Managing paediatric illness

Accidents will happen however careful you carry out risk assessments and supervise children. That is why it is recommended that practitioners take a first aid course. There has to be at least one first aider present at all registered settings. The aims of first aid are often remembered as the three p’s, these are: Preserve Life.

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Prevent the condition from worsening.
Promote recovery.
Sometimes first aid is all that is necessary- for instance, common minor injuries such as grazes can be treated sufficiently. However, it is important to recognise when medical assistance is required urgently. Whenever you are dealing with an accident, incident or illness you must stay calm. You should reassure casualties, and children who are bystanders, as they may be frightened. You should ensure that you and others are not put at unnecessary risk. Think through your actions carefully and make safety your priority. Major fractures are often associated with other injuries and priorities must be set in each patient. Control of internal concealed haemorrhage, for example, from a ruptured spleen, takes precedence over fracture management. It is, however, important in severely injured patients that open fractures are managed as early as possible. The advantages of this approach include diminished risk of infection, reduction in pain, early ability to sit upright with improved respiratory function, reduced continuing blood loss, and improved healing of soft tissue injuries and a reduced incidence of fat embolism.

Initial assessment.
Primary survey- the ABCDE’s of the primary survey should be assessed. Haemorrhage from a musculoskeletal injury should be identified and controlled with direct pressure. It is important to recognise that significant amounts of blood may be lost from fractures of the pelvis or femur and haemodynamic instability from hypovolemia may be present. Physical examination is carried out while resuscitation is in progress in hypovolemic patients. Clothing is cut free and the patient is examined for fractures and for evidence of internal haemorrhage. The following are important adjuncts to the primary survey and resuscitation; Fracture reduction and immobilisation emergency splinting of fractures will minimise soft tissue damage, reduce blood loss, control pain and prevent conversion of a closed fracture to an open fracture. Temporary traction devices may be used to maintain satisfactory alignment. It is important to examine the injured limb for signs of vascular and nerve injury, as well as searching for a fracture or dislocation. The fractured limb should be handled as gently as possible if some realignment is necessary in order to apply a padded standard or improvised splint.

Splinting should immobilise the joints above and below the fracture also. The open wound compound fracture should be promptly covered with a clean or sterile dressing. Bone protruding from the wound should be left undisturbed. Analgesia. Although splinting greatly assists pain control, the emergency services may administer an intravenous narcotic analgesia. Resuscitation- up to four litres of blood may be lost with severe fractures of the pelvis or femur. Adequate resuscitation before internal fixation is particularly important in such patients, who may lose 50% or more of their blood volume, either externally (with open injuries) or into the tissues of the thigh and pelvis. One or two litres of blood distributed evenly throughout the soft tissues of the thigh will increase the external diameter by a mere 1-2cm; patients with multiple pelvic and other fractures can require replacement or considerably more than their blood volume.

Secondary survey- during the secondary survey a focused history and examination are performed, including a neurological assessment. History taking should incorporate ‘ample’ and the following points should be considered: circumstances of the accident, and history of crushing trauma or explosive forces. If the patient has been involved in a motor vehicle accident. Physical examination and neurological assessment. Signs of fracture are local loss of function, bony tenderness, swelling, deformity, bruising and protective muscle spasm. Testing for abnormal movement and crepitus is unnecessarily painful and contraindicated. An obvious fracture may often distract attention from a less obvious injury. For example, dislocation of the hip may coexist with an obvious femoral shaft fracture (sometimes the real cause of persistent shock); a spinal fracture with a fracture of the calcaneus. Visceral injuries such as splenic rupture are seen with fractured ribs; urethral or bladder injuries with a fractured pelvis. The examiner should check peripheral pulses and evidence of limb ischemia beyond a fracture-such a complication requires urgent correction.

The most common vascular injuries are at the knee and elbow-to the popliteal vessels after severe knee injury in children and to the brachial artery following supracondylar fracture. Neurological examination is also essential; loss of motor power in any muscle group or loss of any cutaneous sensation indicates nerve injury. If the patient can flex and extend the toes and ankle, the major nerves of the lower extremity are intact; if the fingers can be spread and flexed and the thumb can be extended, functional integrity of the major nerves of the upper limb is present. Common nerve injuries following fractures are: the radial nerve from fracture of the mid-humerus, the peroneal nerve from proximal fibular fracture and knee injuries, and the ulnar nerve from fracture of the medical epicondyle of the humerus. Sciatic and axillary nerve injuries must always be excluded after dislocation of the hip or shoulder. Careful attention to the details of local treatment is most important. Fractures heal promptly with correct local treatment. Children are constantly bumping and bruising themselves. All it takes is one fall too hard, and the child might just end up with a broken bone. One out of five people has had a fracture at some point in time, and the maximum of these fractures occur during childhood. How can you tell if it’s a fracture or a sprain? The pains is less intensive in a sprain than in a fracture, but never make a mistake of underestimating someone’s pain threshold.

