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سیداسدالله سا
03.12.2012

CARDIO PULMONARY RESUSCITATION

Place the casualty on their backs on a firm surface.
Give two breaths as above.
Place locked hands over low centre of chest.
Depress chest 1.5 – 2 inches. (Don’t bend your elbows).
14 Depressions followed by two breaths.
Repeat cycle until help arrives or you are exhausted (or 10 minutes has elapsed).
Patient starts breathing again, place in recovery position.

BLEEDING CASUALTY
There are effectively four kinds of bleeding that concern the First Aider:
Venous, Arterial, Capillary and Internal. There is little that the First Aider can do to effectively staunch internal bleeding. However you should be aware that internal bleeding can be life threatening. The body may effectively lose up to 2 litres of blood from a fractured femur without there being any visible loss.
If you suspect internal bleeding, seek emergency help. Signs of internal bleeding may include:
• Bleeding from body cavities (such as the ears, nose, rectum or vagina)
• Vomiting or coughing up blood
• Bruising on neck, chest, abdomen or side (between ribs and hip)
• Wounds that have penetrated the skull, chest or abdomen
• Abdominal tenderness, possibly accompanied by rigidity or spasm of abdominal muscles
• Fractures
• Shock, indicated by weakness, anxiety, thirst or skin that's cool to the touch.
CAPILLARY BLEEDING

Capillary bleeding whilst often associated with painful grazes is seldom life threatening,

BLEEDING FROM VEINS OR ARTERIES

External Symptoms:

• Venous Bleeding. Bright red blood pumping from the wound site.
• Arterial Bleeding. Darker red blood “pulsing” from a wound.

TREATMENT

As long as there is no foreign object in the wound apply direct pressure to the wound site. If the Injury is on a limb maintain the pressure and if possible elevate the wound above the level of the heart. Apply (tightly) a dressing to the wound. Please note, it is NOT advised to tie a dressing tightly around a neck wound.

1. Elevate the wound above the heart and apply firm pressure with a clean compress (such as a clean, heavy gauze pad, washcloth, T-shirt, or sock) directly on the wound. Call out for someone to get help, or call your country’s emergency number yourself. Do not remove a pad that is soaked through with blood; you will disturb any blood clots that have started to form to help stop the bleeding. If blood soaks through, place another pad on top of the soaked one and continue applying direct pressure. 2. When the bleeding slows or stops, tie the pad firmly in place with gauze strips, a necktie, strips of sheet, or a shoelace. Do not tie so tightly that blood flow to the rest of the limb is cut off. Stay with the person and keep the wound elevated until medical help arrives.
Pressure Points for Severe Bleeding
If severe bleeding does not stop with direct pressure and elevation, apply direct pressure to an artery. Use direct pressure on an artery along with elevation and direct pressure on the wound. There are specific major arteries in the body where pressure should be placed (see illustration below)
When you apply pressure to an artery, you stop bleeding by pushing the artery against bone. Press down firmly on the artery between the bleeding site and the heart. If there is severe bleeding, also apply firm pressure directly to the bleeding site.
To check if bleeding has stopped, release your fingers slowly from the pressure point, but do not release pressure at the bleeding site. If bleeding continues, continue to apply pressure to the artery. Continue until the bleeding stops or until help arrives. After bleeding stops, do not continue to apply pressure
to an artery for longer than 5 minutes.

SPECIFIC WOUNDS
• Be wary of applying too much pressure to scalp wounds and other maxillae facial wounds. There may be underlying damage to the skull and you may cause further serious injury.
• In the case of wounds where the abdominal wall has been compromised to not attempt to push organs back into the body cavity. Cover with a moist dressing.
• In the case of amputated / or near amputated limb apply a tourniquet 2-3” above the site of the amputation.

