and you've performed 30 chest compressions, open the person's airway using the head-tilt, chin-lift manoeuvre. Put your palm on the person's forehead and gently tilt the head back. Then with the other hand, gently lift the chin forward to open the airway.

2. Check for normal breathing, taking no more than five or 10 seconds. Look for chest motion, listen for normal breath sounds, and feel for the person's breath on your cheek and ear. Gasping is not considered to be normal breathing. If the person isn't breathing normally and you are trained in CPR, begin mouth-to-mouth breathing. If you believe the person is unconscious from a heart attack and you haven't been trained in emergency procedures, skip mouth-to-mouth rescue breathing and continue chest compressions.

Breathing: Breathe for the person

Rescue breathing can be mouth-to-mouth breathing or mouth-to-nose breathing if the mouth is seriously injured or can't be opened.

1. With the airway open (using the head-tilt, chin-lift maneuver), pinch the nostrils shut for mouth-to-mouth breathing and cover the person's mouth with yours, making a seal.

2. Prepare to give two rescue breaths. Give the first rescue breath — lasting one second — and watch to see if the chest rises. If it does rise, give the second breath. If the chest doesn't rise, repeat the head-tilt, chin-lift maneuver and then give the second breath. Thirty chest compressions followed by two rescue breaths is considered one cycle.

3. Resume chest compressions to restore circulation.

4. If the person has not begun moving after five cycles (about two minutes) and an automatic external defibrillator (AED) is available, apply it and follow the prompts. Administer one shock, then resume CPR — starting with chest compressions — for two more minutes before administering a second shock. If you're not trained to use an AED, a 108 or 102 operator may be able to guide you in its use. Use pediatric pads, if available, for children ages 1 through 8. Do not use an AED for babies younger than age 1. If an AED isn't available, go to step 5 below.

5. Continue CPR until there are signs of movement or emergency medical personnel take over.

To perform CPR on a child

The procedure for giving CPR to a child age 1 through 8 is essentially the same as that for an adult. The differences are as follows:

ü If you're alone, perform five cycles of compressions and breaths on the child — this should take about two minutes — before calling 108 or 102 or your local emergency number or using an AED.

ü Use only one hand to perform heart compressions.

ü Breathe more gently.

ü Use the same compression-breath rate as is used for adults: 30 compressions followed by two breaths. This is one cycle. Following the two breaths, immediately begin the next cycle of compressions and breaths.

ü After five cycles (about two minutes) of CPR, if there is no response and an AED is available, apply it and follow the prompts. Use pediatric pads if available. If pediatric pads aren't available, use adult pads.

ü Continue until the child moves or help arrives.
To perform CPR on a baby

ü Most cardiac arrests in babies occur from lack of oxygen, such as from drowning or choking. If you know the baby has an airway obstruction, perform first aid for choking. If you don't know why the baby isn't breathing, perform CPR.

ü To begin, examine the situation. Stroke the baby and watch for a response, such as movement, but don't shake the baby.

ü If there's no response, follow the CAB procedures below and time the call for help as follows:

ü If you're the only rescuer and CPR is needed, do CPR for two minutes — about five cycles — before calling 108 or 102 or your local emergency number.
* If another person is available, have that person call for help immediately while you attend to the baby.

Circulation: Restore blood circulation

1. Place the baby on his or her back on a firm, flat surface, such as a table. The floor or ground also will do.

2. Imagine a horizontal line drawn between the baby's nipples. Place two fingers of one hand just below this line, in the center of the chest.

3. Gently compress the chest about 1.5 inches (about 4 cm).

4. Count aloud as you pump in a fairly rapid rhythm. You should pump at a rate of 100 compressions a minute.

Airway: Clear the airway

1. After 30 compressions, gently tip the head back by lifting the chin with one hand and pushing down on the forehead with the other hand.

2. In no more than 10 seconds, put your ear near the baby's mouth and check for breathing: Look for chest motion, listen for breath sounds, and feel for breath on your cheek and ear.

Breathing: Breathe for the infant

1. Cover the baby's mouth and nose with your mouth.

2. Prepare to give two rescue breaths. Use the strength of your cheeks to deliver gentle puffs of air (instead of deep breaths from your lungs) to slowly breathe into the baby's mouth one time, taking one second for the breath. Watch to see if the baby's chest rises. If it does, give a second rescue breath. If the chest does not rise, repeat the head-tilt, chin-lift manoeuvre and then give the second breath.

3. If the baby's chest still doesn't rise, examine the mouth to make sure no foreign material is inside. If the object is seen, sweep it out with your finger. If the airway seems blocked, perform first aid for a choking baby.

4. Give two breaths after every 30 chest compressions.

5. Perform CPR for about two minutes before calling for help unless someone else can make the call while you attend to the baby.

6. Continue CPR until you see signs of life or until medical personnel arrive.

Chemical burns

If a chemical burns the skin, follow these steps:

1. Remove the cause of the burn by first brushing any remaining dry chemical and then rinsing the chemical off the skin surface with cool, gently running water for 20 minutes or more.

2. Remove clothing or jewelry that has been contaminated by the chemical.

3. Wrap the burned area loosely with a dry, sterile dressing or a clean cloth.

4. Rewash the burned area for several more minutes if the person experiences increased burning after the initial washing.

5. Take an over-the-counter pain reliever. These include aspirin, ibuprofen (Advil, Motrin, others), naproxen (Aleve) or acetaminophen (Tylenol, others). Use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 2, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. Talk to your doctor if you have concerns.

Get a tetanus shot. All burns are susceptible to tetanus. Doctors recommend you get a tetanus shot every 10 years. If your last shot was more than five years ago, your doctor may recommend a tetanus shot booster.

Minor chemical burns usually heal without further treatment.

Seek emergency medical assistance if:

· The person shows signs of shock, such as fainting, pale complexion or breathing in a notably shallow manner

· The chemical burn penetrated through the first layer of skin, and the resulting second-degree burn covers an area more than 3 inches (7.6 centimetres) in diameter

· The chemical burn occurred on the eye, hands, feet, face, groin or buttocks, or over a major joint

· The person has pain that cannot be controlled with over-the-counter pain relievers

If you are unsure whether a substance is toxic, call the poison control centre at 1066. If you seek emergency assistance, take the chemical container or a complete description of the substance with you for identification.

Chemical splashes into your eye

If a chemical splashes into your eye, take these steps immediately:

ü Flush your eye with water. Use clean, lukewarm tap water for at least 20 minutes, and use whichever of these approaches is quickest:

ü Get into the shower and aim a gentle stream of lukewarm water on your forehead over your affected eye. or direct the stream on the bridge of your nose if both eyes are affected. Hold your affected eye or eyes open.

ü Put your head down and turn it to the side. Then hold your affected eye open under a gently running faucet.

ü Young children may do best if they lie down in the bathtub or lean back over a sink while you pour a gentle stream of water on the forehead over the affected eye or on the bridge of the nose for both eyes.

ü Wash your hands with soap and water. Thoroughly rinse your hands to be sure no chemical or soap is left on them. Your first goal is to get the chemical off the surface of your eye, but then you must remove the chemical from your hands.

Remove contact lenses. If they do not come out during the flush, then take them out.

Caution:

ü Don't rub the eye — this may cause further damage.

ü Don't put anything except water or contact lens saline rinse in the eye, and don't use eyedrops unless emergency personnel tell you to do so.

ü Seek emergency medical assistance

ü After following the above steps, seek emergency care or, if necessary, call 108 or 102 or your local emergency number.

ü Take the chemical container or the name of the chemical with you to the emergency department. If readily available, wear sunglasses because your eyes will be sensitive to light.

Chest pain

Causes of chest pain can vary from minor problems, such as indigestion or stress, to serious medical emergencies, such as a heart attack or pulmonary embolism. The specific cause of chest pain is often difficult to interpret.

Finding the cause of your chest pain can be challenging, especially if you have never had symptoms in the past. Even doctors may have a difficult time deciding if chest pain is a sign of a heart attack or something less serious, such as indigestion. If you have unexplained chest pain lasting more than a few minutes, you should seek emergency medical assistance rather than trying to diagnose the cause yourself.

As with other sudden, unexplained pains, chest pain may be a signal for you to get medical help. Use the following information to help you determine whether your chest pain is a medical emergency.
Heart attack

A heart attack occurs when an artery that supplies oxygen to your heart muscle becomes blocked. A heart attack may cause chest pain that lasts 15 minutes or longer. However, a heart attack can also be silent and produce no signs or symptoms.

Many people who experience a heart attack have warning symptoms hours, days, or weeks in advance. The earliest warning sign of an attack may be ongoing episodes of chest pain that start when you are physically active, but are relieved by rest.

Someone having a heart attack may experience any or all of the following:

ü Uncomfortable pressure, fullness or squeezing pain in the centre of the chest lasting more than a few minutes

ü Pain spreading to the shoulders, neck or arms

ü Light-headedness, fainting, sweating, nausea or shortness of breath

If you or someone else may be having a heart attack:

ü Call emergency medical assistance.

ü Do not "tough out" the symptoms of a heart attack for more than five minutes. If you do not have access to emergency medical services, have someone, such as a neighbour or friend, drive you to the nearest hospital. Drive yourself only as a last resort, if there are no other options. Driving yourself puts you and others at risk if your condition suddenly worsens.

ü Chew a regular-strength aspirin. Aspirin reduces blood clotting, which can help blood flow through a narrowed artery that has caused a heart attack. However, do not take aspirin if you are allergic to aspirin, have bleeding problems or take another blood-thinning medication, or if your doctor previously told you not to do so.

ü Take nitro-glycerine, if prescribed. If you think you are having a heart attack and your doctor has previously prescribed nitro-glycerine for you, take it as directed. Don't take anyone else's nitro-glycerine.

