First Aid Treatment of Unconsciousness

New Zealand Journal of Agriculture, Volume 74, Issue 2, 15 February 1947, Page 215

First Aid Treatment of Unconsciousness

By

C. MEACHEN,

Secretary, St. John Ambulance Association,

Wellington.

UNCONSCIOUSNESS may be caused by injury, sudden illness, poisoning, disease, or shock to the nervous system, or by asphyxia, a condition affecting the respiratory and circulatory systems which is caused by restriction of the supply of oxygen to the lungs. A patient may be in a state of stupor or delirium for some time after an injury occurs or the onset of an illness, and may not become completely unconscious for some time.

GENERAL principles in the treatment of unconsciousness are:—

1. Immediately remove the patient to fresh air or away from the cause of unconsciousness.

2. Lay the patient on the back and loosen tight clothing round the neck and chest. 3. If the face is flushed and congested, raise and support the head and shoulders and apply warmth to the legs and feet. 4. If the face is pale, lower the head . and turn it to one side. 5. Make sure that breathing is possible by examining the air passages. fl. If breathing has stopped or is failing, turn the patient face down- . ward and apply artificial respiration. ' 7. Arrest any apparent hemorrhage and treat for any other injuries or complications present. :8. Keep the patient warm to prevent or lessen the effects of shock.

'9. Do not give stimulants, fluids, or food of any kind while the patient is unconscious. When the patient is able to swallow, sips of warm tea, black coffee, milk, or other non-alcoholic stimulant may be given if the patient has no hemorrhage or head or internal injuries. 10. Cover the patient and do not allow exertion of any kind. 11. Watch the breathing very closely, especially in cases of electric shock, suffocation by gases and fumes, and poisoning, guarding against the possibility of secondary collapse. 12. Send for a doctor in all cases suspected to be serious. Electric Shock Quickly switch off the current if possible, or release the patient from parts charged with electricity. Those assisting must take precautions to protect themselves from contact with the patient’s body or with wires, etc.

Insulate yourself from the earth by standing on a non-conductor of electricity, such as rubber, linoleum, or dry clothing.

Protect your hands and body with rubber gloves, dry folded newspaper, or dry clothing, or drag the patient

away from electric wires with a dry rope made into a loop, a dry rubber hose, or other dry non-conducting articles that can be hooked in the clothing. Avoid touching wet clothing on the patient or boots which have nailed soles. Do not grip under the armpits, because the clothing there is usually wet from perspiration.

Apply artificial respiration immediately the patient has been released from contact, even if breathing has not stopped.

Treat the patient for shock by keeping him warm, and by giving a nonalcoholic stimulant if he is conscious and able to swallow.

Treat burns caused by the electricity and cover the part well. Use tannic acid if it is available.

Watch the breathing closely. If it is laboured, or fails after having been restored, apply artificial respiration again. In many cases of electric shock the breathing will cease suddenly after having been restored and the patient will lapse into unconsciousness without warning. That is caused by the very severe shock, which affects all the organs and systems, especially the nervous system. Send for a doctor as soon as possible in all cases of electric shock. Drowning Lose no time in starting artificial respiration immediately the patient has been carried above high-water mark and the air passages have been examined for obstructions. Adjust the patient’s position. Lay the patient face downward with the arms above the head and, if there are no injuries to the chest or back, perform artificial respiration by the Schafer method (illustrated in the “Journal” in December).

If the face is congested but there are no injuries to the body and arms, apply artificial respiration by the Sylvester method, in which a pillow or bundle of clothing is placed under the shoulder blades and the head allowed to drop backward.

Promote warmth and circulation. If you are working single-handed, the breathing must be restored first. Then warmth and circulation can be pro-

moted by removing the patient’s wet clothes, wrapping him in warm blankets, and applying well-wrapped hot water bags or bottles, or warmed bricks, to the body. Warmth and circulation may also be promoted by rubbing the patient’s body toward the heart. If assistance is available, the promotion of warmth and circulation may be started immediately the patient’ is in position and while the operator is performing the artificial respiration.

