Encyclopedia of Family Medicine

Chapter 19 First Aid Common Sense (2)
(7) Bleeding on palms and backs of hands.Use the thumbs of both hands to press on the ulnar and radial arteries of the wrist respectively.

(8) FINGER BLEEDING.Use the unaffected finger to pinch the base of the injured finger from both sides (not up and down).

(9) Thigh bleeding.Feel the femoral artery just below the midpoint of the groin (at the base of the thigh), and press the femoral artery toward the femur with overlapping thumbs of both hands.

(10) Calf bleeding.Press the leg artery in the middle of the leg socket.

(11) FEET BLEEDING.Below the ankle joint is the dorsal artery and the beating part (posterior tibial artery) later on the medial malleolus. Press them with the thumbs of both hands.

3. Limb flexion to stop bleeding

If the forearm or calf is bleeding, a cotton pad can be placed in the elbow or leg socket, the forearm or calf is extremely bent and clamped, and then the forearm and upper arm or calf and thigh are bandaged in an "8" shape.

4. Compression dressing to stop bleeding

Cover the patient's wound with a sterile dressing or a clean handkerchief, and bandage it firmly to stop the bleeding.But please note that since the pressure bandage is less powerful to stop blood pressure, it can only block the venous return, while the arterial blood flow still flows, so care should be taken when implementing this measure.

5. Tourniquet hemostasis

(1) Common methods.

Rubber tourniquet to stop bleeding.

Cloth tourniquet to stop bleeding can be replaced by triangular towel and handkerchief.

(2) Notes.

Hemostasis with a tourniquet is a temporary measure and should be used with caution because it can easily cause tissue necrosis.

Tourniquets are commonly used on the upper arms and thighs, and tourniquets are not suitable for forearms and calves.

Before applying the tourniquet, the injured limb should be raised for 2 to 3 minutes to allow the venous blood to return.

The tourniquet cannot be directly strangled on the skin, and an insert such as cotton, dressing or clothes, towels, etc. should be placed between the tourniquet and the skin.

The tightness of the upper tourniquet should be based on the cessation of bleeding and the inability to feel the pulse of the distal artery.

Immediately after the tourniquet is put on, it should be clearly marked and the time should be marked, and it should be relaxed every 15 to 30 minutes for about 1 to 1 minutes each time to avoid tissue ischemic necrosis.

When transferring for treatment, they should be escorted by a special person, who is responsible for loosening and tightening the tourniquet on time.

The second tourniquet should be placed slightly distally.

fracture fixation

Broken bones due to direct or indirect violence are called fractures.Fractures are usually accompanied by damage to the surrounding soft tissue, bleeding, and therefore severe pain.However, after appropriate temporary immobilization at the rescue scene, the pain can be relieved and the affected limb can be kept in the functional position.In general, splint immobilization is the easiest and easiest way to do it.

1. Rib fracture fixation
Rib fractures that do not puncture the pleura and lungs can be immobilized with multi-head straps.At the end of the patient's deep exhalation, wrap a multi-head strap around the chest at the broken bone to reduce breathing motion.

Another method is to put cotton pads on the fracture site first, let the patient exhale forcefully, and then stick a 3 cm wide adhesive plaster on the injured area in the shape of imbricate tiles.The adhesive tape only needs to slightly exceed the midline of the front chest and back, so as not to hinder the breathing of the healthy side.

2. Humeral fracture fixation
First bend the injured arm 90 degrees from the elbow joint, place a splint on the inside of the upper arm, the upper end against the armpit, the lower end reaches the elbow, put a splint on the outer side of the upper arm, the upper end extends over the shoulder, and the lower end extends outside the elbow, then wrap it with a bandage and fix it. And use a triangular towel or cloth belt to lift the upper limbs.

If you can't find a splint, you can bend the injured limb close to the axillary side of the chest, and fix the injured limb on the chest with a bandage.

3. Forearm fracture fixation
Put a small splint on the inside and outside of the forearm, then wrap it with a bandage, and hang it with a triangular towel or cloth belt.

