DIAGNOSIS OF CONDITIONS AND FIRST AID MANAGEMENT
DIAGNOSIS OF CONDITIONS AND FIRST AID MANAGEMENT: Burns are injuries caused to the skin and other tissues by heat, radiation and chemicals. Burns are the leading causes of injury at home. Most burns affect only the skin (epidermis and dermis). Rarely do deeper tissues such as muscle, bone, and blood vessels get injured.
Scalds.
Injuries caused by moist heat (hot water) or chemical (acid).
TYPES OF BURNS
1. Heat / Thermal Burns
Burns from too much heat applied to the body. Common examples are open flames like candles or fire and hot objects like stoves, or car engines.
2. Chemical Burns
This is often serious because the chemicals continue to burn as long as it remains on the skin. Example is acid.
3. Electrical Burns
This results from contact with electrical current. Here, lighting is also considered as electrical burns since it has charges at the same time.
4. Radiation Burns
Most people experience radiation burns in the
form of sunburns where sun is the source of the radiation energy. Other examples
include x-ray machine used in some institutions like hospitals.
Classification of Burns
1. Degree free
2. Depth (thickness)
3. Magnitude (minor, moderate, major)
4. Surface area (extent)
5. Etiology
Classification of Burns according to Degree
1. First degree
the epidermis is only affected. There is pain, pink to red colour of the skin. It heals within 3-5 days.
Treatment
Cold moist compress should be applied to reduce pain.
2. Second degree
It affects the epidermis and the dermis. There are blisters, redness, pain, and oedema. It heals within 2-6 weeks.
3. Third degree
The whole skin is affected. There is usually no pain because the nerves are also destroyed. There is severe oedema, red, white, brown-yellow, or black colour of tissue. It heals in weeks.
4. Fourth degree
The skin, muscles, and tendons are damaged sometimes exposing the underlying bone. There is no pain, blisters, or oedema. It heals in weeks to months.
Classification of Burns according to Depth
1. Superficial burns
Damage affects the epidermis of skin. There is pain, pink to red colour of skin; blisters may not appear in some cases. It heals within 3-5 days.
2. Deep burns
Can be deep partial or full thickness burns of the skin. It involves the dermis and the deeper structures such as muscles and bones. Clinical features are the same as 2nd and 3rd degree burns.
Surface Area (Extent) of burns
This is the means by which burns are assessed. The criteria commonly used are the Wallace Rule of Nine.
Emergency Management of Burns
Aims of burns management
To prevent respiratory distress.
To prevent permanent deformities or disabilities.
To restore loss of body fluid.
To get rid of residual heat.
To control shock.
To prevent infection.
Emergency Procedure at Burn Scene
a. Extinguish the flames
b. Cool the burn
c.Remove restrictive objects
d. Cover the wound
e. Irrigate chemical burn
General Treatment / Management of Burns
1. Call for help
2. Remove the source of heat or patient from the source of heat. If flame, goes down / off at all cool with plenty of cold water to relieve pain. If it is electrical burn, switch off the power and use an insulated hand to remove the client.
3. Reassure client to allay any fear and anxiety.
4. lce-packs or towels soaked in ice water can be used as temporary first aid on the burnt surface. This helps in reducing the amount of local swelling on the burnt area and also to alleviate pain.
5. Remove tight clothing (jewelleries if any) from the injured area before the area begins to swell. This prevents any constriction on blood flow to vital organs
6. Do not remove stacked clothing on the skin as removing it may cause more pain and damage.
7. Watch for signs of difficulty in breathing. Be prepared to give chest compression. Ensure environment is well ventilated by instructing by-standers to move back.
8. Cover the injured area with a sterile dressing to protect it from infection.
If a sterile bandage is not around, use a part of a bed sheet or a kitchen clean plastic bag.
NB. Don’t break the blisters as it induces pain and also increases fluid and electrolyte loss. Broken blisters also serve as site for infection
9. Treat for shock if there is by raising the foot end of the patient to improve circulation to the brain. Shock might occur due to the traumatic experience, loss of body fluid and pain.
10.Transport patient to the hospital if the burns is severe.
Burning clothing
1. When a person’s cloth catches fire, approach him holding a wet blanket or coat in front of you for protection.
2. Wrap it around him and lay him flat to smoother the flames. If a person’s clothes catch fire when he is alone, he should roll on the floor smothering the flames.
3. After flame has gone down, cool the patient with cold water. Too much of it can bring the temperature down.
Management of patient with burned clothes
1. Use DRABC. Meaning;
D- Danger should be assessed.
R-Respond to external stimuli
B- Breathing (airway patency)
C-Circulation (free flow of blood)
2. Protect your hands.
3. Introduce yourself and assure the casualty.
4. Assist casualty to assume a sitting position if appropriate.
5.Cool the burnt area with clean water for at least 10 minutes in case of ordinary burns. However, wash / cool the area for 20 minutes in case of any chemical burns since it remains in the body for long time and also travels faster than other burns. Then treat for chock if required.
6.Continue to assure casualty and monitor the vital signs as well.
7. Use a clean material/gauze to cover the burnt area.
8. Transport casualty to hospital.
Caution
Do not make any attempt to break blisters
Do not apply any oil, cream or lotion on the skin.
Do not cover the burnt area with any unclean
material / gauze hence infection would set in.
Complications of Burns
1. Infection
2. Shock
3. Contractures
4. Keloid / scarring
5. GIT ulcers
6. Amputation
7. Respiration distress due to inhalational burns.
8. Multiple organ dysfunction
POISONING
Meaning of Poison
This is any substance or drug when internally or externally taken into the body is likely to cause harmful action on the human body.
