Encyclopedia of Family Medicine

Chapter 18 First Aid Common Sense (1)
Condition observation method

The purpose of observing the condition is to detect it in time and deal with it properly, so that the patient can turn the crisis into safety.The patient's consciousness, heartbeat, breathing, pupils, etc. are often important items to observe.

1. Observation content and method
(1) Observe with eyes.Check whether the patient has bleeding, trauma and other symptoms?Is the heart still beating?Use words to test whether the patient is still conscious?Is the patient's skin pale or bruised?

(2) Touch by hand.Touch the patient with your hands to know the speed of the pulse, the level of body temperature, the speed of breathing and the location of pain.

(3) Auscultate with the ear close to the patient's chest.The content of auscultation includes breathing and heartbeat.

(4) Check pupils.With the help of the flashlight, pay attention to observe whether the pupils on both sides are the same size and round, and whether they are sensitive, slow or disappear to the flashlight.The normal pupil diameter is about 2-5 mm, and the pupil diameter exceeding 3.5 mm or less than 5 mm is abnormal, which is often a sign of a critical condition.

2. Matters needing attention

When observing, be calm and calm, and check whether there are various life-threatening symptoms, such as massive bleeding, whether there is breathing, consciousness, serious injury, poisoning or poisoning symptoms, and grasp the accurate situation for treatment.

Do not move the patient around or deal with it alone, try to find a helper to help, and take appropriate emergency treatment as quickly as possible.

Methods of escorting critically ill patients
1. Escort method

(1) Send the patient quickly and treat them nearby.Time is life, and we must race against time to get the patients treated as soon as possible.For patients with massive hemoptysis, hematemesis, traumatic bleeding, stroke, acute myocardial infarction, etc., they should be treated as close as possible, and seek local doctors or send them to nearby hospitals for emergency treatment as soon as possible.Don't look far away, otherwise the condition may be delayed due to the long journey.

(2) Keep it steady.In close quarters, the patient can be transported on a stretcher or a recliner.A tricycle is used for a longer distance, and an ambulance or other cars can be used for a long distance.While seeking speed, it should also be "stable", so that the bumps on the road can be minimized, and it should be as stable as possible when going up and down stairs and climbing slopes.

(3) Properly arrange the patient's position.For a large number of hemoptysis, hematemesis, coma and frequent vomiting, the patient's head should be turned to one side to prevent vomitus from blocking the trachea and causing suffocation.

Patients with heart failure should adopt a position with the head high and the feet low to reduce the venous return of the lower extremities, reduce the burden on the heart, and improve dyspnea caused by cardiac insufficiency.

Stroke patients can adopt a lying position with the head high and the feet low, minimizing vibration and moving lightly.

Patients with hemoptysis should lie on the known side of the disease, which can compress the lungs of the affected side, reduce its breathing movement and reduce bleeding.

For patients with traumatic bleeding, the bleeding site should be placed above the level of the heart. After local bandaging to stop the bleeding, patients with head and face bleeding should take a sitting position if there is no shock, and those with shock should sit with the head down and feet high, so as to ensure the protection of important organs such as the brain. blood supply.

For those suspected of lumbar fractures due to lumbar trauma, a rigid plate should be used to transport them to avoid paraplegia caused by the fracture end compressing the spinal cord.If the limbs are fractured, they should be fixed before transportation to avoid displacement of the fractured limbs and damage to blood vessels and nerves.

(4) Keep calm, busy and not chaotic.After general first aid, if the patient urgently needs to be sent to the hospital for further treatment, it is necessary to pay attention to bring the relevant medical information of the patient, such as outpatient medical records, electrocardiograms, laboratory tests, X-rays, etc.In the case of poisoning or suspected poisoning, samples with reference value, such as drugs and medicine bottles, should also be taken to provide clues for doctors to take corresponding rescue measures as soon as possible.