4. Thigh fracture fixation method
First straighten the injured leg and gently pull the injured limb outward. Another person holds down the patient's pelvis and places a splint on the inner and outer sides of the thigh.The inner splint is shorter, from the upper end to the root of the thigh, and the lower end passes through the heel. The outer splint is slightly longer, from the upper end to the armpit, and the lower end passes through the heel. Cotton gauze is placed on the joint and fixed with a triangular bandage or bandage.

When there is no splint, the injured leg and the unaffected leg can be raised straight and fixed with a strap or a triangle towel.

5. Calf fracture fixation
Use a long and narrow wooden plank, one side is padded with cotton or clothes, and the outside is wrapped with a bandage. It is attached to the outside or bottom of the injured leg. One end of the splint reaches the upper thigh and the other end reaches the heel.Use four triangular scarves to fasten the thighs, the top and bottom of the knees, and the top of the heels, respectively, with the legs and splints.

6. Use simple materials for fixing

If the splint cannot be found for a while, thick paper, periodicals, cushions and even snowboards can also be used instead of the splint for fixation.

7. Matters needing attention

On-site fixation is not restoration, but only to limit the activity of the injured limb and facilitate the doctor's diagnosis and treatment in the future. Therefore, non-professionals should not attempt to reset the broken bone.

When fixing, some cotton and gauze should be placed on the splint, bony protrusions and joints to avoid long-term oppression and necrosis.

Do not wrap the gauze too tightly.When fixing, finger (toe) tips should be exposed in order to observe blood circulation.If the fingers (toes) are found to be pale, numb, painful, swollen, or blue-purple, they should be released and re-fixed in time.

wound dressing

Bandaging is one of the most commonly used surgical first aid techniques. It has the functions of compressing hemostasis, protecting wounds, preventing infection, fixing fractures and relieving pain.Bandages are usually used for bandages, but in first aid, it can also be replaced by clean clothes, towels, handkerchiefs and other materials according to local conditions.

1. Bandage method
The key points of bandaging: the rescuer covers the wound with sterile gauze or clean gauze, then holds the bandage head in the left hand and the bandage roll in the right hand, and wraps it from left to right and from top to bottom. 1/2 or 1/3 of the bandage.The bandaging should not be too tight, so as not to compress the tissue and cause local swelling, and it should not be too loose, so as not to slip and not achieve the effect of bandaging.When bandaging the limbs, it should start from the end, and the fingers (toes) should be exposed to the outside, so as to observe the blood circulation at any time.Generally, the arms should be bent and bandaged, and the legs should be bandaged straight to keep the limbs in a functional position.The bandage must be wrapped for two weeks at the beginning and end to prevent it from falling off and loosening.

2. The dressing method of the toilet material
At the scene of ambulance, it is very practical to use handkerchiefs, towels and other feces materials for first aid bandaging.For example, wrapping the head with a handkerchief or a towel, and wrapping the shoulders and chest with a towel can replace the wound of the above-mentioned parts with a bandage.

Heat stroke
Heat stroke is an acute disease caused by living or working in an environment with high temperature or scorching sun for a long time.It includes three diseases: heat stroke, sunstroke, and heat cramps, which can lead to heat exhaustion in severe cases.

1. Disease characteristics

(1) Premonition of heatstroke.The patient has symptoms such as general fatigue, profuse sweating, thirst, dizziness, chest tightness, palpitation, vertigo, nausea, and inattention, and the body temperature is normal or slightly elevated.

(2) Characteristics of heat stroke, sunstroke and heat cramps.

2. Identification method

(1) Differentiate from cerebrovascular disease.Cerebrovascular disease is more common in the elderly. The patient is coma or unconscious first, followed by fever, and is often accompanied by medical history and signs such as hypertension, hemiplegia or limb paralysis.

(2) It is distinguished from toxic bacillary dysentery.The patient was weak and had severe diarrhea. Leukocytes and pus balls were found in stool microscope examination, and Shigella could be found in stool culture.

(3) Differentiate from hypoglycemic coma.The patient had a history of repeated fainting, his body temperature did not increase, his blood sugar level was lower than normal, and he recovered quickly after taking sugar.

(4) Differentiate from organophosphorus pesticide poisoning.The patient has a history of drug exposure, salivation, vomiting and diarrhea, miosis, and blood cholinesterase activity can be found to decrease.

3. On-site rescue

Quickly transfer the patient to a shaded place with better ventilation, unbutton the clothes, let the patient lie down, apply a cold towel to his head, and fan.