• A tourniquet is a constricting band placed around an arm or leg to control bleeding. A casualty whose arm or leg has been completely amputated may not be bleeding when first discovered, but a tourniquet should be applied anyway. This absence of bleeding is due to the body's normal defences (contraction of blood vessels) as a result of the amputation, but after a period of time bleeding will start as the blood vessels relax. Bleeding from a major artery of the thigh, lower leg, or arm and bleeding from multiple arteries (which occurs in a traumatic amputation) may prove to be beyond control by manual pressure. If the pressure dressing under firm hand pressure becomes soaked with blood and the wound continues to bleed, apply a tourniquet.
WARNING
A tourniquet is only used on arm(s) or leg(s) where there is danger of loss of casualty's life.

• Remember that the penetrating wound caused by bullets will often have not only an entry point but also an exit wound; very often the exit wound will be more severe than the initial entrance wound. Before applying the dressing; carefully examine the casualty to determine if there is more than one wound. A missile may have entered at one point and exited at another point.
WARNING
• If the missile lodges in the body (fails to exit), DO NOT attempt to remove it or probe the wound. Apply a dressing. If there is an object extending from (impaled in) the wound, DO NOT remove the object. Apply a dressing around the object and use additional improvised bulky materials/dressings (use the cleanest material available) to build up the area around the object. Apply a supporting bandage over the bulky materials to hold them in place.

• Casualty should be continually monitored for development of conditions which may require the performance of necessary basic lifesaving measures, such as clearing the airway and mouth-to-mouth resuscitation. All open (or penetrating) wounds should be checked for a point of entry and exit and treated accordingly.

a. Closed Fracture. A closed fracture is a broken bone that does not break the overlying skin. Tissue beneath the skin may be damaged. A dislocation is when a joint, such as a knee, ankle, or shoulder, is not in proper position. A sprain is when the connecting tissues of the joints have been torn. Dislocations and sprains should be treated as closed fractures.
b. Open Fracture. An open fracture is a broken bone that breaks (pierces) the overlying skin. The broken bone may come through the skin, or a missile such as a bullet or shell fragment may go through the flesh and break the bone. An open fracture is contaminated and subject to infection.
Signs/Symptoms of Fractures
Indications of a fracture are deformity, tenderness, swelling, pain, inability to move the injured part, protruding bone, bleeding, or discoloured skin at the injury site. A sharp pain when the individual attempts to move the part is also a sign of a fracture. DO NOT encourage the casualty to move the injured part in order to identify a fracture since such movement could cause further damage to surrounding tissues and promote shock. If you are not sure whether a bone is fractured, treat the injury as a fracture.
Purposes of Immobilising Fractures
A fracture is immobilised to prevent the sharp edges of the bone from moving and cutting tissue, muscle, blood vessels, and nerves. This reduces pain and helps prevent or control shock. In a closed fracture immobilisation keeps bone fragments from causing an open wound and prevents contamination and possible infection. Splint to immobilise.
Splints, Padding, Bandages, Slings, and Swathes
a. Splints. Splints may be improvised from such items as boards, poles, sticks, tree limbs, rolled magazines, rolled newspapers, or cardboard. If nothing is available for a splint, the chest wall can be used to immobilise a fractured arm and the uninjured leg can be used to immobilise (to some extent) the fractured leg.
b. Padding. Padding may be improvised from such items as a jacket, blanket or dressing.
c. Bandages. Bandages may be improvised from belts, hankerchiefs, or strips torn from clothing or blankets. Narrow materials such as wire or cord should not be used to secure a splint in place.
d. Slings. A sling is a bandage (or improvised material such as a piece of cloth, a belt and so forth) suspended from the neck to support an upper extremity. Also, slings may be improvised by using the tail of a coat or shirt, and pieces torn from such items as clothing and blankets. The triangular bandage is ideal for this purpose. Remember that the casualty's hand should be higher than his elbow, and the sling should be applied so that the supporting pressure is on the uninjured side.
e. Swathes. Swathes are any bands that are used to further immobilise a splinted fracture. Triangular and cravat bandages are often used as or referred to as swathe bandages. The purpose of the swathe is to immobilise, therefore, the swathe bandage is placed above and/or below the fracture--not over it.
Procedures for Splinting Suspected Fractures
Before beginning first aid treatment for a fracture, gather whatever splinting materials are available. Materials may consist of splints, such as wooden boards, branches, or poles. Other splinting materials include padding, improvised cravats, and/or bandages. Ensure that splints are long enough to immobilise the joint above and below the suspected fracture. If possible, use at least four ties (two above and two below the fracture) to secure the splints. The ties should be non slip knots and should be tied away from the body on the splint.
Evaluate the Casualty Be prepared to perform any necessary lifesaving measures. Monitor the casualty for development of conditions which may require you to perform necessary basic lifesaving measures. These measures include clearing the airway, rescue breathing, preventing shock, and/or bleeding control.