A dislocation is when the bone has come out from the socket. This also results in acute pain, swelling, an inability to carry any weight and an inability to move the injured limb. A hairline fracture is just when the bone gets a crack that goes through it. Such fractures still cause immense pain, but at least the chances of needing an operation are slim. A compound fracture is one in which the bone completely breaks apart pops out through the skin. This is the worst kind and it may result in loss of blood as well. The first step to be taken is to immobilise the should not be moved at all. Leg fracture- if a child has a suspected fractured leg, carefully straighten it. Call for emergency services and in the meantime, secure the leg so it doesn’t move. Apply two splints, one on the inner leg from the foot to inner thigh, and the other on the outside, from the foot to the armpit. Secure the splints well. Do not move the child until their leg has been completely immobilised. You could tie both legs together for added support. Hand fracture- the hand should be moved to a 90 degree angle and kept close to the chest. It should be immobilised in this position, and if the pain is too intense, do not move it at all.

To help maintain the position place the injured arm into a sling. Bleeding- if a child is bleeding, you should treat the bleeding first. Stop the bleeding by first cleaning it with sterile water and then apply a sterile clean dressing. Keep RICE in mind, as a first aid treatment for all fractures, sprains and dislocations: Rest- Give plenty of rest to the immobilised limb. Move it as little as possible so that there is no strain. Ice- Apply ice to the injured area. No heat treatment or massage should be given. Use an ice pack or wrap some ice cubes in a damp towel and apply it to the injured area. You could also use anything frozen such as a packet of frozen peas. Compression- Wrap up the injured area with a large crepe bandage if possible, or use any clean, fresh cloth available. Wrap it as tight as is comfortable. However ask the patient don’t assume how tight it is. This will relieve pain somewhat. Elevation- The injured limb should preferably be raised above the level of the heart. This could be done using something like a pillow. During any first aid treatment it is vital that the patient is reassured and is made as comfortable as possible and that you stay as calm as possible to keep the situation and patient calm, do not delay seeking medical assistance and ensure the patient remains nil by mouth in case surgery or anaesthesia is needed as this will delay things.

Head injuries occur commonly in child hood and adolescence. Most head injuries are mild and not associated with brain injury or long term complications. A head injury is any trauma that injures the scalp, skull, or brain. The injury may be only a minor bump on the skull or a serious brain injury. A closed head injury means you received a hard blow to the head from striking an object, but the object did not break the skull. An open, or penetrating, head injury means you were hit with an object that broke the skull and entered the brain. This usually happens when you move at high speed. Symptoms of a head injury can occur right away, or develop slowly over several hours or days. Even if the skull is not fractured, the brain can bang against the inside of the skull and be bruised. The head may look fine, but problems could result from bleeding or swelling inside the skull. In any serious head trauma, the spinal cord is also likely to be injured. Some head injuries cause changes in brain function. This is called a traumatic brain injury. Learning to recognise a serious head injury and give basic first aid can save someone’s life. Get medical help immediately if the person:

Becomes very sleepy.
Behaves abnormally.
Develops a severe headache or stiff neck.
Has pupils of unequal size.
Is unable to move an arm or leg.
Loses consciousness, even briefly.
Vomits more than once.
Concussion-the term concussion is used to describe a mild form of traumatic brain injury. Concussion includes confusion, amnesia, headache, vomiting and dizziness. Seizures.
The signs and symptoms of a skull fracture are:
A cut, bruise, or swelling on their head. There may also be bruising around their eyes and behind their ears. Blood or clear fluid coming out from their head, ear or nose. Bump or lump on their head.

Dizziness, feeling tired.
Pain or tenderness on their head.
Very bad headache.
Cerebral compression is very serious and almost invariably requires surgery. Cerebral compression occurs when there is a build-up of pressure on the brain. This pressure may be due to one of several different causes, such as an accumulation of blood within the skull or swelling of injured brain tissues. Cerebral compression is usually caused by a head injury. However, it can also be due to other causes, such as stroke, infection or a brain tumour. The condition may develop immediately after a head injury, or it may appear a few hours or even days later. Recognising cerebral compression

Deteriorating level of response.
History of a recent head injury.
Intense headache.
Noisy breathing, becoming slow.
Slow, yet full and strong pulse.
Unequal pupil size.
Weakness/paralysis down one side.
High temperature.
Abnormal behaviour.
You should always consider the possibility of cervical spine injury in cases of head injuries. There are two types of injury. Typical cervical hyperextension injuries occur in drivers/passengers of a statutory or slow-moving vehicle that is struck from behind. The person’s body is thrown forward but the head lags, resulting in hyperextension of the neck. When the head and neck have reached maximum extension the neck then snaps into flexion. A rapid deceleration throws the head forwards and flexes the cervical spine. The chin limits forward flexion but the forward movement may be sufficient to cause longitudinal distraction and neurological damage. Hyperextension may occur in the subsequent recoil. The symptoms include:

Neck pain, jaw pain, para spinal muscle tightness and spasms. Interscapular and low back pain.
Reduced range of movements and neck tenderness.
Headache, dizziness, vertigo, blurring of vision.
Numbness in shoulders and arms.
Insomnia, anxiety.
Leg weakness.
Arm weakness.
Other possible cause of acute neck pain and stiffness caused by head injury include: Spinal fracture.
Cervical disc herniation.
Subarachnoid haemorrhage.
Cervical spondylosis.
The primary goal in the early management of a severely injured patient is the provision of sufficient oxygen to the tissues to avoid organ failure and secondary central nervous system damage. The first priority is to establish and maintain a patient’s airway. With the addition of high-concentration oxygen and the presence of adequate tissue perfusion, this will enable sufficient spontaneous breathing or assisted ventilation to oxygenate the patient. The possibility of an unstable cervical injury exists in patients exposed to significant blunt trauma; during airway interventions neck movements must be minimised to avoid secondary harm to the spinal cord. Head injury with impaired consciousness and reduced pharyngeal tone is the commonest trauma-related cause of airway obstruction. The airway may also be soiled with blood or regurgitated matter. Blunt or penetrating injuries that obstruct the airway include maxillary, mandibular and laryngotracheal fractures, and the large anterior neck haematomas. Significant partial and incipient airway obstruction are also potential causes of early death.

Vigilant reassessment with immediate restoration and protection of airway patency is essential. Having ensured scene safety, the initial approach to the trauma victim begins with an assessment of the patency of the airway and if indicated manual in line stabilisation (MILS) of the cervical spine. In unconsciousness patients, the head and neck should be maintained in neutral alignment. MILS may be replaced with a correctly sized hard cervical collar, lateral blocks and straps across the forehead and chin piece of the collar. Spinal immobilisation prohibits head tilt. A jaw thrust may be more effective in relieving airway obstruction with decreased consciousness than a chin lift. However, a jaw thrust can cause significant movement of an unstable cervical spine. If tolerated an oropharyngeal airway may maintain airway patency while exerting less force on the vertebrae. Subsequently assisted ventilation may be more successful if separate rescuers apply the jaw thrust, hold the face mask and begin resuscitation.

Any material such as dust, sand or paint that gets into the eye is called a foreign body. Foreign bodies fall into two categories; Superficial- these stick to the front of the eye or get trapped under one of the eyelids, but do not enter the eye. Penetrating- these penetrate the outer layer of the eye and enter the eye. These objects are usually travelling at high speed and are commonly made of metal. Superficial foreign bodies are not usually

A penetrating eye injury can be extremely serious-it may lead to blindness in not detected and treated promptly. If you get a superficial body in your eye, first aid treatment in the form of a gentle rinsing with sterile water is appropriate it is easier to tilt the head or lie down and rinse the eye from the side. It is vital to keep the child calm and reassure them throughout. If a child has a penetrating eye injury you must seek urgent medical assistance remembering to keep calm and reassure the child.

Foreign bodies in the ear can either be in the lobe or in the ear canal. Objects usually found in the ear lobe are earrings, either stuck in the lobe from infection or placed too deep during insertion. Foreign bodies in the ear canal can be anything a child can push into their ear. The reason children place things in their ears is usually because they are bored, curious or copying other children. Sometimes, one child may put an object in another child’s ear during play. Insects may also fly into the ear canal, causing potential harm. The treatment for foreign bodies in the ear is prompt removal of the object. In the case of the foreign body being an insect you can use tepid water in any other case it is important that trained professionals remove the items to prevent any further damage occuring. The techniques they may use include: Instruments may be inserted to retrieve it.

Magnets in the case of metal objects.
Cleaning the ear canal with water.
A machine with suction to help pull the object out.
After removal of the object the ear will be re-examined to determine whether there is any injury to the ear canal. Antibiotic drops may be prescribed to treat any possible infection. Medical help should be sought if treatment is unsuccessful and to ensure all materials are removed. The most common symptom of a foreign body in the nose is nasal discharge. The drainage appears only on one side of the nose and often has a bad odour. In some cases, the child may also have a bloody nose. The treatment for this involves prompt removal by a medical professional. They may find if necessary to sedate a child in order to remove the object successfully. Again the doctor may prescribe nose drops or antibiotic treatment. Whilst waiting for medical assistance it is vital to encourage the child to breathe through their mouth.

Corneal abrasions- are a scratch or injury to the cornea, the clear, dome-shaped surface that covers the front of the eye. There are many things that can cause an abrasion to the cornea. When objects make contact with the surface of the eye, a small abrasion can occur. Chemical burn- occurs when a child gets any type of chemical in their eye. Chemical burns are a medical emergency. They can result in a loss of vision and even a loss of the eye itself. Household cleaning agents are a common cause of this type of injury. Bruising or black eye- usually occurs from some type of injury to the eye, causing the tissue around the eye to become bruised. Fractures to the orbit- the orbit is the bony structure around the eye. When one or more bones surrounding the eye are broken. An orbital fracture usually occurs after some type of injury or strike to the face. Eyelid lacerations- are cuts to the eyelids caused by injury.

General symptoms of eye injuries can include:
Blood in the eyeball.
Changes in the shape of the iris or pupil.
Eye pain.
The absence of obvious symptoms.
When checking eyes for injury it is important to wear gloves and any cuts should be cleaned with sterile water to prevent infection, always wash hands before and after examining a patient. Check the patient’s vision. Within the setting the most common eye injury is caused by things such as sand this can be dealt with by a trained first aider on site. However other injuries will more than likely need medical assistance.