Give the sick person to drink cold salt water or other refreshing drink.

Wipe the patient's body with 10-15°C cold water, then gradually lower the water temperature, continue to bathe, and apply ice packs or ice cubes to the patient's head, armpits, and groin.Also, use fans or electric fans to increase air circulation.

The patient can be given ten drops of water, human pills, etc.

Scraping therapy is very practical.The parts to be scraped are mostly selected on the back, neck or eyebrows on both sides, so that the local skin becomes red.

When ambulancemen give simple on-the-spot treatment to patients, they should also send patients to the hospital without losing the opportunity.

4. Matters needing attention

During the cooling process, pay attention to changes in body temperature, blood pressure, and pulse.When the patient's anus temperature is 38 ℃, cooling should be suspended.

Pay attention to replace the ice pack to prevent the patient from frostbite or cold.

coma
In medicine, coma has a specific meaning, it refers to the complete loss of consciousness of a patient.There are many reasons for coma, such as meningococcal meningitis, Japanese encephalitis, cerebral hemorrhage, cerebral thrombosis, craniocerebral injury, heat stroke, gas poisoning, drug poisoning, hypoglycemia, etc., all of which can lead to coma.

1. Disease characteristics

Manifestation of coma.The patient may lose consciousness, motor, sensory and reflex dysfunction, and any stimulation cannot wake the patient up.

2. On-site rescue

Call for help from a first aid station or hospital.

Place the patient in a supine position, prevent the tongue from falling back, remove dentures, and remove secretions and vomit from the mouth and nose.

Respiratory and cardiac arrest, immediate artificial respiration and chest cardiac compression.

Those who have the conditions can inhale oxygen.

Pay attention to heat preservation and do not eat for the time being.

Try pinching Renzhong, Hegu, Zusanli and other acupoints.

Be smooth and fast when transporting patients.

convulsions (convulsions)
A convulsion, or convulsion, is a twitch of muscles all over the body caused by a morbid excitement of the brain.It is more common in children and can cause sequelae such as mental retardation and paralysis in children.Hyperthermia, meningitis, and hypocalcemia are the most common causes of convulsions.

1. Disease characteristics

The patient suddenly loses consciousness, holds his breath, twitches his limbs, turns his eyes up, tilts his head back, and his face is blue. In mild cases, he shows twitching of one hand, foot and limbs, or squints or turns up his eyes, corners of his mouth and facial muscles. twitch.

2. On-site rescue

Loosen the button of the patient's clothes, make him lie on his back, turn his head to one side, and remove secretions in the respiratory tract and oral cavity at any time.

Use a small wooden board or bamboo chopsticks wrapped with gauze to insert between the upper and lower molars of the patient to prevent biting the tongue and lips.

Acupuncture or hand pinch Renzhong, Baihui, Shaoshang, Hegu, Shixuan and other acupoints
Do not feed water or medicine to the patient to prevent him from falling.

Sent to the hospital for emergency treatment, and at the same time observe the duration, performance, and number of seizures of the patient.

Acute abdominal pain

There are three types of abdominal pain: ① colic: severe pain, often paroxysmal, more common in gallstones and intestinal obstruction; ② dull pain: persistent pain that can be tolerated by the patient, such as pain caused by gastritis and hepatitis; ③ radiating pain : Due to innervation, pain in one organ involves other parts, such as pain in the liver and gallbladder can radiate to the right shoulder.Abdominal pain that comes suddenly, and is severe and unbearable, is often a sign of a serious condition and needs to be rushed to the hospital for treatment.

1. Acute abdominal pain that needs to be sent to the hospital for treatment

The pain is severe, the patient sweats coldly, falls to the ground and rolls around, or bends and crouches with knees tucked in, making it difficult to stand up, even taking painkillers is of no avail.

The abdomen is hard or hard like a hard board due to tension in the abdominal muscles.

Localized abdominal pain becomes general abdominal pain.

In addition to abdominal pain, there is bloating, a palpable mass, or blood in the stool.

In addition to abdominal pain, the patient had symptoms of shock such as confusion, pale complexion, clammy limbs, and weak pulse.