WARNING
Unless there is immediate life-threatening danger, such as a fire or an explosion, DO NOT move the casualty with a suspected back or neck injury. Improper movement may cause permanent paralysis or death.
Locate the Site of the Suspected Fracture. Ask the casualty for the location of the injury. Does he have any pain? Where is it tender? Can he move the extremity? Look for an unnatural position of the extremity. Look for a bone sticking out (protruding).
Prepare the Casualty for Splinting the Suspected Fracture
(1) Reassure the casualty. Tell him that you will be taking care of him and that medical aid is on the way.
(2) Loosen any tight or binding clothing.
(3) Remove all the jewellery from the casualty and place it in the casualty's pocket. Tell the casualty you are doing this because if the jewellery is not removed at this time and swelling occurs later, further bodily injury can occur.
NOTE
If splinting material is not available and suspected fracture CANNOT be splinted, then swathes or a combination of swathes and slings can be used to immobilise an extremity.
Pad the splints where they touch any bony part of the body, such as the elbow, wrist, knee, ankle, crotch, or armpit. Padding prevents excessive pressure to the area.
. Check the Circulation below the Site of the Injury
(1) Note any pale, white, or bluish-gray colour of the skin which may indicate impaired circulation. Circulation can also be checked by depressing the toe/fingernail beds and observing how quickly the colour returns. A slower return of pink colour to the injured side when compared with the uninjured side indicates a problem with circulation. Depressing the toe/fingernail beds is a method to use to check the circulation in a dark-skinned casualty.
(2) Check the temperature of the injured extremity. Use your hand to compare the temperature of the injured side with the uninjured side of the body. The body area below the injury may be colder to the touch indicating poor circulation.
(3) Question the casualty about the presence of numbness, tightness, cold, or tingling sensations.
WARNING
Casualties with fractures to the extremities may show impaired circulation, such as numbness, tingling, cold and/or pale to blue skin. These casualties should be evacuated by medical personnel and treated as soon as possible. Prompt medical treatment may prevent possible loss of the limb.
WARNING
If it is an open fracture (skin is broken; bone(s) may be sticking out), DO NOT ATTEMPT TO PUSH BONE(S) BACK UNDER THE SKIN. Apply a field dressing to protect the area.
. Apply the Splint in Place
(1) Splint the fracture(s) in the position found. DO NOT attempt to reposition or straighten the injury. If it is an open fracture, stop the bleeding and protect the wound. Cover all wounds with field dressings before applying a splint. Remember to use the casualty's field dressing, not your own. If bones are protruding (sticking out), DO NOT attempt to push them back under the skin. Apply dressings to protect the area.
(2) Place one splint on each side of the arm or leg. Make sure that the splints reach, if possible, beyond the joints above and below the fracture.
(3) Tie the splints. Secure each splint in place above and below the fracture site with improvised (or actual) cravats. Improvised cravats, such as strips of cloth, belts, or whatever else you have, may be used. With minimal motion to the injured areas, place and tie the splints with the bandages. Push cravats through and under the natural body curvatures (spaces), and then gently position improvised cravats and tie in place. Use non slip knots. Tie all knots on the splint away from the casualty. DO NOT tie cravats directly over suspected fracture/dislocation site.

