Encyclopedia of Family Medicine

Chapter 20 First Aid Common Sense (3)
2. On-site rescue

(1) Upside down method.The rescuer lifts the two feet of the sick child, head down, and pats the back, relying on the foreign body's own gravity and the force generated by exhalation to expel the foreign body from the body, or pick it up and place it on the knees, fall to the ground, and pat the back , to expel foreign bodies.

(2) Extrusion method.The rescuer stood behind the sick child, hugged the patient with both arms, made a fist with one hand, placed the thumb inward, placed it between the sick child's navel and the xiphoid process, and pressed the other palm on the fist, rhythmically pressing it towards the patient. Squeeze inward and upward to raise the diaphragm, compress the bottom of the lung, and generate a strong airflow in the lung to flush the foreign body out of the trachea.If the patient has fallen into a coma and fell to the ground, the patient can be laid flat and supine. The rescuer kneels down with his legs apart, sandwiches the patient in the middle, and presses the patient between the navel and the xiphoid process with both hands.

For example, after the foreign body is inhaled into the trachea and there are no other rescuers beside the patient, the patient can use the protruding parts of the railing, the back of the chair, the corner of the table and other hard objects to squeeze the upper abdomen for self-rescue.

If the foreign body still stays in the oropharynx, the child should take the head down and try to induce it to spit it out. Do not take it out with your hands, or swallow a large piece of food to try to swallow it forcibly.

At the same time of first aid, the patient should be sent to the hospital as soon as possible, and the doctor should be asked to remove the foreign body with a direct laryngoscope or bronchoscope.

Angina

Angina pectoris refers to transient retrosternal pain caused by insufficient coronary blood supply, temporary myocardial ischemia and hypoxia.It mostly occurs in middle-aged and elderly people over 40 years old, and most of them are male.

1. Disease characteristics

It is often induced by fatigue, emotional agitation, cold, fullness, and smoking.

Sudden crushing or suffocating pain in the chest, radiating to the left shoulder and anterior and medial of the left upper limb, reaching the ring finger and little finger, lasting 1 to 5 minutes, rarely more than 5 minutes, relieved by rest or nitroglycerin, accompanied by a A sense of near-death.

2. On-site rescue

Have the patient lie still and remain calm.

Those with oxygen bags can inhale oxygen.

Immediately take one of the following medicines: ① 1~2 nitroglycerin tablets, sublingually, it will take effect in 2~5 minutes; ② 1~2 tablets of Xiaoxintong, take it with your mouth, it will take effect in 2~3 minutes, ③ Suxiao Jiuxin Pills 10~ 15 capsules, taken by mouth.At the same time, 2 tablets of diazepam can be taken orally to enhance the efficacy of the above drugs.

Call an emergency station or hospital, call an ambulance.

Pay attention to observe the patient's consciousness, pulse, breathing, blood pressure, etc., and do not move the patient at will.

Poisoning
There are many types of poisons, here only refers to organophosphorus pesticides, such as dichlorvos, 1605 (parathion), 1059 (demeton), trichlorfon, dimethoate and so on.There are many reasons for poisoning, including accidental ingestion due to improper storage, eating fruits and vegetables contaminated by pesticides, working in areas with large pesticide residues, etc., and intentional poisoning.

1. Disease characteristics

(1) Mild poisoning.Patients may experience dizziness, nausea, vomiting, sweating, chest tightness, weakness, and miosis.

(2) Moderate poisoning.In addition to the manifestations of mild poisoning, the patients also have muscle tremors, mild dyspnea, sweating, drooling, abdominal pain, diarrhea, etc., and some may also appear confused.

(3) Severe poisoning.In addition to the above manifestations, the patient's pupils are as small as pinpoints, cyanosis, pulmonary edema (dyspnea, spit out pink foamy sputum), obvious muscle tremors, and some patients have symptoms of cerebral edema (coma, convulsions, mydriasis) , to death.

2. Identification method

It should be distinguished from heatstroke and acute gastroenteritis, especially in summer.General observation of the scene and asking whether there is pesticide contact can provide important clues.If the clothes or vomit worn by the patient have a garlic-like odor, it is determined that the possibility of pesticide poisoning is high.

3. On-site rescue

Quickly remove the patient from the scene.

Take off the contaminated clothes, wash with soapy water or water (note: trichlorfon poisoning should only be washed with water), never wash with hot water, so as not to accelerate the absorption of poison.

If the patient is conscious, induce vomiting.The method of inducing vomiting is to ask the patient to open his mouth and use goose feathers, chopsticks or other thin stick-like hard objects to stick into the mouth to stimulate the uvula ("little tongue") and throat, causing nausea and vomiting.Vomiting can be repeated until there is no pesticide smell in the vomit.Emesis should not be administered if the patient has esophageal varices, peptic ulcers, severe heart disease, or is pregnant.

At the same time of rescue, the patient should be sent to the hospital quickly for gastric lavage, injection, and medication for thorough treatment.In addition, attention should be paid to looking for residual poisons or containers in order to provide evidence of poisoning for doctors and facilitate doctors to judge the type and quantity of poison taken by patients.

wrong medicine

Drugs used to treat diseases are also poisons, but within a certain dose, they have the function of curing diseases, but if they exceed the range, they will cause poisoning.

1. Disease characteristics

Medications that are easily taken by mistake include: sleeping pills, aspirin, dewormers, iodine, lysole, and potassium permanganate.

2. On-site rescue

Clear oral secretions and keep the airway open.

Those with respiratory or cardiac arrest should immediately perform artificial respiration and chest compression.

Send the patient to the hospital for first aid as soon as possible, and don't forget to bring the medicine bottle of the medicine that the patient may have taken by mistake, so that the doctor can diagnose it.

If conditions permit, induce vomiting (see the section on "Taking poisons").

