First Aid and Emergency Care
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Bandaging and Dressing
There are no hard and fast rules for dressing and bandaging wounds as long as the following conditions are met:
- Use sterile material or material that is as clean as possible.
- Bleeding is controlled.
- The dressing is opened carefully and handled in an aseptic manner.
- The dressing adequately covers the wound.
- Wounds are bandaged snugly, but not too tightly. Too tight a bandage may interfere with the blood supply and damage surrounding tissue.
- There are no loose ends that could get caught on other objects while the patient is being moved.
- The bandage is securely tied or fastened in a place so that it will not move.
- In bandaging the arms or the legs, leave the tips of the fingers or toes uncovered where possible so that any interference with circulation can be detected.
- Always place the body part to be bandaged in the position in which it is to be left. Because swelling frequently follows an injury, a tight bandage may cause serious interference with circulation. On the other hand, a loosely applied bandage may slip off and expose the wound.
- If the patient complains that the bandage is too tight, loosen it and make it comfortable but snug. Unless otherwise specified, all knots should be tied over open wounds to help control bleeding.
Types of Shock:
Hemorrhagic (resulting from the loss of blood).
Metabolic (resulting from profound fluid loss in an untreated illness).
Cardiogenic (resulting from injury to theheart itself).
Neurogenic (resulting from the loss of effective nervous control of blood vessels).
Toxic or septic (resulting from the effect of toxic substances on the body).
Respiratory (resulting from impaired breathing).
Anaphylactic (a form of toxic shock that follows an overwhelming allergic reaction).
Signs and Symptoms of Shock:
The most common early manifestation of shock include restlessness, mental confusion, and disorientation. These are accompanied by evidence of the body's attempt to compensate, resulting in such associated signs and symptoms as skin paleness, rapid pulse, coldness of extremities, thirst, and dryness of the mouth. In early shock, the pulse rate may be normal or slowed, or it may be quite rapid. Late symptoms of shock include low or unobtainable blood pressure; rapid, "thready," or unobtainable pulse; a bluish or purplish discoloration of the skin; dilated pupils; faintness or unconsciousness; and irregular, gasping respirations. It is important to remember that low blood pressure (hypotension) is a late and usually serious sign of shock. Remember -- a restless hypoxic patient who is in need of oxygen and lower extremity elevation can be in shock and have near normal blood pressure. The signs and symptoms of shock should not be studied merely as a means of identify- ing shock; rather, they are of tremendous help in determining what will be required in treatment of shock. What we call "shock" is simply the total of the body's response to a particular type of injury. For instance, consider the teenage boy who faints in the excitement of seeing a celebrity in person. He obviously represents a far different medical problem than the victim of an automobile accident who is found unconscious in a pool of blood; yet, both are in shock. Both can be described by the following signs of shock:
- Condition of the skin -- pale, covered with sweat, cold, and clammy.
- Condition of the blood pressure -- gradual drop or unobtainable.
- Condition of the brain's activity -- confusion, restlessness, and possibly unconscious.
- Condition of the pulse -- weak, difficult to find.
There is a difference -- if you know what to look for. The pulse rate of the boy is essentially normal, perhaps slower than normal, while the pulse rate of the accident victim is so rapid that it is difficult to count. The boy is in early neurogenic shock; the accident victim is in late hemorrhagic shock. In summary, the most common signs and symptoms of shock include:
- Restlessness, anxiety, weakness, anxious or dull expression, and disorientation (often precede other signs and symptoms).
- Weak and rapid (thready) pulse.
- Cold, clammy, moist skin.
- Profuse sweating.
- Initially, a dull, chalklike appearance to the patient's skin, regardless of color; later, a bluish (cyanotic) color to the skin.
- Shallow, irregular breathing; may be labored, rapid, or gasping.
- Closed or partially closed eyelids; dull, lusterless eyes; dilated pupils.
- Extreme thirst.
- Nausea and possible vomiting.
- Gradual and steady drop in blood pressure (to 90/60, or lower); eventually, blood presure that is unobtainable.
- Possible fainting in cases of rapidly developing transient shock.
- Shaking and trembling of the arms and legs, as if chilled.
- Feeling of impending doom.
Causes of Anaphylactic Shock
- Insect stings -- including bee, wasp, hornet, yellow jacket, and other stinging insects. Reaction is usually severe and rapid.
- Injected serums or drugs. The tetanus antitoxin sometimes causes anaphylactic shock, as does the drug penicillin (whether ingested or injected, although the reaction is more rapid from injection).
- Foods. Common foods that precipitate anaphylactic shock include shellfish, fish, berries (especially strawberries), and milk. The reaction is usually gradual but can become very severe.
- Drugs. Depending on the sensitivity of the person, a simple drug like aspirin can cause fatal anaphylactic shock.
- Inhaled substances. If a person is allergic to them, inhaled substances such as ragweed, pollens, animal hair, and dust can produce anaphylactic shock.
Signs & Symptoms of Anaphylactic Shock
- Signs and symptoms involving the skin:
- Itching and burning of the skin with flushing, especially around the face and chest.
- Blueness (cyanosis) around the lips.
- Raised, hivelike patches with severe itching.
- Swelling of the face and tongue.
- Swelling of the blood vessels just underneath the skin.
- Signs and symptoms involving the heart and circulation:
- Weak, rapid pulse.
- Low blood pressure.
- Diminished stroke volume and cardiac output.
- Signs and symptoms involving the respiratory tract:
- Spasm of the bronchioles.
- A painful, squeezing sensation in the chest.
- Difficulty in breathing.
- Coughing, bronchial obstruction.
- Swelling of the larynx.
- Swelling of the epiglottis.
- Respiratory wheezes.
- Signs and symptoms involving the gastrointestinal tract:
- Abdominal cramps.
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