Nasal Bleeding (Epistaxis)

Nasal Bleeding (Epistaxis)

Epistaxis means bleeding from the nose. It may cause mild or severe blood loss. It may occur when a small vein, along the lining of the nose, bursts.

Causes of Nasal Bleeding

• Dryness,
• Ingestion of medications like aspirin,
• Introducing objects into nose,

• Injuries,

• High blood pressure,
• Blood-clotting disorders,
• Vigorous nose blowing.

Sign and Symptoms of Nasal Bleeding

• Bleeding from nose,
• Difficulty in breathing,
• Restlessness,
• Low blood pressure,
• Weak, rapid pulse,
• May collapse.

First Aid of Nasal Bleeding

• Boost patient confidence.
• Lean forward while keeping the victim seated upright.
• Tell them to avoid inhaling through their noses and to keep their mouths wide.
• Pinch the soft area of the nose with the thumb and index finger.
• Hold on until the bleeding stops.
• Apply an ice pack on the nose's bridge.
• Keep holding for a further 10 minutes if bleeding persists.
• Dress her/him loosely, especially around the neck and chest.
• Do not pick, blow, or rub your nose for two days.
• Apply the nasal pack and transport the person to the hospital if the aforementioned method is unsuccessful in stopping the bleeding.

Poisoning

Poisoning is the condition or physical state produced by the ingestion, injection, inhalation or exposure of poisonous substances. Poisoning is a condition caused by introduction to harmful substances or chemicals into the body either by injection, inhalation or ingestion.

A poison or toxin is a substance when, if taken into the body in sufficient quantity, can cause temporary or permanent damage. Poison may enter the body accidentally or willingly. Once introduced into the body, a poison can quickly be carried to all the tissues via bloodstream, causing harmful action on the human body, injuring health and even causing death. The majority of medicines if taken in excessive doses act as poison.

Routes of Poisoning

• Ingestion (by swallowing): Poison enters the body through the mouth by eating or drinking poisonous substance which include foods, alcohol, medication, household and garden items and certain plants.
• Absorption (through the skin): Absorbed poisons enter the body through the skin, they may come from plants, fertilizers or pesticides.
• Inhalation (breathing it): It may enter through lungs by inhaling household or gases. Inhaled poisons may be gases like carbon monoxide from car exhaust, carbon dioxide from sewers, and chlorine from a pool or fumes from household products like glue, cleaners or drugs.
• Injection (injected into the body): Injected poisons enter the body through bites or stings of insects, spiders, snakes and other animals or medication injected with hypodermic needle.

Causes of Poisoning

• Accidental poisoning: Due to contaminated food, poisonous fungi, berries, clinical substance, overdoses and sleeping pills, etc.
• Suicidal poisoning: When a person ingests any harmful substance intentionally with a purpose to commit suicide.
• Homicidal poisoning: It may be administered intentionally for killing enemies.

Common Types of Poisons

• Organophosphate poisoning e.g. metacid
• Aluminium phosphate
• Food poisoning
• Drugs and chemical e.g. acid, alkalis, high doses medicine or drug
• Gases- carbon monoxide may leak from faulty gas heaters, furnaces, fires
• Plant poisoning e.g. mushroom poisoning
• Alcohol poisoning
• Household detergents and cleaning products
• Cosmetics (incorrectly used)
• Occupational chemical exposures
• Bites-snake, scorpion

Sign and Symptoms of Poisoning

Different poisons have different signs and symptoms. The general signs and symptoms are as mentioned below:

• Burning pain in alimentary canal
• Chest pain
• Confusion
• Burns or redness around the mouth and lips
• Delirious and convulsion
• Asphyxiated
• Cyanosis
• Vomiting and diarrhoea
• Unconscious
• Cough
• Fever
• Headache
• Irritability
• Numbness or tingling
• Seizures
• Skin rash or burn
• Unusual breath odor like smell of chemicals
• Weakness