ü Begin CPR on the person having a heart attack, if directed. If the person suspected of having a heart attack is unconscious, a 108 or 102 dispatcher or another emergency medical specialist may advise you to begin cardiopulmonary resuscitation (CPR). Even if you're not trained, a dispatcher can instruct you in CPR until help arrives. If help from a 108 or 102 dispatcher or emergency medical specialist is unavailable, begin CPR. If you don't know CPR, begin pushing hard and fast on the person's chest — 100 compressions per minute.

Angina

Angina is a type of chest pain or discomfort caused by reduced blood flow to your heart muscle. Angina may be stable or unstable:

1. Stable angina — persistent, recurring chest pain that usually occurs with exertion

2. Unstable angina — sudden, new chest pain, or a change in the pattern of previously stable angina, that may signal an impending heart attack

Angina is relatively common, but can be hard to distinguish from other types of chest pain, such as the pain or discomfort of indigestion.

Angina signs and symptoms include:

* Chest pain or discomfort

* Pain in your arms, neck, jaw, shoulder or back accompanying chest pain

* Nausea

* Fatigue

* Shortness of breath

* Anxiety

* Sweating

* Dizziness

The severity, duration, and type of angina can vary. If you have new or changing chest pain, these new or different symptoms may signal a more dangerous form of angina (unstable angina) or a heart attack. If your angina gets worse or changes, becoming unstable, seek medical attention immediately.

Pulmonary embolism

Pulmonary embolism occurs when a clot — usually from the veins of your leg or pelvis — lodges in an artery of your lung. The lung tissue served by the artery doesn't get enough blood flow, causing tissue death. This makes it more difficult for your lungs to provide oxygen to the rest of your body.

Signs and symptoms of pulmonary embolism include:

* Sudden, sharp chest pain that begins or worsens with a deep breath or a cough, often accompanied by shortness of breath

* Sudden, unexplained shortness of breath, even without pain

* Cough that may produce blood-streaked sputum

* Rapid

* Heartbeat

* Fainting

* Anxiety

* Sweating

Pulmonary embolism can be life threatening. As with a suspected heart attack, call 108 or 102 or emergency medical assistance immediately.

Aortic dissection

An aortic dissection is a serious condition in which a tear develops in the inner layer of the aorta, the large blood vessel branching off the heart. Blood surges through this tear into the middle layer of the aorta, causing the inner and middle layers to separate (dissect). If the blood-filled channel ruptures through the outside aortic wall, aortic dissection is usually fatal.

If you think aortic dissection is the cause of your chest pain, seek emergency medical assistance immediately.
Pneumonia with pleurisy

Frequent signs and symptoms of pneumonia are chest pain accompanied by chills, fever and a cough that may produce bloody or foul-smelling sputum. When pneumonia occurs with an inflammation of the membranes that surround the lung (pleura), you may have considerable chest discomfort when inhaling or coughing. This condition is called pleurisy.

One sign of pleurisy is that the pain is usually relieved temporarily by holding your breath or putting pressure on the painful area of your chest. This isn't true of a heart attack. If you've recently been diagnosed with pneumonia and then start having symptoms of pleurisy, contact your doctor or seek immediate medical attention to determine the cause of your chest pain. Pleurisy alone isn't a medical emergency, but you shouldn't try to make the diagnosis yourself.
Chest wall pain

One of the most common varieties of harmless chest pain is chest wall pain. One kind of chest wall pain is costochondritis. It causes pain and tenderness in and around the cartilage that connects your ribs to your breastbone (sternum).

In costochondritis, pressing on a few points along the edge of your sternum often results in considerable tenderness in those small areas. If the pressure of a finger causes similar chest pain, it's unlikely that a serious condition, such as a heart attack, is the cause of your chest pain.

Other causes of chest pain include:

* Strained chest muscles from overuse or excessive coughing

* Chest muscle bruising from minor injury

* Short-term, sudden anxiety with rapid breathing

* Peptic ulcer disease

* Pain from the digestive tract, such as esophageal reflux, peptic ulcer pain or gallbladder pain that may feel similar to heart attack symptoms

Choking

Choking occurs when a foreign object becomes lodged in the throat or windpipe, blocking the flow of air. In adults, a piece of food often is the culprit. Young children often swallow small objects. Because choking cuts off oxygen to the brain, administer first aid as quickly as possible.

The universal sign for choking is hands clutched to the throat. If the person doesn't give the signal, look for these indications:

* Inability to talk

* Difficulty breathing or noisy breathing

* Inability to cough forcefully

* Skin, lips and nails turning blue or dusky

* Loss of consciousness

If choking is occurring, the Red Cross recommends a "five-and-five" approach to delivering first aid:

Give 5 back blows. First, deliver five back blows between the person's shoulder blades with the heel of your hand.

Give 5 abdominal thrusts. Perform five abdominal thrusts (also known as the Heimlich manoeuvre).

Alternate between 5 blows and 5 thrusts until the blockage is dislodged.

To perform abdominal thrusts (Heimlich manoeuvre) on someone else:

Stand behind the person. Wrap your arms around the waist. Tip the person forward slightly.
Make a fist with one hand. Position it slightly above the person's navel.
Grasp the fist with the other hand. Press hard into the abdomen with a quick, upward thrust —

as if trying to lift the person up.

Perform a total of 5 abdominal thrusts, if needed. If the blockage still isn't dislodged, repeat the five-and-five cycle.

If you're the only rescuer, perform back blows and abdominal thrusts before calling 108 or 102 or your local emergency number for help. If another person is available, have that person call for help while you perform first aid.

If the person becomes unconscious, perform standard CPR with chest compressions.

To perform abdominal thrusts (Heimlich manoeuvre) on yourself:

If you're alone and choking, you'll be unable to effectively deliver back blows to yourself. However, you can still perform abdominal thrusts to dislodge the item.

Place a fist slightly above your navel.

Grasp your fist with the other hand and bend over a hard surface — a countertop or chair will do.

Shove your fist inward and upward.

Clearing the airway of a pregnant woman or obese person:

Position your hands a little bit higher than with a normal Heimlich maneuver, at the base of the breastbone, just above the joining of the lowest ribs.

Proceed as with the Heimlich maneuver, pressing hard into the chest, with a quick thrust.
Repeat until the food or other blockage is dislodged or the person becomes unconscious.

Clearing the airway of an unconscious person:

Lower the person on his or her back onto the floor.

Clear the airway. If there's a visible blockage at the back of the throat or high in the throat, reach a finger into the mouth and sweep out the cause of the blockage. Be careful not to push the food or object deeper into the airway, which can happen easily in young children.

Begin cardiopulmonary resuscitation (CPR) if the object remains lodged and the person doesn't respond after you take the above measures. The chest compressions used in CPR may dislodge the object. Remember to recheck the mouth periodically.

Clearing the airway of a choking infant younger than age 1:

Assume a seated position and hold the infant facedown on your forearm, which is resting on your thigh.
Thump the infant gently but firmly five times on the middle of the back using the heel of your hand. The combination of gravity and the back blows should release the blocking object.
Hold the infant faceup on your forearm with the head lower than the trunk if the above doesn't work. Using two fingers placed at the center of the infant's breastbone, give five quick chest compressions.
Repeat the back blows and chest thrusts if breathing doesn't resume. Call for emergency medical help.
Begin infant CPR if one of these techniques opens the airway but the infant doesn't resume breathing.

If the child is older than age 1, give abdominal thrusts [AJ2] only.

To prepare yourself for these situations, learn the Heimlich maneuver and CPR in a certified first-aid training course.

Corneal abrasions

The most common types of eye injury involve the cornea — the clear, protective "window" at the front of your eye. Contact with dust, dirt, sand, wood shavings, metal particles or even an edge of a piece of paper can scratch or cut the cornea. Usually the scratch is superficial, and this is called a corneal abrasion. Some corneal abrasions become infected and result in a corneal ulcer, which is a serious problem. Corneal abrasions caused by plant matter (such as a pine needle) can cause a delayed inflammation inside the eye (iritis).

Corneal abrasions can be painful. If your cornea is scratched, you might feel like you have sand in your eye. Tears, blurred vision, increased sensitivity or redness around the eye can suggest a corneal abrasion. You may get a headache.

In case of corneal abrasion, seek prompt medical attention. Other immediate steps you can take for a corneal abrasion are to:

Rinse your eye with clean water (use a saline solution, if available). You can use an eyecup or small, clean drinking glass positioned with its rim resting on the bone at the base of your eye socket. If your work site has an eye-rinse station, use it. Rinsing the eye may wash out a foreign object.

Blink several times. This movement may remove small particles of dust or sand.

Pull the upper eyelid over the lower eyelid. The lashes of your lower eyelid can brush a foreign object from the undersurface of your upper eyelid.

Take caution to avoid certain actions that may aggravate the injury:

Don't try to remove an object that's embedded in your eyeball. Also avoid trying to remove a large object that makes closing the eye difficult.

Don't rub your eye after an injury. Touching or pressing on your eye can worsen a corneal abrasion.

Don't touch your eyeball with cotton swabs, tweezers or other instruments. This can aggravate a corneal abrasion.

