The LEARNING CREATORS guide to
Paediatric First Aid
LEARNING CREATORS
What is first aid? 2
First aid in the workplace 3
Responsibilities of the first aider 5
Casualty communication 8
Primary assessment 9
Unconscious casualty management 12
Resuscitation 17
Choking 20
Asthma 23
Hyperventilation 24
Drowning 24
Croup 25
Shock 26
Wounds and bleeding 27
Anaphylaxis 32
Fainting 33
Head injuries 34
Meningitis 36
Sickle cell 37
Seizures 38
Diabetes 41
Burns 42
Poisons 45
Bites and stings 46
Eye injuries 47
Bones, joints and muscle injuries 49
Effects of heat and cold 54
Author Robert Shaloe
Introduction
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Introduction First aid training is a requirement in the vast majority of organisations. Each year there occurs a significant number of work-related injuries that require first aid treatment, and whilst many people will only attend a first aid course for a regulatory purpose, the skills learnt on a first aid course are just as useful at home and in leisure time as they are in the workplace. By the end of your training course you should be able to understand the key aspects of first aid, and whilst you will not become a paramedic, doctor or nurse at the end of your course, you will have the key information that you need to manage and deal with the typical first aid-related incidents in the Early Years setting, in a confident manner.
Important This booklet is written and produced as a support guide to a Paediatric First Aid course delivered by an appropriately qualified trainer. This material cannot replace “hands-on” training. In this paediatric manual the term baby refers to a casualty aged 0–12 months and the term child refers to a casualty aged between 1 year and puberty. Whilst every effort has been made to ensure the accuracy of the information contained within this manual, the author and Learning Creators cannot accept any liability for any inaccuracies or for any subsequent mistreatment of any person, howsoever caused. © Learning Creators June 2013. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the copyright owner.
What is first aid? 2
First aid in the workplace 3
Responsibilities of the first aider 5
Casualty communication 8
Primary assessment 9
Unconscious casualty management 12
Resuscitation 17
Choking 20
Asthma 23
Hyperventilation 24
Drowning 24
Croup 25
Shock 26
Wounds and bleeding 27
Anaphylaxis 32
Fainting 33
Head injuries 34
Meningitis 36
Sickle cell 37
Seizures 38
Diabetes 41
Burns 42
Poisons 45
Bites and stings 46
Eye injuries 47
Bones, joints and muscle injuries 49
Effects of heat and cold 54
LEARNING CREATORS The Paediatric First Aid Manual
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What is first aid?
What is first aid? First aid is the immediate assistance or treatment given to a casualty before the arrival of the emergency services, doctor, paramedic or other appropriately qualified personnel. First aid is also the treatment of injuries that don’t require further medical assistance.
Aims of first aid The aims of first aid are to: • preserve life • prevent worsening • promote recovery. It is important that each decision made when dealing with a first aid-related incident follows the above principles. Preserving life has to take priority. Although we are usually very cautious about moving or turning a patient over, if the alternative is likely death - then moving them is what needs to happen.
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Preventing the casualty from becoming worse is also an important rule to follow. Much of first aid is common sense. Following your instincts is often the best policy. Obviously there are exceptions but those will be covered in the first aid training courses. Where and when possible, the first aider should also aim to promote recovery. This involves making the casualty comfortable, keeping them warm and of course, providing reassurance.
First aid in the workplace
First aid in the workplace A workplace must provide a fully stocked and ready-to-use first aid container. Each workplace must also ensure that someone is appointed to be responsible for first aid. This person is classed as the appointed person. Formal training for the appointed person role is not required as the role is limited to ensuring that first aid containers are fully stocked and ready to use, and contacting the emergency services when required. Where an organisation foresees the need to provide first aid treatment, it should ensure that it has a suitable number of first aiders. There are two categories of first aider: • emergency first aider • full first aider. A first aider is someone who has attended a suitable first aid course and has had their skills assessed. All workplaces are different, and as such, each workplace should undertake a risk assessment of its first aid
needs. Anyone dealing with children under the age of 5 and who is recognised under the Early Years Foundation Stage, should ensure that at least one member of staff has attended the a paediatric first aid course. Details of the above first aid courses can be found on the HSE website, in the Approved Code of Practice and through local authority approval schemes.
First aid containers Each workplace must have a suitably stocked first aid kit. This first aid kit should be accessible and all staff should know its location. First aid kits are recognisable by a white cross logo on a green background. The container should be free from dust and moisture, and if possible, stored near hand-washing facilities.
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First aid in the workplace - First aid containers
There is no prescribed list of contents for the first aid kit. The HSE recommends the following basic supplies as a guide: • a guidance card • 20 adhesive dressings (assorted and individually wrapped • 6 triangular bandages (individually wrapped and sterile) • 6 medium sterile wound dressings (individually wrapped and unmedicated) • 2 large sterile wound dressings (individually wrapped and unmedicated) • 2 sterile eye dressings (individually wrapped and un-medicated) • 6 safety pins • disposable gloves.
Some items are NOT to be in a workplace first aid kit. These include: • • • •
burns creams and sprays pain killers medication antiseptics.
The Professional Association for Childcare and Early Years (PACEY) has created a comprehensive first-aid kit suitable for childminders, nannies and nursery workers. PACEY has designed these kits to ensure the contents are suitable for use with children.
The kit contains: 20 Assorted Washproof Plasters
1 Microporous Tape 1.25cm x 10m
2 Eyepad Dressing with loop
5 Sterile low adherent dressing pads 5cm x 5cm
4 Triangular Bandage 6 Medium Dressing 12cm x 12cm 2 Large Dressing 18cm x 18cm 6 Assorted Safety Pins 6 Sterile Wipes 1 Resuscitation Device 5 Sterile Gauze Swabs 2 Gloves (pair) 1 Tubular Gauze 1m 1 Plastic Finger Applicator
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1 First Aid Scissors The size of the kit is dependent on the nature of the workplace and the number of employees.
Responsibilities of the first aider
Responsibilities of the first aider When an incident occurs that requires assistance, the first aider should deal with it in a calm and confident manner, even if this means simply portraying confidence until the end of the incident. During the management of the incident, the first aider will have a range of responsibilities and actions to undertake. These responsibilities can be divided into 3 stages:
1. A pproaching the scene This may arise when the first aider is called to go and deal with an incident or it may be that the incident has occurred in front of the first aider. Tasks may include: • assessing the situation • identifying possible causes and controlling any hazards
• identifying the casualty • identifying appropriate assistance • obtaining a first aid container.
2. D ealing with the casualty/casualties Every incident is different and therefore will have varying priorities and responsibilities for the first aider. However, during the incident the first aider may have to: • put on gloves • identify the casualty’s condition and ideally obtain: • history (What happened?
Does the casualty have a medical history? Have they eaten recently?) • signs (What the first aider can see, hear, feel and smell. Taste could identify a sign but it is seriously not recommended for first aid!) • symptoms (How the casualty feels, what they complain of: pain, feeling cold, feeling dizzy, being thirsty, feeling tired.)
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Responsibilities of the first aider - contacting the emergency services
• p rioritise casualties and their injuries, remembering the 3 main categories : • breathing • bleeding • bones (NB: burns categories are interchangeable, depending on the burn’s severity)
• treat appropriate injuries • reassure the casualty and any relevant bystanders
• monitor the casualty • ensure the emergency services have been contacted.
Memory Aid
3. End of the incident Depending on the nature of the incident, the first aider may need to: • • • •
report the incident replenish the first aid kit clean and disinfect the area ensure the risk of recurrence is dealt with • inform others • be aware of their own feelings.
