WHERE THERE IS NO DOCTOR FIRST AID
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CHAPTER
10
FIRST AID
This is a reprint from
WAere There Is No Doctor
( Indian adaptation )
Published by the
VOLUNTARY HEALTH ASSOCIATION OF INDIA
40, Institutional Area, South of l.l.T.
New Delhi 110016
COA/IMIJNITY HFALTH nr-
10
87
First Aid
FEVER
When a person's body temperature is too hot, we say he has a fever. Fever itself
is not a sickness, but a sign of many different sicknesses. However, high fever can
be dangerous, especially in a small child.
When a person has a fever:
1.
Uncover him completely.
Small children should be
undressed completely and left
naked until the fever goes down.
Never wrap the child in
clothing or blankets.
To wrap up a child with
fever is dangerous.
Fresh air or a breeze will not harm a person with fever. On the contrary, a fresh
breeze helps lower the fever.
2.
Also take aspirin to lower fever (see p. 414). Small children can be given either
acetaminophen (paracetamol, p. 414), children's aspirin, or a piece of a regular
5-grain (300 mg.) aspirin tablet.
3.
Anyone who has a fever should drink lots of water, juices, or other liquids. For
small children, especially babies, give boiled and then cooled drinking water.
4.
When possible, find and treat the cause of the fever.
88
Very High Fevers
A very high fever can be dangerous if it is not brought down quickly. It can
cause fits (convulsions) or even permanent brain damage (paralysis, mental
slowness, epilepsy, etc.). High fever is most dangerous for small children.
When a fever goes very high (over 40°), it must be lowered at once:
1.
Pour cool water over him, or soak some pieces of cloth in cool water.
Place these wet cloths on his forehead, arms and legs. Fan the cloths and
change them often, to keep them cool. Continue to do this until the fever
goes down below 38°. Be sure not to use ice cold water as this may cause
shivering and the fever may go up.
2.
If a person has fever, he loses lots of energy. Give him plenty of cool
water with a little sugar or jaggery to drink, to keep up his strength.
3.
Give a medicine to bring down fever. Aspirin works well.
Dosage (using 300 mg.adult tablets):
Persons over 12 years: 2 tablets every 8 hours
Children 6 to 12 years: 1 tablet every 8 hours after food
Children 3 to 6 years: % tablet every 8 hours after food
Children under 3 years: ’/> tablet every 8 hours after food
To babies under one year, do not give any aspirin tablets. If you keep
them naked, the fever will come down. You can also give paracetamol.
If a person with fever cannot swallow aspirin, grind it up, mix it with some
water, and put it up the anus as an enema or with a syringe without the needle.
Some doctors consider acetaminophen (paracetamol) safer than aspirin for small
chiIdren. For the dosage see p.41 5)__________________________ ____
If a high fever does not go down soon or if fits (convulsions) begin,
continue cooling with water and seek medical help at once.
89
SHOCK
Shock is a life-threatening condition that develops when the body's blood
poressure drops dangerously low. It can result from great pain, a large burn, losinc
a« lot of blood, severe illnesses, dehydration, or severe allergic reaction.
Signs of SHOCK:
'
’
*
*
•
•
weakness after fainting especially on standing up
feels like vomitting
cold damp skin
too much sweating even in cold weather
severe thirst
restlessness, mental confusion or loss of consciousness.
weak rapid pulse (more then 100 per minute.)
What to do to prevent or treat shock:
At the first sign of shock; or if there is risk of shock . . .
♦ Have the person lie down with his feet higher than his head, like this:
If he is conscious, give him warm water or other lukewarm drinks. If shock is
due to injury (accidents, stab wounds, etc. see pt 03)then do not give him
anything to drink. He may need surgery. Get medical help fast.
•
♦ If he is in pain, give him aspirin or another pain medicine.
♦ Keep calm and reassure the person.
♦
if shock is due to allergic reaction, for treatment see page 83
90
If the person is unconscious:
♦ Lay him on his side with his head low, tilted back and to one side.
If he seems to be choking, pull his tongue forward with your finger.
♦ If he has vomited, clear his mouth immediately. Be sure his head is low,
tilted back, and to one side so he does not breathe vomit into his lungs.
♦ Do not give him anything by mouth until he becomes conscious.
♦ If you or someone nearby knows how, give intravenous solution (normal
saline) at a fast drip.
♦ Seek medical help fast.
Common causes of loss of
consciousness are:
■ drunkenness
■ a hit on tne head
(getting knocked out)
■ fainting (from fright, weakness, etc.)
■ shock (p.89)
■ stroke (p. 373)
■ heat stroke (p.94)
• poisoning (p.1 16 )
■ heart attack (p. 371)
■ Diabetes (p 149)
• Epilepsy (p 216)
It a person is unconscious and you do not know why, immediately check each
of the following:
1.
Is he breathing well? If not, tilt his head way back and pull the jaw and
tongue forward. If something is stuck in his throat, pull it out. If he is not
breathing, use mouth-to-mouth breathing at once (see p. 92).
2.
Is he losing a lot of blood? If so, control the bleeding (see p. 95).
3.
Is he in shock (moist, pale skin; weak, rapid pulse)? If so, lay him with his
head lower than his feet and loosen his clothing.
4.
Could it be heat stroke (no sweat, high fever, hot, red skin, see p.94)? If so,
shade him from the sun, keep his head higher than his feet, and soak him with
cold wat^r (ice water if possible).