Cuts and scrapes

Minor cuts and scrapes usually don't require a trip to the emergency room. Yet proper care is essential to avoid infection or other complications. These guidelines can help you care for simple wounds:

1. Stop the bleeding. Minor cuts and scrapes usually stop bleeding on their own. If they don't, apply gentle pressure with a clean cloth or bandage. Hold the pressure continuously for 20 to 30 minutes and if possible elevate the wound. Don't keep checking to see if the bleeding has stopped because this may damage or dislodge the clot that's forming and cause bleeding to resume. If blood spurts or continues flowing after continuous pressure, seek medical assistance.
2. Clean the wound. Rinse out the wound with clear water. Soap can irritate the wound, so try to keep it out of the actual wound. If dirt or debris remains in the wound after washing, use tweezers cleaned with alcohol to remove the particles. If debris still remains, see your doctor. Thorough cleaning reduces the risk of infection and tetanus. To clean the area around the wound, use soap and a washcloth. There's no need to use hydrogen peroxide, iodine or an iodine-containing cleanser.
3. Apply an antibiotic. After you clean the wound, apply a thin layer of an antibiotic cream or ointment such as Neosporin or Polysporin to help keep the surface moist. The products don't make the wound heal faster, but they can discourage infection and help your body's natural healing process. Certain ingredients in some ointments can cause a mild rash in some people. If a rash appears, stop using the ointment.
4. Cover the wound. Bandages can help keep the wound clean and keep harmful bacteria out. After the wound has healed enough to make infection unlikely, exposure to the air will speed wound healing.
5. Change the dressing. Change the dressing at least daily or whenever it becomes wet or dirty. If you're allergic to the adhesive used in most bandages, switch to adhesive-free dressings or sterile gauze held in place with paper tape, gauze roll or a loosely applied elastic bandage. These supplies generally are available at pharmacies.

6.Get stitches for deep wounds. A wound that is more than 1/4-inch (6 millimeters) deep or is gaping or jagged edged and has fat or muscle protruding usually requires stitches. Adhesive strips or butterfly tape may hold a minor cut together, but if you can't easily close the wound, see your doctor as soon as possible. Proper closure within a few hours reduces the risk of infection.

7.Watch for signs of infection. See your doctor if the wound isn't healing or you notice any redness, increasing pain, drainage, warmth or swelling.

8.Get a tetanus shot. Doctors recommend you get a tetanus shot every 10 years. If your wound is deep or dirty and your last shot was more than five years ago, your doctor may recommend a tetanus shot booster. Get the booster as soon as possible after the injury.

Dislocations

A dislocation is an injury in which the ends of your bones are forced from their normal positions. The cause is usually trauma, such as a blow or fall, but dislocation can be caused by an underlying disease, such as rheumatoid arthritis.

Dislocations are common injuries in contact sports, such as football and hockey, and in sports that may involve falls, such as downhill skiing and volleyball. Dislocations may occur in major joints, such as your shoulder, hip, knee, elbow or ankle or in smaller joints, such as your finger, thumb or toe.

The injury will temporarily deform and immobilize your joint and may result in sudden and severe pain and swelling. A dislocation requires prompt medical attention to return your bones to their proper positions.

If you believe you have dislocated a joint:

1. Don't delay medical care. Get medical help immediately.

2. Don't move the joint. Until you receive help, splint the affected joint into its fixed position. Don't try to move a dislocated joint or force it back into place. This can damage the joint and its surrounding muscles, ligaments, nerves or blood vessels.

3. Put ice on the injured joint. This can help reduce swelling by controlling internal bleeding and the buildup of fluids in and around the injured joint.

Electrical burns

An electrical burn may appear minor or not show on the skin at all, but the damage can extend deep into the tissues beneath your skin. If a strong electrical current passes through your body, internal damage, such as a heart rhythm disturbance or cardiac arrest, can occur. Sometimes the jolt associated with the electrical burn can cause you to be thrown or to fall, resulting in fractures or other associated injuries.

Call your local emergency number for assistance if the person who has been burned is in pain, is confused, or is experiencing changes in his or her breathing, heartbeat or consciousness.

While helping someone with an electrical burn and waiting for medical help, follow these steps:

1. Look first. Don't touch. The person may still be in contact with the electrical source. Touching the person may pass the current through you.

2. Turn off the source of electricity if possible. If not, move the source away from both you and the injured person using a dry, nonconducting object made of cardboard, plastic or wood.

3. Check for signs of circulation (breathing, coughing or movement). If absent, begin cardiopulmonary resuscitation (CPR) immediately.

4. Prevent shock. Lay the person down with the head slightly lower than the trunk, if possible, and the legs elevated.

5. Cover the affected areas. If the person is breathing, cover any burned areas with a sterile gauze bandage, if available, or a clean cloth. Don't use a blanket or towel, because loose fibers can stick to the burns.

Electrical shock

The danger from an electrical shock depends on the type of current, how high the voltage is, how the current traveled through the body, the person's overall health and how quickly the person is treated.

Call your local emergency number immediately if any of these signs or symptoms occur:

Cardiac arrest

Heart rhythm problems (arrhythmias)

Respiratory failure

Muscle pain and contractions

Burns

Seizures

Numbness and tingling

Unconsciousness

While waiting for medical help, follow these steps:

Look first. Don't touch. The person may still be in contact with the electrical source. Touching the person may pass the current through you.

Turn off the source of electricity, if possible. If not, move the source away from you and the person, using a non-conducting object made of cardboard, plastic or wood.

Check for signs of circulation (breathing, coughing or movement). If absent, begin cardiopulmonary resuscitation (CPR) immediately.

Prevent shock. Lay the person down and, if possible, position the head slightly lower than the trunk, with the legs elevated.

After coming into contact with electricity, the person should see a doctor to check for internal injuries, even if he or she has no obvious signs or symptoms.

Caution

Don't touch the person with your bare hands if he or she is still in contact with the electrical current.

Don't get near high-voltage wires until the power is turned off. Stay at least 20 feet away — farther if wires are jumping and sparking.

Don't move a person with an electrical injury unless the person is in immediate danger.

Fainting

Fainting occurs when the blood supply to your brain is momentarily inadequate, causing you to lose consciousness. This loss of consciousness is usually brief.

Fainting can have no medical significance, or the cause can be a serious disorder. Therefore, treat loss of consciousness as a medical emergency until the signs and symptoms are relieved and the cause is known. Discuss recurrent fainting spells with your doctor.

If you feel faint:

* Lie down or sit down. To reduce the chance of fainting again, don't get up too quickly.
* Place your head between your knees if you sit down.

If someone else faints:

* Position the person on his or her back. If the person is breathing, restore blood flow to the brain by raising the person's legs above heart level — about 12 inches (30 centimeters) — if possible. Loosen belts, collars or other constrictive clothing. To reduce the chance of fainting again, don't get the person up too quickly. If the person doesn't regain consciousness within one minute, call 108 or 102 or your local emergency number.

Check the person's airway to be sure it's clear. Watch for vomiting.

Check for signs of circulation (breathing, coughing or movement). If absent, begin CPR. Call 108 or 102 or your local emergency number. Continue CPR until help arrives or the person responds and begins to breathe.

If the person was injured in a fall associated with a faint, treat any bumps, bruises or cuts appropriately. Control bleeding with direct pressure.

Fever

Fever is a sign of a variety of medical conditions, including infection. Your normal temperature may differ slightly from the average body temperature of 98.6 F (37 C).

For young children and infants, even slightly elevated temperatures may indicate a serious infection. In newborns, either a subnormal temperature or a fever may be a sign of serious illness. For adults, a fever usually isn't dangerous until it reaches 103 F (39.4 C) or higher.

Don't treat fevers below 102 F (38.9 C) with any medications unless your doctor tells you to. If you have a fever of 102 F (38.9 C) or higher, your doctor may suggest taking an over-the-counter medication, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others).

Adults also may use aspirin, but don't give aspirin to children. It may trigger a rare, but potentially fatal, disorder known as Reye's syndrome. Also, don't give ibuprofen to infants younger than 6 months of age.

Today most thermometers have digital readouts. Some take the temperature quickly from the ear canal and can be especially useful for young children and older adults. Other thermometers can be used rectally, orally or under the arm.

If you use a digital thermometer, be sure to read the instructions so that you know what the beeps mean and when to read the thermometer. Under normal circumstances, temperatures tend to be highest around 4 p.m. and lowest around 4 a.m.

Because of the potential for mercury exposure or ingestion, glass mercury thermometers have been phased out and are no longer recommended.

Taking a rectal temperature is also an option for older adults when taking an oral temperature is not possible.

A rectal temperature reading is generally 1 degree Fahrenheit (about 0.5 degree Celsius) higher than an oral reading.

Orally
To take your temperature orally:

Place the bulb under your tongue

Close your mouth for the recommended amount of time, usually three minutes

Under the arm (axillary) Although it's not the most accurate way to take a temperature, you can also use an oral thermometer for an armpit reading:

Place the thermometer under your arm with your arm down.

Hold your arms across your chest.

Wait five minutes or as recommended by your thermometer's manufacturer.
Remove the thermometer and read the temperature.

To take your child's axillary temperature, have the child sit in your lap, facing to the side. Place the thermometer under your child's near arm, which should be against your chest.

An axillary reading is generally 1 degree Fahrenheit (about 0.5 degree Celsius) lower than an oral reading.

Food-borne illness

All foods naturally contain small amounts of bacteria. But poor handling of food, improper cooking or inadequate storage can result in bacteria multiplying in large enough numbers to cause illness. Parasites, viruses, toxins and chemicals also can contaminate food and cause illness.

Signs and symptoms of food poisoning vary with the source of contamination, and whether you're dehydrated or have low blood pressure. Generally they include:

Diarrhea
Nausea
Abdominal pain

Vomiting (sometimes)

Dehydration (sometimes)

If you develop food poisoning:

Rest and drink plenty of liquids.

Don't use anti-diarrhea medications because they may slow elimination of bacteria from your system.

Food-borne illness often improves on its own within 48 hours. Call your doctor if you feel ill for longer than two or three days or if blood appears in your stools.

Call call for emergency medical assistance if:

You have severe symptoms, such as watery diarrhea that turns very bloody within 24 hours.

You belong to a high-risk group.

You suspect botulism poisoning. Botulism is a potentially fatal food poisoning that results from the ingestion of a toxin formed by certain spores in food. Botulism toxin is most often found in home-canned foods, especially green beans and tomatoes. Signs and symptoms of botulism usually begin 12 to 36 hours after eating the contaminated food and may include headache, blurred vision, muscle weakness and eventual paralysis. Some people also have nausea and vomiting, constipation, urinary retention, difficulty breathing, and dry mouth. These signs and symptoms require immediate medical attention.

