Choking

Choking is a blockage of the upper airway by food or other objects, which prevents a person from breathing effectively. Choking can cause a simple coughing fit, but complete blockage of the airway may lead to death.

Choking is a true medical emergency that requires fast, appropriate action by anyone available. Emergency medical teams may not arrive in time to save a choking person's life.

Choking Symptoms

*Universal Sign Of Choking

If an adult is choking, you may observe the following behaviors:

• Coughing or gagging
  
• Hand signals and panic (sometimes pointing to the throat)
  
• Sudden inability to talk
  
• Clutching the throat: The natural response to choking is to grab the throat with one or both hands. This is the universal choking sign and a way of telling people around you that you are choking.
  
• Wheezing (A whistling noise in the chest during breathing. Wheezing occurs when the airways are narrowed or compressed.)
  
• Passing out
  
• Turning blue: a blue coloring to the skin, can be seen earliest around the face, lips, and fingernail beds. You may see this, but other critical choking signs would appear first.
  
• If an infant is choking, more attention must be paid to an infant's behavior. They cannot be taught the universal choking sign.
  
• Difficulty breathing
  
• Weak cry, weak cough, or both

Treatment for adult or child

Your aims are to remove the obstruction and to arrange urgent removal to hospital if necessary.

If the obstruction （障碍物） is mild

• Encourage them to continue coughing.
• Remove any obvious obstruction from the mouth.

If the obstruction is severe

• Give up to five back blows.
• Check the mouth and remove any obvious obstruction.

If the obstruction is still present:

• Give up to five abdominal thrusts / heimlich manoeuvre*
• Check the mouth and remove any obvious obstruction.

If the obstruction does not clear after three cycles of back blows and abdominal thrusts:

• Dial 999 for an ambulance.
• Continue until help arrives.

Treatment for infants:

Your aims are to remove the obstruction and to arrange urgent removal to hospital if necessary.

If the infant is distressed, is unable to cry, cough, or breathe:

• Lay them face down along your forearm, with their head low, and support the back and head.
• Give up to five back blows, with the heel of your hand.
• Check the infant's mouth; remove any obvious obstructions.
• Do not do a finger sweep of the mouth.

If the obstruction is still present:

• Turn the infant onto his back and give up to five chest thrusts.
• Use two fingers, push inwards and upwards (towards the head) against the infants breastbone, one finger's breadth below the nipple line.
• The aim is to relieve the obstruction with each chest thrust rather than necessarily doing all five.

OR

• Check the mouth.

If the obstruction does not clear after three cycles of back blows and chest thrusts:

• Dial 999 for an ambulance.
• Continue until help arrives.

Burn And Scald

*Please take note of this topic as it is a popular questions that will come out in the examination.

DEFINITION
-Injuries caused by extremes of temperature, chemicals or radiation.

CAUSES OF BURNS AND SCALDS 
A BURN is caused by:
1) Dry heat - fire or hot objects.
2) Electrical burn - contact with electrical current or by lighting.
3) Friction - from a revolving wheel or fast moving rope.
4) Chemical burn - strong acids or alkalis.
5) Intense cold - liquid oxygen, liquid nitrogen and extremely cold metals.
6) Radiation - exposure to sun or radioactive substances.

A SCALD is caused by:
1) Moist heat - hot liquid or steam.

• The Rule Of Nines assesses the percentage of burn and is used to help guide treatment decisions including fluid resuscitation and becomes part of the guidelines to determine transfer to a burn unit.

DEPTH OF BURN

  A. Superficial burn injury

• 1^st degree burn
• Limited to the epidermis
• Presents with erythema and minimal swelling
• Mild discomfort
• Commonly treated on outpatient basis

B. Intermediate burns

• 2^nd degree burns
• Involves the epidermis and superficial portion of the dermis
• Often seen with scalding injuries
• Presents with blister formation and typically blanches with pressure
• Sensitive to light touch or pinprick
• Commonly treated on outpatient basis; heal in 1-3 wks

C. Full-thickness burns

• 3^rd degree burns
• Involves epidermis, and all layers of dermis, extending down to subcutaneous tissue
• Appears dry, leathery, and insensate, often without blisters
• Can be difficult to differentiate from deep partial-thickness burns
• Commonly seen when patient’s clothes caught on fire/ skin directly exposed to flame
• Usually require referral to burn surgeon; need skin grafting to heal.

SYMPTOMS AND SIGNS

• Severe pain at injury.
• Reddening of the skin. (Skin becomes red)
• Blister. (起泡泡）
• Destruction of skin.
• Shock.

Treatment for Severe Burn

• Start cooling the burn immediately under running water for at least 10 minutes
• Dial 999 for an ambulance.
• Make the casualty as comfortable as possible, lie them down.
• Continue to pour copious amounts of cold water over the burn for at least ten minutes or until the pain is relieved.
• Whilst wearing disposable gloves, remove jewellery, watch or clothing from the affected area - unless it is sticking to the skin.
• Cover the burn with clean, non-fluffy material to protect from infection. Cloth, a clean plastic bag or kitchen film all make good dressings.