91
If there is any chance that the unconscious person is badly injured:
It is best not to move him until he becomes conscious. If you have to move him,
do so with great care, because if his neck or back is broken, any change of
position may cause greater injury.
Look for wounds or broken bones, but move the person as little as possible. Do
not bend his back or neck.
Never give anything by mouth to a person who is unconscious.
WHEN SOMETHING GETS STUCK IN THE THROAT
When food or something
else sticks in a person's throat
and he cannot breathe, quickly
do this:
♦ Stand behind him and
wrap your arms around his
♦ put your fist against his belly above the navel
and below the ribs,
♦ and_press into his belly with a sudden strong
upward jerk.
This forces the air from his lungs and should free
his throat. Repeat several times if necessary.
If the person is a lot bigger than you, or is already
unconscious, quickly
do this:
♦ Lay him on his back.
♦ Sit over him like this, with the heel of
your lower hand on his belly between his
navel and ribs.
♦ Make a quick, strong upward push.
♦ Repeat several times
if necessary.
♦ If he still cannot
breathe, try mouth-tomouth breathing (see
next page).
92
DROWNING
A person who has stopped breathing has only 4 minutes to live! You must act
fast!
Start mouth-to-mouth breathing at once (see next page)—if possible, even
before the drowning person is out of the water, as soon as it is shallow enough to
stand.
If you cannot blow air into his lungs,
when you reach the shore, quickly put
him with his head lower than his feet
and push his belly as described above.
Then continue mouth-to-mouth breathing
at once.
ALWAYS START MOUTH-TO-MOUTH
BREATHING AT ONCE before trying
to get water out of the drowning
person’s stomach.
When a person it having trouble with hit breathing;
• his lips, nails and tongue turn blue in color
’ pulse is slow and irregular
• breathing is irregular or absent
• he may lose consciousness
WHAT TO DO WHEN BREATHING STOPS:
MOUTH-TO-MOUTH BREATHING
Common causes for breathing to stop are:
■ something stuck in the tnroat
■ the tongue or thick mucus blocking the throat of an unconscious person
■ drowning, choking on smoke, or poisoning
■ a strong blow to the head or chest
■ a heart attack
A person will die within 4 minutes if he does not breathe.
If a person stops breathing,
begin mouth-to-mouth breathing IMMEDIATELY.
93
Do all of the following as quickly as you can:
Step 1: Quickly remove anything stuck in the mouth or
throat. Pull the tongue forward. If there is mucus in the
throat, quickly try to clear it out.
Step 2: Quickly lay the person face up, tilt his
head way back, and pull his jaw forward.
Step 3: Pinch his nostrils closed with
your fingers, open his mouth wide, cover
his mouth with yours, and blow strongly
into his lungs so that his chest rises.
Pause to let the air come back out and
blow again. Repeat about 15 times per
minute. With newborn babies, breathe
very gently about 25 times per minute.
Continue mouth-to-mouth breathing until the person can breathe by himself,
or until there is no doubt he is dead. Sometimes you must keep it up for an hour
or more.
EMERGENCIES CAUSED BY HEAT
Heat Cramps
In hot weather people who work hard and sweat a
lot sometimes get painful cramps in their legs, arms,
or stomach. These occur because the body lacks salt.
Treatment: Put a teaspoon of salt in a liter of
boiled water and drink it. You can.add a little
sugar and lime juice to the drink.; ■
94
Heat Exhaustion
Signs: A person who works and sweats a lot in hot weather may become very
pale and weak and perhaps feel faint. The skin is cool and moist. The pulse is
rapid and weak. The most striking thing is that on a very hot day the skin is cold
and moist.
Treatment: Have the person lie down in a cool place, raise his feet, and rub his
legs. Give salt water to drink: 1 teaspoon of salt in a liter of water. (Give nothing
by mouth while the person is unconscious.)
Heat Stroke
Heat stroke is not common, but is very dangerous. It occurs especially in older
people and alcoholics during hot weather.
Signs: The skin is red, very hot, and dry. Not even the armpits are moist. The
person has a very high fever, sometimes more than 42° C. Often he is unconscious.
Treatment: The body temperature must be lowered immediately.
■
"
'
*
■
"
■
Put the person in the shade
Take off his clothes and pour cold water over him
Fan him
Give ice cold water enema
Take the temperature every 10 minutes
When the temperature comes down to 38°, stop pouring cold water on him, and
Seek medical help
DIFFERENCES BETWEEN 'HEAT EXHAUSTION'AND 'HEAT STROKE':
To avoid all these emergencies due to too much heat, always
drink plenty of water with salt throughout the day in summer.
95
HOW TO CONTROL BLEEDING FROM A WOUND
1. Raise the injured
2. With a clean cloth (or your hand if there is no
3. If the bleeding cannot be controlled by pressing on the wound, and if the
oerson is losing a lot of blood, do the following:
♦ Keep pressing on the wound.
Keep the wounded part as high as
possible.
4-- ♦ Tie the arm or leg as close to the
wound as possible—between the
wound and the body. Tighten enough
to control the bleeding.
Do not make it so tight that the arm or
leg becomes blue.
♦ For the tie, use a folded cloth or a
wide belt; never use thin rope, string,
or wire.
PRECAUTIONS:
• Tie the limb only if bleeding is severe and cannot be controlled by pressing
directly on the wound.
• Loosen the tie for a moment every half hour to see if it is still needed and to
let the blood circulate. Leaving it too long may damage the arm or leg so much it
must be cut off.
■ Newer use dirt, cowdung, kerosene, lime, or coffee to stop bleeding.