Contacting the emergency services Contacting the emergency services by phone is free. You can call the traditional 999 number, or you can now dial 112. Once connected, the emergency services will ask a range of questions regarding the incident. It is important to provide as much information as possible. Typical information required will include: • • • • •
who you are and your telephone number what has happened where the incident is how many casualties are involved what the casualty’s condition is.
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TRIAGE
Breathing, Bleeding, Bones.
Responsibilities of the first aider - Preventing cross-infection
Preventing cross-infection One of the roles of the first aider is to prevent further harm: this is aimed at not only protecting the casualty, but also the first aider and others who may be affected. One area for special consideration is that of preventing cross infection. Infections and viruses can spread from one person to another in many different ways. This can be through bodily fluids and waste. Bacteria can also be found on equipment and surfaces.
• t rying to wash hands before and after dealing with a casualty • disposing of bodily fluids and other waste in the correct containers • considering wearing an apron to minimise the risk of contamination from bodily fluids • using a resuscitation device when undertaking cardio-pulmonary resuscitation (CPR).
It is not always possible see if someone has an infection, as they may not show signs of being infected. It is therefore important to minimise the risk of cross-infection by following good practice. This can be done by: • e nsuring equipment is sterile where appropriate • ensuring first aid containers are kept free from dust and moisture • ensuring gloves are worn and changed when dealing with different casualties It should be noted that, whilst there have been a small number of cases reporting the contracting of TB and SARS during resuscitation, at this time there remain no reported cases of contracting the HIV virus through CPR. Special precautions are of course recommended during outbreaks of viruses.
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Casualty communication
Casualty communication Effectively communicating with a casualty is always important. Some simple rules of communication include: • E ye contact is important to ensure that the casualty feels as though they can trust you. • Telling the casualty the truth is vital – they know something is wrong: don’t lie. There is no need to go into too much depth though. • Use plain language: the casualty needs to understand what you are saying and should not be confused. Use simple terms, especially when dealing with children. • Allow time for the casualty to respond: it is easy to ask questions but we sometimes forget to wait for the full reply. Listen to your casualty.
When dealing with a child, also consider: • T he parents may be upset and affected by the injury to their child. It may be beneficial to keep some parents back slightly, they may be able to contact the emergency services. • Some parents want to help but don’t know what to do. Use these parents to help clean a wound on their child or apply a dressing, as appropriate. • Use cuddly toys or other distractions to help keep the child’s mind off their injury. • Tell the child what you are going to do before you do it. Remember, your body language and tone of voice may convey as much information as words.
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Primary Assessment
Primary assessment Danger
Response
Shout for help
Airway
When approaching the scene of an incident, it is important to check the condition of the casualty. To do this in the most effective way, the first aider should follow the primary assessment.
Danger When approaching the scene, be aware of any dangers to yourself, the casualty or others. There may be obvious hazards such as an electric cable or an overturned garden slide, or less obvious ones such as leaking gas.
Where possible, isolate or remove the hazard. If it is not possible to remove the hazard then try to remove the casualty. If approaching the scene is too dangerous, the first aider should keep themselves clear of the danger, stop others from approaching and contact the emergency services.
Breathing
Response Once the area is safe to approach, check to see whether the casualty is conscious, unconscious or somewhere in between. There are four levels of response: • • • •
alert responds to voice responds to pain unresponsive
As you approach, the casualty may look up and call to you. They are aware of their surroundings and therefore they are alert.
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Primary Assessment (Response Continued) If the casualty only responds once you speak to them, then they have lowered levels of response. They are responding to voice. If, after speaking to the casualty, there is no response, gently shake the casualty’s shoulders. If the casualty responds to this then they are known to be responding to
pain. This is the procedure for assessing the pain response of a child aged over 1 year. When assessing a baby for a response to pain, gently scrape the sole of the baby’s foot. If the casualty does not respond to the pain stimulus, they are classed as unresponsive or unconscious.
Shout for help The first aider should shout for help to draw attention to themselves in order that a bystander will come and assist them if possible. The bystander may need to get first aid supplies or call the
emergency services when required. If a bystander is present, ask them to remain until further checks have been carried out and the first aider has decided how to proceed.
Airway If the casualty is responsive, try to keep them in a safe position and treat them appropriately. If the casualty is unresponsive, turn the casualty onto their back and open their airway.
To open the airway on a child, place one of your hands on the casualty’s forehead then place two fingers under the chin. Push back on the forehead and raise the chin. This action should lift the tongue
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off the back of the casualty’s throat and should clear their airway. To open the airway on a baby, place one of your hands on the casualty’s forehead, then place ONE finger under the chin. Gently tilt the casualty’s airway but do not fully extend the head back. This is known as hyperextension and actually compresses a baby’s underdeveloped airway, thus closing it.
Primary Assessment
Breathing Once the airway is open, you will look, listen and feel for normal breathing. This should be done for up to 10 seconds: • l ook along the line of the chest to see it rising and falling • listen for breath by placing your ear close to the casualty’s mouth and nose • feel for breathing on the side of your face. It is important to note that you are checking for normal breathing. 40% of casualties may demonstrate Agonal
Danger
Response
gasps. Agonal gasps are often referred to as “the last breaths”. These last breaths indicate that the casualty’s heart has already stopped and therefore the casualty will require resuscitation. Agonal gasps are often infrequent gasps or attempts at breathing. If you are unsure whether the casualty is breathing normally, attempt resuscitation.
Once the primary assessment is complete, the casualty will be classed as one of 3 types:
Breathing
• u nconscious and breathing normally: this casualty should be checked for injuries and placed in a recovery position
Conscious
Unconscious and breathing normally
Shout for help
Airway
• u nconscious and not breathing normally: this casualty requires resuscitation and an ambulance • conscious casualty: this casualty should be treated according to their condition.
Unconscious and not breathing normally
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Unconscious Casualty Management
Unconscious casualty management Once you have established that the casualty is breathing, the next step is to identify any injuries or illnesses that they have. Danger
Response
Shout for help
Airway
Breathing
Conscious
Often, a conscious casualty indicates their most prominent injury: however, where injuries are suspected in either a conscious or unconscious casualty, the first aider should undertake a secondary assessment to identify those injuries. The secondary assessment is often referred to as the top-to-toe. This is generally because the checks carried out start at the head and finish at the feet. However, this will depend on the nature of the incident. When checking for injuries, it is important to recognise that maintaining the casualty’s airway and breathing is of utmost importance.
Unconscious and breathing normally
Unconscious and not breathing normally
Head and neck Wearing gloves; check the casualty’s head for injuries. Use the flat of your hand. Check your hands at regular intervals for signs of blood. Check the ears and nose for fluid. Check the forehead, nose, cheeks and jaw by sweeping your fingers over the casualty’s face. Check the casualty’s
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eyes. Check the casualty’s neck, look for a medical identification necklace and monitor the casualty’s pulse.
Unconscious Casualty Management
Torso Check the casualty’s shoulders and collar bones. Check down the sternum and feel the ribs for normal breathing. Check the casualty’s sides and, where possible, under their back. Gently check the casualty’s stomach area for hardness.
Arms Check the casualty’s arms; look for signs of needle marks and medical identification bracelets. If possible, compare the arms to check for symmetry.
Hips and legs Gently check the casualty’s hips. Be careful not to shake the hips. Check the casualty’s legs for signs of injury. If possible, compare the legs to check for symmetry.
Remember to check your own hands regularly for signs of blood or fluids. If injuries are identified, follow the principles of prioritisation (triage) and treat appropriately. Once you are aware of injuries, you should place the casualty into the recovery position. If a spinal injury is suspected, follow the procedures on page 52.
