FIRST AID KIT
First of all, let us make sure that we have the basic supplies required in a good first aid kit. Keep your kit separate from other everyday requirements, so that everything will be handy if needed. Always keep it beyond the reach of small children, but don't lock it, you could waste valuable time hunting for the key. 

SUPPLIES NEEDED:
1. Sterile gauze and lint dressings (preferably 4 inches by 4 inches in size) or cleaning and covering wounds.
2. Bandages: 1 inch and 3 inches, linen. Also some crepe bandages and triangular bandages.
3. Assorted adhesive dressings.
4. Cotton Wool.
5. Adhesive tape.
6. Mild antiseptic. 

THE COLLAPSED PATIENT:
Probably the commonest situation that will be met is when someone collapses. A faint may be the reason, but equally the cause could be a heart attack, a stroke or some other medical emergency. It is important, therefore, to assess the patient as fully as possible before attempting any procedure. 

THE VITAL SIGNS:
In the case of a collapsed person the two most important assessments are respiration and circulation.

1. Respiration:

It is essential to make sure that the individual is breathing and that the airway is clear. If the brain is starved of oxygen for more than a few minutes then irreversible brain damage can occur.
· look for evidence of movement of the chest or abdomen;
· listen near the mouth and chest to hear whether there are breath sounds;
· it should be possible to feel the breath on the cheek.
Breathing can be obstructed by blood, saliva, vomit, food residues or dentures. If the breathing seems to be obstructed then two fingers should be placed in the mouth above the tongue and swept round to remove any such obstruction.
If having done all these things there is still no sign of breathing then artificial respiration should be started at once.

2. Circulation:

The pulses should be checked. First check for the radial then the carotid.
If there is no breathing and no pulse, then cardio-pulmonary resuscitation (CPR) should be started. 

CARDIO-PULMONARY RESUSCITATION:

This technique can be life-saving. Ideally, the student should have practical tuition, either at a first aid class or on a CPR training course. These are offered by various groups and are well worth attending.
We will firstly assume that the individual is alone.

Two points have to be reiterated:

1. The airway must be clear, otherwise there is a risk of blowing a foreign body further down the airway. (Remember that the individual could have collapsed after choking on something).

2. External chest compression must not be done if there is a pulse or heart?beat. The danger is that a weakly beating heart could actually be stopped. 

ARTIFICIAL VENTILATION:

The first thing to do is make sure that the individual is lying on a firm surface. However, if the patient is a casualty case and a neck or spinal problem is suspected try to move as little as possible.
Next, tilt the head back slightly, in order to open the airway.
Check immediately for a pulse. If there is no pulse, then chest compression must be begun. If there is a pulse then chest compression should not be performed.
A handkerchief may be placed over the patient's mouth. Then with a full breath in, open the mouth fully and seal it round the patient's mouth. Blow, watching for the rise of the chest. As it rises, stop blowing, physically turn and watch it go down again as you take another breath to fill your lungs. Give 4 quick breaths like this then check the pulse. If the pulse is present then you should do 16 ventilations per minute. 

CHEST COMPRESSION:

Again, it has to be said that there is no substitute for being shown how to do this in person.
Kneel beside the patient. If and only if there is no pulse should this be done.
Feel for the angle at the bottom of the rib cage at the top of the abdomen. Place the heel of the hand on the sternum, two finger-breadths above the angle. Then place the palm of the other hand above it. Keep the elbows straight and lean forward to compress the chest. An adult's chest wall should be compressed by about 1 inch; a child's by half this.

15 compressions at a rate of 80 bpm should be given. This is slightly more than one compression per second.
After the 15 compressions the patient should be given two ventilations.
Check the pulse.
Repeat the cycle until heartbeat and respiration start, or until help and relief arrive. 

RECOVERY SIGNS:

The patient starts to lose the cyanosis. This means that oxygen is reaching the tissues.
The pulse returns.
The breathing restarts, often preceded by a groan. 

RECOVERY POSITION:

Once recovery signs have been found, the patient should be placed in the recovery position.
Kneel beside the patient and gently turn their head towards you. Then straighten and tuck the nearest arm under their body. Draw the farther arm across the chest and cross the farther ankle over the one nearest to you. Gently roll the patient towards you, taking care to avoid injury to their head. Once they are over, tilt the head to ensure that the airway remains open. Then bend the arm and knee nearest to you at 90 degrees so that they will not roll over.
The patient should not be left alone.
If there are two people present, then 5 compressions at 60 bpm or one every second should be done to every 1 ventilation. 


