Common First Aid Procedures in General Practice

First Aid is the provision of limited care for an illness or injury, which is provided to a sick or injured patient until definitive medical treatment can be accessed, or until the illness or injury is fully dealt with. It generally consists of series of simple, sometimes life-saving, medical techniques, that an individual can be trained to perform with minimal equipment. There are other articles dealing with resuscitation and coma.

• The principle of first aid is immediate action, but it is essential that quick action does not cause panic.
• Any action taken needs to be careful and deliberate and the first-aider must remain calm at all times.
• It is equally important to assess the situation quickly, to appreciate the limitations of your own actions and to seek expert assistance, e.g. calling 999 when necessary for ambulance, fire brigade, or police as soon as possible.
• The first priority is to yourself and to others - protect the scene after assessing risk, and think before you act (there may be gas - risk of asphyxiation/explosion; electricity - the pool of water round the faulty washing machine may be live; fire - opening a hot door may be the last thing you do; assault - the assailant with knife or gun may be behind the door awaiting their next victim or a hostage; blood - avoid unnecessary contact with body fluids by wearing gloves).

• Immobilise the affected area (especially the neck if there is any possibility of an injury to the cervical spine).
• Keep the patient still and support the injured area.
• For arm fractures, a sling can be made to support and immobilise the affected area.
• Splints (any long firm object) can be used for support and immobilisation but, ideally, splint the affected area to another part of the body when appropriate, e.g. using one leg to splint the other leg.
• For open fractures, control the bleeding with a sterile dressing and apply pressure if required.

RICE procedure:

• R - rest and support affected limb
• I - apply ice or a cold compress to reduce swelling
• C - compress by applying gentle, even pressure on the limb; pad the affected limb with foam or cotton wool, secured with a bandage
• E - elevate limb to reduce blood flow to affected area

Burns are classified as:

• Superficial: only damage the outer layer of the skin; cause reddening of the skin.
• Partial thickness: damage the epidermis layer of the skin; cause blistering.
• Full thickness: damage all the layers of the skin and underlying tissue.

Treatment

• Extinguish flames by water, extinguisher, or smothering.
• Remove any continuing source of heat, removing non-adherent clothing/plastic.
• Immediately submerge the affected part in cold water for at least 10 minutes (20 minutes for chemical burns).
• Remove jewellery or release tight clothing that may act as tourniquet.
• Cover with a clean, non-stick sterile dressing (cling-film or plastic bags may be used).
• DO NOT: break blisters or use any lotions or creams.
• If electrical burn, actively seek other entry/exit wound.
• Keep patient warm - do not let overzealous cooling of the burn exacerbate shock.
• The patient should be seen by the practice nurse and/or doctor and, depending on the severity of the burn, may need to be sent for treatment in hospital.

• Only 10% of patients with epistaxis seek medical attention, and 80% of these have anterior nose bleeds (from Little's area). See separate article Nosebleeds (Epistaxis).
• Use sterile disposable gloves, and face shield if possible (nasal bleeding is one of the commonest emergencies to put medical staff at risk of blood contamination, and the conjunctivae are potential sites for the transmission of HIV).
• Get the casualty to sit down, lean slightly forward and pinch the fleshy part of the nose, and push against the bony parts of the face. They should breathe through their mouth, spitting out blood to avoid choking, and to aid assessment of control of blood loss.
• The pressure and posture should be maintained for at least 10 minutes but a longer time may be required.
• Ice packs to adjacent cheeks/face may be applied but there is conflicting evidence of effectiveness.
• Uncontrollable epistaxis and posterior epistaxis should be referred to hospital.

If a second or permanent tooth is knocked out:

• Use sterile disposable gloves if possible.
• Hold the crown of the tooth and not the root. Do not scrape the root to remove dirt.
• Rinse the tooth immediately with milk or saline solution.
• If possible and safe (i.e. person is not a child or there is reduced consciousness) then replace the tooth gently into its socket, and bite down on a gauze pad or handkerchief to help keep it in place. Care must be taken not to swallow the tooth.
• If the tooth cannot be reinserted then put it in whole milk or saliva, and control bleeding with a gauze pad inserted in the tooth socket with the person biting gently on the pad.
• If the gums are bleeding, put cold water on a piece of gauze and push it between the lips and gums.
• The person should see a dentist as soon as possible, ideally within 20 minutes, as the tooth begins to die after 15 minutes.

If a primary tooth (likely if the child is under the age of 7) is knocked out or the gum is injured:

• Put on disposable gloves.
• Control bleeding by soaking a piece of gauze in cold water and applying pressure to the site.
• Treatment may not be necessary but the child should see a dentist to assess whether there is a need for realignment or the removal of a very loose tooth.

• A convulsion (violent, involuntary contraction or muscle spasm) can be caused by epilepsy or sudden illness.
• Most convulsions are often followed by a period of unconsciousness or sometimes another convulsion.

Treatment

• Lay patient on ground in safe area.
• Clear all objects away from the victim and place something soft under their head.
• Do not place anything between their teeth or in their mouth.
• Loosen tight clothing, particularly round the neck.
• Do not give the victim any liquids.
• Stay calm and keep the victim comfortable until help arrives.

• Use sterile disposable gloves, and face shield if possible.
• Calm and reassure the patient.
• Lay the patient down, to avoid fainting.
• Check the wound for any foreign material; however, do not remove deeply penetrating objects; rather, pad and try to immobilise them.
• Apply firm direct pressure using a clean, folded cloth over the injured area. If blood soaks through, do not remove it but cover that cloth with another one and continue to apply pressure to the wound for 7-10 minutes.
• Elevate the injury. Position the wounded part of the body above the level of the heart if possible while you apply direct pressure.
• If direct pressure and elevation do not sufficiently slow the blood flow, apply pressure to the closest pressure point. An essential part of first aid training is to learn how to locate the various pressure points of the body.
• On very rare occasions, when everything listed above has failed, you should apply a tourniquet proximal to the wound. Once a tourniquet is applied, it should not be loosened or removed until the victim has reached medical help. If you use a tourniquet, write down somewhere on the victim the time it was applied, so medical personnel will know how long it has been in place.
• Further management will depend on the source and extent of the bleeding.

Faints are a sudden brief loss of consciousness followed by full recovery within two minutes.

Treatment

• Lay the casualty flat with their legs raised.
• Loosen restrictive clothing around the neck, remembering over-zealousness in the absence of witnesses could leave you open to an assault charge.
• Check airway, breathing and pulse.
• If the casualty has vomited, put in the recovery position to prevent choking.
• There is usually a full recovery when laid flat. If this does not occur then further expert medical help is required.

• The First Aid Cafe
• BBC Website; First Aid Advice
• St. John's Ambulance Service; Advice/Training courses
• Red Cross; Training courses