Basic First Aid Principles

Test your knowledge of basic first aid by taking a look at common issues requiring first aid and how to treat them.

Carpenter CPR Solutions
Created by Carpenter CPR Solutions
On Mar 23, 2015

First Aid for low blood sugar

Hypoglycemia, or low blood sugar, is one of the most common medical emergencies experienced by diabetic patients. It is most commonly brought on by taking diabetes medicines (usually insulin, but potentially also with some oral diabetes medicines) and not eating enough to cover the lower blood sugar that these medicines induce, causing the sugar to go abnormally low. Generally, diabetics will only go too low by taking medicine but not eating. Strenuous physical activity coupled with medication can also induce low blood sugar.

Early symptoms of hypoglycemia include shakiness and hunger, progressing to confusion, profuse sweating, nausea, fast heart rate, and passing out. Most diabetics can tell when their sugar is going too low.

The first priority is to get the person some high sugar drink or candy. Diet drinks will not work. Apple juice or similar will work well, but high sugar things will not work for long. Afterward the person should have a real meal, with plenty more juice. The biggest immediate danger is that the person will return to a hypoglycemic state. If they have the means to check their sugar, they should do so frequently over the next several hours.

If the victim is passed out, call 911 immediately. The victim will most likely need intravenous dextrose (sugar) at that point. It is usually advisable to lay the patient in the recovery position while awaiting the ambulance.


First Aid for sprains and strains

Sprains and strains are simply abnormal stretching or tearing of the ligaments or tendons around a joint. Ligaments attach bones to bones, and tendons attach muscles to bones. These tissues do not receive a lot of blood flow, so healing can be delayed to the structures.

The good news is that tendons and ligaments are designed to stretch and contract- so a simple sprain, where the ligament is simply stretched too far, can return to normal shape and function in a matter of days. More complex sprains, where tissues are torn, can take significantly longer, or may even require surgical repair.

No matter what grade of sprain or strain, initial treatment revolves around R.I.C.E. therapy, designed to reduce the swelling and inflammation around the area, so that it can feel better faster, and heal faster.

R- Rest. Rest the injured part during the initial 2-3 days. Thereafter, gentle stretching is often recommended for simple sprains or strains

I- Ice. Ice directly reduces swelling at the site

C- Compression. An Ace type bandage not only provides support, but also drives swelling away.

E- Elevation. Again, the focus here is to reduce swelling.

Additionally, Ibuprofen is often recommended for a few days, as this anti-inflammatory drug not only helps pain, but acts internally to reduce inflammation.


First Aid for frostbite

Exposure to extreme cold can cause frostbite, a serious medical condition that requires emergency first aid. Frostbite is a more serious version of frost nip, and often occurs on exposed extremities such as fingers and toes, hands, feet and face and ears. Symptoms are aching pain and numbness and skin that may feel hard, with a waxy whitish or purplish appearance.

What to do:

Bring the person indoors immediately, do not try to thaw frostbite until you are in a warm place, because warming then re-freezing can cause permanent damage.

Remove any wet clothing, and treat the frozen parts carefully, don't rub them!

Warm the frozen parts in warm (not hot!) water, for about 30 minutes. Do not use dry heat, such as a fireplace, or heating pads, to thaw frostbite.

Make sure to warm the entire body, not just the frostbitten areas. This is especially important in children. Wrap the victim in warm blankets.

Place cotton balls between fingers or frostbitten toes after re-warming, but be careful not to pop any blisters.

Loosely wrap the re-warmed areas with clean bandages to prevent any re-freezing, and keep the victim still.

Ibuprofen or Tylenol is generally a good idea for pain.

Frostbite victims should receive medical attention after First Aid as soon as possible.

Keeping warm and dry in the winter is the best prevention, with well insulated boots, thick socks, and hats and scarves.


Rattlesnakes and First Aid

Rattlesnakes are still out sunning this fall!

Rattler venom is poisonous in several different ways. It is hemotoxic, breaking down blood cells, and damaging the endothelium of vessels, which causes plasma leakage, pulmonary edema, and shock. It is also directly toxic to muscles, and can cause muscle necrosis. Additionally, it can destroy platelets and fibrinogen, causing blood clotting problems.

First aid used to consist of a tourniquet above the level of the wound, but this can lead to ischemia (lack of oxygen to the tissues) and is no longer recommended. Also, wounds used to be incised (cut open with a knife), however, this has been shown to not be helpful, and can lead to infection. "Sucking" out the poison also leads to infection with no real benefits.

So, what to do for a rattlesnake bite? Currently the guidelines are to immobilize the extremity, note the time of the bite, trace the red border around the wound, and get the patient to medical help.

In the Emergency Department, treatment consists of checking the patient's airway, breathing and circulation, obtaining labs, an X-ray to ensure that no part of the fang is left in the wound, tetanus shot, and EKG.

There is a grading system for snake bite.