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Unconscious Casualty Management - Recovery Position
Recovery position The recovery position is an ideal position for a casualty who is unconscious and breathing, as it: • • • • •
maintains a clear airway by keeping the tongue off the back of the throat allows fluid to drain from the airway is reasonably comfortable is stable – the casualty won’t roll onto their back if you have to leave them is a suitable position to minimise pressure on the chest.
To place a child into the recovery position: • Kneel beside the casualty. • Remove any spectacles and carefully remove any bulky items from the casualty’s pockets. • Straighten the casualty’s legs and bring their arms to their sides. • Place the casualty’s arm that is nearest to you out at right angles to their body, palm upwards.
• W ith your other hand raise the casualty’s farthest leg.
• E nsure the casualty’s foot is flat on the floor and your hand is on top of their knee. • Pull the casualty’s knee towards the floor, remembering to protect their head. The casualty will roll onto their side.
• B ring the casualty’s arm farthest from you up and across their chest. Place the back of their hand against the side of their face, nearest to you. Hold the hand there and support their head. • O nce the casualty has rolled over, gently place the casualty’s head down on the ground, ensuring it does not hit the floor. • Bring the casualty’s bent leg so that it is at right angles to their body.
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Unconscious Casualty Management - Recovery Position
• O pen the casualty’s airway by tilting their head back and so that fluids will drain from the body. • Ensure the ambulance has been called. Keep the casualty warm and monitor their vital signs.
• T he casualty should be turned from one side to the other if unconscious for more than 30 minutes, unless injuries prevent this.
To place a baby into the recovery position: • Cradle the baby in your arms. • The baby should initially be horizontal, as with breast feeding. • Ensure the baby’s head is lower than their tummy. • Ensure the airway is clear. This position is comfortable and reassuring for both the baby and the rescuer and allows for the key benefits of the recovery position.
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Unconscious Casualty Management - Action for vomit
Action for vomit When a casualty is placed in the recovery position, their airway should remain protected if they vomit. If a casualty has not yet been turned into the recovery position, or if a casualty vomits during resuscitation, they should be turned onto their side.
To turn a casualty that is vomiting, you should: • Turn the casualty away from you. • Keep them on their side and prevent them from toppling onto their front. • Ensure that the head is turned towards the floor, and the mouth is open and at the lowest point, thus allowing vomit to drain away. • Clear any residual debris from the mouth with your fingers; then immediately turn the casualty on to their back, re-establish an airway, and continue rescue breathing and chest compressions at the recommended rate if required.
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First aiders should be reminded of the need to protect their own safety - for example coming into contact with bodily fluids and manual handling. Whilst your own safety is important, additional risks are often accepted for lifesaving purposes.
Cardio-Pulmonary Resuscitation (CPR)
Cardio-Pulmonary Resuscitation (CPR) Where a child is found not breathing, the most likely cause is lack of oxygen. This could be due to choking, suffocation or drowning. The child may also have been in an incident where they received a head injury. In any of these cases it is important to contact the emergency services and to provide oxygen to the casualty through ventilations/rescue breaths. Danger
Response
Shout for help
Once it has been established that the casualty is not breathing normally through a primary assessment: • • • • •
ask a bystander to phone the emergency services* administer 5 initial rescue breaths start 30 compressions administer a further 2 breaths repeat at a ratio of 30 compressions to 2 breaths.
* If you are alone, perform 1 minute of resuscitation before leaving the casualty, in order to contact the emergency services.
Airway
Rescue breaths for children: Breathing
• E nsure that the casualty’s airway is open.
5 breaths
30:2 (1 minute)
999/112
30:2
• U se your hand placed on the casualty’s forehead to pinch the casualty’s nose. • Open your mouth and place it over the casualty’s mouth. • Breathe a gentle
breath into the casualty’s mouth for approximately 1 second. • Come up and away from the casualty after each breath and watch the casualty’s chest fall before repeating the rescue breath. After administering breaths, move onto compressions.
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Cardio-Pulmonary Resuscitation (CPR)
Chest compressions for children: • Kneel beside the casualty. • Place the heel of one of your hands onto the centre of the casualty’s chest. • Push onto the casualty’s chest so that it is depressed one third of the depth of the chest. • Release the pressure on the chest before reapplying the pressure. Continue to compress at a rate of 100–120 compressions per minute.
Rescue breaths for babies: • Ensure the casualty’s airway is open. • Open your mouth and place it over the casualty’s mouth and nose. • Breathe a gentle puff into the casualty’s mouth for approximately 1 second. • Come up and away from the casualty after each breath and watch the casualty’s chest fall before repeating the rescue breath. After administering breaths, move onto compressions.
Chest compressions for babies: • Kneel beside the casualty. • Place 2 fingers onto the centre of the casualty’s chest.
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NB: 2 hands may be used to compress the chest if adequate depth is not achieved by the use of one hand.
Cardio-Pulmonary Resuscitation (CPR)
• P ush onto the casualty’s chest so that it is depressed one third of the depth of the chest. • Release the pressure on the chest before reapplying the pressure. Continue to compress at a rate of 100–120 compressions per minute.
This resuscitation should be continued until: • t he victim starts to show signs of regaining consciousness, such as coughing, opening their eyes, speaking, or moving purposefully AND starts to breathe normally
• you are too tired to continue • the emergency services arrive and take over • another first aider takes over: you could then maintain resuscitation in a relay format. Each person would resuscitate for approximately 1–2 minutes before swapping.
Compression-only resuscitation Some first aiders will feel unable to perform rescue breaths. This may be due to facial injuries on the casualty or may be for aesthetic reasons. In such cases, performing no resuscitation will reduce the casualty’s chance of survival, therefore the first aider may decide to simply perform compression-only resuscitation. To do this, once you have contacted the emergency services you will need to perform 100–120 compressions per minute every minute until the ambulance arrives, or until you would normally stop resuscitation.
Mouth to nose
Mouth to mask
If, when resuscitating a child, you are unable to breathe into their mouth, you may be able to try to breathe into their nose.
Most first aid kits will have a resuscitation face shield. This may be a full mask or, more likely, a plastic face shield with a one-way valve. Place the plastic over the casualty’s face as shown on the mask and breathe through the one-way valve.
With the head tilted back, push the mouth closed with your 2 fingers under the chin. Place your mouth over the casualty’s nose and breathe.
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Choking
Choking Choking is caused when an object – such as food – becomes lodged in the airway. This may cause a partial or full obstruction. Recognition Partial obstruction:
Full obstruction:
• • • •
• • • • •
coughing watery eyes distress difficulty in speaking.
inability to speak inability to cough distress becoming weak hands around throat or signalling.
Treatment
FULL OBSTRUCTION
Partial obstruction – effective cough: • Encourage the casualty to cough. • Lean a baby forward to allow fluids to drain.
Up to 5 back blows Up to 5 thrusts
Full obstruction – ineffective cough: • Administer up to 5 back blows. • If unsuccessful, administer up to 5 thrusts.* • If assistance is available send them to contact the emergency services. Do not leave the casualty if they are conscious. • If unsuccessful, repeat back blows and thrust continuously until the object is dislodged or casualty becomes unconscious. * If the casualty is under one give chest thrusts. If the casualty is over one give abdominal thrusts.
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Repeat
less than 1 year old chest thrusts more than 1 year old abdominal thrusts
If the casualty becomes unconscious, begin CPR by administering 5 initial rescue breaths. After the 5 initial breaths, start compressions. After the compressions, check the casualty’s mouth to see if the object has cleared.
Choking
Back blows in a baby: • L ay the baby, tummy down, on your arm. Incline the baby so the head is lowermost. • If you are seated or kneeling, you should be able to support the baby safely across your lap. • Support the baby’s head by placing the thumb of one hand at the angle of the lower jaw, and one or two fingers from the same hand at the same point on the other side of the jaw. • Do not compress the soft tissues under the baby’s jaw, as this will compress the airway.