■ If bleeding or injury is severe, raise the feet and lower the head to prevent
shock (see p.89).
96
Leave the cotton in place for a few hours after the bleeding stops; then take it
out very carefully.
Do not dig into the nose or try to remove clotted blood. Bleeding will start again.
If a person's nose bleeds often, smear a little Vaseline inside the nostrils twice
a day.
Eating oranges, tomatoes, and other fruits may help to strengthen the small
tl blood vessels so that the nose bleeds less. •
In older persons especially, bleeding may
come from the back part of the nose and
cannot be stopped by pinching it. In this
case, have the person hold a cork, corn cob,
or other similar object between his teeth
and, leaning forward, sit quietly and try
not to swallow until the bleeding stops.
{The cork helps keep him from swallowing,
and that gives the blood a chance to clot.)
97
CUTS, SCRAPES, AND SMALL WOUNDS
Cleanliness is of first importance in preventing
infection and helping wounds to heal.
To treat a wound . . .
First, wash your hands very well
with soap and water.
Then wash the wound well with
soap and boiled water.
When cleaning the wound, be careful to
clean out all the dirt. Lift up and clean under
any flaps of skin. You can use a clean tweezers
or other instruments to remove bits of dirt,
but always boil them first to be sure they are
sterile.
If possible, squirt out the wound with
boiled water in a syringe or suction bulb.-
Any bit of dirt that is left in a wound can
cause an infection.
NEVER put animal or human feces or mud on a wound.
These can cause dangerous infections, such as tetanus.
A clean wound will heal without any madlcina.
98
If a person gets a cut.scrape or wound, give him an injection of tetanus toxoid
immediately. If he has not been immunized against tetanus, give him one injection
each month for the next two months.
LARGE CUTS: HOW TO CLOSE THEM
A recent cut that is very clean will heal faster if you bring the edges together so
the cut stays closed.
Close a deep cut only if all of the following are true:
■ the cut is less than 12 hours old.
■ the cut is very clean, and
■ it is impossible to get a health worker to close it the same day.
Before closing the cut, wash it very well with boiled water and soap. If
possible, squirt it out with a syringe and water. Be absolutely sure that no dirt is
left hidden in the cut.
There are two methods to close a cut:
'BUTTERFLY' BANDAGES OF ADHESIVE TAPE
99
STITCHES OR SUTURES WITH THREAD
To find out if a cut needs stitches see if the edges of the skin come together by
themselves. If they do, usually no stitches are needed.
To stitch a wound:
♦ Boil a sewing needle and a thin thread (nylon or silk is best) for 10 minutes.
• Wash the wound with boiled water and soap, as has been described.
♦ Wash your hands very well with boiled water and soap.
Make the first stitch in the middle of the cut, and tie it closed (1. and 2.).
Make enough other stitches to close the whole cut (3.).
Leave the stitches in place for 6 to 12 days (on the face 6 days; the body 8
days; the hand or foot 12 days). Then remove the stitches: cut the thread on one
side of the knot and pull the knot until the thread comes out.
WARNING: Only close wounds that are very clean and less than 12 hours old.
Old, dirty, or infected wounds must be left open. Bites from people, dogs, pigs, or
other animals should also be left open. Closing these can cause dangerous
infections.
If the wound that has been closed shows any signs of infection, remove the
Stitches immediately and leave the wound open (see p. 101).
100
BANDAGES
Bandages are used to help keep wounds clean. For this reason, bandages or
pieces of cloth used to cover wounds must always be clean themselves. Cloth used
for bandages should be washed and then dried with an iron or in the sun, in a
clean, dust-free place.
If possible, cover the wound-with a sterile gauze pad before bandaging. These
pads are often sold in sealed envelopes in pharmacies.
Or prepare your own sterile gauze or cloth. Wrap it in thick paper, seal it with
tape, and bake it for 20 minutes in an oven. Putting a pan of water in the oven
under the cloth will keep it from charring.
It is better to have no bandage at all than one that is dirty or wet.
If a bandage gets wet or dirt gets under it, take the bandage off, wash the cut
again, and put on a clean bandage.
Examples of bandages:
CAUTION:
Be careful that a bandage that goes around a limb is not so tight it cuts off the
flow of blood.
Many small scrapes and cuts do not need bandages. They heal best if washed
with soap and water and left open to the air. The most important thing is to keep
them clean.
101
INFECTED WOUNDS:
HOW TO RECOGNIZE AND TREAT THEM
A wound is infected if:
• it becomes red, swollen, hot, and painful,
<> it has pus,
» or if it begins to smell bad.
The infection is spreading to other parts of the body if:
• it causes fever.
• there is a red line above the wouna.
• or if the lymph nodes become swollen and tender. Lymph nodes—often
called 'glands'—are little traps for germs that form small lumps under the skin
when they get infected.
Swollen lymph nodes behind the ear point to an
infection on the head or scalp, often caused by sores
or lice. Or German measles may be the cause.
Swollen nodes below the ear and on the neck indicate
infections of the ear, face, or head (or tuberculosis).
Swollen nodes below the jaw indicate infections
of the teeth or throat.
Swollen nodes in the armpit indicate an infection of
the arm, head, or breast (or sometimes breast cancer).
Swollen nodes in the groin indicate an infection of
the leg, foot, genitals, or anus.
Treatment of infected wounds:
♦ Put hot compresses over the wound for 20 minutes 4 times a day. You
use hot water with salt, soap or potassium permanganate for the compre
♦ Keep the infected part at rest and elevated (raised above tne level of the heart).