2. Matters needing attention

(1) Don't drag the patient to cry and shake the patient's body.For patients with massive hemoptysis and hematemesis, the blood cannot be spit out in time due to shaking, causing airway obstruction and suffocation. For patients with traumatic brain injury or stroke, excessive shaking can aggravate intracranial hemorrhage. Patients with acute myocardial infarction are often conscious. Crying and shaking can make the patient nervous, increase blood pressure and increase the size of myocardial infarction.

(2) Pay attention to observe the condition and properly handle emergencies.Pulse and respiration should be measured frequently during transportation. If the patient's breathing and heartbeat are found to have stopped, precordial percussion, artificial respiration and chest cardiac compression should be performed immediately.When the patient is found to be suffocating, the patient should be placed on his stomach immediately and patted on the back to help expel the blood clots, vomitus, and sputum that block the trachea.

Precautions for calling an ambulance
When you encounter a patient who is suddenly ill or seriously injured, in addition to doing simple emergency treatment on the spot, you should also get in touch with the health center, hospital or emergency station as soon as possible, and the best way is to call for help by calling an ambulance.

1. Content of call for help

Calmly and accurately tell the other party the main things such as "who", "what", "where", "how it happened".

Explain the main signs and specific streets of the location.

Patient's condition, morbidity and condition.

Ask the person what steps to take until ambulance arrives.

2. Matters needing attention

The first aid station or the nearest hospital should be contacted.

The emergency number should be recorded and posted in a conspicuous place.

When contacting, be sure to listen to the other party's reply.

It is advisable to let one person wait for people and cars at the alley or roadside near the scene, so as to avoid the ambulance's delay in searching for patients.

Don't add too much of your own expectations or opinions when reporting, but inform the other party of the main issues concisely.

After the contact is completed, the emergency treatment should be continued, the patient's condition should be carefully observed, and some necessary preparations should be made for the patient to be admitted to the hospital.

Methods of transporting patients

When transporting patients, it is necessary to select appropriate transport methods and transport tools according to the specific conditions of the patients and local conditions.When hugging and helping the patient, the rescuer's movements should be light, agile and consistent.The whole process should be fast and stable to avoid aggravating the patient's condition due to handling.

1. Stretcher handling method
(1) Types of stretchers.There are many types of stretchers. In addition to standard stretchers, at the rescue scene, rescuers can temporarily make simple stretchers according to the site conditions, such as blanket stretchers, rope stretchers, door stretchers and chair stretchers.

(2) Handling method.Form a group of 3 to 4 people, and move the patient onto the stretcher safely.

The patient's head is turned to the right and the feet are forward, so that the stretcher can observe the changes of the patient at any time.

Stretcher bearers should move forward steadily. It is advisable that the person in front should step with his left foot, and the person behind should step with his right foot.

Whether going uphill or downhill, the stretcher bearer should keep the patient level.

2. Freehand handling method
If a stretcher cannot be found at the emergency scene, and the transfer distance is relatively short, and the patient's condition is relatively mild, the manual transport method can be used, but this method is not suitable for patients with severe conditions or fractures or chest trauma.

Commonly used bare-handed handling methods include: single-handed hand-carrying methods such as support method, hug-supporting method, and back-carrying method; two-person or multi-person hand-carrying methods such as cart-type, chair-style, and flat-holding methods.

If it is suspected that the patient has fractures of the thoracic and lumbar vertebrae, a "special" method should be adopted to carry the patient. The two-person lifting method of one person hugging the chest and the other lifting the legs is prohibited, because this kind of handling is likely to aggravate the spinal cord injury.The correct one is carried by three people.One person supports the shoulder blades, another person supports the waist and hips, and the other person supports the two limbs that are straightened and closed together. The three people act at the same time to gently "roll" the patient onto the hard board stretcher.When taking the supine position, use a small pad or clothes about 10 cm high on the chest and waist.