• D eliver up to 5 sharp back blows with the heel of one hand in the middle of the back between the shoulder blades. • The aim is to relieve the obstruction with each blow rather than to give all 5.
Back blows in a child over 1 year: • B ack blows are more effective if the child is positioned head down. • A small child may be placed across your lap as with a baby. • If this is not possible, support the child in a forward-leaning position and deliver the back blows from behind, striking between the shoulder blades with the heel of your hand.
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Choking
Chest thrusts for babies: • T urn the baby onto their back but keep the head lowermost. This is achieved safely, by placing your free arm along the baby’s back and cupping the back of the baby’s head with your hand. • Support the baby down your arm, which is placed down (or across) your thigh. • Deliver up to 5 chest thrusts. These are similar to chest compressions, but sharper in nature and delivered at a slower rate.
• T he aim is to relieve the obstruction with each thrust rather than to give all 5.
Abdominal thrusts for children over 1 year: • S tand or kneel behind the child. Place your arms under the child’s arms and encircle their torso. • Clench your fist and place it between the belly button and the bottom of the sternum. • Grasp this hand with your other hand and pull sharply inwards and upwards. • Repeat up to 4 more times (a total of 5). • Ensure that pressure is not applied to the lower rib cage as this may cause injury.
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• T he aim is to relieve the obstruction with each thrust rather than to give all 5.
Asthma
Asthma Asthma is a condition that affects 5.4 million people in the UK. It is a condition that affects the small airways in the lungs called the bronchioles. When a person with asthma comes into contact with an asthma trigger, their airways begin to narrow. The body may also respond by producing a phlegm that further reduces the passages. Common triggers:
Recognition
• • • • •
• • • • •
animals foods exercise or physical activity smoking, and even the weather.
cyanosis on the extremities difficulty in breathing and speaking wheezing dry cough use of the muscles in the neck and upper chest to help breathe.
Treatment • S it the casualty down and ensure that any tight clothing is loosened. Do not lie the casualty down. • If the casualty has an inhaler, retrieve it for them and allow them to use it immediately. It is usually blue. • If the casualty’s condition does not improve during an attack, allow them to continue to take one puff of their reliever inhaler every minute for 5 minutes or until symptoms improve. • If the casualty does not improve in 5 minutes – or you are in doubt – call 999/112. • While waiting for the ambulance, the casualty should continue to take their inhaler once every minute.
• Call 999/112 if: • the casualty’s condition does not improve • they cannot speak, eat or sleep • their inhaler has no effect after 5 minutes • their symptoms are worsening • this is their first attack • you are unsure.
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Hyperventilation
Hyperventilation Hyperventilation is simply a term for over-breathing. This can accompany a panic attack, but can also be brought on by an emotional upset. The increased breathing can raise the level of oxygen in the blood, resulting in an insufficient amount of carbon dioxide. This can lead to changes in the chemical levels in the blood.
Signs and symptoms: • • • • •
fast breathing fast pulse rate attention-seeking behaviour dizziness tingling or cramps in the hands.
Treatment • B e calm and reassure the casualty using a firm voice. • Try to remove the casualty to a quiet place, away from the cause. • Help the casualty to control their breathing by coaching them through how to take deeper controlled breaths. • Do not use a paper bag to control breathing as this can cause further complications.
Drowning Drowning is caused by a lack of oxygen in the lungs due to the presence of water. This is often a result of submersion in water. Each year about 50 children drown in the UK: many of these are in the home. If a child has drowned they will be unconscious and not breathing. It is important to start resuscitation immediately. Keep the child horizontal when rescuing as this helps to maintain appropriate blood pressure after removal from the water. It also reduces the risk of vomiting and in turn the risk of inhaling this.
Near-drowning Near-drowning occurs when an individual has been submerged in water but has managed to continue to breathe. This may be because they have been removed from the water or only a small amount of water entered their lungs. The Paediatric First Aid Manual
Drowning & Croup
If the casualty is unconscious but breathing normally, place them in the recovery position and call the emergency services. If the casualty has been submerged in cold water, the first aider should treat for hypothermia as well. See “Effects of heat and cold” (See page 54).
Secondary drowning Secondary drowning can occur up to 72 hours after rescue. This occurs when some water enters the body and in time enters the bloodstream. The water in the bloodstream interrupts the pH and can lead to death. Therefore all casualties involved in a drowning incident should be seen in hospital.
Croup Croup is a condition where the voice box and windpipe become infected and swollen. This is often caused by a virus such as the flu virus. As croup is often viral, it can be contagious. Most cases of croup affect children aged 6 months – 3 years. Attacks generally occur at night, in winter months. Recognition • • • • • •
difficulty in inhaling barking cough and hoarseness normally occurs during night-time sleep rapid and deep breathing possible fever possible signs of cyanosis.
Treatment • B e calm and reassure (a child panicked by its parents’ response can make the situation worse) • Allow the child to sit up to help ease the breathing. • If croup has been diagnosed by a medical professional, it is often enough to ease the condition by raising the humidity of the environment: this can be done by taking the child to a bathroom and running a hot tap or shower. The humidity eases the dry upper airway. • If croup has not yet been diagnosed, medical help should be obtained as other conditions may be present.
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Shock
Shock Shock can occur in several forms. The most common type of shock is called hypovolaemic shock. This is caused by a low volume of circulating fluids. This is commonly caused by blood loss but can also be caused by excessive sweating, severe dehydration or extensive burns. A child suffering from shock can deteriorate quickly, therefore prompt recognition and treatment are important. History A recent injury that may have caused blood or fluid loss.
Recognition The signs and symptoms deteriorate with the severity of the shock. Typical signs and symptoms include: • pale, cold, clammy skin • rapid, weak pulse • rapid, shallow breathing • dizziness • weakness • thirst • disorientation • cyanosis • nausea or vomiting • yawning (air hunger) • eventual cardiac arrest.
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Treatment • treat the cause • lay the casualty down and raise their legs • keep the casualty warm • nil by mouth • reassurance • call 999/112 • monitor.
Wounds and bleeding
Wounds and bleeding The majority of wounds and bleeds that are dealt with on a day-to-day basis are quite minor. But severe bleeding can be life-threatening. A casualty with a severe bleed can progress into shock and ultimately become unconscious and suffer from cardiac arrest. A child has approximately 80 ml of blood for every 1 kg of weight. Irreversible shock will occur when a child loses 40% of their blood. The amount of blood loss can be distressing for both the first aider and the casualty. Swift treatment is important.
Types of wounds There are 6 main categories of wounds: • • • • • •
puncture contusion gunshot abrasion incision laceration.
Memory Aid PC GAIL P uncture C ontusion G unshot A brasion I ncision L aceration
Types of bleeding The type of bleeding that occurs is dependent on the type of blood vessel that is damaged. The three categories of bleeding are: • Arterial: damage to the artery causing blood to be pumped out of the wound • Venial: damage to the veins causing blood to flow out of the wound • Capillary: damage to the capillaries causing blood to seep out of the wound
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Wounds and bleeding
Treatment • Help the casualty to sit or lie down. • Put on gloves. • Apply direct pressure to the wound. Preferably ask the casualty to do this. • Elevate the injury above the heart, if possible. • Secure a dressing onto the wound. • If blood seeps through the first dressing, apply a second. • If blood seeps through the second dressing remove both dressings and apply new ones. • Call 999/112 for an ambulance. • Treat the casualty for shock.
Embedded objects An object that is embedded into a wound should not be removed. The removal may cause further bleeding, an increased risk of infection or the object may break, causing further complications.