♦ If the infection is severe or the person nas not been vaccinated agamst
tetanus, use an antibiotic like penicillin (see p. 397, 398) and vaccinate
against tetanus.
J
WARNING: If the wound has a bad smell, if brown or gray liquid oozes out, or
if the skin around it turns black and forms air bubbles or blisters, this may be
S'
gangrene. Seek medical help fast. Meanwhile, follow the instructions for gangrene
on p. 254)
COMMUNITY HEALTH CEX.L
(Fust Floor Ct -Yrrnks-Pvart,
Barn nil
102
WOUNDS THAT ARE LIKELY TO BECOME
DANGEROUSLY INFECTED
These wounds are most likely to become
dangerously infected:
■ dirty wounds, or wounds
made with dirty objects
■ puncture wounds and other
deep wounds that do not
bleed much
■ wounds made where animals
are kept: in cowsheds.
pigpens, etc.
• large wounds with severe
mashing or bruising
■ bites, especially from pigs,
dogs, or people
■ bullet wounds
Special care for this type of 'high risk' wound:
1. Wash the wound well with boiled water and soap. Remove all pieces of dirt,
blood clots, and dead or badly damaged flesh. Squirt out the dirt using a
syringe or suction bulb.
2.
Soak the wound in water with potassium permanganate (1 teaspoon to a
bucket). Then paint the wound with gentian violetand cover it with a clean
bandage.
3.
If the wound is very deep, if it is a bite, or if there is a chance that it still has
dirt in it, use an antibiotic. The best is ampicillin, in capsules or, in the most
serious cases, injections. If you cannot afford ampicillin, use penicillin,
tetracycline, or a sulfa. For dosages, see the GREEN PAGES.
4.
Never close this type of wound with stitches or 'butterfly' bandages. Leave the
wound open.
The danger of tetanus is very great in people who have not been vaccinated
against this deadly disease. To lower the risk, a person who has not been vaccinated
against tetanus should use penicillin or ampicillin immediately after receiving a
wound of this type, even if the injury is small.
If a wound of this type is very severe, a person who has not been vaccinated
against tetanus should take large doses of penicillin or ampicillin for a week or
more. Tetanus antitoxin should also be considered—but be sure to take the
necessary precautions in its use (see p. 83).
103
BULLET, KNIFE, AND OTHER SERIOUS WOUNDS ^=2^
Danger of infection: Any deep bullet or knife wound runs a high risk of
dangerous infection. For this reason an antibiotic, preferably penicillin (p.397) or
ampicillin (p. 399) should be used at once.
Persons who have not been vaccinated against tetanus should perhaps be given
an injection of tetanus antitoxin, and be vaccinated against tetanus as well.
If possible, seek medical help.
Bullet Wounds in the Arms or Legs
♦ If the wound is bleeding a lot, control the bleeding as shown on page 95♦ If the bleeding is not serious, let-the wound bleed for a short while. This will
help clean it out.
♦ Wash the wound with boiled water and soap and apply a clean bandage. In the
case of a gunshot wound, wash the surface (outside) only. It is usually better
not to poke anything into the hole.
♦ Give antibiotics.
CAUTION:
If there is any possibility that
the bullet has hit a bone, the
bone may be broken.
Using or putting weight on
the wounded limb (standing,
for example) might cause a
more serious break, like this:
If a break is suspected, it is
best to splint the limb and not
to use it for several weeks.
if you suspect a broken,
bone,do not massage the
arsa. This will make the
break bigger and much more
difficult to heal.
104
When the wound is serious, raise the wounded part higher than the heart and
Deep Chest Wounds
Chest wounds can be very dangerous. Seek medical help
at once.
♦ If the wound has reached the lungs and air is being
sucked through the hole when the person breathes, cover
the wound at once so that no more air enters. Spread
Vaseline or vegetable fat on a gauze pad or clean bandage
and wrap it tightly over the hole like this:--------------- •r
If you do not have Vaseline or vegetable oil. fold some clean
cloth into a pad. place it on the wound and bandage firmly.
♦ This is a serious condition. SeeK medical help at once. Meanwhile, put the injured
person in the position in which he feels most comfortable.
♦ If there are signs of shock, give proper treatment (see p.89)
♦ Give antibiotics and painkillers.
Bullet Wounds in the Head
♦ Cover the wound with a clean bandage.
105
Place the injured person in a 'half-sitting' position.
Give antibiotics (penicillin).
Seek medical help.
Deep Wounds in the Abdomen
Any wound that goes into the belly or gut is dangerous. Seek medical help
immediately. But in the meantime:
Cover the wound with a clean bandage.
If the guts are partly outside the wound,
cover them with a clean cloth soaked in lightly
salted, boiled water. Do not try to push the
gjts back in.
If the wounded person is in
shock, raise his feet higher
than his head.
Give absolutely noting by mouth: no food, no
drink, not even water
If the wounded person i-thirsty, let him suck on
a piece of cloth soaked in^ater.
Never give an enema, even if the stomach
swells up or the injured person does not move
his bowels for days. If the gut is torn, an
nema or purge can kill him.
Inject antibiotics (see the following
page for instructions).
106
DO NOT WAIT FOR A
HEALTH WORKER.
IMMEDIATELY TAKE THE
INJURED PERSON TO THE
CLOSEST HEALTH CENTER
OR HOSPITAL. He will need
an operation.