If a patient is suspected of having an injury to the cervical spine, the rescuer needs to be very careful.When moving to the stretcher, 3 to 4 people should move it together, and one of them is responsible for the traction and fixation of the patient's head, so that the head is always kept in a straight line with the trunk, and the neck is kept still.Two other people supported the torso, one supported the lower limbs, lifted the patient straight onto a stretcher, put a small pillow under the patient's neck, and fixed the head with soft pads or sandbags.

3. Moving vehicle handling method
Transporting patients by motor vehicles (especially ambulances) is ideal, but subject to limitations.Driving on the way to reduce the bumps, keep stable.Generally, patients can take the supine position, patients with chest injuries can use the semi-recumbent position, and patients with craniocerebral injuries should turn their heads to one side.Rescuers should pay attention to observe the patient's breathing, pulse and other important signs.

emergency patient position

Under normal circumstances, the patient can take the supine position.However, when an unconscious patient is lying on his back, his head should be turned to one side, so that oral secretions and vomit can flow out easily, so as to prevent suffocation and aspiration pneumonia.

If the patient has asthma, dyspnea or severe heart failure, the patient can be placed in a semi-recumbent position.Use quilts and other objects to support the patient's upper body, and place a round pillow or folded quilt under the knees to prevent the patient from sliding down.

For patients with wounds on the back, waist, or buttocks who cannot lie on their backs or sides, a prone position is advisable: the patient lies on his stomach, his head is turned to one side, his arms are bent on both sides of his head, and a soft pillow is placed under his abdomen and knees. The posture is comfortable without affecting the smoothness of the airway.

For patients with abdominal pain or abdominal trauma, the legs can be flexed to relax the abdominal muscles and reduce the tension of the abdominal wall.

For limb bleeding, the injured limb should be elevated above the level of the heart.

keeping the patient warm
1. The meaning of keeping warm
Keeping warm for emergency patients, especially critically ill patients, can not only maintain their normal body temperature, but also avoid fever caused by the decline of systemic resistance caused by serious illness, so that they can calm down and rest quietly, and can also reduce the movement and transportation of patients in various ways.Vibration generated during transfer.

2. Specific measures

If the patient's clothes get wet, take off the wet clothes as soon as possible and put on clean clothes.

Cover the sick person with a blanket, towel, or other warm item, especially if the temperature is cold.

If conditions are limited, all items should be used for heat preservation as much as possible. Gunny bags, paper, straw, etc. can all play this role.

Pay attention to laying warm materials under the patient.

If necessary, hot water bottles, electric blankets, etc. can be used to keep warm, but care should be taken to prevent the patient from being burned.

Keeping warm should be appropriate and should not be overdone, causing the patient to sweat due to heat.

airway clearing
Unblocking the airway can relieve the patient's airway obstruction and facilitate the implementation of artificial respiration. It is the primary measure to rescue patients with loss of consciousness and respiratory arrest.

1. Lift the tongue drop method

Patients who have stopped breathing often cause the base of the tongue to fall backward due to the lower jaw, blocking the airway.The rescuer should tilt the patient's head back as far as possible until the patient's lips can be opened.After the head is raised, the patient's jaw and throat are tightened, and the base of the tongue is also lifted up to relieve the airway blockage.

If the patient's neck is injured or the patient is too old, and the upward method cannot completely relieve the tongue drop, the jaw pushing method can be used: that is, the rescuer grasps and lifts the mandibular angles on both sides of the patient with both hands, so that the mandible is pushed forward and the tongue falls The base of the tongue leaves the posterior pharyngeal wall.

2. Simple suction method
(1) Mouth-to-mouth suction method.The rescuer holds up the patient's jaw with one hand, tilts his head back, pinches the patient's nostrils with the other hand, and uses his own mouth to point at the patient's mouth to suck out the secretions forcefully.This method is most suitable for patients who suffocate due to sudden blockage of sputum, but without any emergency equipment.