If it is suspected that the patient has taken lysate, potassium permanganate, iodine and other strong corrosive drugs by mistake, they can be given milk, raw egg white, thick rice soup or soy milk to protect the gastric mucosa.

gas poisoning
Gas poisoning, also known as carbon monoxide poisoning.In the case of poor ventilation and insufficient oxygen, the carbon monoxide generated due to incomplete combustion is absorbed into the blood by the lungs, and then combined with hemoglobin, so that hemoglobin loses its ability to transport oxygen (this hemoglobin is called carboxyhemoglobin), causing Tissue hypoxia, causing acute poisoning.

1. Poisoning performance

According to the degree of poisoning, it can be divided into three degrees.

(1) Mild poisoning.The patient's blood carboxyhemoglobin is 10% to 20%, with headache, dizziness, palpitation, nausea, vomiting, general malaise or brief fainting, which can be quickly eliminated from the environment.

(2) Moderate poisoning.The patient's blood carboxyhemoglobin is 30% to 40%.In addition to the aggravation of the above symptoms, the patient's skin and mucous membranes were cherry red, irritable, and often coma or collapse.

(3) Severe poisoning.The patient's blood carboxyhemoglobin is above 50%.In addition to the above symptoms, the patient may suddenly faint, then coma, may be accompanied by myocardial damage, febrile convulsions, pulmonary edema, cerebral edema, peripheral neuritis, etc., and may produce sequelae.

2. Identification method

different from cerebrovascular disease.Cerebrovascular disease mostly occurs in the elderly, and may have a history of hypertension and arteriosclerosis; symptoms such as hemiplegia, aphasia, and visual impairment appear.

3. On-site rescue

If a poisoned patient is found, the doors and windows should be opened immediately, ventilation should be enhanced, and the source of gas should be excluded.

Quickly lift the patient off the scene and move to a fresh, ventilated, warm place.

Pay attention to the patient's heat preservation, and those who can drink water by themselves can be given hot sugar tea or other hot drinks.

Clear the patient's oral and nasal secretions, and keep the airway open (see the section "The method of clearing the airway").If there is vomiting, the patient's head should be turned to one side to avoid suffocation caused by inhalation of vomitus into the trachea.

If the patient's breathing and heartbeat have stopped, mouth-to-mouth artificial respiration and chest compression should be performed immediately.

Send first aid to the hospital at the same time, so as not to delay the time for treatment.

Electric shock
Electric shock refers to the process in which a certain amount of current passes through the human body, causing damage to the body or organ dysfunction.

1. Disease characteristics

(1) Lightweight.The patient became pale for a moment due to mental stress, his expression was dull, his breathing and heartbeat seemed to stop suddenly, and he lost his response to the surroundings, but he recovered quickly without any special discomfort.

(2) Medium.The patient's breathing becomes faster and shallower, the heartbeat speeds up, and he may fall into a coma for a short time, his pupils do not dilate, and he responds to light.

(3) Heavy.Immediately after screaming, the patient fainted, convulsed, shocked, and had arrhythmia. If ventricular fibrillation occurred, the heartbeat and pulse disappeared, and then breathing stopped.

2. On-site rescue

Quickly cut off the power supply, turn off the switch, or push the patient away from the power supply as soon as possible with non-conductive items such as dry sticks, poles, bamboo poles or plastic boards at hand.

Check the patient's consciousness, breathing, heartbeat, and whether there is a combined injury.

Loosen the patient's collar and pull out the patient's tongue.If the patient's breathing stops, artificial respiration and chest compression should be performed immediately.

Disinfect and bandage the local wound of the electric burn.

On the basis of on-site rescue, the patient should be transferred to the hospital as soon as possible, but the rescue should not be interrupted on the way.

3. Matters needing attention

The rescuer must not directly touch the patient with hands or body when the power is on.

Pay attention to changes in the patient's blood pressure, pulse, respiration and consciousness.

Take care to prevent the sudden onset of mental symptoms or circulatory failure after the patient wakes up.

Burn (scald)

Burns (scalding) are a common injury.Its severity depends on the extent (depth) and area of ​​the injury, the larger the area and the deeper the burn, the more severe the condition.

1. Estimation of burn area
The burn area can be roughly estimated by the palm method, that is, the patient's own hand shall prevail, and the area of ​​a palm with the five fingers together is approximately equal to 1% of the body surface area.

2. On-site rescue

Get the patient out of the source of ignition quickly.

Carefully check the patient's general condition, whether it is associated with other injuries, such as craniocerebral injury, thoracic and abdominal organ injury, gas poisoning, fracture, and take corresponding measures.

Wrap the wound or whole body with clean sheets or sterile sheets to prevent bumps or contamination.Avoid applying oil or colored drugs (such as purple syrup) to the wound, and try not to break the blisters.

Antibiotics are given to the patient to fight the infection.

If the patient is thirsty, let him drink some light saline, 50-100 ml each time, 20 ml each time for children, 1-2 hours work time.Do not drink too much to cause vomiting or gastric distension, and do not simply drink boiled water or sugar water.

Take the patient to the hospital immediately after first aid.The movement of carrying the patient should be gentle, the movement should be steady, and the patient should be supine or head down to avoid cerebral anemia.

3. Family treatment for small area burns (scalds)
If there is only skin redness or blisters (vesicles are not broken), rinse or soak in tap water for 20-30 minutes, and then apply badger oil, dog oil, or clean animal or vegetable oil.

If the skin is broken, do not wash or soak it in cold water casually. After sterilizing the scissors (cooling after burning), cut off the detached epidermis, then apply gauze soaked in dog, badger oil or cool oil, and then wrap it with gauze. , Change the dressing every 3 to 5 days until the wound heals.

(End of this chapter)