MEDICINE FOR A WOUND THAT GOES INTO THE GUT
(Also for appendicitis or peritonitis)
Until you can get medical help, do the following:
Inject penicillin (crystalline, if possible, p. 398), immediately
Inject ampicillin (p. 399).1 gm. (four 250 mg. ampules) every 4 hours
If you cannot obtain these anitbiotics in injectable form, give amr jicillin or
penicillin by mouth together with chloramphenicol or tetracycli ne, and very
little water.
EMERGENCY PROBLEMS OF THE GIT f (ACUTE ABDOMEN)
Acute abdomen is a name given to a number of sudden, severe conditions of
the gut for which prompt surgery is often needer j to prevent death. Appendicitis,
peritonitis, and gut obstruction are examples I see following pages). Often the
exact cause of acute abdomen will be uncerta-’ <n‘ untj| a surgeon cuts open the belly
and looks inside.
If a person has continuous se ,vere gUt pain with vomiting,
but does not have diarrhe? ,, suspect an acute abdomen.
107
Acute abdomen:
Less serious illness:
Take to a hospital
surgery may be needed
Probably can be treated
in the home or health center
continuous severe pain that keeps
getting worse
pain that comes and goes (cramps)
Constipation and green
coloured foul smelling vomiting.
sometimes signs of an infection,
perhaps a cold or sore throat
belly swollen, hard, person protects
it
severely ill
moderate or severe diarrhea
he has had pains like this before
only moderately ill
If a person shows signs of acute abdomen,
get him to a hospital as fast as you can.
Obstructed Gut
An acute abdomen may be caused by something that blocks or 'obstructs' a
part of the gut, so that food and stools cannot pass. More common causes are:
■ a ball or knot of roundworms (Ascaris, p. 193)
■ a loop of gut that is pinched in a hernia (p.215 )
■ a part of the gut that slips inside the part below it (intussusception)
Almost any kind of acute abdomen may show some signs of obstruction.
Because it hurts the damaged gut to move, it stops moving.
Get this person to a hospital at once. His life is in danger and surgery may be
meeded.
108
Appendicitis, Peritonitis
These dangerous conditions often
require surgery. Seek medical help fast
Appendicitis is an infection of the
appendix, a finger-shaped sac attached to
the large intestine in the lower right
hand part of the belly. An infected
appendix sometimes bursts open, causing
peritonitis.
Peritonitis is an acute, serious
infection of the lining of the cavity or
bag that holds the gut. It results when
the appendix or another part of the gut
bursts or is torn.
Signs of appendicitis:
• The main sign is a steady pain in the belly
that gets worse and worse.
• The pain often begins around the navel
('bellybutton'),
but it soon moves to the lower right side.
There may be loss of appetite, vomiting,
constipation, or a mild fever.
A TEST FOR APPENDICITIS OR PERITONITIS:
Slowly but forcefully,
press on the abdomen
a little above the left
groin until it hurts a
little.
Then quickly remove
the hand.
If a very sharp pain
(rebound pain) occurs
when the hand is
removed, appendicitis
or peritonitis is likely.
If no rebound pain
occurs above the left
groin, try the same test
above the right groin.
109
IF IT SEEMS THAT A PERSON HAS APPENDICITIS OR PERITONITIS:
♦ Seek medical help immediately, if possible, take the person where he can
have surgery.
♦ Do not give anything by mouth and do not give an enema. Only if the person
begins to show signs of dehydration, give sips of water or Rehydration Drink
(p. 1 82) —but nothing more.
♦ The person should rest very quietly in a half-sitting position.
Note: When peritonitis is advanced, the belly becomes hard like a board, and the
person feels great pain when his belly is touched even lightly. His life is in danger.
Take him to a medical center immediately and on the way give him the medicines
indicated at the top of page 106.
BURNS
Prevention:
Most burns can be prevented. Take
special care with children:
♦ Do not let small babies go near a
fire.
♦ Keep lamps and matches out of
reach.
* Turn handles of pans on the stove
so children cannot reach them.
Minor Burns that Do Not Form Blisters (1st degree)
To help ease the pain and lessen damage caused by a minor burn, put the
burned part in cold water at once. No other treatment is needed. Take aspirin for
pain.
Burns that Cause Blisters (2nd degree)
Do not break blisters.
If the blisters are broken, wash gently with soap and boiled water that has been
cooled. Sterilize a little Vaseline by heating it until it boils and spread it on a
piece of sterile gauze. Then put the gauze on the burn.
If there is no Vaseline, put some Gentian violet, leave the burn uncovered.
It is very important to keep the burn as clean as possible.
Protect it from dirt, dust, and flies.
110
If signs of infection appear—pus, bad smell, fever, or swollen lymph nodesapply compresses of potassium permanganate solution 3 times a day. If
potassium permanganate is not available, you can use warm salt water (1
teaspoon salt to 1 litre water). Boil both the water and cloth before use. With
great care, remove the dead skin and flesh. You can spread on a little
antibiotic ointment such as Neosporin (p. 409). In severe cases, consider
taking an antibiotic such as penicillin or ampicillin by mouth.
Deep Burns (3rd degree) that destroy the skin and expose raw or charred
flesh are always serious, as are any burns that cover large areas of the body. Take
the person to a health center at once. In the meantime wrap the burned part with
a very clean cloth or towel.
If it is impossible to get medical help, treat the burn as described above. If you
do not have vaseline, put some gentian violet and leave the burn in the open air,
covering it only with a loose cotton cloth or sheet to protect it from dust and flies.
Keep the cloth very clean and change it each time it gets dirty with liquid or blood
from the burn. Give penicillin.