Check the Splint for Tightness
(1) Check to be sure that bandages are tight enough to securely hold splinting materials in place, but not so tight that circulation is impaired.
(2) Recheck the circulation after application of the splint. Check the skin colour and temperature. This is to ensure that the bandages holding the splint in place have not been tied too tightly. A finger tip check can be made by inserting the tip of the finger between the wrapped tails and the skin.
(3) Make any adjustment without allowing the splint to become ineffective.
i. Apply a Sling if Applicable An improvised sling may be made from any available non stretch piece of cloth, such as a shirt or trouser, Slings may also be improvised using the tail of a coat, belt, or a piece of cloth from a blanket.

Spinal Column Fractures
It is often impossible to be sure a casualty has a fractured spinal column. Be suspicious of any back injury, especially if the casualty has fallen or if his back has been sharply struck or bent. If a casualty has received such an injury and does not have feeling in his legs or cannot move them, you can be reasonably sure that he has a severe back injury which should be treated as a fracture. Remember, if the spine is fractured, bending it can cause the sharp bone fragments to bruise or cut the spinal cord and result in permanent paralysis. The spinal column must maintain a swayback position to remove pressure from the spinal cord. Caution him not to move. Ask him if he is in pain or if he is unable to move any part of his body.
• Leave him in the position in which he is found. DO NOT move any part of his body.
• Slip a blanket, if he is lying face up, or material of similar size, under the arch of his back to support the spinal column in a sway back position. If he is lying face down, DO NOT put anything under any part of his body.
Neck Fractures
A fractured neck is extremely dangerous. Bone fragments may bruise or cut the spinal cord just as they might in a fractured back