First Aid Management of Poisoning

• Look at the victim's condition by checking his pulse and respiration.
• Try to find out the type of poison, amount and time if the victim is conscious.
• If there are empty bottles and wrappers of medicine, keep them for examination.
• If the person vomits, clear the airway. Wrap a cloth around your fingers before cleaning out the mouth and throat. Save the vomit as it may help the experts identify what medicine can be used to help reverse poisoning.
• If the victim has taken non-corrosive poison, induce vomiting by:
  • Forcing foreign object down the victim's throat, e.g. tongue depressor.
  • Tickling back of the throat by inserting two fingers in throat.
  • Making him drink warm water mixed with two tablespoons of common salt.
  • If the victim has had corrosive poison, do not try to make him vomit.
  •  Corrosives are those chemicals which destroy or burn the tissues.
  •  Signs of corrosive poisoning are lips, mouth and skin show grey white or yellow patches.
  •  Put the patient in a comfortable position.
  •  For strong acid poisoning give chalk, milk of magnesia or sodium bicarbonate in water to neutralize its corrosive effect.
  •  For strong alkali poisoning give lemon juice, vinegar, butter milk, etc.
  •  Give olive oil, ghee, white part of egg and milk orally if the patient is conscious.
• Mix the charcoal with water and make the victim swallow. The charcoal prevents absorption of most poisonous substances.
• If the victim has exposed to poisonous fumes, such as carbon monoxide, get him or her into fresh air immediately. Open windows and door.
• If the poison is in the skin, rinse it off with running water for 10 minutes and remove any poisoned clothing.
• For injected poisoning:
  • Monitor airway, breathing and circulation.
  • Treat for shock.
  • Observe victim for allergic reaction.
  • Calm the victim.
• If the victim is unconscious:
  • Do not induce vomiting.
  • Make the victim lie on his back on a flat hard surface and turn the head to one side.
  • Take victim into the fresh air.
  • Maintain airway breathing circulation.
  • If the victim is not breathing, start resuscitation.
• Seek medical help as soon as possible.

Burn

Burn is an injury to tissue of the body caused by dry heat, electricity, chemicals, radiation or gases in which the extent of the injury is determined by the amount of exposure of the cell to the agent and to nature of the agent.

Before giving first aid, it is necessary to evaluate the extension, involved body part and severity of the burn. Giving immediate first aid before the arrival of medical team can help lessen the severity of the burn. Prompt medical attention in case of serious burns can help to prevent scarring, disability and deformity. Burns on the face, hands, feet and genitals can be particularly serious. Children under age 4 and adults over age 60 have a higher chance of complications and death from severe burns.

Scald: A scald is a burn caused by moist vapour or a hot liquid e.g. boil water, oil, etc.

Causes of Burn Injury

Flame Burn: Flame burns are common during playing with lighter, candles, matches or open fire in winter seasons or from fireworks during festivals.

Scalds: Scalds are important burn injury caused by contact with hot liquids (water or oil) and steam. The most common hot liquids are liquid foods such as hot water, tea, coffee, milk, etc. It is common in children below 3 years of age. Steam is a common gas that causes scalds.

Electrical Burn: Electrical burns are common in toddler and adolescent when playing with electrical out let, extension cords, touching high tension wires and using electrical appliance. It is caused by an exogenous shock. Such injuries may lead to cardiac arrhythmias, cardiac and unexpected falls with resultant factures. arrest

Chemical Burn: Most chemicals that cause severe chemical burns are strong acids or bases Because of the curious nature children are exposed with the different kinds of household chemical products. A variety of common household products that may cause chemical burns are as follows:

• Bleach,
• Concrete mix,
• Drain or toilet bowl cleaners,
• Metal cleaners,
• Pool chlorinators.

Radiation Burns: Radiation burns are burns due to prolonged exposure to ultraviolet rays (UV) of the sun or to other sources of radiation, such as x-ray or gamma radiation therapy for cancer. Sunburn is literally a burn on the skin from ultraviolet radiation. The consequence of this is swelling and redness of the skin. Injury can start within 30 minutes of exposure. UVA and UVB refer to different wavelengths in the light spectrum. UVB is more damaging to the skin and the main UV cause of skin cancer. Both UVA and UVB are responsible for photo aging (premature aging of the skin and wrinkles) and sunburn. UVA rays are predominately responsible for the aging process. Tanning beds produce both UVA and UVB rays.