Treatment for Clothing On Fire

• Stop the casualty panicking or running – any movement or breeze will fan the flames.
• Drop the casualty to the ground.
• If possible, wrap the casualty tightly in a coat, curtain or blanket (not the nylon or cellular type), rug or other heavy-duty fabric. The best fabric is wool.
• Roll the casualty along the ground until the flames have been smothered.

On all burns:

• DO NOT overcool the casualty; this may dangerously lower the body temperature.
• DO NOT remove anything sticking to the burn; this may cause further damage and cause infection.
• DO NOT touch or interfere with the injured area.
• DO NOT burst blisters.
• DO NOT apply lotions, ointment, or fat to the injury.

*Please refer to text book Lesson 12 for more information.

Cardio Pulmonary Resuscitation (CPR)

Cardiopulmonary resuscitation (CPR) is an emergency procedure which is performed in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person in cardiac arrest. It is indicated in those who are unresponsive with no breathing or abnormal breathing, for example agonal respirations. It may be performed both in and outside of a hospital.

CPR involves chest compressions at least 5 cm deep and at a rate of at least 100 per minute in an effort to create artificial circulation by manually pumping blood through the heart. In addition, the rescuer may provide breaths by either exhaling into the subject's mouth or utilizing a device that pushes air into the subject's lungs. This process of externally providing ventilation is termed artificial respiration. Current recommendations place emphasis on high-quality chest compressions over artificial respiration; a simplified CPR method involving chest compressions only is recommended for untrained rescuers.

CPR alone is unlikely to restart the heart; its main purpose is to restore partial flow of oxygenated blood to the brain and heart. The objective is to delay tissue death and to extend the brief window of opportunity for a successful resuscitation without permanent brain damage. Administration of an electric shock to the subject's heart, termed defibrillation, is usually needed in order to restore a viable or "perfusing" heart rhythm. Defibrillation is only effective for certain heart rhythms, namely ventricular fibrillation or pulseless ventricular tachycardia, rather than asystole or pulseless electrical activity. CPR may succeed in inducing a heart rhythm which may be shockable. CPR is generally continued until the subject regains return of spontaneous circulation (ROSC) or is declared dead.

Medical uses 

CPR is indicated for any person who is unresponsive with no breathing, or who is only breathing in occasional agonal gasps, as it is most likely that they are in cardiac arrest. If a person still has a pulse, but is not breathing (respiratory arrest), artificial respirations may be more appropriate, but due to the difficulty people have in accurately assessing the presence or absence of a pulse, CPR guidelines recommend that lay persons should not be instructed to check the pulse, while giving health care professionals the option to check a pulse. In those with cardiac arrest due totrauma CPR is considered futile in the pulseless case, but still recommended for correctible causes of arrest.

Methods

In 2010, the American Heart Association and International Liaison Committee on Resuscitation updated their CPR guidelines.The importance of high quality CPR (sufficient rate and depth without excessively ventilating) was emphasized. The order of interventions was changed for all age groups except newborns from airway, breathing, chest compressions (ABC) to chest compressions, airway, breathing (CAB). An exception to this recommendation is for those who are believed to be in a respiratory arrest (drowning, etc.)

CPR IN THREE SIMPLE STEPS

1. CALL Check the victim for unresponsiveness. If the person is not responsive and not breathing or not breathing normally. Call 999 and return to the victim. In most locations the emergency dispatcher can assist you with CPR instructions.
2. PUMP If the victim is still not breathing normally, coughing or moving, begin chest compressions.  Push down in the center of the chest 2 inches 30 times. Pump hard and fast at the rate of at least 100/minute, faster than once per second.
3. BLOWTilt the head back and lift the chin. Pinch nose and cover the mouth with yours and blow until you see the chest rise. Give 2 breaths.  Each breath should take 1 second.
CONTINUE WITH 30 PUMPS AND 2 BREATHS UNTIL HELP ARRIVES  NOTE: This ratio is the same for one-person & two-person CPR.  In two-person CPR the person pumping the chest stops while the other gives mouth-to-mouth breathing.

How to control bleeding.

1. INDIRECT PRESSURE
place your finger on the pulse to stop bleeding.
a) Radial Pulse 手腕
b) Carotid Pulse 颈项
c) Brachial Pressure Point 手腕内侧
d) Femoral Pressure Point 大腿内侧

2. DIRECT PRESSURE
Use triangular bandage to stop bleeding.
Place it on the wound.


3. ELEVATION
Raise the casualty's limb that injured and bleeding over the heart to let the blood flows back to the heart.

Apply direct pressure first , if it doesn't stop bleeding , apply indirect pressure.
When applying elevation , you should stop bleeding by direct pressure or indirect pressure too.