Sickle Cell Anaemia.
Symptoms vary, ranging from mild to severe, and may be less severe, or different in children who have inherited a sickle cell gene from one parent and a different abnormal haemoglobin gene from the other. Most children with
sickle cell disease have some degree of anaemia and might develop one or more of the following conditions and symptoms as part of the disorder: Acute chest syndrome.

Aplastic crisis.
Hand-foot syndrome.
Painful crisis.
Splenic sequestration crisis.
Bone marrow transplant is the only known cure for sickle cell disease. But even without a cure, children with sickle cell can lead relatively normal lives. Medicines are available to help manage the pain and immunisations and daily doses of penicillin can help prevent infection. Most children will require two doses of penicillin, as prescribed by their GP, if attending a setting a nominated individual will be responsible for the administration of this medication. It is vital to seek emergency attention if the child develops: Fever of 101 °F or higher.

Chest pains
Pain that isn’t relieved by oral medication.
Shortness of breath or trouble breathing.
Extreme fatigue.
Severe headache or dizziness.
Severe stomach pain or swelling.
Jaundice or paleness.
Sudden change of vision.
Loss of consciousness.
Numbness or tingling.
Remember to reassure the child, you should encourage the child to drink plenty of fluids, rest regularly and avoid temperatures.

Regular testing of blood glucose levels is a very important part of diabetes care. Testing is done by taking a drop of blood, usually from a finger, and placing it on a special test strip in a glucose meter. Caregivers must practice universal precautions when handling and disposing of testing equipment. Hyperglycaemia, or high blood sugar, occurs with both types of diabetes. It occurs when the body gets too little insulin, too much food, too little exercise or with illness. Stress from a cold, sore throat, or other illness may increase the level of blood glucose. Symptoms include frequent irritation, excessive thirst, extreme hunger, unusual weightless, irritability and poor sleep, nausea and vomiting, and weakness and blurred vision.

Hypoglycaemia, or low blood sugar, is more common in people with type 1 diabetes. It is the most common immediate health problem and is also called ‘insulin reaction’ or ‘insulin shock’. It occurs when the body gets too much insulin, too little food, a delayed meal or more than the usual amount of exercise. Symptoms include hunger, changes in mood or behaviour, sweating, and rapid pulse. Treatment commonly involves quickly restoring glucose levels to normal with a sugary food or drink such as orange juice, candy, biscuits or glucose tablets. If not treated properly, it can result in loss of consciousness and a life-threatening coma. Glucagon injections are used in life-threatening situations to increase blood glucose. First aid for a diabetic come are as followed:

Call emergency services.
Don’t try to give them food or fluids as they may choke.
Place them into the recovery position to prevent any obstruction to breathing. Follow any instructions given to you by the emergency services operator until paramedics arrive.

In an asthma attack the muscles of the air passages in the lungs go into spasm and the linings of the airways swell. As a result, the airways become narrowed and breathing becomes difficult. Sometimes there is a specific trigger for an asthma attack such as: an allergy

a cold
cigarette smoke
extremes of temperature

Recognition features
Difficulty in breathing, with a very prolonged breathing-out phase. There may also be:
wheezing as the casualty breathes out
difficulty speaking and whispering
distress and anxiety
features of hypoxia, such as a grey-blue tinge to the lips, earlobes and nail beds (cyanosis).

Severities of attacks are frightening for the child concerned and can also by frightening for those children who may be witnessing it. The child wheezes and becomes breathless. Prompt action is needed. Reassure the child. Give bronchodilator inhaler as instructed if the child is a known asthmatic. These inhalers should always be immediately available- they deliver medication to the lungs to relieve the affected airways. Children may also have another type of inhaler used to prevent attacks. Make sure you know which to use in an emergency, particularly if older children generally use their inhalers themselves. Sit child upright and leaning forwards in a comfortable position. Stay with them. If this is the first attack or the condition persists call for an ambulance remember to note changes in the child’s face and lips (colour) and all breathing difficulties and speech to pass onto paramedics. Ensure there is adequate ventilation and encourage the child to breathe deeply and slowly.

Meningitis should be treated as a medical emergency because bacterial meningitis can lead to septicaemia which can be fatal. Bacterial meningitis is the more serious form of the condition. The symptoms usually begin suddenly and rapidly get worse. Emergency services should be contacted immediately if it is suspected. Bacterial meningitis has a number of early warning signs that usually occur before other symptoms. These are: Pain in the muscles, joints or limbs.

Unusually cold hands and feet.
Pale or blotchy skin and blue lips.
The presence of a high temperature with any of the above symptoms should be taken very seriously and emergency services should be called. Early symptoms are similar to those of many other conditions, and include: A severe headache.

Feeling generally unwell.
As the condition gets worse it may cause:
Seizures or fits.
Being unable to tolerate bright light.
A stiff neck.
A rapid breathing rate.
A blotchy rash that does not fade or change colour when you place a glass against it. Viral meningitis- most people will experience mild flu like symptoms. When examining a child with suspected meningitis it is vital to wash hands and wear personal, protective, equipment such as disposable aprons, and gloves to reduce the risk of cross infection, ensure you reassure and don’t panic the child at any stage. It is important to inform senior staff or management of the case so they can contact and inform others where necessary.