Watch the breathing. If breathing is difficult or failing, or stops again after having been restored, immediately apply artificial respiration again.

If the throat is swollen, making breathing difficult, apply hot flannels or poultices to the front of the neck, and give sips of cold water if the patient is conscious.

Stimulants: When the patient is conscious and able to swallow, warm drinks of tea, coffee, or milk are the best stimulants to give.

Call a doctor. The patient should receive proper medical attention in all cases in which the breathing has been suspended. Choking ' Remove the obstruction in the throat immediately by slapping the patient sharply on the back between the

shoulder blades. If that fails, put the index finger to the back of the throat and try to pull the obstruction out. If that is not possible, try to push it down the gullet past the entrance to the windpipe. Loosen tight clothing from the neck to the waist. If breathing has stopped, as soon as the throat is clear of obstruction apply artificial respiration by the Schafer method and promote warmth and circulation as for cases of drowning. Constricting Bands Round the Neck Cut or remove the bands immediately.

Loosen tight clothing from the neck to the waist.

Examine the air passages and make sure that breathing is possible. If breathing has stopped or is failing, immediately apply artificial respiration by the Schafer method. If the throat and neck are swollen, making breathing difficult, apply hot flannels or poultices to the front of the neck, and give sips of iced or cold water if the patient is conscious. Promote warmth and circulation in the same way as for cases of drowning. Hanging Cut the patient down. Immediately relieve the strain on the neck by supporting the weight of the body, and have the rope cut or removed. Apply the general principles of treatment for cases of unconsciousness. Asphyxiation or Suffocation Gases and fumes, apart from causing asphyxiation and suffocation when inhaled, cause a general weakening and poisoning of the whole respiratory system. That condition is brought about by the poison circulated in the bloodstream to all parts of the body. Therefore the patient must have plenty of oxygen from fresh air, the circulation must be stimulated, and the breathing- must be assisted artificially.]

When breathing has been restored it must be watched very closely in case it fails again, which is a grave possibility .in these cases, because the respiratory and circulatory organs in their weak and poisoned state cannot perform their normal functions without assistance and stimulation. Move the patient into fresh air immediately, bearing in mind that it may be necessary to protect yourself while doing so. If it is not possible to flood

the atmosphere with fresh air by open- ; ing doors and windows, cover the nose ! and mouth with some damp material : to filter the poisoned air. As most .gases rise, keep as near as possible

to the ground when entering gasfilled spaces, thus avoiding the higher concentrations of gas. Apply warm and cold douches to the head, neck, and chest as soon as the patient has been carried to fresh air. If breathing has stopped, it must be restored, and warmth and circulation must be promoted as soon as possible. Give an emetic of 1 tablespoonful of mustard in J pint of water when the patient is conscious and able to swallow. That will cause vomiting and rid the stomach. of its poisonous contents. Give a stimulant of warm tea, black coffee, or milk when the emetic has acted. Keep the patient warm. Wrap him in warm blankets, and apply warmth and friction to body and limbs. Provide shelter to guard against further shock and collapse. Watch the breathing very closely in case it again fails after having been restored. If necessary, apply artificial respiration again. Call a doctor as soon as possible, especially if the breathing has been suspended. Sunstroke and Heatstroke Symptoms of sunstroke or heatstroke: After exposure to intense heat or to the sun in hot weather the patient becomes faint, giddy, thirsty,