Grade 0, - no bite seen, perhaps the patient thought they were bitten, but were not. Several hours of observation may still be needed.
Grade 1, - bite visible, with localized redness around the wound of 1-5 inches, no other signs. This patient may be observed for up to 12 hours.
Grade 2,- spreading redness, with petechiae formation (small red or purple dots, caused by hemorrhage).
Grade 3,- systemic changes with nausea, vomiting, difficulty breathing, vision changes, cardiovascular problems that start slowly and progress over hours.
Grade 4,- similar to grade 3, but symptoms develop within minutes, muscle fasciculations, convulsions, cardiovascular collapse (shock), or coma.

Antivenin can be given for grades 2-4 bites. This consists of reconstituting 4-6 vials of antivenin to saline for IV drip. The potential for anaphylaxis is high with antivenin, which is usually of sheep origin, so it must be given really slowly for the first 10 minutes. The rest is given over 1 hour. It can be repeated if needed, multiple times.


Epi Pens

Someone having a severe allergic reaction with trouble breathing and/ or swelling of the airway may need help in using their Epinephrine Pen. An EpiPen is a device often carried by people with a known history of these types of severe reactions. These reactions can be caused by anything from bee stings to peanut butter.

EpiPens are designed to go through clothing, and should be injected into the outside part of the leg, halfway between the hip and knee. Heart Association recommends keeping the pen in place 10 seconds to allow the medication to auto inject into the patient, and to massage the area for a few seconds afterwards to promote blood flow.

Be aware that EpiPens have a safety on the top of the injector that must be removed before use. Do not touch the orange bottom part of the injector. This is where the needle comes out. The needle is automatically shielded when removed from the leg, so that should not be a major worry, but it needs to be "inserted" into the leg firmly. Follow up after using an EpiPen should be 911, as the patient will need close monitoring for some time. Note the time that the EpiPen was used.


First Aid for Tick Bite

Ticks themselves don't really create a problem. They don't cause pain, only take a tiny amount of blood, then they leave. Problem is, ticks carry and transmit a fair amount of nasty diseases, like Lyme and Rocky Mountain Spotted Fever. These diseases can be a nightmare to diagnose and treat because they have a dizzying constellation of symptoms, including potential neurological complications, malaise, and fever. Best to avoid being bitten if possible, and do frequent tick checks.

DEET is still the repellent of choice, placed at the cuffs of pants, long sleeved shirts, and even on hats. If a tick is found attached, the recommendation is removal right away with tweezers placed really close to the person's skin. Continued, even pressure applied straight up is the way to go. Experts do not recommend burning them off, or putting any lotions or petroleum jelly on them to loosen them first, as this can make them regurgitate into their host. Don't twist the tick out!. If any jaw parts are left in, these can be removed with a needle or by scraping. Ticks can be saved for identification, and possible testing if needed.

Lyme disease, the biggest risk in the U.S. for "vector-borne" disease, (a disease transmitted to humans through an animal host) is an East Coast disease primarily transmitted by very small deer ticks, and actually takes at least 24 hours of the tick being attached to transmit it to a human. Some say it takes 48 hours or more. Unfortunately, it does have a high prevalence due to the fact that the ticks are so small and hard to see, which means they can remain on longer undetected.

Rocky Mountain Spotted Fever can be transmitted in just an hour or two. Don't let the name fool you, it is also prevalent on the East Coast.


Black Widow Bites

Black Widow spiders live in temperate places all over the world. In the United States, they are mostly in the South and West, including Maryland. They have a large black body with a red hourglass or dots on the underside, and possess a neurotoxic venom. They are usually found outdoors in sheds, woodpiles, and the like.

Although both males and females posses venom, only females have fangs long enough to inject it. This neurotoxic venom works in the synaptic area between nerve cells. Essentially, the venom causes massive neurotransmitter release from the cells, most notably discharging large amounts of acetylcholine, norepinephrine and dopamine. Eventually, all of the neurotransmitters become depleted from the neurons, causing another set of problems.

Symptoms can start within an hour of the bite, and the initial manifestations depend on where the victim was bitten. The acetylcholine release causes spasm of muscle. With a lower extremity bite, this can lead to abdominal cramping, and lower extremity spasm. Bites in the arm tend to cause facial cramping, and chest pain associated with muscle spasms there.

Norepinephrine and dopamine release can cause shortness of breath, high blood pressure, and fast heart rate.

As symptoms progress, and the neurotransmitters are depleted from the neurons (in 2-8 hours), paralysis can set in, perhaps starting with a facial droop, and even progressing to respiratory arrest, as the victim us unable to use the muscles to breathe. Cardiac arrhythmias can also be present at this stage. The total course can last two or three days.

As the initial stages are very painful, patients may require IV narcotics for pain, and benzodiazepines (Valium-like drugs) for cramping. Late stages may require mechanical ventilation in severe cases.

There is a horse serum based antivenin called Lyovac that can be infused IV over 2 hours. This drug is dangerous in it's own right, potentially causing seizures, for example. It has a mixed history of success, and may not work in children at all.

Generally, patients should be observed for some time following a possible bite, and some may need an ICU admission for further observation or care.