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First Aid for Close Combat
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VITAL PARAMETERS

For Life to sustain, following are reqd

n  Cardiac Output – 5 L/min depends on external water 3L & salt 1tsp intake/24hr

n  BP 120/80mm, BP less than 80/40 is Shock

n  Pulse is 60-100/min, more than 100 may shows dehydration,

n  UO-Urine output of 500-2000ml/24hrs, less than 300ml is Renal failure

 

WOUNDS

Types of Wounds

n  Bruise by Blunt object without break in skin– only massage to prevent hematoma

n  Incised wound by sharp object– First Arrest bleeding then Suture or Tape 2 ends of wound

n  CLW – Open wound by Blunt Object breaking skin

  Arrest Bleeding

  Clean surrounding skin,

  Scrub dirt from inside wound,

  Suture /Tape – Single & Double Mattress technique,

  Dress to close 

n   Open Fracture , Abdominal Stab, Deep Muscular wounds – Hospital Needed

 

WATER & ELECTROLYTE BALANCE

n  Water – you require 3 litre a day, 1 L of this from comes from food

n  Add 1 L for losses due to sweating in Exercise causing dehydration

n  For every 1 hour of moderate exertion,  you need

   1L or 5 glasses of  Fluids) (Water) +

  tsp Salt (Sodium & Chloride) +

    1 small ball Jaggery, honey or fruit (Potassium) +

    1 tbsp / 3 tsp Sugar (Glucose) +

     Every 10 Km – I cheese cube or 1 glass Milk (Calcium)

One may preload these nutrients or consume after recovery of exertion, in the next meal.

           

ELECTROLYTES

n  Water: Deficiency causes weakness & giddiness, Normal Reqt-3L/day

n  Sodium Chloride: Salt- Deficiency causes fall in BP, giddiness, calf pains. Normal Reqt- 1tsp /day

n  Potassium: Deficiency causes Nausea & Vomiting, Bloating, Disorientation  Normal Reqt- 1 Fruit/day

n  Calcium: Deficiency causes Facial Tics, Foot & Hand spasms, Fits Reqt: 2 equiv of Milk

n  (Lactic acids: Excess causes muscle soreness & pains)

 

BLOOD PH

n  Normal 7.32 to 7.42 Alkaline

n  Eating Acidic Sour Food will cause Acidosis: Joint Pains, Sprains & Muscle tears, make one injury prone, all disease will worsen. Exercise causes Lactic Acidosis.

n  Eating Raw Green Salad/ Vegetable juices will cause Alkaline restoration: All disease will heal rapidly, Joint Pains will disappear.

n  AVOID: Pickle, Tamarind, Kokum, Sour Curds, Citrus Fruits, Chinese food withVinegar, Non veg foods for a while till injury heals

 

SEVERE PAIN

occurs in:

n  Acute Abdomen, Stab Wounds, Severe Head Injury, Amputation Injury, Heart Attack, Bullet wounds, etc

 

SIGNS OF SEVERE PAIN

Severe Pain in Body is indicative of Serious Disease within the Body like  Heart attack, Renal Stone Colic, Appendicitis, Stab Injury

n  SEVERE PAIN

n  PALLOR & WHITENESS of SKIN

n  NAUSEA & VOMITING

n  SWEATING

n  FEVER

n  HIGH PULSE RATE

n  SHOCK & LOW BP

Treat with A) Pain Relief b) Arresting Bleeding c) Treatment of Shock

Pain Relief is with Fortwin (Morphine) Injections, causes Vomiting, treat with anti emetic

 

BAD SIGNS OF ABDOMINAL INJURY

n  Severe Pain,

n  Patient Immobile

n  Hard Board Abdomen

n  Nausea, Vomiting, Sweating, Fever

n  Blood in Vomit or Stool or Urine.

n  Shock

n  No passage of Stools & Gas in 24 hours

n  TREATMENT – NIL BY MOUTH, IV FLUIDS

 

BAD SIGNS OF CHEST INJURY

n  Severe Pain,

n  Patient Immobile

n  Shallow Breaths

n  Nausea, Vomiting, Sweating, Fever

n  Shock

n  No movement of Chest during breathing on one or both sides of chest

n  Coughing out Blood

n  TREATMENT – NIL BY MOUTH, IV FLUIDS

 

BAD SIGNS OF HEAD INJURY

n  Within 24 hours after Injury LOOK for

n  HEADACHE

n  VOMITING

n  DOUBLE VISION

n  UNCONSCIOUSNESS

n  FITS

n  TREATMENT- There may be internal bleeding and Emergency Hospitalization is needed.