Never put grease, fat, hides, coffee, herbs, or feces on a burn.
Special Precautions for Very Serious Burns
Any person who has been badly burned can easily go into shock (see p. 89)
because of combined pain, fear, and the loss of body fluids from the oozing burn.
Comfort and reassure the burned person. Give him Paracetamol for the pain
and codein if you can get it. Bathing open wounds in slightly salty water also
helps calm pain. Put 1 teaspoon of salt for each liter of boiled (and cooled)
water.
Give the burned person plenty of liquid. If the burned area is large (more than
twice the size of his hand), make up the following drink:
soda.
Also put in 2 or 3 tablespoons of sugar or honey and some orange or
lemon juice if possible.
The burned person should drink this as often as possible, especially until he
urinates frequently.
It is important for persons who are badly burned to eat foods rich in protein
(see p.1 28 ). He can also eat all other foods.
Burns around the Joints
When someone is badly
burned between the fingers, in
the armpit, or at other joints,
gauze pads with Vaseline on
them should be put between the
burned surfaces to prevent them
from growing together as they
heal. Also, fingers, arms, and legs
should be straightened completely
several times a day while healing.
This is painful but helps prevent
stiff scars that limit movement.
BROKEN BONES (FRACTURES)
When a bone is broken, the most important thing to do is keep the bone in a
fixed position. This prevents more damage and lets it mend.
Before trying to move or carry a person with a broken bone, keep the bones
from moving with splints, strips of bark, or a sleeve of cardboard. Later a plaster
cast can be put on the limb at a health center, or perhaps you can make a 'cast'
according to local tradition
Setting broken bones: If the bones seem more or less in the right position, it is
better not to move them—this could do more harm than good.
If the bones are far out of position and the break is recent, you can try to 'set'
or straighten them before putting on a cast. The sooner the bones are set, the
easier it will be.
HOW TO SET A BROKEN WRIST
Pull the hand forcefully and steadily for 5 or 10 minutes to
separate the broken bones.
112
WARNING: It is possible to do a lot of damage while trying to set a bone. Ideally,
it should be done with the help of someone with experience.
HOW LONG DOES IT TAKE FOR BROKEN BONES TO HEAL?
The worse the break or the older the person, the longer healing takes.
Children's bones mend rapidly. Those of old people sometimes never join. A
broken arm should be kept in a cast for about a month, and no force put on it for
another month. A broken leg should remain in a cast for about 2 months.
BROKEN THIGH BONE
A broken upper leg often needs special attention. It is best to splint the whole
body like this:
and to take the injured person to a health center at once.
BROKEN NECKS AND BACKS
If there is any chance a person's back or neck has been broken, be very careful
when moving him. Try not to change his position. If possible, bring a health
worker before moving him. If you must move him, do so without bending his
back or neck. For instructions on how to move the injured person, see the next
page.
113
BROKEN RIBS
These are very painful, but almost always heal on their own. It is better not to
splint or bind the chest. The best treatment is to take aspirin—and rest. It may
take months before the p’ain is gone completely.
A broken rib does not often puncture a lung. But if the person coughs blood or
develops breathing difficulties, use antibiotics (penicillin or ampicillin) and seek
medical help.
BROKEN BONES THAT BREAK THROUGH THE SKIN (COMPOUND FRACTURES)
Since the danger of infection is
very great in these cases, it is always
better to get help from a health
worker or doctor in caring for the
injury. Clean the wound and the
exposed bone very thoroughly with
boiled water. Never put the bone back into the wound until the wound and the
bone are absolutely clean.
Splint the limb to prevent more injury.
If the bone has broken the skin, use an antibiotic immediately to prevent
infections: penicillin or ampicillin in high doses (p. 397and 399).
CAUTION: Never rub or massage a broken limb
or a limb that may possibly be broken.
HOW TO MOVE A BADLY INJURED PERSON
With great care, lift the injured
person without bending him
anywhere.
114
Have another person put the
stretcher in place.
With the help of everyone, place
the injured person carefully on
the stretcher.
If the neck is injured or broken, put bags
of sand or tightly folded clothing on
each side of the head to keep it from
moving.
DISLOCATIONS
(BONES THAT HAVE COME OUT OF PLACE AT A JOINT)
Three important points of treatment:
♦ Try to put the bone back into place. The sooner the better!
♦ Keep it bandaged firmly in place so it does not slip out again (about a month).
♦ Avoid forceful use of the limb long enough for the joint to heal completely
(2 or 3 months).
115
HOW TO SET A DISLOCATED SHOULDER:
Lie down on the floor next to the injured person. Put your bare foot in his
armpit and pull his arm slowly downward, at an angle to the body, as shown (1),
using steady force for 10 minutes.
Then swing the arm closer to his body, using your foot to position the bone (2).
The shoulder should 'pop' back into place.
After the shoulder is in place, bandage the arm firmly
against the body. Keep it bandaged for a month. To
prevent the shoulder from becoming completely stiff,
older persons should unbandage, the arm for a few
minutes 3 times a day and, with the arm hanging at
the side, move it gently in narrow circles.
In case you cannot put the dislocated limb back
in place, look for medical help at once. The longer
you wait, the harder it will be to correct.
STRAINS AND SPRAINS
(BRUISING OR TEARING IN A TWISTED JOINT)
Many times it is impossible to know whether a hand or foot is bruised, sprained,
or broken. It helps to have an X-ray taken.
But usually, breaks and sprains are treated more or less the same. Keep the
joint motionless. Wrap it with something that gives firm support. Serious sprains
need at least 3 or 4 weeks to heal. Broken bones take longer.