(2) Syringe suction method.The patient is placed in a supine or semi-recumbent position with the head slightly tilted back and to one side.Rescuers use 50 or 100 ml syringes and connect them with thick and porous catheters. If not, plastic tubes can be used instead of suction.If there is secretion in the throat, the catheter can be inserted through the mouth; if there is secretion in the throat, the catheter can be inserted through the nasal cavity.

3. Cricothyroid membrane puncture

For patients with acute laryngeal edema or laryngeal trauma, if the above methods cannot be used to relieve airway obstruction or the above methods are ineffective, a thicker injection needle can be used for cricothyroid membrane puncture to ensure oxygen supply.

4. Matters needing attention

Before dredging the airway, other influencing factors should be eliminated, such as unbuttoning the patient's collar button and belt in time, and removing the bra for the female patient to enhance the ventilation effect.

Turn the patient's head to one side to prevent secretions from flowing backward into the pharynx.

Pay attention to observe the ups and downs of the patient's chest and abdomen, listen to the sound of airflow passing through the patient's mouth and nose, and put the cheek close to the patient's mouth and nose to feel whether there is air coming in or out.

Artificial respiration

Artificial respiration refers to the rhythmic inhalation or discharge of gas into the lungs by artificial methods to ensure the supply of oxygen consumption and the removal of carbon dioxide.It is one of the measures to rescue the patient's apnea.

1. Mouth-to-mouth artificial respiration
(1) Application indications.It is suitable for emergency rescue of patients with apnea without any medical equipment, especially for neonatal asphyxia.

(2) Operation method.Immediately put the patient supine, loosen the clothes buttons, remove sputum, vomit, blood clots, etc. in the oral cavity, and keep the airway open.Then hold up the patient's chin with one hand, make the head tilt back as far as possible, pinch the patient's nostrils with the other hand to prevent air leakage, and use the hand holding the chin to spread the patient's mouth, and the rescuer takes a deep breath , blow into the patient a few mouthfuls forcefully, and observe whether the patient's chest rises and falls.Immediately after blowing, leave the patient's mouth and release the fingers pinching the nostrils so that the air insufflated into the lungs can be discharged naturally.Do this repeatedly, 14 to 16 times per minute for adults, 18 to 24 times per minute for children, and 30 to 40 times per minute for infants.The blowing force should be moderate, not too strong or too large to prevent blowing of the alveoli, and not too small to avoid insufficient gas supply and fail to achieve the purpose of first aid.

2. Mouth-to-nose artificial respiration

(1) Application indications.It can be used when mouth-to-mouth artificial respiration cannot be performed when the patient is in trismus.

(2) Operation method.The method of blowing is basically the same as that of mouth-to-mouth artificial respiration, except that pinching the nose with hands is changed to pinching the lips of the patient, and blowing at the nostrils, but the blowing force should be slightly larger and the blowing time should be slightly longer.

3. Manual artificial respiration
(1) Face-to-face artificial respiration.The patient lies prone, with one arm stretched forward, the other arm bent under the head, and the face turned to one side.The ambulanceman faces the patient's head, straddles the patient's thighs, puts his hands flat on the lower ribs behind his back, his thumbs are close to the spine, and the other four fingers are separated, sticking outwards to the back. straight.The rescuer leans forward, relies on body weight and arm strength, slowly pushes down, then raises the body upright, relaxes both hands, and presses and releases regularly.16~20 times per minute.Be careful not to apply too much pressure to avoid rib fractures.

(2) Supine compression chest artificial respiration.First let the patient lie on his back, put his arms flat beside him, and loosen his belt and clothes buttons.Add a pad to the back to slightly lift the chest.The patient's head is turned sideways.The rescuer separates his legs, straddles the outside of the patient's thighs, faces the patient's head, spreads his hands in a fan shape, places them under the patient's breasts, stretches his arms straight, and pushes the patient's chest upwards and inwards by relying on his body weight and arm strength , making the chest shrink, forcing the air out of the lungs.Then quickly relax both hands to expand the chest naturally so that the outside air can enter the hilum. Repeat this operation, 16-20 times per minute for adults.

precardiac percussion

Precardiac percussion refers to the rescuer punching the patient's chest with a fist to make the heart beat again.However, strictly speaking, it does not function as an artificial heartbeat, but merely stimulates the heart.