Febrile convulsions.
Febrile convulsions maybe due to epilepsy, or a high temperature. Violent muscle twitching, clenched fists, arched back, may lead to unconsciousness. Do not try to restrain the child. Instead clear the immediate area and surround the child with pillows or padding for protection. Cool the environment and the child gradually (as for a temperature), sponging skin if necessary. When seizures stop place the child in the recovery position and reassure. Dial 999. Remember to prevent choking ensure the mouth is clear; drain any fluids, pulling the chin and jaw forward if breathing is affected.

It is vital to remain calm when dealing with seizures as a person’s response to seizures can influence how other people act. If the first person remains calm, it will help others stay calm too. Talking calmly and reassuring the patient during and after the seizure- it will help them as they recover from the seizure. Don’t be afraid. Stay calm. The person will be ok.

Do not try to stop the person from shaking. If the patient is walking, gently guide them away from dangerous places like stairs. Call emergency services and tell them clearly what is happening and you need an ambulance. To make sure they don’t get hurt, move anything sharp.

Place something soft under the patients head, loosen tight clothing, and remove jewellery and glasses. Do not put anything in the patient’s mouth.
If you can, check a clock to see what time the seizure begun and the time the shaking stops or the person wakes up. Once the seizure has ended place them in the recovery position to stop them from choking and causing any harm to themselves. Never leave the patient wait until medical help is there and remember to speak in a quiet voice to reassure the patient. You should never restrain someone having a seizure. Just protect the person form injury, as restrains them, can cause more harm, and remember putting someone into the recovery position after a seizure can stop them from swallowing their own tongue which could lead to death.

Hypothermia happens when a person’s body temperature drops below 35°C (95°F). Normal body temperature is around 37°C (98.6°F). Hypothermia can quickly become life threatening and should be treated as a medical emergency. It’s usually caused by being in a cold environment and can be triggered by a combination of things – such as being outdoors in cold conditions for a long time, living in a poorly heated house or falling into cold water. The signs of hypothermia vary depending on how low a person’s temperature has dropped. Initial symptoms include shivering, tiredness, fast breathing and cold or pale skin. As the temperature drops, shivering becomes more violent (although this will stop completely if the hypothermia worsens further), the person is likely to become delirious, and struggle to breathe or move and they may lose consciousness. Babies with hypothermia may look healthy but their skin will feel cold. They may also be limp, unusually quiet and refuse to feed. You should seek immediate medical help if you suspect someone has hypothermia. If someone you know has been exposed to the cold and they are distressed, confused, have slow, shallow breathing or they’re unconscious, they may have severe hypothermia. In this case, dial 999 immediately to request an ambulance. While waiting for medical help, it is important to try to prevent further heat loss and gently warm the person. You should: Move the person indoors or somewhere warm as soon as possible. Once they are somewhere warm, carefully remove any wet clothing and dry the person. Wrap them in blankets, towels or coats.

If the person is unconscious, not breathing and you can’t detect a pulse in their neck after 60 seconds, cardio-pulmonary resuscitation (CPR) should be given if you know how to do it. Once CPR is started, it should be continued without any breaks until medical assistance arrives. There are several things you can do to prevent hypothermia. Simple measures can help, such as wearing appropriate warm clothing in cold weather and ensuring that children are well wrapped up when they go outside.

Hyperthermia is the general name given to a variety of heat-related illnesses. Warm weather and outdoor activity go hand in hand. However, it is important for older people to take action to avoid the severe health problems often caused by hot weather. The two most common forms of hyperthermia are heat exhaustion and heat stroke. Of the two, heat stroke is especially dangerous and requires immediate medical attention. Heat stress occurs when a strain is placed on the body as a result of hot weather. Heat fatigue is a feeling of weakness brought on by high outdoor temperature. Symptoms include cool, moist skin and a weakened pulse. The person many feel faint. Heat syncope is a sudden dizziness experienced after exercising in the heat. The skin appears pale and sweaty but is generally moist and cool. The pulse is weakened and the heart rate is usually rapid. Body temperature is normal.

Heat cramps are painful muscle spasms in the abdomen, arms or legs following strenuous activity. Heat cramps are caused by a lack of salt in the body. Heat exhaustion is a warning that the body is getting too hot. The person may be thirsty, giddy, weak, uncoordinated, nauseated and sweating profusely. The body temperature is normal and the pulse is normal or raised. The skin is cold and clammy. Heat stroke can be life-threatening and victims can die. A person with heat stroke usually has a body temperature above 104 degrees Fahrenheit. Other symptoms include confusion, combativeness, bizarre behaviour, faintness, staggering, strong and rapid pulse, and possible delirium or coma. High body temperature is capable of producing irreversible brain damage.

If the child is exhibiting signs of heat stroke, emergency assistance should be sought immediately. Without medical attention, heat stroke can be deadly. Heat exhaustion may be treated in several ways:

get the victim out of the sun into a cool place, preferably one that is air conditioned offer fluids but avoid alcohol and caffeine – water and fruit juices are best encourage the individual to shower and bathe, or sponge off with cool water urge the person to lie down and rest, preferably in a cool place to prevent injury if the casualty does faint. Remain calm and reassure the child.