Foreign object in the ear

A foreign object in the ear can cause pain and hearing loss. Usually you know if an object is stuck in your ear, but small children may not be aware of it.

If an object becomes lodged in the ear, follow these steps:

* Don't probe the ear with a tool. Don't attempt to remove the foreign object by probing with a cotton swab, matchstick or any other tool. To do so is to risk pushing the object farther into the ear and damaging the fragile structures of the middle ear.
* Remove the object if possible. If the object is clearly visible, pliable and can be grasped easily with tweezers, gently remove it.
* Try using gravity. Tilt the head to the affected side to try to dislodge the object.
* Try using oil for an insect. If the foreign object is an insect, tilt the person's head so that the ear with the offending insect is upward. Try to float the insect out by pouring mineral oil, olive oil or baby oil into the ear. The oil should be warm but not hot. As you pour the oil, you can ease the entry of the oil by straightening the ear canal. Pull the earlobe gently backward and upward for an adult, backward and downward for a child. The insect should suffocate and may float out in the oil bath. Don't use oil to remove any object other than an insect. Do not use this method if there is any suspicion of a perforation in the eardrum — pain, bleeding or discharge from the ear.

If these methods fail or the person continues to experience pain in the ear, reduced hearing or a sensation of something lodged in the ear, seek medical assistance.

Foreign object in eye

If you get a foreign object in your eye:

* Wash your hands.
* Try to flush the object out of your eye with clean water or saline solution. Use an eyecup or a small, clean drinking glass positioned with its rim resting on the bone at the base of your eye socket.

To help someone else:

1. Wash your hands.
2. Seat the person in a well-lighted area.
3. Gently examine the eye to find the object. Pull the lower lid down and ask the person to look up. Then hold the upper lid while the person looks down.
4. If the object is floating in the tear film on the surface of the eye, try flushing it out with saline solution or clean, lukewarm water.

Caution

* Don't try to remove an object that's embedded in the eyeball.
* Don't rub the eye.
* Don't try to remove a large object that makes closing the eye difficult.

Call 108 or 102 or your local emergency number when:

You can't remove the object.

The object is embedded in the eyeball.

The person with the object in the eye is experiencing abnormal vision.
Pain, redness or the sensation of an object in the eye persists after the object is removed.

Foreign object in nose

If a foreign object becomes lodged in your nose:

* Don't probe at the object with a cotton swab or other tool.
* Don't try to inhale the object by forcefully breathing in. Instead, breathe through your mouth until the object is removed.
* Blow out your nose gently to try to free the object, but don't blow hard or repeatedly. If only one nostril is affected, close the opposite nostril by applying gentle pressure and then blow out gently through the affected nostril.
* Gently remove the object if it's visible and you can easily grasp it with tweezers. Don't try to remove an object that isn't visible or easily grasped.
* Call for emergency medical assistance or go to your local emergency room if these methods fail.

Foreign object in your skin

If a foreign object is projecting from your skin:

* Wash your hands and clean the area well with soap and water.
* Use tweezers to remove splinters of wood or fiberglass, small pieces of glass or other foreign objects.

If the object is completely embedded in your skin:

* Wash your hands and clean the area well with soap and water.
* Sterilize a clean, sharp needle by wiping it with rubbing alcohol. If rubbing alcohol isn't available, clean the needle with soap and water.
* Use the needle to break the skin over the object and gently lift the tip of the object out.
* Use tweezers to remove the object. A magnifying glass may help you see the object better.
* Wash and pat dry the area. Follow by applying antibiotic ointment.
* Seek medical help if the particle doesn't come out easily or is close to your eye.

Foreign object inhaled

If you or your child inhales a foreign object, see your doctor. If the inhaled object causes choking, the American Red Cross recommends the "five-and-five" approach to delivering first aid:

* First, deliver five back blows between the victim's shoulder blades with the heel of your hand.
* Next, perform five abdominal thrusts (also known as the Heimlich maneuver).
* Alternate between five back blows and five abdominal thrusts until the blockage is dislodged.

To perform the Heimlich maneuver on someone else:

* Stand behind the person. Wrap your arms around the waist. Tip the person forward slightly.
* Make a fist with one hand. Position it slightly above the person's navel.
* Grasp the fist with the other hand. Press hard into the abdomen with a quick, upward thrust — as if trying to lift the person up.
* Perform a total of five abdominal thrusts, if needed. If the blockage still isn't dislodged, repeat the five-and-five cycle.

To perform the Heimlich maneuver on yourself:

* Place a fist slightly above your navel.
* Grasp your fist with the other hand and bend over a hard surface — a countertop or chair will do.
* Shove your fist inward and upward.

Foreign object swallowed

If you swallow a foreign object, it will usually pass through your digestive system uneventfully. But some objects can lodge in your oesophagus, the tube that connects your throat and stomach. If an object is stuck in your oesophagus, you may need to remove it, especially if it is:

* A pointed object, which should be removed as quickly as possible to avoid further injury to the oesophageal lining
* A tiny watch- or calculator-type button battery, which can rapidly cause nearby tissue injury and should be removed from the oesophagus without delay

If a swallowed object blocks the airway, the American Red Cross recommends the "five-and-five" approach to first aid:

Call 108 or 102 or your local emergency number for help.

To perform abdominal thrusts (the Heimlich maneuver) on someone else:

You can't perform back blows on yourself. But you can perform abdominal thrusts.

To perform abdominal thrusts (the Heimlich maneuver) on yourself:

* Place a fist slightly above your navel.
* Grasp your fist with the other hand and bend over a hard surface — a countertop or chair will do.
* Shove your fist inward and upward.

Fractures

A fracture is a broken bone. It requires medical attention. If the broken bone is the result of major trauma or injury, call your local emergency number. Also call for emergency help if:

* The person is unresponsive, isn't breathing or isn't moving. Begin cardiopulmonary resuscitation (CPR) if there's no respiration or heartbeat.
* There is heavy bleeding.
* Even gentle pressure or movement causes pain.
* The limb or joint appears deformed.
* The bone has pierced the skin.
* The extremity of the injured arm or leg, such as a toe or finger, is numb or bluish at the tip.
* You suspect a bone is broken in the neck, head or back.
* You suspect a bone is broken in the hip, pelvis or upper leg (for example, the leg and foot turn outward abnormally).

Don't move the person except if necessary to avoid further injury. Take these actions immediately while waiting for medical help:

* Stop any bleeding. Apply pressure to the wound with a sterile bandage, a clean cloth or a clean piece of clothing.
* Immobilize the injured area. Don't try to realign the bone or push a bone that's sticking out back in. If you've been trained in how to splint and professional help isn't readily available, apply a splint to the area above and below the fracture sites. Padding the splints can help reduce discomfort.
* Apply ice packs to limit swelling and help relieve pain until emergency personnel arrive. Don't apply ice directly to the skin — wrap the ice in a towel, piece of cloth or some other material.
* Treat for shock. If the person feels faint or is breathing in short, rapid breaths, lay the person down with the head slightly lower than the trunk and, if possible, elevate the legs.

Frostbite

When exposed to very cold temperatures, skin and underlying tissues may freeze, resulting in frostbite. The areas most likely to be affected by frostbite are your hands, feet, nose and ears.

If your skin looks white or greyish-yellow, is very cold and has a hard or waxy feel, you may have frostbite. Your skin may also itch, burn or feel numb. Severe frostbite can cause blistering and hardening. As the area thaws, the flesh becomes red and painful.

Gradually warming the affected skin is key to treating frostbite. To do so:

* Protect your skin from further exposure. If you're outside, warm frostbitten hands by tucking them into your armpits. Protect your face, nose or ears by covering the area with dry, gloved hands. Don't rub the affected area and never rub snow on frostbitten skin.
* Get out of the cold. Once you're indoors, remove wet clothes.
* Gradually warm frostbitten areas. Put frostbitten hands or feet in warm water — 104 to 107.6 F (40 to 42 C). Wrap or cover other areas in a warm blanket. Don't use direct heat, such as a stove, heat lamp, fireplace or heating pad, because these can cause burns.
* Don't walk on frostbitten feet or toes if possible. This further damages the tissue.
* If there's any chance the affected areas will freeze again, don't thaw them out. If they're already thawed out, wrap them up so that they don't become frozen again.
* Get emergency medical help. If the skin turns red and there's a tingling and burning sensation as it warms, circulation is returning. But if numbness or sustained pain remains during warming or if blisters develop, seek medical attention.

Gastroenteritis

Gastroenteritis is an inflammation of your stomach and intestines. Common causes are:

Viruses.

Food or water contaminated by bacteria or parasites.

Reaction to a new food. Young children may develop signs and symptoms for this reason. Infants who are breast-fed may even react to a change in their mothers' diets.

Side effect from medications.

Characteristic signs and symptoms include:

Nausea or vomiting

Diarrhea

Abdominal cramps

Bloating

Low-grade fever (sometimes)

Depending on the cause of the inflammation, symptoms may last from one day to longer than a week.

If you suspect gastroenteritis in yourself:

*Stop eating and drinking for a few hours to let your stomach settle.
* Drink plenty of liquids, such as a sports drink or water, to prevent dehydration. If you have trouble tolerating liquids, take them in frequent sips. Make sure that you're urinating normally, and that your urine is light and clear and not dark. Infrequent passage of dark urine is a sign of dehydration. Dizziness or lightheadedness also are signs of dehydration. If any of these symptoms occur and you can't drink enough fluids, seek medical attention.
* Ease back into eating. Gradually begin to eat bland, easy-to-digest foods, such as soda crackers, toast, gelatin, bananas, rice and chicken. Stop eating if your nausea returns. Avoid milk and dairy products, caffeine, alcohol, nicotine, and fatty or highly seasoned foods for a few days.
* Consider acetaminophen (Tylenol, others) for relief of discomfort, unless you have liver disease.
* Get plenty of rest. The illness and dehydration can make you weak and tired.