 

DIAGNOSIS OF FRACTURE

n  Severe Pain as below

n  Irregularity of bony surface

n  Deformity may be present / absent

n  Swelling will come in a few hours

n  Immobility of Affected part

n  Unnatural movement may be elicited with Crepitus

 

SIGNS OF INTERNAL BLEEDING

n  In Internal Bleeding, the Blood may make its appearance via

n  COUGH – Hemoptysis ‘Red Stained Frothing’

n  VOMIT – Hemetemesis ‘Cofee color’

n  URINE – Hematuria ‘Bloody Urine’

n  STOOL – Dysentry ‘Bloody Stool’

n  SKIN – Echymosis ‘Blood under Skin’

n  A falling BP, rising HR (Pulse), Unconsciousness & Urine Output less than 300ml/24hrs are Danger Signals (SHOCK)

 

SHOCK

n  Causes: Dehydration or Water Loss via A) Vomiting b) Diarrhoea c) Bleeding d) Sweating e) Heat Stroke

n  Diagnosis: Low BP (less than 80 systolic), Altered Consciousness / Confusion, Cold Pale Hands, Feet & Face, No Urine for 12 hours

n  Treatment A) Give Head Low by raising feet b) Warm extremities c) Give Water & Electrolytes d) Blood Transfusion may be needed

 

FIRST AID PRINCIPLES

  1. DIAGNOSIS
  2. Clear AIRWAY
  3. LIFE SUPPORT - CPR
  4. Arrest BLEEDING
  5. Treat SHOCK – Circulation
  6. Treat TRAUMA Wounds & Fractures
  7. Treat PAIN
  8. DISPOSE – To Hospital, Clinic or Home

 

ARRESTING BLEEDING

n  Apply Pressure with Cloth

n  Apply more Pressure,

n  Raise the part

n  Forcep Clamp bleeding points

n  Burn bleeding points with Agarbatti 

n  Suture ends to arrest bleeding

n  Tie Tourniquet above wound with Rubber band / hanky – Release every 20 mins for 3 min

 

Fracture Forearm

n  If Open fracture – treat like open wound, Hospital needed

n  If Closed –

a) Traction

b) Splint

c) Plaster

n  POP technique – Dip in water & roll

n  Healing, Young man – 3 months Older man -6 mo

 

  a. Ice compress

  b. Check continuity

  c. Splint with 2 Foot Rulers

  d. Strap with Crepe bandage

  e. String around neck with Roller bandage

 

TREATMENT OF SEVERE PAIN

n  MILD – Local Anesthetic Ointment, Brandy, Pain Balms

n  MODERATE – Oral Pain Anti inflammatory Drugs / Brufen Tabs

n  SEVERE – Pain Killing Injections

n  LIFE THREATENING –Intravenous Opiods Injections

n  Remember Pain can also be suppressed by Psychological Determination

 

CPR – Cardio Pulmonary Resuscitation

o   In short, this involves following steps

n  Ascertain the heart has stopped by confirming lack of pulse & heart beat and loss of breathing & consciousness. CPR is not indicated in “Chest Pains & Heart Attacks” where patient is conscious. CPR is indicated only within the first few minutes after Cardiac arrest, before brain death.

n  Check & Clear blocked airway if any

n  Give mouth to mouth breaths

n  Thump the chest, followed by external cardiac massage

n  Continue for few minutes till consciousness, pulse & breathing restores.

 

Immediate Diagnosis of death

n  No consciousness

n  No Pulse, Heartbeat & BP

n  No Breathing

n  Cold & Pale Limbs

n  No Pupillary Reflex

n  No effect of CPR

 

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