1. Applicable indications
Precardiac percussion can only be used in patients whose heart has stopped for 30 seconds.

2. Operation method

Determine the patient’s left nipple and the middle part of the chest, make a fist with your hand, tap 20 to 30 times at a height of 2 to 3 centimeters above the chest wall, and check the pulse and heartbeat. If percussion is successful, otherwise this method should be abandoned and external cardiac compression should be used instead.

Extrathoracic Cardiac Compression

Cardiac compression is one of the effective methods to rescue patients with cardiac arrest on the spot.It has the characteristics of simple method and exact effect, and is very suitable for application in family rescue.

1. Adult extrathoracic cardiac compression
The patient lies supine on a hard bed or on the ground, and feels a long and narrow bone, the sternum, in the middle of the chest.The rescuer puts the heels of the palms of both hands on the junction of the middle and lower 1/3 of the patient's sternum, straightens both elbows, and presses down vertically with impact force to make the sternum sink by 3 to 4 centimeters, and then relax to restore the sternum , but the heel of the palm does not leave the chest wall skin.Such a press and a release are repeated rhythmically, about 70 times per minute.

2. Infant thoracic cardiac compression
The rescuer puts the index finger and middle finger on the upper part of the lower sternum to squeeze, and squeezes down rhythmically about 120 times per minute.You can also squeeze with your thumb, and put the other four fingers together on the baby's back.When squeezed, the sternum sinks to a depth of 1.5 to 2 centimeters.

3. External thoracic cardiac compression for preschool children

The rescuer pressed the lower part of the sternum of the sick child with the heel of one palm, straightened the elbow joint, and squeezed it down rhythmically.The depth of sternal depression is 2-4 cm.About 100 times per minute.

4. Matters needing attention

Squeeze should be rhythmic, impactful, and directed toward the spine.

When squeezing, do not act violently or use too much force, so as not to cause rib fractures or even liver and spleen rupture.

After pressing, if the femoral artery or carotid artery pulse is felt, it means that the squeezing is effective.Artificial respiration should be performed at the same time.

Patients with severe chest trauma should not use this method.

Hemostatic method

Hemorrhage caused by trauma can often lead to shock or even death of the patient. Only rapid, decisive and effective hemostasis can save the patient's life.

1. Elevate the injured limb

If the small arteries or small veins of the extremities are bleeding, the patient's injured limb can be raised to reduce the pressure on the bleeding site and reduce bleeding.

2. Shiatsu hemostasis

Finger pressure hemostasis refers to using fingers to press the artery at the proximal end of the wound to the deep bone to block the blood flow, so as to achieve the purpose of temporary hemostasis.

(1) Bleeding from the front of the head.The rescuer or the patient himself uses the thumb to compress the superficial temporal artery in front of the tragus and facing the mandibular joint.

(2) Bleeding on the back of the head.Press on the post-auricular artery slightly laterally below the post-auricular protrusion.

(3) Facial bleeding.Compress the facial artery 1.2 cm anterior to the mandibular angle.

(4) Neck bleeding.Below the Adam's apple, the anterior edge of the sternocleidomastoid muscle can feel the pulse of the common carotid artery, and the bleeding can be stopped by pressing it against the cervical spine.However, please note that since the blood of the common carotid artery mainly supplies the cranial nerves, it is forbidden to press both common carotid arteries at the same time.

(5) Armpit and shoulder bleeding.Press on the beating subclavian artery above the midpoint of the clavicle in the depression below the base of the neck (supraclavicular fossa).

(6) Upper extremity bleeding.Press the brachial artery toward the humerus where the pulsation of the medial artery of the upper arm is evident.

(End of this chapter)