Get medical help if:

Vomiting persists for more than two days

Diarrhea persists for longer than several days

Diarrhea turns bloody

Fever is 101 F (38.3 C) or higher

Lightheadedness or fainting occurs with standing

Confusion develops

Worrisome abdominal pain develops

If you suspect gastroenteritis in your child:

Allow your child to rest.

When your child's vomiting stops, begin to offer small amounts of an oral rehydration solution, such as Pedialyte or Infalyte. Don't use only water. In children with gastroenteritis, water isn't absorbed well and won't adequately replace lost fluids. Also avoid apple juice and milk, which can make diarrhea worse.

Gradually introduce bland, easy-to-digest foods, such as toast, rice, bananas and potatoes. Avoid giving your child dairy products and sugary foods, such as ice cream, sodas and candy. These can make diarrhea worse.

Consider acetaminophen (Tylenol, others) for relief of discomfort, unless your child has liver disease. Don't give your child aspirin.

If you have a sick infant, let your baby's stomach rest for 30 to 60 minutes, then offer small amounts of liquid. If you're breast-feeding, let your baby nurse. If your baby is bottle-fed, offer a small amount of an oral rehydration formula (Pedialyte, Infalyte) or regular formula.

Headaches

Most headaches are minor, and you can treat them with a pain reliever. Some head pain, however, signals a dangerous or serious medical problem. Don't ignore unexplained head pain or head pain that steadily worsens. Get medical attention right away if your head pain:

Develops suddenly and severely

Accompanies a fever; stiff neck; rash; mental confusion; seizures; changes in vision, such as blurring or seeing halos around lights; dizziness; weakness or paralysis, such as in the arms or legs; loss of balance; a reddened eye; numbness; or difficulty speaking

Is severe and follows a recent sore throat or respiratory infection

Begins or worsens after a head injury, fall or bump

Is a new pain and you're older than 50

Progressively worsens over the course of a single day or persists for several days

Head trauma

Most head trauma involves injuries that are minor and don't require hospitalization. However, call your local emergency number if any of the following signs or symptoms are apparent:

Severe head or facial bleeding

Bleeding from the nose or ears

Severe headache

Change in level of consciousness for more than a few seconds

Black-and-blue discoloration below the eyes or behind the ears

Cessation of breathing

Confusion

Loss of balance

Weakness or an inability to use an arm or leg

Unequal pupil size

Repeated vomiting

Slurred speech

Seizures

If severe head trauma occurs:

Keep the person still. Until medical help arrives, keep the injured person lying down and quiet, with the head and shoulders slightly elevated. Don't move the person unless necessary, and avoid moving the person's neck.

Stop any bleeding. Apply firm pressure to the wound with sterile gauze or a clean cloth. But don't apply direct pressure to the wound if you suspect a skull fracture.

Watch for changes in breathing and alertness. If the person shows no signs of circulation (breathing, coughing or movement), begin CPR.

Heart attack

Someone having a heart attack may experience any or all of the following:

Uncomfortable pressure, fullness or squeezing pain in the center of the chest

Prolonged pain in the upper abdomen

Discomfort or pain spreading beyond the chest to the shoulders, neck, jaw, teeth, or one or both arms

Shortness of breath

Lightheadedness, dizziness, fainting

Sweating

Nausea

A heart attack occurs when an artery supplying your heart with blood and oxygen becomes partially or completely blocked. This loss of blood flow injures or destroys part of your heart muscle. A heart attack generally causes chest pain for more than 15 minutes, but it can also have no symptoms at all.

Many people who experience a heart attack have warning symptoms hours, days or weeks in advance. The earliest warning sign of an attack may be ongoing episodes of chest pain that start when you're physically active, but are relieved by rest.

If you or someone else may be having a heart attack:

Call your local emergency medical assistance number. Don't tough out the symptoms of a heart attack for more than five minutes. If you don't have access to emergency medical services, have a neighbor or a friend drive you to the nearest hospital. Drive yourself only as a last resort, if there are absolutely no other options, and realize that it places you and others at risk when you drive under these circumstances.

Chew and swallow an aspirin, unless you're allergic to aspirin or have been told by your doctor never to take aspirin. But seek emergency help first, such as calling 108 or 102.

Take nitroglycerin, if prescribed. If you think you're having a heart attack and your doctor has previously prescribed nitroglycerin for you, take it as directed. Do not take anyone else's nitroglycerin, because that could put you in more danger.

Begin CPR. If you're with a person who might be having a heart attack and he or she is unconscious, tell the 108 or 102 dispatcher or another emergency medical specialist. You may be advised to begin cardiopulmonary resuscitation (CPR). If you haven't received CPR training, doctors recommend skipping mouth-to-mouth rescue breathing and performing only chest compressions. The dispatcher can instruct you in the proper procedures until help arrives.

Heat cramps

Heat cramps are painful, involuntary muscle spasms that usually occur during heavy exercise in hot environments. The spasms may be more intense and more prolonged than are typical nighttime leg cramps. Inadequate fluid intake often contributes to heat cramps.

Muscles most often affected include those of your calves, arms, abdominal wall and back, although heat cramps may involve any muscle group involved in exercise.

If you suspect heat cramps:

Rest briefly and cool down

Drink clear juice or an electrolyte-containing sports drink

Practice gentle, range-of-motion stretching and gentle massage of the affected muscle group

Don't resume strenuous activity for several hours or longer after heat cramps go away

Call your doctor if your cramps don't go away within one hour or so

Heat exhaustion

Heat exhaustion is one of the heat-related syndromes, which range in severity from mild heat cramps to heat exhaustion to potentially life-threatening heatstroke.

Signs and symptoms of heat exhaustion often begin suddenly, sometimes after excessive exercise, heavy perspiration, and inadequate fluid or salt intake. Signs and symptoms resemble those of shock and may include:

Feeling faint or dizzy

Nausea

Heavy sweating

Rapid, weak heartbeat

Low blood pressure

Cool, moist, pale skin

Low-grade fever

Heat

Cramps

Headache

Fatigue

Dark-coloured urine

If you suspect heat exhaustion:

Get the person out of the sun and into a shady or air-conditioned location.

* Lay the person down and elevate the legs and feet slightly.

* Loosen or remove the person's clothing.

* Have the person drink cool water or other non-alcoholic beverage without caffeine.

* Cool the person by spraying or sponging him or her with cool water and fanning.

* Monitor the person carefully. Heat exhaustion can quickly become heatstroke.

If fever greater than 102 F (38.9 C), fainting, confusion or seizures occur, call 108 or 102 or emergency medical help.

Heatstroke

Heatstroke is the most severe of the heat-related problems, often resulting from exercise or heavy work in hot environments combined with inadequate fluid intake.

Young children, older adults, people who are obese and people born with an impaired ability to sweat are at high risk of heatstroke. Other risk factors include dehydration, alcohol use, cardiovascular disease and certain medications.

What makes heatstroke severe and potentially life-threatening is that the body's normal mechanisms for dealing with heat stress, such as sweating and temperature control, are inadequate. The main sign of heatstroke is a markedly elevated body temperature — generally greater than 104 F (40 C) — with changes in mental status ranging from personality changes to confusion and coma. Skin may be hot and dry — although if heatstroke is caused by exertion, the skin may be moist.

Other signs and symptoms may include:

* Rapid heartbeat

* Rapid and shallow breathing

* Elevated or lowered blood pressure

* Cessation of sweating

* Irritability, confusion or unconsciousness

* Feeling dizzy or lightheaded

* Headache

* Nausea

* Fainting, which may be the first sign in older adults

If you suspect heatstroke:

* Move the person out of the sun and into a shady or air-conditioned space.

* Call 108 or 102 or emergency medical help.

* Cool the person by covering him or her with damp sheets or by spraying with cool water. Direct air onto the person with a fan or newspaper.

* Have the person drink cool water or other nonalcoholic beverage without caffeine, if he or she is able.

Human bites

Human bites can be as dangerous as or even more dangerous than animal bites because of the types of bacteria and viruses contained in the human mouth. If someone cuts his or her knuckles on another person's teeth, as might happen in a fight, this is also considered a human bite.

If you sustain a human bite that breaks the skin:

* Stop the bleeding by applying pressure.

* Wash the wound thoroughly with soap and water.

* Apply an antibiotic cream to prevent infection.

* Apply a clean bandage. If the bite is bleeding, apply pressure directly on the wound, using a sterile bandage or clean cloth, until the bleeding stops.

* Seek emergency medical care.

If you haven't had a tetanus shot within five years, your doctor may recommend a booster. In this case you should have the booster within 48 hours of the injury.

Hypothermia

Under most conditions your body maintains a healthy temperature. However, when exposed to cold temperatures, especially with a high wind chill factor and high humidity, or to a cool, damp environment for prolonged periods, your body's control mechanisms may fail to keep your body temperature normal. When more heat is lost than your body can generate, hypothermia, defined as an internal body temperature less than 95ºF (35ºC), can result.

Wet or inadequate clothing, falling into cold water and even not covering your head during cold weather can increase your chances of hypothermia.

Signs and symptoms include:

* Shivering

* Slurred speech

* Abnormally slow breathing

* Cold, pale skin

* Fatigue, lethargy or apathy

* Confusion or memory loss

* Bright red, cold skin (infants)

Signs and symptoms usually develop slowly. People with hypothermia typically experience gradual loss of mental acuity and physical ability, so they may be unaware that they need emergency medical treatment.