Electric Shock.
The human body conducts electricity very well. That means electricity passes very easily throughout the body. Direct contact with electrical current can be deadly. While some electrical burns look minor, there still may be serious internal damage, especially to the heart, muscles, or brain. Electric current can cause injury in three ways:

Cardiac arrest due to the electrical effect on the heart
Muscle, nerve, and tissue destruction from a current passing through the body Thermal burns from contact with the electrical source
1. If you can do so safely, turn off the electrical current. Unplug the cord, remove the fuse from the fuse box, or turn off the circuit breakers. Simply turning off an appliance may NOT stop the flow of electricity. Do NOT attempt to rescue a person near active high-voltage lines.

2. Call your local emergency number, such as 911.

3. If the current can’t be turned off, use a non-conducting object, such as a broom, chair, rug, or rubber doormat to push the person away from the source of the current. Do not use a wet or metal object. If possible, stand on something dry and that doesn’t conduct electricity, such as a rubber mat or folded newspapers.

4. Once the person is away from the source of electricity, check the person’s airway, breathing, and pulse. If either has stopped or seems dangerously slow or shallow, start first aid. (See: CPR)

5. If the person has a burn, remove any clothing that comes off easily, and rinse the burned area in cool running water until the pain subsides. Give first aid for burns.

6. If the person is faint, pale, or shows other signs of shock, lay him or her down, with the head slightly lower than the trunk of the body and the legs elevated, and cover him or her with a warm blanket or a coat.

7. Stay with the person until medical help arrives.

8. Electrical injury is frequently associated with explosions or falls that can cause additional severe injuries. You may not be able to notice all of them. Do not move the person’s head or neck if the spine may be injured.

Stay at least 20 feet away from a person who is being electrocuted by high-voltage electrical current (such as power lines) until the power is turned off. Do NOT touch the person with your bare hands if they are still in contact with the source of electricity Do NOT apply ice, butter, ointments, medications, fluffy cotton dressings, or adhesive bandages to a burn Do NOT remove dead skin or break blisters if the person has been burned After the power is shut off, do NOT move the person unless there is a risk of fire or explosion

Burns and Scalds.
Superficial burns
Superficial burns only affect the surface of your skin (epidermis). Your skin will be red and painful, but not blistered. Mild sunburn is an example of a superficial burn. Partial-thickness burns
Partial-thickness burns are deeper burns that damage your epidermis and dermis to varying degrees. If the damage to your dermis is shallow, your skin may be pale pink and painful, with blisters. Deeper burns to your dermis will cause your skin to become dry or moist, blotchy and red. Deep partial-thickness burns may or may not be painful and they may blister. Full-thickness burns

All layers of your skin are damaged by full-thickness burns. Your skin will look white, brown or black and dry, leathery or waxy. Because the nerves in your skin are destroyed with full-thickness burns, you won’t feel any pain or have blisters.

Symptoms vary depending on the severity of your burn. They include: changes in your skin colour – burns can cause your skin to look pink, red, white, brown or black blisters
pain in the burnt area
Symptoms of a burn to your airway include:
burned nostril hairs
a change in your voice (it may sound hoarse)
a sore throat
Treatment for burns depends on their severity. You can treat superficial and minor partial-thickness burns that are caused by heat yourself at home. However, seek urgent medical help from your GP or an accident and emergency department in a hospital for: all deep partial-thickness and full-thickness burns

all chemical and electrical burns
superficial and partial-thickness burns that cover an area larger than the palm of your hand burns that cover a joint or are on your face, hands, feet or groin all burns that extend completely around a limb

all burns where you may have inhaled smoke
Also seek medical help for advice if you’re not sure about the extent of a burn or how to deal with it. For burns caused by chemicals, if possible look at the advice on the label of the chemical product. For full-thickness burns or burns that are caused by chemicals or electricity, it’s important that you start cooling the burn immediately under cool or tepid water (unless instructed otherwise on the chemical product) and then call for emergency help. While you’re waiting, there are a number of important things you can do. For burns caused by heat, keep cooling the burn with cool or tepid water for between 10 and 30 minutes or until medical help is available. Don’t use iced water. Carefully remove any restrictive clothing or jewellery that isn’t stuck to the burn. Next, cover the burn using cling film – layer this on to the burn rather than wrapping it around a limb, for example. If you have a burn on your hand, use a clean, clear plastic bag. Don’t use wet dressings or creams. For burns caused by chemicals, keep cooling the burn with cool or tepid water for at least 20 minutes and remove any affected clothing (wear gloves if possible). Don’t try to neutralise the chemical with another chemical.

Facial Burns.
Facial burns will need to be treated differently depending on the degree of the burn. First-degree burns only penetrate into the epidermis and cause redness and swelling. Second-degree burns penetrate the hypodermis and cause redness, blotching, and blistering. Third degree burns penetrate all layers of skin and cause areas of blackening. A third-degree burn needs to be treated with emergency medical care. Treatment for a minor facial burn would include holding a cold compress to the burn for 10 to 15 minutes. After cooling, lotion should be applied. Cover with a sterile gauze bandage. Don’t pop blisters and if they pop on their own, wash them gently with soap and water, and apply an antibiotic ointment under the sterile gauze.