Treatment • Help the casualty to sit or lie down. • Put on gloves. • Apply direct pressure to the sides of the wound. Preferably ask the casualty to do this. • Elevate the injury above the heart if possible. • Place a rolled up dressing, or similar, either side of the object. • Secure the dressings in place with a
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third dressing. Ensure pressure is not applied to the object. • Call 999/112 for an ambulance. • Treat the casualty for shock.
Wounds and bleeding
Splinters Splinters are small embedded objects. They are typically wood splinters. If the splinter is deeply embedded, is difficult to remove or if there are any other concerns, the splinter should not be removed. The area should be covered and medical assistance sought.
Treatment If the splinter can be removed, the following procedure should be followed. • A clean pair of tweezers should be used to grip the splinter as close to the skin as possible.
• G ently pull the splinter out at the same angle it entered the body. • Squeeze the skin: this will allow some bleeding to help flush the wound. • Wash the wound and cover with a sterile dressing.
Small cuts, grazes and bruises Whilst the emphasis in respect of major bleeding is the control of blood loss, the primary focus in a minor bleed is minimising the risk of infection. It remains important to control the bleeding but taking an extra moment to clean a wound and apply a sterile dressing is a priority for someone whose blood loss is minimal.
Treatment Where possible, clean your own hands with soap and water and put on gloves. If the wound has dirt or small particles on it, gently rinse these under lightly running water. Gently dry the area and apply a sterile dressing.
For grazes, use a sterile wipe or piece of gauze to wipe the wound. Where possible, use a sweeping action from the centre of the wound, outwards. With minor bruising, the bleeding is under the surface. To minimise the amount of blood to the area, elevate if possible. Also apply a cold compress.
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Wounds and bleeding
Nosebleed A child may suffer a nosebleed after a blow to the face or head. Nosebleeds can also be caused by raised blood pressure bursting small capillaries. This could have occurred after exercise. A more common cause is a child blowing or picking their nose.
Treatment • S it the casualty down and lean them forward to avoid swallowing the blood or compromising the casualty’s airway. • Ask or help the casualty to pinch the soft tissue of their nostrils. • Give the casualty some tissues or bandages to hold under their nose to collect any dribbling blood. • Keep the nostrils pinched for 10 minutes. If the bleeding continues, repeat for 2 more cycles of 10 minutes, giving 30 minutes in total, and if bleeding still persists, seek medical attention. DO NOT: • elevate the head backwards • insert tissue to the nasal cavity • pinch the hard part of the nose.
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Wounds and bleeding
Bleeding from the mouth A bleed in the mouth may have been caused by an impact or by a child biting their tongue or lip. Whilst the majority of bleeds in the mouth are minor, there could be damage to teeth and there is a slight risk of inhaling blood into the lungs.
Treatment • S it the casualty down and lean them forward to avoid swallowing the blood or compromising the casualty’s airway. • Ask or help the casualty to pinch a gauze pad onto the affected area. • Keep the area pinched for 10 minutes. If the bleeding continues, repeat with a new pad. • Advise the casualty not to have a hot drink for 12 hours.
Amputation Amputation is the partial or complete severing of a limb. The injury is naturally traumatic for the child involved.
Treatment • Help the casualty to sit or lie down. • Put on gloves. • Apply direct pressure to the wound. Preferably ask the casualty to do this. • Elevate the injury above the heart, if possible.
• Secure a dressing onto the wound. • Call 999/112. • Wrap the severed part in plastic, then wrap in fabric then place in a container with crushed ice.
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Anaphylactic shock
Anaphylactic shock Anaphylaxis is a severe allergic reaction. It is estimated that a third of the UK’s population will have an allergic reaction at some time in their life. Anaphylactic shock is caused when the individual is exposed to their allergen. Their body responds by releasing large amounts of histamine which in turn dilate the blood vessels. The now-widened blood vessels cause a drop in blood pressure (shock). The blood leaking from the capillaries causes swelling and discolouration.
Common allergens include:
Recognition
• peanuts • tree nuts such as almonds, walnuts, cashews, brazils • fish and shellfish • dairy products and eggs • wasp or bee stings • natural latex (rubber) • penicillin and other drugs or injections.
• • • • • •
the casualty may appear to be anxious swelling of the throat, mouth and face flushed, blotchy skin distressed breathing rapid, weak pulse if the reaction is severe, the casualty may become unconscious and stop breathing.
Treatment A severe allergic reaction could cause the casualty’s airway to close within a couple of minutes. Therefore, rapid recognition and treatment are of utmost importance. • Call 999/112. • Sit the casualty down to help relieve any breathing difficulties. • If the casualty has an Epipen or Anapen, retrieve it for them and allow them to administer it. • If the casualty is becoming pale and weak, consider laying them down to treat for shock.
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• A second Epipen/Anapen can be administered after 5 minutes if the casualty is showing no signs of improvement.
Fainting
Fainting Fainting is caused by a temporary lack of oxygen to the brain. This can be caused by various factors, including a lack of food, an emotional upset, standing for long periods of time or spending time in hot environments. Most causes of fainting are not harmful: however, there may be underlying medical causes. Anyone who remains unresponsive should be seen in hospital.
Recognition • • • • • •
yawning a sudden, clammy sweat nausea fast, deep breathing confusion blurred vision, or “spots” in front of the eyes • ringing in your ears. It is common for the person to collapse quickly so the above may not be recognised.
Treatment • W ith the casualty laid down, raise their legs. • Ensure the casualty receives plenty of fresh air. • Reassure. • Allow the casualty to sit up in their own time as they recover, assisting them as necessary. Once collapsed on the floor, the casualty should regain consciousness within a few seconds. If the casualty does not quickly regain consciousness, the airway should be opened and breathing checked. If the casualty is breathing they should then be placed into the recovery position.
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Head injuries
Head injuries The head is an important structure. Within the walls of the hard, strong skull is one of the most important organs of the body – the brain. Head injuries can range from a minor injury like a bump on the head to life-threatening conditions such as cerebral compression. With the potential for serious harm to the brain, all head injuries should be treated seriously and further medical treatment should always be advised. In some instances, a head injury may need to be treated as a suspected spinal injury. Please refer to Spinal Injury Recognition and Treatment pg 51. Minor wounds can be dealt with in the way same as wounds to other parts of the body. More serious head injuries can be dealt with as either concussion or cerebral compression.
Concussion Concussion is caused by the shaking of the brain. This often occurs in sports injuries, bumped heads in playgrounds and after trips and falls. Recognition • • • • •
briefly unconscious dizziness confusion nausea memory loss – often of the incident or the events leading to the incident • mild headache.
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Treatment • I f the casualty is still unconscious, carry out the primary assessment and treat appropriately. • If the casualty has regained consciousness, monitor their condition. • Advise the casualty to seek medical advice.
Head injuries
Cerebral Compression Cerebral compression is caused by a build-up of pressure on the brain. A blow to the head can cause a blood vessel in the brain to burst and blood to build up in the area surrounding the brain. This blood then applies pressure to the brain, causing the compression. Pressure can also build up due to an infection or tumour. Recognition • t here may be a history of a head injury within the past few days • deteriorating levels of response • intense headache • slow, strong pulse • flushed skin • unequal pupils • change in personality.
Treatment • A ssist the casualty into a comfortable position. • Call the emergency services. • Reassure and monitor the casualty.
Skull fracture A skull fracture is caused by a direct blow to the head, such a fall onto concrete. It can also occur due to indirect force: for example, jumping from a swing and landing with straight legs. The shock waves can fracture the base of the skull. The bone may compress the brain, causing signs of cerebral compression. Recognition • possible unconsciousness • soft area or depression in the scalp • clear or straw-coloured fluid coming from the ears or nose • bruising behind one or both ears • bruising around the eyes.