Older adults, infants, young children and people who are very lean are at particular risk. Other people at higher risk of hypothermia include those whose judgment may be impaired by mental illness or Alzheimer's disease and people who are intoxicated, homeless or caught in cold weather because their vehicles have broken down. Other conditions that may predispose people to hypothermia are malnutrition, cardiovascular disease and an underactive thyroid (hypothyroidism).

To care for someone with hypothermia:

* Call 108 or 102 or emergency medical assistance. While waiting for help to arrive, monitor the person's breathing. If breathing stops or seems dangerously slow or shallow, begin cardiopulmonary resuscitation (CPR) immediately.

* Move the person out of the cold. If going indoors isn't possible, protect the person from the wind, cover his or her head, and insulate his or her body from the cold ground.

* Remove wet clothing. Replace wet things with a warm, dry covering.

* Don't apply direct heat. Don't use hot water, a heating pad or a heating lamp to warm the victim. Instead, apply warm compresses to the center of the body — head, neck, chest wall and groin. Don't attempt to warm the arms and legs. Heat applied to the arms and legs forces cold blood back toward the heart, lungs and brain, causing the core body temperature to drop. This can be fatal.

* Don't give the person alcohol. Offer warm nonalcoholic drinks, unless the person is vomiting.

* Don't massage or rub the person. Handle people with hypothermia gently; their skin may be frostbitten, and rubbing frostbitten tissue can cause severe damage.

Insect bites and stings

Signs and symptoms of an insect bite result from the injection of venom or other substances into your skin. The venom sometimes triggers an allergic reaction. The severity of your reaction depends on your sensitivity to the insect venom or substance and whether you've been stung or bitten more than once.

Most reactions to insect bites are mild, causing little more than an annoying itching or stinging sensation and mild swelling that disappear within a day or so. A delayed reaction may cause fever, hives, painful joints and swollen glands. You might experience both the immediate and the delayed reactions from the same insect bite or sting. Only a small percentage of people develop severe reactions (anaphylaxis) to insect venom. Signs and symptoms of a severe reaction include:

* Nausea

* Facial swelling

* Difficulty breathing

* Abdominal pain

* Deterioration of blood pressure and circulation (shock)

Bites from bees, wasps, hornets, yellow jackets and fire ants are typically the most troublesome. Bites from mosquitoes, ticks, biting flies and some spiders also can cause reactions, but these are generally milder. Although rare, some insects also carry disease such as West Nile virus or Lyme disease.

For mild reactions

* Move to a safe area to avoid more stings.

* Remove the stinger, especially if it's stuck in your skin. This will prevent the release of more venom. Wash area with soap and water.

* Apply a cold pack or cloth filled with ice to reduce pain and swelling.

* Apply hydrocortisone cream (0.5 percent or 1 percent), calamine lotion or a baking soda paste — with a ratio of 3 teaspoons (15 milliliters) baking soda to 1 teaspoon (5 milliliters) water — to the bite or sting several times a day until symptoms subside.

* Take an antihistamine containing diphenhydramine (Benadryl, Tylenol Severe Allergy) or chlorpheniramine maleate (Chlor-Trimeton, Actifed).

Allergic reactions may include mild nausea and intestinal cramps, diarrhea, or swelling larger than 2 inches (5 centimeters) in diameter at the site. See your doctor promptly if you experience any of these signs and symptoms.

For severe reactions

evere reactions may progress rapidly. Call 108 or 102 or emergency medical assistance if the following signs or symptoms occur:

* Difficulty breathing

* Swelling of the lips or throat

* Faintness

* Dizziness

* Confusion

* Rapid heartbeat

* Hives[AJ3]

* Nausea, cramps and vomiting

Take these actions immediately while waiting with an affected person for medical help:

* Check for medications that the person might be carrying to treat an allergic attack, such as an auto-injector of epinephrine (for example, EpiPen). Administer the drug as directed — usually by pressing the auto-injector against the person's thigh and holding it in place for several seconds. Massage the injection site for 10 seconds to enhance absorption.

* Have the person take an antihistamine pill if he or she is able to do so without choking. Do this after administering epinephrine.

* Have the person lie still on his or her back with feet higher than the head.

* Loosen tight clothing and cover the person with a blanket. Don't give anything to drink.

* Turn the person on his or her side to prevent choking if there's vomiting or bleeding from the mouth.

* Begin CPR if there are no signs of circulation, such as breathing, coughing or movement.

If your doctor has prescribed an auto-injector of epinephrine, read the instructions before a problem develops and also have your household members read them.

Motion sickness

Any type of transportation can cause motion sickness. It can strike suddenly, progressing from a feeling of uneasiness to a cold sweat, dizziness and then vomiting. Motion sickness usually quiets down as soon as the motion stops. The more you travel, the more easily you'll adjust to being in motion.

You may escape motion sickness by planning ahead. If you're traveling, reserve seats where motion is felt least:

* By ship, request a cabin in the front or middle of the ship, or on the upper deck.

* By plane, ask for a seat over the front edge of a wing. Once aboard, direct the air vent flow to your face.

* By train, take a seat near the front and next to a window. Face forward.

* By automobile, drive or sit in the front passenger's seat.

If you're susceptible to motion sickness:

* Focus on the horizon or on a distant, stationary object. Don't read.

* Keep your head still, while resting against a seat back.

* Avoid smoking (passive or active).

* Avoid spicy and greasy foods and alcohol. Don't overeat.

* Take an over-the-counter antihistamine, such as meclizine (Bonine), or one containing dimenhydrinate (Dramamine) at least 30 to 60 minutes before you travel. Expect drowsiness as a side effect.

* Consider scopolamine (Transderm Scop), available in a prescription adhesive patch. Several hours before you plan to travel, apply the patch behind your ear for 72-hour protection. Talk to your doctor before using the medication if you have health problems such as asthma, glaucoma or urine retention.

* Eat dry crackers or drink a carbonated beverage to help settle your stomach if you become ill.

Nosebleeds

Nosebleeds are common. Most often they are a nuisance and not a true medical problem. But they can be both.

Among children and young adults, nosebleeds usually originate from the septum, just inside the nose. The septum separates your nasal chambers.

In middle-aged and older adults, nosebleeds can begin from the septum, but they may also begin deeper in the nose's interior. This latter origin of nosebleed is much less common. It may be caused by hardened arteries or high blood pressure. These nosebleeds begin spontaneously and are often difficult to stop. They require a specialist's help.

To take care of a nosebleed:

* Sit upright and lean forward. By remaining upright, you reduce blood pressure in the veins of your nose. This discourages further bleeding. Sitting forward will help you avoid swallowing blood, which can irritate your stomach.

* Pinch your nose. Use your thumb and index finger to pinch your nostrils shut. Breathe through your mouth. Continue to pinch for five to 10 minutes. This maneuver sends pressure to the bleeding point on the nasal septum and often stops the flow of blood.

* To prevent re-bleeding after bleeding has stopped, don't pick or blow your nose and don't bend down until several hours after the bleeding episode. Keep your head higher than the level of your heart.

* If re-bleeding occurs, blow out forcefully to clear your nose of blood clots and spray both sides of your nose with a decongestant nasal spray containing oxymetazoline (Afrin, others). Pinch your nose in the technique described above and call your doctor.

Seek medical care immediately if:

* The bleeding lasts for more than 20 minutes

* The nosebleed follows an accident, a fall or an injury to your head, including a punch in the face that may have broken your nose

For frequent nosebleeds

If you experience frequent nosebleeds, make an appointment with your doctor. You may need a blood vessel cauterized. Cautery is a technique in which the blood vessel is burned with electric current, silver nitrate or a laser. Sometimes your doctor may pack your nose with special gauze or an inflatable latex balloon to put pressure on the blood vessel and stop the bleeding.

Also call your doctor if you are experiencing nasal bleeding and are taking blood thinners, such as aspirin or warfarin (Coumadin). Your doctor may advise adjusting your medication intake.

Using supplemental oxygen administered with a nasal tube (cannula) may increase your risk of nosebleeds. Apply a water-based lubricant to your nostrils and increase the humidity in your home to help relieve nasal bleeding.

Poisoning

Many conditions mimic the signs and symptoms of poisoning, including seizures, alcohol intoxication, stroke and insulin reaction. So look for the signs and symptoms listed below and if you suspect poisoning, call your regional poison control center or, in the United States, the National Poison Control Center at 800-222-1222 before giving anything to the affected person.

Signs and symptoms of poisoning:

* Burns or redness around the mouth and lips, from drinking certain poisons

* Breath that smells like chemicals, such as gasoline or paint thinner

* Burns, stains and odors on the person, on his or her clothing, or on the furniture, floor, rugs or other objects in the surrounding area

* Empty medication bottles or scattered pills

* Vomiting, difficulty breathing, sleepiness, confusion or other unexpected signs

* When to call for help:
Call 108 or 102 or your local emergency number immediately if the person is:

* Drowsy or unconscious

* Having difficulty breathing or has stopped breathing

* Uncontrollably restless or agitated

* Having seizures

If the person seems stable and has no symptoms, but you suspect poisoning, call your regional poison control center or, in the United States, the National Poison Control Center at 800-222-1222. Provide information about the person's symptoms, the person's age and weight, and any information you have about the poison, such as amount and how long since the person was exposed to it. It helps to have the pill bottle or poison container on hand when you call.

What to do while waiting for help:

* If the person has been exposed to poisonous fumes, such as carbon monoxide, get him or her into fresh air immediately.

* If the person swallowed the poison, remove anything remaining in the mouth.

* If the suspected poison is a household cleaner or other chemical, read the label and follow instructions for accidental poisoning. If the product is toxic, the label will likely advise you to call the poison control center at 800-222-1222. Also call this 800 number if you can't identify the poison, if it's medication or if there are no instructions.

* Follow treatment directions that are given by the poison control center.

* If the poison spilled on the person's clothing, skin or eyes, remove the clothing. Flush the skin or eyes with cool or lukewarm water, such as by using a shower for 20 minutes or until help arrives.