Classification of Burn Injury

Burn can be classified as follows:

1. According to extent of burn injury

First, second, third and fourth degree

According to Depth of Injury

Superficial Burn Injury

• 1st degree burn.
• Limited to the epidermis.
• Red, painful and mild discomfort.
• Presents with erythema and minimal swelling, no blistering.
• No permanent scar.
• Heals rapidly (reversible injury).
• Commonly treated on outpatient basis.

Partial Thickness Burn Injury

Superficial partial-thickness burns

• Superficial 2nd degree burns.
• Involves the epidermis and superficial portion of the dermis.
• Red and Painful.
• Moist, often seen with scalding injuries.
• Presents with blister formation and typically blanches with pressure.
• Sensitive to light touch or pinprick.
• Heals by epithelialization.
• Minimal or no permanent scars but can leave discolouration.
• Commonly treated on outpatient basis; heals in 1-3 wks.
• Deep partial-thickness burns
• Deep 2nd degree burns.
• Involves the epidermis and most of the dermis.
• Appears white or poorly vascularized.
• May be painful or insensate (depending on depth) less sensitivity to light touch and pinprick than superficial form.
• May not blister, fixed staining (no blanching).
• Can leave significant scars and contractures over joints depending on time taken to heal.
• Often require excision of the wound and skin grafting.
• Takes extensive time to heal (3-4 wks).

Full-thickness Burns

• 3rd degree burns.
• Involves epidermis, and all layers of dermis, extending down to subcutaneous tissue.
• Appears dry, leathery (white, dark brown or charred) & insensate, often without blisters.
• Can be difficult to differentiate from deep partial-thickness burns.
• Commonly seen when patient's clothes caught on fire/ skin directly exposed to flame.
• Delayed healing, leads to contractures.
• Usually require referral to burn surgeon; need skin grafting to heal.

Fourth Degree Burns

• Full-thickness burn extending to muscle or bone
• Common result of high-voltage electric injury or severe thermal burns
• Requires hospital admission

According to Severity of Burn Injury

(Schematic Classification of burn severity)

Minor Burns

• 10% of TSBA burn with 1st and 2nd degree burns

Moderate Burns

• 10-20% TBSA burn and 2nd degree burn
• 2-5% TBSA burn and 3rd degree burn, but not involving eyes, ears, face, genitals, hands, feet or circumferential burns (over chest or abdomen) 

Major Burns

• 20% or more TBSA burn & 2nd degree burns
• All 3rd degree greater than 10% TBSA
• All burns involving face, eyes, ears, feet, hands or genitals
• All electrical burns
• Complicated burns with trauma, fracture, head injury, cancer, pulmonary disease & all at risk patients.

Signs and Symptoms of Burn Injury

Sign and symptoms of burn depend upon the cause and severity of the burn. The common sign and symptoms are:

• Skin becomes red and raw.
• Blisters are formed and tissue gets damaged.
• There is a severe pain.
• Sometimes skin becomes black.
• Immediate swelling of the affected area.
• The victim is restless and thirsty.
• Extreme tenderness.
• Oozing of fluid from the burn area.
• Shock may be present in severe burn.

Calculation of Total Body Surface Area Burn

Four commonly used methods are:

• The rule of 9's
• Lund and Browder charts
• Palm of hand
• Unburnt area

Rules for Nine for Adults

Lund and Browder Charts

• More accurate method of measuring the extent of total body burn especially in children.
• Subdivides body areas into segments and assigns a proportionate percentage of body surfaces to each area based on age.
• The lower extremity is divided into foot, leg and thigh areas.
• The head of a newborn baby is proportionately much larger than any other area of the body.
• As a child grows, the lower extremities assume more body surface area; the head becomes relatively smaller compared with the rest of the body.
• Considers the age and growth of the children in specific.