Treatment • T reat as a possible spinal injury (see pg 51) • Control any fluid loss from the ears/nose by gently securing a sterile pad in place; do not plug the ears. • Control any bleeding to the scalp by applying pressure to the wound. • Call 999/112. • Monitor the casualty.
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Meningitis
Meningitis Meningitis is caused by an inflammation of the area surrounding the brain, the meninges. This inflammation is commonly caused by a bacteria or virus and can affect any age group, although a children are at a higher risk than adults. Whilst many children will have been immunised against some forms of meningitis, other forms cannot be vaccinated against. The inflammation can cause extreme illness, septicaemia, brain damage and even death. Prompt access to emergency help is vital.
Recognition Meningitis can affect the various groups in different ways. Depending on the age of the person and the form of the infection, some of the following may be recognised: • • • • • • • •
flu-like symptoms fever with cold hands and feet headache stiff neck sore throat vomiting unusually sleepy rash – red and purple spots that do not fade when pressed • refusal to eat • in babies, a raised fontanel • dislike of being handled.
Treatment Whilst the above may be signs of other infections or viruses, it should be remembered that meningitis can be life-threatening. If the possibility of meningitis is suspected, the casualty should be seen by a doctor as soon as possible.
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Sickle cell
Sickle cell Sickle cell is an inherited condition where an individual’s blood cells are sickle-shaped instead of the normal flexible circular shape. These irregularly shaped cells do not carry a normal amount of oxygen. They also break up easily, causing anaemia. The crescent shape of the cells also causes them to become blocked, and oxygen fails to reach the person’s internal organs. An individual with sickle cell has inherited this trait from both parents. If only one parent has the sickle cell gene, their child will not show signs of crisis.
History: Crisis occurs when the amount of oxygen in the individual’s blood drops. This may be through exercise, illness, changes in body temperature, dehydration or stress. Preventing crisis is important. This can be done by: • • • •
encouraging the person to drink plenty of fluids keeping children warm and dry allowing children to rest: consider low activity sessions such as art ensuring medication is taken as and when appropriate.
Recognition The lack of oxygen to cells will contribute to the following signs and symptoms: • • • •
pain in any of the following areas: • chest • bones • stomach • head vomiting difficulty in breathing fever.
Treatment An individual care plan is important, and in a childcare setting, parents and health visitors are key in working with the setting for the best care plan. Minimising the risk of crisis is important: however, if crisis does occur, the care plan should be followed. This plan will often include: • • • • •
resting the casualty keeping the casualty warm and dry allowing fluids allowing pain killer medication contacting the emergency services if required.
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Seizures
Seizures It is suggested that there are over 40 types of seizures. These seizures range from brief absent moments to full convulsions. There are also many causes of seizures. Some people will have seizures because they have another medical condition such as diabetes. Others will have a seizure as a result of a fever brought on by infection. These seizures are referred to as febrile convulsions. People who have regular seizures may suffer from a condition called epilepsy. When dealing with first aid, seizures can be placed into 2 categories: • convulsive seizures
• non-convulsive seizures.
Convulsive seizures Recognition The casualty: • will become unconscious • may fall to the floor and let out a loud cry • may become rigid, with an arching of their back • may have impaired breathing with possible cyanosis
Treatment • Note the time the seizure started. • Ensure there is space around the casualty, or pad any objects that cannot be removed from the environment. • Place padding under the casualty’s head. • Protect the casualty’s dignity at all times. • Once the casualty relaxes, open their airway and check breathing. • If the casualty is breathing place them in the recovery position. • Monitor the casualty.
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• • • •
may commence convulsive movements may have a clenched jaw may lose bladder or bowel control will eventually relax and normal breathing will return • will return to consciousness but may be tired or confused. • Call 999/112 if: • the casualty has repeated convulsions • the convulsion lasts more than 5 minutes • the casualty remains unconscious for more than 10 minutes • the casualty is having their first seizure. • DO NOT: • restrain the casualty • move the casualty unnecessarily • put anything in their airway • give the casualty anything to eat or drink until they are fully recovered.
Seizures
Non-Convulsive seizures There are a range of non-convulsive seizures, however, a common type is absence seizures.
Recognition • the casualty may appear to “switch off” and stare blankly • slight twitching movements or repetitive actions • lip-smacking.
Treatment • G uide the casualty away from any hazards. • Stay with the casualty until the absence passes. • Reassure the casualty. • Explain what has happened. • Call 999/112 if: • it is the person’s first seizure
• the
seizure continues for more than 5 minutes • the person is injured. • DO NOT: • restrain the casualty • do anything to scare the casualty • give the casualty anything to eat or drink until they have fully recovered.
Febrile Convulsions A febrile convulsion mainly occurs in the age range of 1 – 4 year olds although it can occur in younger and slightly older children. Approximately 1 in 20 children will have a febrile convulsion before the age of 5. A febrile convulsion occurs when a child’s body temperature suddenly rises to 39oC. This is generally caused when a child has an infection such as chicken pox, measles or tonsillitis.
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Seizures (Febrile Convulsions- Continued) Recognition The casualty: • may have a raised body temperature • may have a recent history of an infection or vaccination • will become unconscious • may fall to the floor and let out a loud cry • may become rigid, with an arching of their back
• m ay have impaired breathing with possible cyanosis • may commence convulsive movements • may have a clenched jaw • may lose bladder or bowel control • will eventually relax and normal breathing will return • will return to consciousness but may be tire d or confused.
Treatment • Note the time the seizure started. • Ensure there is space around the casualty, or pad any objects that cannot be removed from the environment. • Place padding under the casualty’s head. • Remove any excessive clothing and allow the child to cool down • Protect the casualty’s dignity at all times. • Once the casualty relaxes, open their airway and check breathing. • If the casualty is breathing place them in the recovery position. • Monitor the casualty. • Call 999/112 if: • the casualty has repeated convulsions • the convulsion lasts more than 5 minutes • the casualty remains
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unconscious for more than 10 minutes • the casualty is having their first seizure. • DO NOT: • restrain the casualty • move the casualty unnecessarily • put anything in their airway • overcool the child • give the casualty anything to eat or drink until they are fully recovered.
Diabetes
Diabetes Diabetes is a condition that is caused when the body does not produce – or does not produce enough of – the hormone insulin. Insulin allows sugars to enter the cells of the body. Young children a more likely to suffer from Type 1 diabetes (insulin dependent) as opposed to Type 2 diabetes (diet controlled). Diabetes becomes a first aid issue when the casualty’s sugar levels are too high (hyperglycaemia) or if their sugar levels are too low (hypoglycaemia).
Hyperglycaemia Hyperglycaemia occurs when blood sugar levels become too high. Hyperglycaemia develops over a longer period of time, normally hours or even days. It is normally caused by failure of the casualty to take their insulin.
Recognition • • • • •
flushed, warm, dry skin rapid pulse rapid breathing acetone smell on breath drowsiness.
Treatment • Call 999/112. • Reassure and monitor the casualty.
Hypoglycaemia Hypoglycaemia is caused when the blood sugar levels drop too low and the levels of insulin then become too high. Hypoglycaemia can be caused if the casualty has: • • • • •
taken too much insulin forgotten to eat after taking insulin not eaten enough undertaken unplanned strenuous exercise drunk too much alcohol.
Recognition • • • • • • •
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Diabetes (Diabetes Hypoglycaemia - Continued) Treatment • A llow the casualty to have some sugar. This can be done with: • sugary drinks • sugar lumps • glucose tablets • glucose gel. • If the casualty responds, allow them to have more food, particularly carbohydrates such as bread, pasta and potatoes, and encourage them
to have a meal to stabilise their blood sugar levels. • If the casualty does not respond, call 999/112. • Reassure and monitor the casualty.