116
You can keep the twisted joint in the
correct position for healing by using an
elastic bandage.
Wrap a twisted ankle as shown
here:
CAUTION: If the foot seems very
loose or 'floppy' or if the person has
trouble moving his toes, look for
medical help. Surgery may be needed.
To relieve pain and swelling, keep
the sprained part raised high. During the first 24 hours, put ice or cold, wet cloths
over the swollen joint. This helps reduce swelling and pain. Also take aspirin.
After 24 hours soak the sprain in hot water several times a day.
Never rub or massage a sprain or broken bone. It does no good and can do
more harm.
For the first day soak the sprained
joint in cold water.
After the first day (24 hours) use hot
soaks.
POISONING
Many children die from swallowing things that are poisonous. To protect your
children, take the following precautions:
Never Reep kerosene,
gasoline, or other poisons
in cola or soft drink
bottles, because children
may try to drink them.
117
■ rat poison
■ cigarettes
■ DDT, lindane, sheep dip, and other
insecticides
■ rubbing or wood alcohol
■ medicine (any kind when much is
swallowed; take special care with
iron pills)
■ tincture of iodine
■ bleach and detergents
■ poisonous leaves-, seeds, or berries
■ Paints
■ unused matches - the tips are
poisonous
■ kerosene, gasoline, petrol
■ lye
Treatment:
If you suspect poisoning, do the following immediately:
In a conscious person:
Make the person vomit. Put your finger in his throat, or tickle the back of his throat
with a spoon, or make him drink warm water with a lot of salt in it.
118
•If the person does not vomit, lay the person on a cot.’Put in a well greased
stomach tube through the mouth and pour in 1 to 2 liters of water through
the funnel. Lower the end of the stomach tube below the level of the bed. The
liquid in the stomach will come out. Continue doing this till the liquid coming
• Have him drink all he can of milk, beaten eggs, or flour mixed with water. If you
have it. give him a tablespoon of powdered charcoal(p422)Keep giving him mure
milk,eggs, or flour and water, and keep him vomiting until the vomit is clear.
If the person is unconscious
Do not make him vomit. If he has stopped breathing, then give mouth-to-mouth
breathing . Seek medical help at once.
CAUTION: Do not make a person vomit if he has swallowed kerosene, gasoline.
petrol, or strong acids or corrosive substances like lye.
Cover the person if he feels cold, but avoid too much heat. If poisoning is
severe, look for medical help.
Pesticide poisoning
Pesticides are substances used to prevent or kill the various pests like insects.
rats, weeds, etc., that destroy the cultivated crops, or spread diseases (flies.
mosquitoes). Poisoning occurs when people carelessly handle the pesticides, and
do not take the necessary precautions, or when the person does not cover his nose
and mouth when spraying pesticides, or if the person does not cover all his food and
drinking water when his house is being sprayed.
Signs of pesticide poisoning:
’ Headache
* vomiting
‘ abdominal pain
• convulsions
‘ signs of shock (p. 89)
* difficulty in breathing
’ loss of consciousness
If first aid is not given immediately, the person will die.
Whar to do in pesticide poisoning:
' remove the person from risk of further exposure
If he has convulsions, give him a sedative (p 422). and protect him fr_>m harm,
and from biting his tongue
• rush him to the health centre fast. He will die if he is not treated immediately.
What to do to prevent poisoning:
‘ Wear rubber gloves, or wrap
your hands in a polythene paper.
£.----->
while handling the pesticides
119
* If you are spraying the pesticides.
cover your nose and mouth
with a cloth
’ Wash your hands well with soap
and water after handling any pesticide
* Cover all your food and drinking
water when your house is being
sprayed with pesticide.
Pesticides can be absorbed
through the skin. Do not
touch pesticide with bare
hands. ___________________
SNAKEBITE
All snakes are not poisonous, nor can they outrun man as commonly believed
There are only four common poisonous snakes in India
1
Common cobra (Hindi. Nag) name in your area.
120
3.
Russel's viper (Hindi’ Daboia) name in your area. ..
4.
Saw-scaled viper (Hindi: Phoorsa) name in your area..
This snake is less than a foot long. It has a clear 'arrowhead' design on the head.
Both Russel's viper and Saw - scaled viper have a triangular head and a narrow thin
neck.
When a person has been bitten by a snake, try to find out if the snake was
poisonous, or not. Their bite marks are different.
•
-<----------- fang marks
POISONOUS
SNAKE
----------- The bite of a poisonous snake leaves
marks of the 2 fangs (and at rare times,
other little marks made by the teeth).
NON-POISONOUS
SNAKE
•
-—The bite of a snake that is not
poisonous leaves only 2 rows of teeth
marks, but no fang marks.
121
Most often the bite marks are not so clear as shown in the picture. There may be just
one fang mark, or just a row of teeth marks, or a ragged tear at the site of the wound.
When in doubt, always look for the local and general signs of poisoning, and keep
the person under observation for at least one day.
The poison from cobra and krait affect the nervous system. The viper venom
affects the blood and prevents it from clotting.
People often believe that certain harmless snakes are poisonous. DO NOT KILL
NON POISONOUS SNAKES, because they do no harm. On the contrary, they kill
mice and other pests that do lots of damage Some even kill poisonous snakes
SIGNS OF POISONOUS SNAKE BITE:
At the site of the snake bite: local signs
These signs appear within 15 to 30 minutes of the bite.
" Pain - may be quite severe and may last for many days.