* Make sure the person is breathing. If not, start rescue breathing and CPR.

* Take the poison container (or any pill bottles) with you to the hospital.

What NOT to do

Don't give ipecac syrup or do anything to induce vomiting. The American Academy of Paediatrics advises discarding ipecac in the home, saying there's no good evidence of effectiveness and that it can do more harm than good.

Puncture wounds

A puncture wound doesn't usually cause excessive bleeding. Often the wound seems to close almost instantly. But these features don't mean treatment isn't necessary.

A puncture wound — such as from stepping on a nail — can be dangerous because of the risk of infection. The object that caused the wound may carry spores of tetanus or other bacteria, especially if the object has been exposed to the soil. Puncture wounds resulting from human or animal bites, including those of domestic dogs and cats, may be especially prone to infection. Puncture wounds on the foot also are more vulnerable to infection.

If the bite was deep enough to draw blood and the bleeding persists, seek medical attention. Otherwise, follow these steps:

1. Stop the bleeding. Minor cuts and scrapes usually stop bleeding on their own. If they don't, apply gentle pressure with a clean cloth or bandage. If bleeding persists — if the blood spurts or continues to flow after several minutes of pressure — seek emergency assistance.
2. Clean the wound. Rinse the wound well with clear water. Use tweezers cleaned with alcohol to remove small, superficial particles. If debris still remains in the wound, see your doctor. Thorough wound cleaning reduces the risk of tetanus. To clean the area around the wound, use soap and a clean cloth.
3. Apply an antibiotic. After you clean the wound, apply a thin layer of an antibiotic cream or ointment such as Neosporin or Polysporin to help keep the surface moist. These products don't make the wound heal faster, but they can discourage infection and allow your body to close the wound more efficiently. Certain ingredients in some ointments can cause a mild rash in some people. If a rash appears, stop using the ointment.
4. Cover the wound. Exposure to air speeds healing, but bandages can help keep the wound clean and keep harmful bacteria out.
5. Change the dressing. Do so at least daily or whenever it becomes wet or dirty. If you're allergic to the adhesive used in most bandages, switch to adhesive-free dressings or sterile gauze and hypoallergenic paper tape, which don't cause allergic reactions. These supplies are generally available at pharmacies.
6. Watch for signs of infection. See your doctor if the wound doesn't heal or if you notice any redness, drainage, warmth or swelling.

If the puncture is deep, is in your foot, is contaminated or is the result of an animal or human bite, see your doctor. He or she will evaluate the wound, clean it and, if necessary, close it. If you haven't had a tetanus shot within five years, your doctor may recommend a booster within 48 hours of the injury.

If an animal — especially a stray dog or a wild animal — inflicted the wound, you may have been exposed to rabies. Your doctor may give you antibiotics and suggest initiation of a rabies vaccination series. Report such incidents to county public health officials. If the bite is from someone's pet, it's important to contact the pet owner to confirm the animal's rabies immunization status. If unknown, the animal should be confined for 10 days of observation by a veterinarian.

Severe bleeding

If possible, before you try to stop severe bleeding, wash your hands to avoid infection and put on synthetic gloves. Don't reposition displaced organs. If the wound is abdominal and organs have been displaced, don't try to push them back into place — cover the wound with a dressing.

For other cases of severe bleeding, follow these steps:

1. Have the injured person lie down and cover the person to prevent loss of body heat. If possible, position the person's head slightly lower than the trunk or elevate the legs. This position reduces the risk of fainting by increasing blood flow to the brain. If possible, elevate the site of bleeding.
2. While wearing gloves, remove any obvious dirt or debris from the wound. Don't remove any large or more deeply embedded objects. Don't probe the wound or attempt to clean it at this point. Your principal concern is to stop the bleeding.
3. Apply pressure directly on the wound until the bleeding stops. Use a sterile bandage or clean cloth and hold continuous pressure for at least 20 minutes without looking to see if the bleeding has stopped. Maintain pressure by binding the wound tightly with a bandage (or a piece of clean cloth) and adhesive tape. Use your hands if nothing else is available. If possible, wear rubber or latex gloves or use a clean plastic bag for protection.
4. Don't remove the gauze or bandage. If the bleeding continues and seeps through the gauze or other material you are holding on the wound, don't remove it. Instead, add more absorbent material on top of it.
5. Squeeze a main artery if necessary. If the bleeding doesn't stop with direct pressure, apply pressure to the artery delivering blood to the area of the wound. Pressure points of the arm are on the inside of the arm just above the elbow and just below the armpit. Pressure points of the leg are just behind the knee and in the groin. Squeeze the main artery in these areas against the bone. Keep your fingers flat. With your other hand, continue to exert pressure on the wound itself.
6. Immobilize the injured body part once the bleeding has stopped. Leave the bandages in place and get the injured person to the emergency room as soon as possible.

If you suspect internal bleeding, call 108 or 102 or your local emergency number. Signs of internal bleeding may include:

* Bleeding from body cavities, such as the ears, nose, rectum or vagina
* Vomiting or coughing up blood
* Bruising on neck, chest, abdomen or side (between ribs and hip)
* Wounds that have penetrated the skull, chest or abdomen
* Abdominal tenderness, possibly accompanied by rigidity or spasm of abdominal muscles
* Fractures
* Shock, indicated by weakness, anxiety, thirst or skin that's cool to the touch

Shock

Shock may result from trauma, heatstroke, blood loss, an allergic reaction, severe infection, poisoning, severe burns or other causes. When a person is in shock, his or her organs aren't getting enough blood or oxygen, which if untreated, can lead to permanent organ damage or death.

Various signs and symptoms appear in a person experiencing shock:

* The skin is cool and clammy. It may appear pale or gray.
* The pulse is weak and rapid. Breathing may be slow and shallow, or hyperventilation (rapid or deep breathing) may occur. Blood pressure is below normal.
* The person may be nauseated. He or she may vomit.
* The eyes lack luster and may seem to stare. Sometimes the pupils are dilated.
* The person may be conscious or unconscious. If conscious, the person may feel faint or be very weak or confused. Shock sometimes causes a person to become overly excited and anxious.

If you suspect shock, even if the person seems normal after an injury:

* Call 108 or102 or your local emergency number.
* Have the person lie down on his or her back with feet about a foot higher than the head. If raising the legs will cause pain or further injury, keep him or her flat. Keep the person still.
* Check for signs of circulation (breathing, coughing or movement). If absent, begin CPR.
* Keep the person warm and comfortable. Loosen belt and tight clothing and cover the person with a blanket. Even if the person complains of thirst, give nothing by mouth.
* Turn the person on his or her side to prevent choking if the person vomits or bleeds from the mouth.
* Seek treatment for injuries, such as bleeding or broken bones.

Snakebite

Most North American snakes aren't poisonous. Some exceptions include the rattlesnake, coral snake, water moccasin and copperhead. Their bite can be life-threatening.

Of the poisonous snakes found in North America, all but the coral snake have slit-like eyes. Their heads are triangular, with a depression, or pit, midway between the eyes and nostrils.

Other characteristics are unique to certain poisonous snakes:

* Rattlesnakes rattle by shaking the rings at the end of their tails.
* Water moccasins' mouths have a white, cottony lining.
* Coral snakes have red, yellow and black rings along the length of their bodies.

To reduce your risk of snakebite, avoid touching any snake. Instead, back away slowly. Most snakes avoid people if possible and bite only when threatened or surprised.

If a snake bites you:

* Remain calm
* Immobilize the bitten arm or leg and stay as quiet as possible to keep the poison from spreading through your body
* Remove jewelry before you start to swell
* Position yourself, if possible, so that the bite is at or below the level of your heart
* Cleanse the wound, but don't flush it with water, and cover it with a clean, dry dressing
* Apply a splint to reduce movement of the affected area, but keep it loose enough so as not to restrict blood flow
* Don't use a tourniquet or apply ice
* Don't cut the wound or attempt to remove the venom
* Don't drink caffeine or alcohol
* Don't try to capture the snake, but try to remember its color and shape so you can describe it, which will help in your treatment

Call 108 or 102 or seek immediate medical attention, especially if the area changes color, begins to swell or is painful.

Spider bites

Only a few spiders are dangerous to humans. Two that are present in the contiguous United States and more common in the Southern states are the black widow spider and the brown recluse spider. Both prefer warm climates and dark, dry places where flies are plentiful. They often live in dry, littered, undisturbed areas, such as closets, woodpiles and under sinks.

Most presumed spider bites are actually bites from other bugs. If you suspect you have been bitten by one of these spiders, check to see if the spider lives in your area.
Black widow spider

Photo of black widow spider Black widow spider

Although serious, a black widow bite is rarely lethal. You can identify this spider by the red hourglass marking on its belly. The bite feels like a pinprick. You may not even know you've been bitten. At first you may notice slight swelling and faint red marks. Within a few hours, though, intense pain and stiffness begin. Other signs and symptoms include:

* Chills
* Fever
* Nausea and vomiting
* Severe abdominal pain

You can identify Brown recluse spider by the violin-shaped marking on its back. The bite produces a mild stinging, followed by local redness and intense pain within eight hours. A fluid-filled blister forms at the site and then sloughs off to leave a deep, enlarging ulcer. Reactions from a brown recluse spider bite vary from a mild fever and rash to nausea and listlessness. On rare occasions death results, more often in children.
If bitten by a spider

Try and identify the type of spider that bit you. Clean the site of the spider bite well with soap and water. Apply a cool compress over the spider bite location. If the bite is on an extremity, elevate it. Aspirin or acetaminophen (Tylenol, others) and antihistamines may be used to relieve minor signs and symptoms in adults. Use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 2, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. Talk to your doctor if you have concerns.
If bitten by a brown recluse or black widow spider

1. Cleanse the wound. Use soap and water to clean the wound and skin around the spider bite.
2. Slow the venom's spread. If the spider bite is on an arm or a leg, tie a snug bandage above the bite and elevate the limb to help slow or halt the venom's spread. Ensure that the bandage is not so tight that it cuts off circulation in your arm or leg.
3. Use a cold cloth at the spider bite location. Apply a cloth dampened with cold water or filled with ice.
4. Seek immediate medical attention. Treatment for the bite of a black widow may require an anti-venom medication. Doctors may treat a brown recluse spider bite with various medications.