• Caution him not to move. Moving may cause death.
Leave the casualty in the position in which he is found. If his neck/head is in an abnormal position, immediately immobilise the neck/head. Use the procedure stated below. To Keep the casualty's head still, if he is lying face up, raise his shoulders slightly, and slip a roll of cloth that has the bulk of a bath towel under his neck). The roll should be thick enough to arch his neck only slightly, leaving the back of his head on the ground. DO NOT bend his neck or head forward. DO NOT raise or twist his head. Immobilise the casualty's head. Do this by padding heavy objects such as rocks or his boots and placing them on each side of his head. If it is necessary to use boots, first fill them with stones, gravel sand, or dirt and tie them tightly at the top. If necessary, stuff pieces of material in the top of the boots to secure the contents.
BURNS
Burns are caused by dry heat, corrosive substances and friction. Scalds are caused by wet heat – hot liquids and vapours. Burns can also be produced by extreme cold, and by radiation, including the sun’s rays. Burns may be related to, or a result of, a more life-threatening situation. Fires may be started accidentally by victims of drug or alcohol overdose. An explosion, or jumping from a burning building, may cause other serious injuries. When burns have been treated, the casualty should be thoroughly examined.
Assessing a Burn
There are a number of factors to consider when assessing the severity of a burn and the method of treatment, including the cause of the burn, whether the airway is involved, the depth of the burn, and its extent.
The extent of the burn will indicate whether shock is likely to develop, as tissue fluid (serum) leaks from the burned area and is replenished by fluids from the circulatory system. The greater the extent of the burn, the more severe the shock will be. The cause of the burn may also signal any other possible complications. Burns also carry a serious risk of infection, which increases according to the size and depth of the burn. The body’s natural barrier, the skin, is destroyed by burning, leaving it exposed to germs.
Depth of Burns
Burns can be categorised as follows:
Superficial burns
These involve only the outer layer of the skin, and are characterised by redness, swelling and tenderness. Typical examples are mild sunburn, or a scald produced by a splash of hot tea or coffee. Superficial burns usually heal well if prompt first aid is given, and do not require medical treatment unless extensive.
Partial-thickness Burns
These damage a ‘partial thickness’ of the skin, and require medical treatment. The skin looks raw, and blisters form. These burns usually heal well, but can be serious, if extensive. In adults, partial-thickness burns affecting more than 50% of the body’s surface can be fatal. This percentage is less in children and the elderly.
Full-thickness Burns
These damage all layers of the skin. Damage may extend beyond the skin to affect nerves, muscle and fat. The skin may look pale, waxy, and sometimes charred. Full-thickness burns of any size always require immediate medical attention, and usually require specialist treatment.
Extent of Burns
The area of a burn gives an approximate indication of the degree of shock that will develop and, in conjunction with depth, can be used as a guide to the required level of treatment. The ‘rules of nine’ is a guide used to calculate the extent of a burn as a percentage of the body’s total surface area, and to assess what level of medical attention is required.
In an otherwise healthy adult:
 Any partial-thickness burn of 1% or more (an area approximating to that of the casualty’s hand) must be seen by a medical practitioner.
 A partial-thickness burn of 9% or more will cause shock to develop, and the casualty will require hospital treatment.
 A full-thickness burn of any size requires hospital treatment.
Severe Burns and Scalds
The priority is to cool the injury; the longer the burning goes unchecked, the more severely the casualty will be injured. Resuscitate the casualty only when cooling is underway. All severe burns carry the danger of shock.
Treatment of Severe Burns and Scalds
DO NOT overcool the casualty; this may dangerously lower the body temperature.
DO NOT remove anything sticking to the burn; this may cause further damage and cause infection.
DO NOT touch or interfere with the injured area.
DO NOT burst blisters.
DO NOT apply lotions, ointment, or fat to the injury.
 Lay the casualty down, protecting the burned area from contact with the ground, if possible.
 Douse the burn with copious amounts of cold liquid. Thorough cooling may take 10 minutes or more, but this must not delay the casualty’s transmission to hospital.
 While cooling the burns, check airway, breathing, and pulse, and be prepared to resuscitate.
 Gently remove any rings, watches, belts, shoes, or smouldering clothing from the injured area, before it starts to swell. Carefully remove burned clothing unless it is sticking to the burn.
 Cover the injury with a sterile burns sheet or other suitable non-fluffy material, to protect from infection. A clean plastic bag or kitchen film may be used. Burns to the face should be cooled with water, not covered.
 Ensure that the emergency service is on its way. While waiting, treat the casualty for shock. Monitor and record breathing and pulse, and resuscitate, if necessary.
Burns to the Mouth and Throat
Burns to the face, and burns in the mouth or throat are very dangerous, as they cause rapid swelling and inflammation of the air passages. The swelling will rapidly block the airway, giving rise to a serious risk of suffocation. Immediate and highly specialised medical assistance is required.
Treatment of Burns to the Mouth and Throat
 Contact the emergency service. Report suspected burns to the airway.
 Take any steps to improve the casualty’s air supply, e.g., loosening clothing around the neck. Give the casualty oxygen if you are trained to do so.
 If the casualty becomes unconscious, place in the recovery position, and be prepared to resuscitate.
Minor Burns and Scalds
Minor burns and scalds are usually the result of domestic accidents. Prompt first aid will generally enable them to heal naturally and well, but the advice of a medical practitioner should be sought if there is doubt as to the severity of the injury.
Treatment of Minor Burns and Scalds
DO NOT use adhesive dressings.
DO NOT break blisters, or interfere with the injured area.
DO NOT apply lotions, ointments, creams, or fats to the injured area.
 Cool the injured part with copious amounts of cold water for about 10 minutes to stop the burning and relieve the pain. If water is unavailable, any cold, harmless liquid such as milk or canned drinks will suffice.
 Gently remove any jewellery, watches, or constricting clothing from the injured area before it starts to swell.
 Cover the injury with a sterile dressing, or any clean, non-fluffy material to protect from infection. A clean plastic bag or kitchen film may be used.

thanks i wish you are us

pattang
04.12.2012

هر هېواد ، هر کام ، هر کلچر دخپلې روزنې او مخبوونې حق لري او روزنه يې بايد
داسې وي چې اکسريت يې پکښې خوشاله وي خو نور څوک حق نلري چې ځانونه هلته
قانوني پوليسان جوړ کړي او دغه طبعي حقوق له نورو څخه په خپل لاس کې واخلي
او په زور يې په خلکو تحميلوي !
په حقيقت کې دا اشغالګر پوليس دکلچر او دين ورانوونکي اشغالګر غله دي!!!
که امکان وي په پښتو يې ليکه !!