FAINTS:

Faints are extremely common. The above checks should be done to ensure that a cardiac arrest has not occurred.
Fear, pain, prolonged standing or straining can all cause a faint. Characteristically, there is pallor, sweating, preceding dizziness and loss of consciousness. Incontinence may also occur.
The patient should not be lifted or supported. They should lie down or be helped to lie. The legs should be raised and tight clothing should be loosened. 

EPILEPTIC FITS:

There are several types of epilepsy. Grand Mal is the name given to the major form.

Different stages are recognised. First, the individual may experience an aura, a set of symptoms which forewarn him/her that an attack is about to come. This may take the form of peculiar tastes, smells or visual disturbance.
The tonic phase follows. Here the individual falls, becomes stiff and the face goes red or purple.
The clonic phase occurs when the individual starts to shake, often violently. The face may grimace, breathing will be slow, there may be salivation from the mouth, and there may be incontinence.
The relaxation phase follows as the convulsion passes over. The patient drifts into sleep. This may last for a few minutes or several hours.
The postictal phase follows the return to consciousness. It may amount to momentary confusion, or it may cause bizarre behaviour for several hours. 

THE MANAGEMENT:

The first thing is to clear things away from the surrounding area so that the patient does not injure him/herself. A cushion or some sort of pad should be placed under the head.
The individual may be carrying an epilepsy card which will inform you of the type of problem they suffer from, and who to contact.
If the attack goes on for more than two minutes an ambulance should be contacted.
You should not attempt to put anything into the mouth. The individual is not likely to swallow their own tongue, so you are more likely to cause injury to their mouth.
After the attack, place the individual in the recovery position. 

CHOKING:

This usually occurs when some foreign body, be that a sweet or piece of food, is inhaled into the larynx. Laughing or sneezing with something in the mouth is the likeliest cause.
The individual should be encouraged to cough.
They should be bent over and slapped between the shoulder blades. This should be done up to 4 times.
Check the mouth again for the foreign object.
The abdominal thrust method should be used if this fails. This should only be used if the other methods have failed. Stand behind the individual and put an arm round him/her. Clench the fist and place it in the middle of the abdomen, above the umbilicus. The closed fist should be so positioned that the thumb knuckle is against the individual's abdominal wall. The fist is grasped with the other hand and both are pulled in a sudden thrust. This could be done up to 4 times.
Clear out the mouth after each attempted procedure. 

ASTHMATIC ATTACKS:

The asthma sufferer will almost certainly have an inhaler upon them. They should be asked to take it themselves. Quite simply, if there is no improvement, then medical help should be sought instantly. People still do die from asthma so treatment should not be delayed. 

TRAUMA:

After ensuring that the individual can breathe and that they have a pulse, the next thing to check on is blood loss.
Pulsing blood flow implies arterial damage and is an emergency. Apply firm pressure to the bleeding point. Do not attempt to put on a tourniquet. This may end up more hazardous to the individual than the blood loss. 

NOSEBLEEDS:

There is a lot of different ideas about stopping nose-bleeds. The nose must be pinched on the fleshy part below the bony part of the nose. The individual should be allowed to sit forward over a basin and the pressure should be maintained for at least ten minutes. The pressure should then be gradually released. 

CHEST PAIN:

Central chest pain, especially with radiation into the neck or down the arms must be assumed to be due to myocardial ischaemia until proved otherwise. The patient must be allowed into the half?sitting position with the head, knees and shoulders supported by cushions. They should be encouraged to try to relax while help is obtained urgently. Tight clothing should be released. 

LOSS OF CONSCIOUSNESS: 
If the individual loses consciousness, do the checks outlined in the first part of this lesson. If they are still breathing with a good pulse, then put them into the recovery position. If not, then be prepared to start artificial ventilation, or possibly CPR. 

Self Assessment Questions:

You may, if you wish, use these questions to test your own understanding. Please DO NOT send your answers it to the school. Thank you.

1. Describe how you would treat a collapsed patient.
2. A patient is having convulsions. Would you try to restrain his movements? Answer Yes or No.
3. Describe cardio? pulmonary resuscitation.
4. You are alone with a casualty who is in urgent need of artificial respiration. What would you do first ? summon a doctor or carry out artificial respiration?
5. What is the cause of fainting?
6. Why should a soft pad be put between the jaws of a patient who is suffering an epileptic fit?
7. A patient is having a heart attack. What is the first thing you should do?
8. In less that a total of 60 words, describe two ways of arresting a nosebleed?
9. How do you help a patient who is choking?
10. A patient has severe chest pains. What do you do to help them? 

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