If the patient has been accidentally exposed to fire or heated gases, damage
may occur to the mouth and airway. There may be signs of burning around the lips, nose, mouth, eyebrows or lashes. A dry cough or hoarse voice is an early sign of airway injury and prompt medical care is essential. How you can help

1. Remove the patient to a safe area
If in a closed area, and if safe for the first aider, it is vital to remove the patient to a place free of the risk of further injury and preferably into fresh air. 2. Cool the injury
If smoke or toxic gases may have been inhaled – including carbon monoxide from a vehicle exhaust, chlorine, ammonia or hydrochloric acid – remove the patient from any enclosed or restricted area into an open area; pour running water over the burn for 20 minutes. If there is any breathing difficulties allow the patient to find the position enabling easy breathing with the head and chest raised. After an inhalation incident the patient may suffer from a severe lack of oxygen due to internal damage to the throat, upper airway and lungs. Call 999 for an ambulance.

Poisoning is when a person is exposed to a substance that can damage their health or put their life in danger. There are many ways in which poison can enter the body:
Through the mouth.
Breathing them through the nose.
Through your eyes.
Through skin contact.
From an insect or animal bite or sting.

The symptoms of poisoning will depend on the type of poison and the amount taken in, the age and weight and size of the individual, but general things to look out for include: vomiting
stomach pains
high temperature
drowsiness and fainting fits
Dizziness, weakness.
Fever or chills.
If a child suddenly develops such symptoms, they may have been poisoned, especially if they are drowsy and confused. Being poisoned can be life-threatening. Giving appropriate first aid, as described below, can help minimise the harm to the person who is poisoned. For simplicity, we have referred to the person (casualty) in the male gender throughout. First, assess the situation and the risk you’re in – don’t put yourself in danger. If you think someone has swallowed, injected or inhaled a poison, or taken a drug overdose and appears to be unconscious, try to rouse him. If the person responds, you shouldn’t move him. Instead, try to find out what’s wrong, make sure his airway is open and that he can breathe comfortably and you can monitor his condition. Call for emergency help or preferably get someone to call for you. If he is unresponsive, you should first shout for help and then open the airway by tilting his head back and lifting his chin. If it’s possible to leave him in the same position to open his airway then do so. However, if it isn’t, turn him onto his back and then open his airway. Ask someone to phone for an ambulance, and if necessary the fire brigade. If you’re on your own, you should do this yourself. Be ready to give as much of the following information as you can to the paramedics and/or the doctor or nurse at the hospital. The name of what was swallowed injected or inhaled if you know it. If possible, keep the container and make a note of how much has been taken. The estimated time that the poison was taken or used.

Whether or not the person has vomited.
Whether you think it was accidental or deliberate.
Whether the person has any chronic illnesses (e.g., heart disease) or takes any medicines (if you know). If the person is unconscious and breathing normally, you should put him into the recovery position. Check his breathing regularly until help arrives. If the person is unconscious and isn’t breathing normally, you should perform emergency resuscitation (CPR), but only if you know how. If you think the poison was swallowed, use the mouth-to-nose method, or preferably, use a pocket mask or face shield for rescue breathing. This way, you avoid any contact with traces of poison or vomit that might remain around the person’s mouth or nose. If you think the person has inhaled poisonous fumes, don’t expose yourself to the person’s breath and use chest compressions only. You should continue at a rate of 100 to 120 compressions per minute. Don’t stop unless the person begins breathing normally, shows signs of regaining consciousness, such as coughing or their opening eyes, or qualified help arrives. If the person has pills, fluids or any substance in his mouth, try to get him to spit them out. You can give them to the hospital staff to help identify the cause of poisoning. Don’t try to make the person sick as vomiting can cause even more damage. If the person has been sick, collect a sample of the vomit to take to hospital. This may help staff identify the poison.

Everyone should learn basic first aid techniques. You never know when you might need them – you could be at home, at work, at school or on holiday. Whether it’s a minor situation or something more serious, first aid knowledge will give you the confidence to act. You could be the difference between life and death. Deal with every day cuts and scrapes and nosebleeds.

First aid advice is also available for asthma, fractures, sunburn, poisons, low blood sugar and more. Heart and circulatory disease is the UK’s biggest killer. Learn how to recognise and treat heart attacks and shock. You can purchase a number of first aid books/manuals which will help and give you knowledge on how to deal with first aid emergencies, some of these manuals are:

The most common first aid manuals which people will recognise are those from the British Red Cross, or St Johns Ambulance as these are well known UK organisations.

The National Poisons Information Service is the service to which frontline NHS staff turn for advice on the diagnosis, treatment and care of patients who have been – or may have been – poisoned, either by accident or intentionally. NPIS provides essential support for NHS healthcare professionals, assisting them in ensuring optimal care for patients in cases of serious poisoning, and, where toxicity is low, offering advice to minimise unnecessary hospital attendances and admissions. NPIS is funded mainly through ‘Government Grant in Aid’ from the UK Health Departments, some contract income and some research income. In an emergency, members of the public should always contact their general practitioners, NHS 24 or NHS Direct or local A&E department. If the patient has collapsed or is not breathing properly, call 999. The NPIS does not provide poisons information directly to members of the public – so, for routine poisons advice you should contact your general practitioner or telephone NHS Direct The National Poisons Information Service does not accept enquiries from the public but supports NHS Direct and NHS 24 to answer such queries.

