Introduction

FAINTING

Fainting is the term used to describe the condition of sudden, brief loss of consciousness with the potential for a full recovery. Loss of consciousness from fainting (syncope) is usually brief, from seconds to one or two minutes, providing the casualty lies down. Prior to the loss of consciousness, the casualty usually feels light-headed, anxious, pale, and maybe nauseous. There can be serious health consequences if the casualty is left supported upright in a chair or supported upright.

CAUSES:

1. Standing for long periods in hot weather or a hot shower
2. Sight of blood
3. Pain
4. The sight of needle, particularly prior to or just following an injection

MANAGEMENT:

1. Follow the DRABCD
2. If the person is in a chair, assist them into a horizontal position
3. Lie the casualty flat
4. Raise the legs if feasible
5. A pregnant woman should be turned onto the left side
6. Assess the casualty for any injury resulting from the fall
7. If the casualty does not regain consciousness turn onto the side into the recovery position.
8. NEVER SIT THE CASUALTY IN A CHAIR AND PUT THE HEAD BETWEEN THE KNEES

ASTHMA

Asthma is a disorder of the airways. People with asthma have sensitive airways which when exposed to certain triggers can narrow, leading to difficulty breathing.

Asthma is a serious and life-threatening illness. Do not underestimate the seriousness of an Asthma attack.

SIGNS AND SYMPTOMS

1. If a casualty has obvious difficulty breathing, first aid should be initiated.
2. Severe asthma can be recognized when a casualty’s asthma symptoms get worse very quickly and are not relieved by the usual dose of bronchodilator.

SIGNS OF SEVERE ASTHMA INCLUDE SOME OR ALL OF THE FOLLOWING

1. Wheezing (a whistling sound in the chest) although in very severe asthma the chest may be almost silent.
2. Chest tightness, and sometimes coughing
3. Difficulty speaking more than a few words or an inability to speak because of wheezing or breathlessness
4. Rapid breathing withdraws in of neck and chest muscles
5. Distress

WHAT IF THE CASUALTY HAS NEVER HAD ASTHMA BEFORE?

If a casualty is in respiratory difficulty and it may be asthma, initiate asthma first aid and call an ambulance (102). No harm is likely to result from giving a reliever medication in recommended doses to someone who does not have asthma.

 MANAGEMENT

Call an ambulance (000) and continue first aid management as listed below.

THE 4X4 TECHNIQUE

(4 puffs, 4 minutes, 4 puffs)

1. Sit the casualty in a comfortably upright position
2. Be calm and reassuring
3. Try not to leave the casualty alone
4. Give 4 puffs of a blue/grey reliever inhaler.
5. This is best given through a spacer if available.
6. Spacers can be improvised by using a paper or Styrofoam cup.
7. Use 1 puff at a time and ask the casualty to take 4 breaths from the spacer after each puff.
8. Use the casualty’s own reliever if possible. If not possible use borrow one (ACT).

Wait 4 minutes, if there is no improvement CALL AN AMBULANCE IMMEDIATELY and state that the casualty is having an asthma attack. Keep giving 4 puffs every four minutes as above until the ambulance arrives or until the casualty improves considerably.

COLLAPSED CASUALTY

1. If the casualty is unable to take the usual bronchodilator reliever medication call an ambulance (102) immediately.
2. If breathing stops give resuscitation following DRABCD

IMPORTANT

If a casualty has collapsed due to a severe asthma attack, rescue breathing may be very difficult due to marked narrowing of airways in the lungs.

1. The lungs should be slowly inflated with a steady pressure such that the chest is seen to slowly rise.
2. An expiration time should be given for the chest to adequately fall. The rate may need to be as slow as 6 breaths per minute.
3. There are several types of asthma medications.
4. RELIEVERS usually in grey or blue containers provide relief from asthma symptoms within minutes. Reliever medications relax the tight muscles around the airways.

HYPERVENTILATION

Hyperventilation occurs when the rate and depth of breathing are more than is necessary to maintain normal levels of carbon dioxide in the blood. Consequently, the carbon dioxide levels in the arterial blood falls (alkalosis) result in diverse symptoms and signs. Although the casualty is often reluctant to agree, anxiety is usually present. Not every person who is breathing rapidly or deeply is suffering from hyperventilation.

Other more serious conditions which could be present include:

1. Asthma attack
2. Heart failure
3. Heart attack
4. Spontaneous pneumothorax
5. Some poisoning accidents
6. Uncontrolled diabetes

  SIGNS AND SYMPTOMS

1. Light-headedness
2. Shortness of breath
3. Being unable to get enough breath in
4. Fleeting chest pain or discomfort
5. Stabbing pain
6. Pressure across chest
7. The feeling of panic or impending death
8. Blurred vision
9. Tingling of lips, fingers, toes
10. Feeling of unreality, detachment.
11. Signs may include
12. Rapid breathing
13. Occasional deep sighing breaths
14. Rapid pulse
15. Altered level of consciousness (fainting)
16. Hand and finger spasm in advanced attacks. Fingers and wrists become claw-like, the thumb held stiffly across the palm.

First AID 

1. DO NOT USE ANY BAG FOR REBREATHING(Rebreathing lowers arterial oxygen)
2. Encourage normal breathing pattern
3. Follow DRABCD
4. Refer toHospital

SEIZURE

A seizure may occur for many reasons.

1. In a person suffering from epilepsy
2. In almost any condition affecting the brain-head injury, stroke, meningitis, brain tumor, and hypoxia. In association with some poisons and drugs
3. During withdrawal from alcohol and other drugs of dependence.
4. In children under 5 years in association with a high temperature (febrile convulsion)

SIGNS AND SYMPTOMS

A seizure may take many forms.

In a major seizure:

There is a sudden spasm of muscles producing rigidity and the casualty will fall down (tonic phase). Jerking movements of the head arms and legs may occur (clonic phase)

The casualty becomes unconscious which may be associated with noisy breathing, salivation, and urinary incontinence

Seizures not resulting in loss of consciousness require little first aid other than reassurance and protection from injury.

MANAGEMENT OF A SEIZURE

1. The first priority is to protect the casualty from dangers like road traffic, fire, and water.
2. If the seizure occurs in water, then the casualty may be best managed in water. The casualty’s head and chest must be supported to keep the face above the water.
3. However, if the person is in deep water, vomits, or has a prolonged seizure then they must be removed from the water.

Manage any unconscious person:

1. Remove from danger or remove dangerous objects from the vicinity
2. Avoid restraining the casualty during the seizure unless this is essential to avoid injury.
3. Turn the casualty onto the side as soon as possible to open and maintain a clear airway.
4. Check for breathing and if resuscitation is needed follow DRABCD.
5. Allow the casualty to sleep under supervision at the end of the seizure.
6. On recovery, the casualty may be dazed or confused for some time.
7. Seek medical advice as soon as possible.

THE CASUALTY’S MOUTH SHOULD NOT BE FORCED OPEN, OR ANYTHING PUT INTO THE MOUTH DURING THE SEIZURE

NOTE: A PERSON KNOWN TO SUFFER FROM EPILEPSY MAY NOT NEED URGENT MEDICAL CARE UNLESS THE ACTIVE OR JERKING PHASE OF THE SEIZURE LASTS FOR MORE THAN 5 MINUTES OR ANOTHER SEIZURE OCCURS BEFORE THE CASUALTY HAS FULLY RECOVERED FROM THE FIRST.