delirious, or unconscious; the skin is very hot, the - face is flushed, the temperature is high, and the pulse is quick and bounding; the breathing becomes difficult, loud, and snorting. Carry the patient to a cool place immediately. Lay him down, raising and supporting the head and shoulders. Remove clothing from the waist up. Bathe the head, neck, and spine freely with iced or cold water and apply ice to the head. Do not give stimulants, but if the patient is conscious, water may be given. Call a doctor as soon as possible. Fainting Fainting is a condition of collapse caused by blood leaving the head. The patient falls down, generally passing into a state of unconsciousness without convulsions. It may be caused by shock, fright, injury, sickness, weakness, the effects of disease, over-exer-tion, heat, deficiency of oxygen in the air, starvation, or excitement. Symptoms are: The patient yawns (a sign known as air hunger); he feels cold and shivering, the skin becomes pale, and the lips take on a bloodless colour; beads of cold sweat .break out on the forehead and skin, which develops a goose-flesh appearance; the breathing becomes panting and the patient falls into a state of collapse; the pulse is weak and almost imperceptible. Carry the patient into fresh air immediately. Loosen tight clothing round the neck .and chest, making sure that breathing is possible. Lay the patient flat if possible, with the head low and turned to one side. In severe cases raise the feet. Keep the patient warm to prevent further shock. Ammonia, sal volatile, or smelling salts on cottonwool may be held near the patient’s nostrils as a form of stimulation.

When the patient regains consciousness, but not before, a stimulant may be given if the faint has not been caused by bleeding or head injuries.

Arrest any bleeding immediately and attend to any other injuries.

Call a doctor if the case appears to be serious.

WISDOM

By keeping silence when we ought to speak, men may be lost. By speaking when we ought to keep silence, we waste our words. The wise man is careful to do neither. —Confucius.

RURAL HOUSING SURVEY PLANNING THE NEW: IMPROVING THE OLD

A RECENT ■ article in a Canadian culture across Canada, architects famiagricultural periodical gives some liar with rural conditions, farmers, interesting facts about farm housing arm housewives. in that Dominion. The writer says: “The present standard of farm houses has reached such a low level that remedial action has become a matter of primary importance.” He reports the findings and recommendations of one of the -committees of the Advisory Committee on Reconstruction set up to investigate housing problems in Canada and which devoted a special section to the needs of the farm population. This sub-committee found four types of need: Replacement of farm houses in such a poor condition that they should be rebuilt; new homes for farm families who are at present sharing their houses with other families; replacement and repair of homes which are becoming obsolete and run down; and the provision of cottages for farm employees. Surveys showed that nearly 40 per cent, of farm dwellings were obviously in need of repairs to foundations, walls, roofs, chimneys, doors, and windows. The sub-committee realised that a farm house must be designed quite differently from an urban house because it is an integral part of the farm plan. The kitchen, dining-room, and porch are often turned into workshops where farm products are prepared for market. Washing, cooking, making butter, preserving fruits and other foodstuffs, and storing them for winter use must be managed in the farm home, and it should be built to meet these needs. In its report the subcommittee calls for the co-operation of the various Departments of AgriNorth Auckland and Auckland: Taranaki, Wellington, Hawke’s Bay, Gisborne, Nelson, and Marlborough: Canterbury, Westland, Otago, and Southland:

The state of rural housing in New Zealand is not accurately known, but it is certain that many new farm houses will be built in the next few years, and many families will alter and adapt their present homes. The Department of Agriculture is constituting a new service for farm people which will provide plans for homes and helpful suggestions about installing up-to-date facilities in older houses.

To prepare these plans in accordance with requirements for comfortable living in rural areas information is required, some of which can be obtained only from farm families. A questionnaire has been drawn up by the Rural Sociology Section which asks about the age, size, and equipment of the house, and the preferences of the family in such respects as size and type of rooms, equipment, porches, and type of cooking facilities. Country families are invited to help with this survey, and any information given will be greatly appreciated and regarded as confidential. Fill in the application form for a questionnaire below, post it to the Rural Sociologist for the district, and have the family help in completing it.

The Rural Sociologists will also answer enquiries from country women about nutrition, preparation and preserving of food, and home management generally. Make use of this service.

Rural Sociologist, Department of Agriculture, AUCKLAND. Rural Sociologist, Department of Agriculture, WELLINGTON. Rural Sociologist, Department of Agriculture, CHRISTCHURCH.

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