If you suspect Carbon Monoxide poisoning or a gas leak you must leave the affected area immediately and report it as a matter of urgency to the National Grid on 0800 111 999.

Pharmacy is the science and technique of preparing and dispensing drugs and medicines. It is a health profession that links the health sciences with the chemical sciences and aims to ensure the safe and effective use of pharmaceutical drugs. The scope of pharmacy practice includes more traditional roles such as compounding and dispensing medications, and it also includes more modern services related to health care, including clinical services, reviewing medications for safety and efficacy, and providing drug information. Pharmacists, therefore, are the experts on drug therapy and are the primary health professionals who optimize use of medication for the benefit of the patients.

Bites and Stings.
Insect bites and stings are quite different attacks on our skin. Stings result when an insect is protecting itself when it feels threatened. Other than the initial pain of the attack, the sting can cause varying degrees of allergic reaction. A bite is a deliberate attack by the insect in order to feed from our blood. After the initial bite, the insect injects its saliva into the wound to allow the blood to flow and for the insect to feed. A reaction to the insect’s saliva causes the bite to become red and swollen and to make it itch. There are many insects that live in the UK that bite or sting to feed or protect themselves. Stingers include wasps, bees, hornets and ants. Biters include mosquitoes, midges, sand flies, horse flies and ticks. It is very rare to catch diseases from insect bites and stings in the UK but it is possible. For example if bitten by a tick when walking in fields where deer have been, the person may catch Lyme disease, a serious infection caused by bacteria (Borrelia burgdorferi) spread by ticks.

Abroad, in places such as Africa, Asia and South America there are a number of diseases that can be caught through insect bites such as malaria, yellow fever, Dengue fever, and West Nile disease. When stung by an insect a baby or infant feels immediate pain, causing her or him to cry. You will recognise this cry as being different from crying associated with hunger or tiredness and should check the child to find the cause. Look at exposed areas of skin, if the baby or infant has been stung, the area around the sting will swell and redden, later it may blister and produce an itchy rash. If the baby or infant has been bitten it may take several minutes for the bite to become itchy and swell into a lump or redden. In the case of midges when they attack in swarms there may be several areas where they have successfully attacked. These areas become hot and itchy and can remain so for several days.

Some children are particularly sensitive to insect bites and stings and will suffer a severe allergic reaction resulting in dizziness, fainting, breathing difficulties, rash, raised pulse, sickness, or a swollen mouth and face. In very severe cases the victim may even collapse and die. This severe reaction is called anaphylactic shock. There are precautions you can take to avoid a baby or infant being stung or bitten by insects. Stings in the mouth or on the face and hands commonly occur in babies and infants when wasps, attracted by the sweet smell of drinks, ice cream, lollipops and sweets, are accidentally touched when eating or drinking. Keep an eye on children when eating or drinking outdoors, if you see a wasp on or near a child, don’t aggravate the insect by flapping around, react calmly and simply brush it away. If you are being bitten by insects when outdoors, it is likely that the children are being bitten too.

Be aware of this and try to cover as much of the child’s skin as possible with long trousers and tops with long sleeves. If in a pram or buggy, use an insect net to protect children particularly if she or he is asleep. Avoid areas such as ponds where mosquitoes, midges and horse flies commonly occur. When travelling abroad, cover the cot with a mosquito net, close all doors and windows at night and spray rooms with an insecticide or use electric vapour producing mosquito killers. Insect repellents containing low concentrations of DEET or icaridin can be used on infants over 2 years of age. They should not be used on babies in case the ingredients come in contact with their eyes or lips. Even when applied correctly, it is possible that a baby will rub its eyes or suck its fingers, allowing the repellents to be absorbed.

If an infant has been playing or walking in fields where deer may have been, inspect the child’s legs and arms closely for ticks; small brown spider-like insects attached to the skin. If present, get hold of the tick with a pair if tweezers and gently lift away from the skin without twisting.

As soon as you notice a child may have been stung by a bee, remove the sting and the venomous sac if it has been left in the skin. Do this by scraping it out, either with your fingernails or using something with a hard edge, such as a bank card. When removing the sting, be careful not to spread the venom further under their skin and do not puncture the venomous sac. Do not pinch the sting out with your fingers or a pair of tweezers because you may spread the venom. If a child has been stung, an adult should remove the sting. Wasps and hornets do not usually leave the sting behind, so could sting you again. If you have been stung and the wasp or hornet is still in the area, walk away calmly to avoid being stung again. Most insect bites and stings cause itching and swelling that usually clears up within several hours. Minor bites and stings can be treated by:

washing the affected area with soap and water
placing a cold compress (a flannel or cloth cooled with cold water) over the affected area to reduce swelling not scratching the area because it can become infected (keep children’s fingernails short and clean)
See your GP if
the redness and itching gets worse or does not clear up after a few days. If they have swelling or itching anywhere else on their body after being bitten or stung, or if they are wheezing or have difficulty swallowing, they will need emergency medical treatment. Call 999 immediately and ask for an ambulance. Throughout the treatment of this it’s vital to reassure and help keep the child calm.

Remember in the event of injury or sudden illness, failure to provide first aid could result in a casualty’s death.

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