■ swelling -dependson the amountof poison that has entered theblood. Incaseof
viper bites, pain and swelling at the site of the bite is more severe
‘ bleeding from the bite: this is more common in case of viper bite
' discoloration of skin around the area of the bite
* infection and gangrene may also develop
General signs.These develop from 15 minutes to one hour after the bite
Cobra and Krait: affect the nervous system
* drowsiness
‘ weakness of the muscles, especially the muscles around the eyes. The person
may start seeing double (double vision ) and may develop a squint
' paralysis of muscles
» respiratory failure may lead to death
Vipers: affects the clotting of blood
■ headache, giddiness
• nausea, vomiting
• cough with blood stained phlegm
• bleeding under the skin
• signs of shock (p 89 )if there is too much bleeding
Treatment for poisonous snakebite:
1 Stay quiet; do not move the part that has been bitten. The more it is moved,
the more rapidly the poison will spread through the body. A person who has been
bitten on the foot should not walk, not even one step if it can be avoided. Carry
him on a stretcher.
2. Tie a cloth around the limb, just above the bite. Do not tie it very tight, and
loosen it for a moment every half hour.
122
3. With a very clean knife
(sterilized in a flame) make a cut
into each fang mark: about 1 cm.
long and 1/z cm. deep.
4. Then suck (and spit out) the
poison—for a quarter hour.
Note: If more than a half hour
has passed since the bite, do not
cut or suck the bite. By then it
may do more harm than good.
5.
If a person develops any of the general
signs described above, inject ANTIVENIN.
being careful to follow the instructions
that come with the medicine. Inject ’/z cc.
of ADRENALINE under the skin to prevent
the person from getting ALLERGIC
SHOCK(p83). The antivenin is most
effective if you inject it within 3 hours
after the bite (for some snakes like cobra it
must be given immediately).
6.
If you can get ice. wrap pieces in thick cloth and pack these around thelimbthat
was bitten.
7.
Give tetanus toxoid injection to prevent tetanus.
8.
If signs of infection develop, use penicillin.
Poisonous snake bite is dangerous. Send for medical help at once — but always
do the things explained above •t once.
Most folk remedies for snakebite do little if any good (see p 3). Never drink alcohol
after a snakebite. It makes things worse!
NoteiYou can get polyvalent antivenin which is effective against the above
snakebites from:
The Haffekine Institute
Acharya Dande Marg
Parel
Bombay 400 01 2
India.
Have snakebite antitoxin ready and study how to use it
ahead of time—before someone is bitten!
123
THE MONITOR LIZARD ('GOH')
There are about 6 varieties of monitor lizards in India. They are about 2 to 3 feet
long . They have very strong claws and their grip is very powerful. They have a forked
tongue like that of a snake.
The monitor lizard is not poisonous.
Many people believe that the very breath of a monitor lizard is poisonous.
particularly of a variety known as "Bishkopra"
Treatment:
There is no need for any antivenin. The bitten person needs patient understanding
and assurance. It is his own fear that makes him sick (see p4 beliefs that can make
people sick.)
SCORPION STING
Some scorpions are far more poisonous than
others.
To children under 5 years old, scorpion
stings can be dangerous, especially if the sting is on
the head or body.
In adults, the first time is rarely dangerous. But if it is for the second time, the
person may die. if not treated soon. The body becomes allergic to the sting with the
first sting. So it is important to find out if he had an earlier scorpion sting. The person
usually develops signs of shock (p83)or heart failure (p.371) and coughs out blood.
What to do for scorpion stings:
If it is for the first time in an adult, do the following:
* Give aspirin and if possible, put ice on the sting
inject Novacaine (5 to 10 ml.) around the sting. This helps reduce pain, but may give
only temporary relief
• Anthistamine tablets can also be given. For details see green pages.
If the sting is for a second time in an adult, or is in children under five, do the
following:
* Get medical help fast.
• If breathing has stopped, do mouth-to-mouth breathing, (see p. 92)
• If the person is in shock, treat the shock (see p.Q3)
• If the child who was stung is very young, or has beenstungonthemainpartofthe
body, or if the sting is for the second time - seek medical help fast.
For an effective home cure for the first scorpion sting in adults, see page. 18
124
BEE AND WASP STINGS:
In most cases these stings are not dangerous, but they are extremely painful. In
some persons, they may cause allergic shockfsee p. 83)The area of the sting
becomes red. hot. swollen, and painful.
Treatment :
* Apply hot compresses on the area of the sting
* For pain give aspirin and anthistamine tablets (see green pages
' If signs of shock develop, treat as for allergic shock (see p 83}
SPIDER BITES
The majority of spider bites, are painful but not
dangerous. The bite of a few kinds of spiderscan make
an adult quite ill. They can be dangerous for a small
child. These bites often causes extreme pain in the
stomach muscles. (Sometimes this is confused with
appendicitis!)
Give asoirin and look for medical help. The most useful medicines are not
found in village stores. (Injection of 10% calcium gluconate, 10 ml., injected
intravenously very slowly over a 10-minute period, helps to reduce the muscular
spasms. Also diazepam, p. 423. may be helpful. If signs of shock develop, treat for
allergic shock, p. 83. Injections of cortisone may be needed in children.)
The book
Where There Is No Doctor
at Rs. 33-00 plus postage.
is available
Multiple copies of reprints
of various chapters are also available.
Please write to :
Publications Officer
Voluntary Health Association of India
40, Institutional Area, South of l.l.T.
New Delhi 110016
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