Burns Minor burns and scalds are common in minor accidents. These are often the result of touching hot equipment such as the cooker or spilling hot drinks. There are various factors to consider when treating a burn. These are: S – size of the burn C – cause of the burn A – age of the casualty L – location of the burn D – depth of the burn.
Memory Aid
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SCALD
CIDERS
A child’s skin is up to 15 times thinner than adults, so they are much more susceptible to burning, and will burn at lower temperatures. In terms of prioritisation, a burn often falls in line with bones. However, this is dependent on the location of the burn. A burn to the airway or face could affect breathing, so it would be classed as such. If a burn is all the way around a limb, the limb could swell and restrict circulation and so then would be classed with bleeding.
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Types of burns C – chemical; example: corrosive chemicals I – ice; example: touching the nozzle of a CO2 fire extinguisher D – dry; example: touching a naked flame or a hot surface E – e lectrical; example: high and low voltage electricity R – radiation; example: sunburn S – scald; example: hot liquid or steam.
Burns
Depths of burns Superficial – the outer surface of the skin is damaged, generally causing some redness and tenderness.
Recognition • reddening of the skin • pain at the site of the injury • possible blistering of the skin.
Partial thickness – the next layer of skin is damaged, generally causing redness and blistering. Full thickness – all the layers of skin have been damaged, generally causing blackened and charred skin.
Treatment • Remove from the cause of the burn. • Cool the burn, ideally with running cold water, for a minimum of 10 minutes. • Remove anything that could cause a constriction i.e. jewellery or clothing. • Gently cover with a non-fluffy, non-adhesive sterile dressing. Plastic wrap found in most kitchens is an ideal dressing to cover the wound.
Contact 999/112 if: • the burn is to the hands, face, feet or genitals • the burn is surrounding a limb • the burn is a full thickness burn • you are unsure.
• DO NOT: • apply creams or ointments • touch the burn • apply fluffy or adhesive dressings or cotton wool • burst blisters.
Chemical burns If the burn is caused by chemicals, the burn follows the same treatment outlined above, but should be irrigated with cool running water for a minimum of 20 minutes instead of 10. Also, remove any clothing with the chemical on it without going over the head as this could compromise the airway and burn their face. The Paediatric First Aid Manual
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Burns
Sunburn Children can suffer from sunburn even on mild days. Children can also suffer from sunburn, regardless of their skin tone and should therefore be protected when spending any time in the sun.
Recognition • generally superficial burns • possible blisters • pain and discomfort.
Treatment • Remove the casualty to a shaded area. • Cool the skin by sponging or by resting in water for 10 minutes.
NB: if cooling a large area of the body in a bath, monitor for signs of shock or hypothermia (see page 55). Do not apply creams until the burn has cooled.
Electric shock If a child has been electrocuted, the electrical current will pass through their body to “earth”. This electricity passing through the body can interrupt the body’s natural electrical impulses. This can interrupt the heartbeat or breathing as well as cause burns throughout the body.
Recognition • high-voltage instances result in fatality • the casualty’s muscles may have contracted and they may still be connected to the power supply • severe, often full-depth burns • entry and exit burns.
Treatment • O nce safe to approach, start primary assessment. • Start CPR if appropriate. • For minor shocks and burns, treat as a normal burn.
WARNING: The area surrounding a high-voltage electrocution can be live for up to 18 metres from the contact point. Electricity can also jump or arc up to 3 metres. In these instances, keep people back at least 18 metres from the incident.
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Poisons
Poisons A poison is a substance that, when taken into the body in sufficient quantity, can cause harm. This harm can be temporary or permanent. There are so many poisons that it is difficult to list all of the specific signs, symptoms and treatments, therefore the first aider should be aware of the main things to look for. How the poison has entered the body will help to identify what treatment to use. Poisons may enter the body in the following routes: • • • •
injection ingestion inhalation absorption.
Injection Fortunately, injected poisons are not common in children. Injection of drugs could occur when children are playing where needles are discarded. Injection may also occur during a puncture wound. In these cases minor wounds should be allowed to bleed to remove any toxin from the bloodstream. They should then be cleaned and the casualty seen in hospital.
Ingested poison There are a range of poisons that can be ingested. These include: • • • •
food tablets chemicals plants.
Recognition • • • • •
nausea and vomiting abdominal pain seizures signs of a reaction evidence of poisonous substances near the casualty.
Treatment • Make the casualty comfortable. • Treat any obvious signs and symptoms as appropriate. • The first aider should gather as much evidence as possible about the suspected poison. • Call 999/112. • D O NOT: • walk the casualty around • make the casualty sick • make the casualty drink large amounts of water.
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Poison
Inhaled poison The most likely poisons to be inhaled in relation to children are gases and fumes. These may occur from mixing chemicals. The child may have: • • • •
a headache distressed or noisy breathing confusion deterioration in responsiveness.
Treatment • Make the casualty comfortable. • Treat any obvious signs and symptoms as appropriate e.g. cool any burns from hot gases. • The first aider should gather as much evidence as possible about the suspected poison. • Call 999/112.
Absorbed poison The most likely absorbed poisons in relation to children are chemicals. There may be obvious burns which should be cooled for a minimum of 20 minutes.
Bites and stings The UK is relatively safe in relation to bites and stings in comparison to other countries children may travel to. There are, of course, still some bites and stings that can occur.
Insect sting Recognition • h istory of being stung by a bee, wasp or hornet • pain at the site of the sting • redness and swelling at the site of the stin g. NB: some casualties may also have an allergic reaction to common stings. This should be dealt with as per the section on anaphylaxis (Page 32).
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Treatment • R emove the sting if possible with the blunt side of a pen knife or fingernail. DO NOT use tweezers as this may squeeze more poison into the skin. • Elevate the area if possible. • Apply ice or cold compress. DO NOT apply ice directly to skin if there is a risk of cold burns.
Bites and stings
Animal bites A range of animals can bite children: these include household pets and other children. It is estimated that 25% of children who receive a serious dog bite will also suffer from post traumatic stress disorder (PTSD). An animal bite may contain several wounds, including puncture wounds and lacerations. The key risk is not just blood loss and tissue damage, but infection of the wound. Treat the wound by cleaning it and dressing it. Ensure the casualty is seen in hospital. If the wound is severe, ensure that an ambulance has been called.
Eye injuries The eye is our window to the world. Injuries to these should be taken seriously and damage to the eye minimised. Of all potential eye injuries, the following are the most likely to occur to children: • chemical burn • foreign object.
Chemical burn Recognition • recent chemical splash to the eye • intense pain in the eye • redness and swelling.
Treatment • F lush from the inner corner of the eye outwards with running water for a minimum of 10 minutes.
• E nsure water flows away from the casualty and does not allow contamination of other areas. • Once cooled, cover the eye with a sterile dressing. • Ensure the casualty is seen in hospital.
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Eye injuries
Foreign object in the eye Recognition • recent history of object going into eye • pain in the eye • redness and watering of the eye.
Treatment • E nsure the casualty does not rub their eye. • Ask the casualty to sit down and face towards a light source. • Look into the casualty’s eye by separating their eyelids with your thumb and forefinger. • If an object is identified, rinse the
eye with water: allow the water to drain away from the casualty. • If the object is unable to float away, use the corner of a swab to lift off the object. • If the object is embedded or cannot be removed, ensure the casualty is seen in hospital.
Foreign object in the nose Treatment Recognition • r ecent history of object going into the nose • pain in the nose • difficulty in breathing.
• E nsure the casualty does not blow their nose or inhale the object further. • Ensure the casualty is seen by a medical professional.