2. On-site rescue

The etiology of abdominal pain is quite complicated and the condition is urgent, so sending the patient to the hospital quickly is the most important thing. Secondly, you can do the following things for the patient:

Ask the patient to lie flat and bend the legs to relax the abdominal muscles and relieve abdominal pain.

Acupuncture or pinch Hegu, Zusanli, Sanyinjiao and other acupoints for intestinal colic, and Tianshu and Qihai for periumbilical pain.

It is forbidden to take painkillers, laxatives, or not to eat for the time being.

Do not use a hot water bottle to warm the abdomen.

Pay attention to observe whether the patient's body temperature, pulse, blood pressure, consciousness, breathing, etc. are normal and how they change.

Hemoptysis
Bleeding from the respiratory tract below the throat and spit out through the mouth is called hemoptysis.Many diseases can cause hemoptysis, such as pneumonia, lung abscess, tuberculosis, bronchiectasis, leukemia, mitral stenosis, left heart failure, etc.The amount of hemoptysis per time is less than 100 ml as a small amount of hemoptysis, 100-300 ml as a moderate amount of hemoptysis, and more than 300 ml as a large amount of hemoptysis.

1. Disease characteristics

When hemoptysis, the patient's throat feels itchy, and then the blood is coughed up.

The coughed-up blood is usually bright red foam.

If the amount of hemoptysis is small, the sputum is blood-tinged.If the blood vessels in the bronchial wall are ruptured, massive hemoptysis can be caused, and even blood clots can block the trachea or be inhaled, causing suffocation.

When suffocation occurs, the patient suddenly feels chest tightness, is extremely nervous and struggles to sit up, and then becomes short of breath, has difficulty breathing, and turns blue. If not rescued in time, he will soon enter a coma.

2. On-site rescue

Keep the patient calm and do not panic.Sedatives can be taken if necessary, such as diazepam 2 mg, 5 times a day.

Do not let the patient suppress the cough, but let the patient cough lightly to cough up the blood to prevent blood from accumulating in the respiratory tract.

When the patient has severe cough, he can take 50 mg of Kebiqing or 30 mg of Ketia by mouth.Place an ice pack or cold water pack on the patient's chest.

Do not frequently turn the patient, eating and defecation should be carried out on the bed.

Patients with massive hemoptysis should take a semi-sitting position to facilitate hemostasis.When hemoptysis, the patient should be placed on his stomach with his head down and his feet high, and his family members gently beat his back with his hands to facilitate the coughing up of blood.

When suffocation occurs, the blood or sputum in the patient's respiratory tract should be sucked out immediately by mouth-to-mouth method.

Notify the first aid station or wait for the patient's condition to stabilize before sending to the hospital.

Hematemesis
Bleeding from the esophagus, stomach, or duodenum and vomiting out of the mouth is called hematemesis.Gastroduodenal ulcer, gastric cancer, gastritis, and rupture and bleeding of lower esophageal and gastric varices caused by liver cirrhosis are the main causes of hematemesis.

1. Disease characteristics

Before the bleeding, the patient may feel severe pain in the upper abdomen, and then vomit blood. The blood is mostly dark red or brown, often mixed with food residues.

The severity of the condition after hematemesis is related to the bleeding speed and the amount of bleeding.Generally, patients may feel dizzy, weak, palpitation, shortness of breath, massive bleeding can cause shock, patients are confused, restless, pulse is weak and fast, often above 130 beats per minute, and limbs are clammy and cold. At this time, the patient's life is in danger .

2. On-site rescue

Let the patient lie on his back or head down and feet up, turn his head to one side and keep calm.

You can take Yunnan Baiyao, 0.3-0.5 grams each time, once every 4 hours; pregnant women should not take it.

Do not let the patient eat for the time being, keep warm.

Place an ice pack or cold water pack on the patient's upper abdomen.

When the patient is in shock, Dushen Decoction can be taken.Ginseng 3 grams, Jianshui clothes.

Take the patient to the hospital for rescue as soon as possible.

Be careful not to discard the patient's vomitus, but give it to the doctor so that the doctor can understand the condition.

Nosebleed
Epistaxis, also known as epistaxis, is a relatively common phenomenon.Dry climate, nasal inflammation, nasal tumor, high blood pressure, blood disease, measles, typhoid, etc., as well as vitamin deficiency, trauma, women's menstrual period, etc., can all cause nosebleeds.