Poisoning
This is the means or the way by which poison enters the body of human. Once in the body, they enter the bloodstream and can be carried swiftly to all vital organs and tissues.
Nature of Poisoning
Poisoning could be
Accidental poisoning
Suicidal poisoning
Murder poisoning
Accidental Poisoning
It occurs through the eating of contaminated food
and drinking of contaminated water or poisonous liquids (or from wrongly
labeled bottles). In older adults, diminished eyesight and impaired memory may
be as a result in accidental ingestion of poisonous substances or an overdose
of prescribed medications. Most accidental poisoning occurs at home especially
in children below 5 years. It is the most common cause of poisoning by
Medicines.
Suicidal Poisoning
Suicide is the ultimate act of self-destruction in which an individual purposely ends his/her life. These suicides will result from underlying causes such as emotional and mental problem and depression. Attempted suicide must always be suspected when an apparently healthy person is found obviously ill but has made no effort to send for help.
Murder
Murder is the act of killing somebody deliberately. Murder or attempted murder may be carried out by the administration of large doses or repeated small doses of poison.
Causes of Poisoning
1. Toxic chemical e.g. Household cleaning products
2. Foods e.g. Mushroom
3. Drinking water contaminated by agricultural or industrial chemicals
4. Food not properly prepared or handled
5. Drugs; drugs that are helpful in therapeutic doses may be deadly when taken in excess.
NB.
The standard toxic symbol is the skull and crossbones.
International application of poison has been used as a method of murder, suicide, and execution.
Classifications of Poisons
There are three (3) main classifications of poison:
Irritant poison
Narcotics poison
Corrosive poison
1. Irritant Poisons
These poisons act on the alimentary tract causing irritation and inflammation.
Examples of irritants
Contaminated food e.g. contaminated fish, meat, fruits, vegetables etc.
Poisonous fruits, Fungi and food. e.g. Berries, mushrooms, cassava etc.
Chemicals: e.g. lead, mercury, lodine, bleaches,
and acids.
Signs and Symptoms irritant poison
Vomiting
Diarrhoea
Nausea
Acute abdomen (sharp /sudden pain)
Faintness and shock.
Management of irritant poison
Give an emetic
Give an aperients solution after vomiting has
stopped.
Treat for shock.
Transport casualty to hospital.
Do not forget to take along the poison if
available.
2.Narcotic Poison
It acts directly on the central nervous system, and depress it.
Effects of Narcotic poisons
They act as hypnotics. Hypnotics induce sleep,
and unconsciousness. Examples include Morphine, cocaine, and heroin.
Act as delirants: they initially produce
excitement and later cause an acute disturbance of the mind characterized by
restlessness, illusions and and incoherence of thought and speech. Soon, they
lead to unconsciousness. E.g. Atropine.
Act as convulsants: they are local anaesthetic
drugs used in operating theatre.
Signs and Symptoms of narcotic poison
Slow respiration.
Dilated pupil.
Weak pulse.
Drowsiness.
Deep sleep.
Management of narcotic poisoning
1 Do transport casualty to hospital if unconscious.
2 However if conscious though very drowsy, assist
him to walk around or about.
3 Give emetics as quickly as possible.
4 After he has vomited, give stimulant like coffee.
3.Corrosive Poisons
They usually cause burns at the point of contact with the body. Corrosive poison may be alkaline or acidic. When a corrosive substance is swallowed, burnt and severe pain are experienced in the lips, mouth, oesophagus, and stomach.
Examples of corrosive poisoning
Acidic poison: e.g. HCL and sulphuric acid
(battery acid).
Alkaline poison: e.g, Caustic soda, ammonium and
caustic potash.
Signs and Symptoms of corrosive poison
A Severe burns around the lips/mouth
Difficulty in speaking
Difficulty in swallowing
Difficulty in breathing
Severe pain in mouth, throat and chest
Nausea and vomiting
Sore mouth/lips
Shock may Occur.
Management of corrosive poisoning
Do not give emetic since this may cause
additional burns.
Give antidote to neutralize the substance.
Give demulcent to soothe the mucous lining.
Treat for shock
Send for medical aid and transport casualty to hospital.
Management of Poison
Aims
To remove or counteract the poison effect.
To send for medical aid.
To identify the type of poison.
To check for vomiting urine or faeces and if any,
then send along to hospital for medical Investigation
Four (4) main ways of managing poison.
The four main ways of managing poison cut across
all the three(3) classifications of poison. They include;
1. Emetics
2. Antidotes
3. Aperients
4. Demulcen
1. Emetics
2. Antidotes
This neutralizes or counteract the effect of the poison taken in e.g. acid can be given to counteract the effect of alkaline by adding approximately 3 table Spoonful of vinegar to a 1 cup of water, likewise, alkaline can be given to neutralize acid by adding one (1) level tea spoonful of bicarbonate of soda to one (1) cup of water.
3. Aperients
Even though, emetic is given initially, however, aperients substance is given to clear all poison that has entered the tissues and intestines e.g. castor oil. Give two (2) tea spoonful to an adult.
4. Demulcent
It is a substance which soothes irritated mucous membrane. E.g. milk, olive oil, liquid paraffin, etc.
Preventions of poisoning
Recommendations of the American Medical Association:
1. Keep all drugs, poisonous substances, and household chemicals out of reach of children. Remember children can climb.
2. Do not store edible products on shelves of poisonous substances and drugs in their original containers.
3. Do not transfer them to unlabelled containers.
4. When medications are discarded, destroy them. Do not throw them where they may be reached by children or pets. Flush them down the toilet when possible.
5. When giving flavored or brightly coloured medicine to children, always refer to it. Buy medicine that come in child proof container
6. Don’t give or take medicine in the dark.
7. Read
labels before using chemical products.
Comments
Post a Comment