Foreign object in the ear Recognition • recent history of object going into ear • pain in the ear • redness of the ear.
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Treatment • E nsure the casualty does not put their finger into their ear as this may push the object in further. • Ensure that casualty is seen by a medical professional.
Bones, joints and muscle injuries
Bones, joints and muscle injuries A fracture is a break in the continuity of the bone. This break can include chips, cracks or complete breaks. It can take a considerable force to break a bone: this force may be direct or indirect. A direct force results in an injury at the site of impact. An example of this would be falling over and outstretching the arm. An injury occurring to the wrist would be a result of direct force. If, however, the same incident led to a fracture of the collar bone, this would be classified as indirect force. Although, in medical terms, there are a large number of different types of fractures, in first aid the first aider will generally only be able to tell whether the fracture has caused the skin to open – an open fracture – or if the skin is still closed – a closed fracture.
Recognition • • • • • • •
pain swelling deformity bruising difficulty in moving signs of shock possible wound with or without bone protruding.
Treatment • I mmobilise the injury in the position found. • Support the injured part. • 999/112. • Treat for shock.
On occasion, the casualty will require additional support. In these cases it may be practical for the first aider to apply a sling. A sling should only be used it if will not cause further pain or discomfort to the casualty.
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Bones, joints and muscle injuries
Arm Sling The arm sling is commonly used for the upper and lower arm and the wrist. It can also be used for a fractured rib. • L ay the bandage across the casualty’s chest. • Ensure the long side is running in a vertical line on the un-injured side of the body, with the top of the long side slightly over the casualty’s shoulder. • Ensure the point is on the injured side. • Have the casualty place their arm over the triangular bandage, resting it against their body. Fold the point and place its tip on the crease of the casualty’s elbow.
• B ring the lowest part of the long side around the casualty’s neck to meet the top end of the long side. • Secure the two ends of the long side.
Elevated Sling The elevated sling is ideal if the forearm needs to be elevated. It is also useful for elevating the hand and fingers. • L ay the bandage across the casualty’s chest but this time on top of the casualty’s arm. • Ensure the long side is running in a vertical line on the un-injured side of the body, with the top of the long side slightly over the casualty’s shoulder. • Ensure the point is on the injured side. • Fold the point and place its tip on the crease of the casualty’s elbow (underneath their arm).
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• B ring the lowest part of the long side under the casualty’s arm and around the back of their shoulder blade to meet the top end of the long side. • Secure the two ends of the long side.
Bones, joints and muscle injuries
Spinal injuries Recognition • • • •
pain in the neck or back a “stepping” of the spine inflammation of the back region loss of movement in the limbs
• loss of sensation in the hands and feet • loss of bladder/bowel control • impaired breathing.
Unconscious Casualty Treatment • C arry out the primary assessment. Remember, airway and breathing are a priority so the first aider must open the airway as usual in order to check for breathing. A “jaw thrust” is no longer used. • If the casualty is breathing, maintain their airway.
• I f the first aider needs to leave to deal with other casualties or to call the emergency services, or they cannot maintain a clear airway, the casualty should be placed in the recovery position. • If the casualty is not breathing, the CPR protocol should be started.
Conscious Casualty Treatment • T he first aider should ensure the casualty does not move and that the emergency services have been called. • The first aider should kneel behind the casualty and support their head in the neutral position. • Padding should be placed either side of the casualty to minimise any movement.
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Bones, joints and muscle injuries (Spinal injuries - Continued) Movement of a casualty with a suspected spinal injury should be kept to a minimum. The Resuscitation Council (UK) suggests that an unconscious casualty should be turned if the first aider needs to leave to deal with other casualties or to call the emergency services. A casualty will also need to be turned to clear their airway, for example in cases of vomiting, or where they cannot maintain a clear airway. If the first aider is alone they will need to use the normal recovery position but they should try to minimise unnecessary head and neck movement. If others are available to help the Log-roll technique can be used.
Log-roll technique • T he first aider should be positioned at the casualty’s head. They will then be able to ensure the casualty remains in the neutral position. • The bystanders should ensure that the casualty’s limbs are laid out straight. • If possible, 2 - 3 bystanders should kneel on one side of the casualty. Any remaining bystanders should kneel on the opposite side. • Bystanders should ensure they have a good hold of the casualty and, when instructed by the first aider, they should turn the casualty towards the group of bystanders.
The Paediatric First Aid Manual
Bones, joints and muscle injuries
Soft tissue injuries The soft tissue that holds joints together is called the ligaments. Tendons are the tissues that connect the muscle onto the bone. If a ligament is over-stretched or torn, it creates a sprain injury. If the muscle or tendons are damaged, this is classified as a strain injury. Soft tissue injuries are very common in sporting activities: they can also be confused with fractures. If a fracture is suspected, it should be dealt with as one.
Recognition • pain and tenderness at the site of injury • difficulty in moving the injury • swelling and bruising.
Treatment • H elp the casualty to sit or lie down. • Raise the injury if possible. • Cool the area using an icepack or cold compress (do not allow the area to become too cold). • Wrap a dressing or elastic bandage around the injury to provide comfortable support. • Check that the dressing is not too tight and impairing circulation.
The treatment of a sprain or strain can be remembered from the acronym RICE: R – Rest I – Ice C – Comfortable support E – Elevation
Memory Aid
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Effects of the heat and cold
Effects of heat and cold The body has the ability to adjust its temperature to suit the situation. However, when very young children become ill or experience extremes of temperature, the body may not regulate temperature very well. This can result in conditions related to a raised temperature such as heat exhaustion and heat stroke, or a low temperature such as hypothermia.
Heat exhaustion Heat exhaustion is caused when the body loses excessive amounts of water and salts. This is often caused by excessive sweating and failing to replace fluids.
Recognition • raised temperature • headache, dizziness • signs of shock: • pale, clammy skin • rapid, weak pulse • rapid, shallow breathing • cramps in the limbs or stomach.
Treatment • R emove the casualty to a cool place. • Lay the casualty down. • Raise the casualty’s legs. • Allow casualty sips of water (isotonic drinks are also of benefit). • If casualty does not show signs of recovery, contact the emergency services.
Heat stroke Treatment Heat stroke is often caused by an infection. The body’s thermostat fails and the body temperature continues to rise. This can also be brought on after heat exhaustion.
Recognition • h eadache and dizziness, possible confusion • flushed, warm and dry skin • slow response • bounding pulse.
The Paediatric First Aid Manual
Failing to lower body temperature can cause death or brain damage: therefore, the treatment will be to: • contact the emergency services • cool the casualty by: • removing excessive clothing • covering the casualty’s body in a wet sheet • reducing the casualty’s temperature to 38oC • once the casualty has cooled down, remove the wet sheet and replace with a dry one • continue to monitor the casualty.
Effects of the heat and cold
Hypothermia Hypothermia occurs when the body’s core temperature falls below 35oC. This can be caused by prolonged exposure to cold weather with insufficient clothing or through sudden immersion in cold water.
Recognition • pale, cold skin • possible shivering that will stop as the condition develops • slow breathing • slow pulse rate • lower level of response • tiredness • confusion.
Treatment • R eplace any wet clothing with warm, dry clothing; also cover the head if possible. • Remove to an indoor environment if possible. • Cover with blankets and insulate from the floor. • Once the casualty has started to become warm, offer them a warm drink such as hot chocolate or soup.
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Notes
The LEARNING CREATORS guide to
Paediatric First Aid • • • • •
Written to meet Resuscitation Council guidelines Over 75 full colour images Easy to follow layout and flow charts Perfect for brain friendly learning The ideal companion for all Level 2 and Ofsted recognised paediatric first aid courses.