1. Disease characteristics

When there is a small amount of bleeding, it will flow out in a point-like manner, and when there is a large amount of bleeding, it may gush out like a spring.Repeated bleeding can cause anemia, and massive bleeding can cause shock.

Generally speaking, the most prone to bleeding is the front and lower part of the nasal septum, which is the so-called Ritter's area, so there are extremely rich vascular plexuses in the area.

2. On-site rescue

Pinch the wings of the nose tightly with your fingers for 10-15 minutes and breathe through your mouth.

Raise the forehead slightly, but not too high, so as not to cause discomfort to the blood flow to the throat.

A towel soaked in cold water or a small ice cube wrapped in a handkerchief can be applied to the patient's nose and forehead to achieve the purpose of constricting nasal blood vessels and stopping bleeding.

When the amount of bleeding is large, use absorbent cotton or soft paper, preferably gauze, soak it with water, and then slowly fill the wet cotton or gauze into the nasal cavity with chopsticks to press the bleeding point. Wait for 3 to 4 hours after observation Take it out again.If Yunnan Baiyao or other hemostatic powder is removed on the stuffing, the effect will be better.

Do not rub the nasal cavity or pick the nostrils after hemostasis, so as not to cause epistaxis again.

For old and young patients, pay attention to their breathing and pulse.

If the bleeding continues after the above methods, the patient should be sent to the hospital as soon as possible.It is advisable to carry, and the patient should lie on his side, and drink light salt water or sugar salt water on the way to compensate for blood loss.

Nasal foreign body
Nasal foreign bodies are more common in children.When children play, stuff beans, melon seeds, candy wrappers, buttons, small glass balls, etc. into the nostrils, but cannot take them out, which can form foreign bodies in the nasal cavity; Can become a foreign body.

1. Disease characteristics

Foreign bodies that remain in the nasal cavity for a long time can cause inflammation of the nasal cavity, purulent mucus or mucus with pus and blood in the sick child, the nose is not ventilated, and there is a stench.

2. Nasal foreign body inspection method
The parent sits and holds the child in their arms, clamps the child's legs with both legs, hugs the child's shoulders with both hands, and the other person holds the child's head and makes it tilt back slightly, so that the child's nose is facing the sun or light , or irradiate the nasal cavity with a flashlight to see the location of the foreign body in the nasal cavity.

3. On-site rescue

Let the sick child sit well, fix it, and don't let it move around.

Block the nostril without foreign body on the side of the sick child with your hands, let him open his mouth, and the parent blows a breath on his throat to induce the sick child to exhale vigorously, and spray out the foreign matter in the nasal cavity.This method is suitable for foreign bodies in the nasal cavity that have just been blocked.

If it is difficult to eject the foreign matter, parents can straighten both ends of the paper clip, hold the big end in hand, and slowly insert the small end into the nasal cavity of the sick child, over the foreign body, and pull it out.Never rush to grab a foreign object with tweezers or pliers, as this will push the object deeper.

Do not force foreign objects from uncooperative children.

If the foreign body is difficult to remove, an otolaryngologist should be asked to dig it out in time.

Tracheal foreign body
Tracheal foreign body refers to a foreign body entering the trachea or bronchi, which is more common in children aged 3 to 5.Common foreign objects include melon seeds, peanuts, broad beans, soybeans, fruit cores and other foods, as well as coins, thumbtacks, buttons, hairpins, glass balls and other items.The consequences of this disease are serious, so it is necessary to rescue them quickly, otherwise, the sick child may become comatose and die within a few minutes.

1. Disease characteristics

The symptoms of sick children vary depending on the size and location of the foreign body.

If the foreign body is small and enters the bronchi, the sick child may have a severe cough, suffocation, and dyspnea at the beginning. Afterwards, the symptoms may improve, but symptoms such as fever, sputum, and lung infection will appear.

If the foreign body is large and can only enter the trachea, the sick child will have severe coughing, flaring of the nose, cyanosis, and dyspnea. When it is close to the sick child's chest, throat sounds can also be heard. When the child is crying, the airflow can be heard pushing the foreign body. The slapping sound of the slamming facade.

(End of this chapter)