Spinal injury

If you suspect a back or neck (spinal) injury, do not move the affected person. Permanent paralysis and other serious complications can result. Assume a person has a spinal injury if:

* There's evidence of a head injury with an ongoing change in the person's level of consciousness
* The person complains of severe pain in his or her neck or back
* The person won't move his or her neck
* An injury has exerted substantial force on the back or head
* The person complains of weakness, numbness or paralysis or lacks control of his or her limbs, bladder or bowels
* The neck or back is twisted or positioned oddly

If you suspect someone has a spinal injury:

* Call 108 or 102 or emergency medical help.
* Keep the person still. Place heavy towels on both sides of the neck or hold the head and neck to prevent movement. The goal of first aid for a spinal injury is to keep the person in much the same position as he or she was found.
* Provide as much first aid as possible without moving the person's head or neck. If the person shows no signs of circulation (breathing, coughing or movement), begin CPR, but do not tilt the head back to open the airway. Use your fingers to gently grasp the jaw and lift it forward. If the person has no pulse, begin chest compressions.
* If the person is wearing a helmet, don't remove it.
* If you absolutely must roll the person because he or she is vomiting, choking on blood or in danger of further injury, you need at least one other person. With one of you at the head and another along the side of the injured person, work together to keep the person's head, neck and back aligned while rolling the person onto one side.

Sprain

Your ligaments are tough, elastic-like bands that connect bone to bone and hold your joints in place. A sprain is an injury to a ligament caused by excessive stretching. The ligament can have a partial tear, or it can be completely torn apart.

Of all sprains, ankle and knee sprains occur most often. Sprained ligaments swell rapidly and are painful. Generally, the greater the pain, the more severe the injury is. For most minor sprains, you probably can treat the injury yourself.

Follow the instructions for P.R.I.C.E.

1. Protect the injured limb from further injury by not using the joint. You can do this using anything from splints to crutches.
2. Rest the injured limb. But don't avoid all activity. Even with an ankle sprain, you can usually still exercise other muscles to minimize deconditioning. For example, you can use an exercise bicycle with arm exercise handles, working both your arms and the uninjured leg while resting the injured ankle on another part of the bike. That way you still get three-limb exercise to keep up your cardiovascular conditioning.
3. Ice the area. Use a cold pack, a slush bath or a compression sleeve filled with cold water to help limit swelling after an injury. Try to ice the area as soon as possible after the injury and continue to ice it for 10 to 15 minutes four times a day for 48 hours. If you use ice, be careful not to use it too long, as this could cause tissue damage.
4. Compress the area with an elastic wrap or bandage. Compressive wraps or sleeves made from elastic or neoprene are best.
5. Elevate the injured limb above your heart whenever possible to help prevent or limit swelling.

After two days, gently begin using the injured area. You should feel a gradual, progressive improvement. Over-the-counter pain relievers, such as ibuprofen (Advil, Motrin, others) and acetaminophen (Tylenol, others), may be helpful to manage pain during the healing process.

See your doctor if your sprain isn't improving after two or three days.

Get emergency medical assistance if:

* You're unable to bear weight on the injured leg, the joint feels unstable or you can't use the joint. This may mean the ligament was completely torn. On the way to the doctor, apply a cold pack.
* You have a fever higher than 100 F (37.8 C), and the area is red and hot. You may have an infection.
* You have a severe sprain. Inadequate or delayed treatment may cause long-term joint instability or chronic pain.

Stroke

A stroke occurs when there's bleeding into your brain or when normal blood flow to your brain is blocked. Within minutes of being deprived of essential nutrients, brain cells start dying — a process that may continue over the next several hours.

Seek immediate medical assistance. A stroke is a true emergency. The sooner treatment is given, the more likely it is that damage can be minimized. Every moment counts.

Signs and symptoms of a stroke include:

* Sudden weakness or numbness in your face, arm or leg on one side of your body
* Sudden dimness, blurring or loss of vision, particularly in one eye
* Loss of speech, trouble talking or understanding speech
* Sudden, severe headache — a bolt out of the blue — with no apparent cause
* Unexplained dizziness, unsteadiness or a sudden fall, especially if accompanied by any of the other signs or symptoms

Risk factors for stroke include having high blood pressure, having had a previous stroke, smoking, having diabetes and having heart disease. Your risk of stroke increases as you age.

Sunburn

Signs and symptoms of sunburn usually appear within a few hours of exposure, bringing pain, redness, swelling and occasional blistering. Because exposure often affects a large area of your skin, sunburn can cause headache, fever and fatigue.

If you have a sunburn:

* Take a cool bath or shower. You can also apply a clean towel dampened with cool water.
* Apply an aloe vera or moisturizing lotion several times a day.
* Leave blisters intact to speed healing and avoid infection. If they burst on their own, apply an antibacterial ointment on the open areas.
* If needed, take an over-the-counter pain reliever such as aspirin, ibuprofen (Advil, Motrin, others), naproxen (Aleve) or acetaminophen (Tylenol, others). Use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 2, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. Talk to your doctor if you have concerns.

Don't use petroleum jelly, butter or other home remedies on your sunburn. They can prevent or delay healing.

If your sunburn begins to blister or if you experience immediate complications, such as rash, itching or fever, see your doctor.

Tick bites

Some ticks transmit bacteria that cause illnesses such as Lyme disease or Rocky Mountain spotted fever. Your risk of contracting one of these diseases depends on what part of the United States you live in, how much time you spend in wooded areas and how well you protect yourself.

If you've received a tick bite:

* Remove the tick promptly and carefully. Use tweezers to grasp the tick near its head or mouth and pull gently to remove the whole tick without crushing it.
* If possible, seal the tick in a jar. Your doctor may want to see the tick if you develop signs or symptoms of illness after a tick bite.
* Use soap and water to wash your hands and the area around the tick bite after handling the tick.
* Call your doctor if you aren't able to completely remove the tick.

See your doctor if you develop:

* A rash
* A fever
* A stiff neck
* Muscle aches
* Joint pain and inflammation
* Swollen lymph nodes
* Flu-like symptoms

If possible, bring the tick with you to your doctor's appointment.

Call 108 or 102 or your local emergency number if you develop:

* A severe headache
* Difficulty breathing
* Paralysis
* Chest pain or heart palpitations

Tooth loss

If your tooth is knocked out, get emergency dental care. It's sometimes possible to successfully implant permanent teeth that have been knocked out, but only if you follow the steps below immediately — before you see a dentist.

If your tooth is knocked out:

* Handle your tooth by the top or crown only, not the roots.
* Don't rub it or scrape it to remove debris. This damages the root surface, making the tooth less likely to survive.
* Gently rinse your tooth in a bowl of tap water. Don't hold it under running water.
* Try to replace your tooth in the socket. If it doesn't go all the way into place, bite down slowly and gently on gauze or a moistened tea bag to help keep it in place. Hold the tooth in place until you see your dentist.
* If you can't replace your tooth in the socket, immediately place it in some milk, your own saliva or a warm, mild saltwater solution — 1/4 teaspoon salt to 1 quart water (about 1 milliliter of salt to about 1 liter water).
* Get medical attention from a dentist or emergency room immediately.

If you participate in contact sports, you can often prevent tooth loss by wearing a mouth guard, fitted by your dentist.

Toothache

Tooth decay is the primary cause of toothaches for most children and adults. Bacteria that live in your mouth thrive on the sugars and starches in the food you eat. These bacteria form a sticky plaque that clings to the surface of your teeth.

Acids produced by the bacteria in plaque can eat through the hard, white coating on the outside of your teeth (enamel), creating a cavity. The first sign of decay may be a sensation of pain when you eat something sweet, very cold or very hot. A toothache often indicates that your dentist will need to work on your teeth.

Self-care tips
Until you can see your dentist, try these self-care tips for a toothache:

* Rinse your mouth with warm water.
* Use dental floss to remove any food particles wedged between your teeth.
* Take an over-the-counter (OTC) pain reliever to dull the ache.
* Apply an OTC antiseptic containing benzocaine directly to the irritated tooth and gum to temporarily relieve pain. Direct application of oil of cloves (eugenol) also may help. Don't place aspirin or another painkiller directly against your gums, as it may burn your gum tissue.

Call your dentist if:

* You have signs of infection, such as swelling, pain when you bite, red gums or a foul-tasting discharge
* The pain persists for more than a day or two
* You have fever with the toothache
* You have trouble breathing or swallowing

References:

1. en.wikipedia.org

2. American medical society
Indian medical society

[AJ3]Urticaria (from the Latin urtica, nettle,) commonly referred to as hives, is a kind of skin rash notable for pale red, raised, itchy bumps. Hives might also cause a burning or stinging sensation. Hives are frequently caused by allergic reactions; however, there are many no allergic causes. Most cases of hives lasting less than six weeks (acute urticaria) are the result of an allergic trigger. Chronic urticaria (hives lasting longer than six weeks) is rarely due to an allergy.

Amaresh Jha

Monday, 17 March 2014

FIRST AID

Foreign object in eye

Frostbite

Gastroenteritis

Headaches

Heart attack

Heat cramps

Heatstroke

Human bites

Hypothermia

Insect bites and stings

Motion sickness

Poisoning

Puncture wounds

Shock

Snakebite

Spider bites

Spinal injury

Sprain

Stroke

Sunburn

Tick bites

Tooth loss

Toothache