Palmer Surface

• Using of the size of the patient's hand, assuming the palmer surface of the hand is roughly 1% of the total body surface.
• Visualizing the patient's hand covering the burn wound approximates the amount of body surface involved,
• Applicable usually if the burn areas are scattered.

Unburnt Area

• Use in very extensive burns.
• Often easier to measure the area of skin that is unburnt and then subtract this from 100%.

First aid Treatment of Burn Injury

• Immediate removal from heat source.
• In case of open flame, the child should help to lie flat on the ground and roll on the floor.
• Fire should be extinguished by pouring water.
• Reassure the victim.
• The victim should be wrapped in clean sheet to prevent heat loss.
• If condition permits, oral fluid or ORS should be given, if the victim is thirsty and able to drink.
• Remove the victim's wet clothing, any rings, bracelets, shoes and any other tight fitting articles carefully as swelling may develop later on and make it difficult to remove.
• Cover the burn site with a clean dressing to prevent infection.
• Do not use adhesive, dry dressing; these will stick to the burn.
• Do not break any blister while the skin is still intact; it will continue to protect from infection.
• Raising a brunt limb may help to minimize swelling.
• Assess for any sign of shock.
• Seek medical help as soon as possible.

Sunburn

Sunburn can be caused by overexposure to the sun or even a sun lamp. At high altitudes sunburn can occur even on an overcast summer day. Some medicines can trigger severe sensitivity to sunlight and rarely can it be caused by exposure to radioactivity. Most sunburn is superficial. In severe cases, the skin is a lobster red in colour and blistered - the casualty may also be suffering from heatstroke.

Signs and Symptoms

Sunburn is often recognized by:

• Reddened exposed skin.
• Pain in the area of the burn.
• Later there may be blistering to the affected skin.

First aid Management

Aims: When dealing with somebody with sunburn is to move the casualty out of the sun or away from the source of the sunburn and to relieve any discomfort and pain. Caution though, if there is extensive blistering or any other skin damage you need to seek medical advice if referral is essential.

• With minor sunburn cover the casualty's skin with light clothing or a towel.
• Move them into the shade or preferably indoors.
• Cool the skin by sponging it with cool water or by soaking the affected area in a cold bath or a cool shower for ten minutes.
• Encourage the casualty to have frequent sips of cold water.
• If the burns are mild calamine lotion or an after sun preparation wollen?
• For severe sunburn obtain medical aid and refer to hospital.

Shock

Shock is a medical emergency in which the organs and tissues of the body are not receiving an adequate flow of blood. The circulatory system distributes blood to all parts of the body, carrying oxygen and nutrients to the tissues. If the circulatory system fails, and insufficient oxygen reaches the tissues, then shock occurs.

Some Common Causes of Shock

• Severe and extensive trauma
• Heart attack or severe pain
• Excessive loss of body fluids
  • Heavy internal or external bleeding
  • Dehydration
  • Burns
  • Persistent vomiting or diarrhoea 
• Severe allergy
• Poisons
• A sudden severe illness
• Infection
• Emotional stress or intense emotiom

Types of Shock

Hypovolemic Shock: It is also known as hemorrhagic shock. It is caused by decrease in fluid volume by severe blood and fluid loss, such as from traumatic bodily injury, which makes the heart unable to pump enough blood to the body, or severe anemia where there is not enough blood to carry oxygen through the body or prolonged vomiting and diarrhoea.

Cardiogenic Shock: It happens when the heart is damaged and unable to supply sufficient blood to the body or vital organs. This can be the end result of a heart attack or congestive heart failure.

Septic Shock: It results from the severe infection. The microorganisms cause loss of fluid through the blood vessel wall. Common causes of this are pneumonia, urinary tract infections, skin infections (cellulitis), intra-abdominal infections (such as a ruptured appendix), and meningitis.

Neurogenic Shock: It is caused by failure of nervous system to maintain a normal contraction of the blood vessels. It is caused by spinal cord injury, usually as a result of a traumatic accident or injury.

Anaphylactic Shock: It is a type of severe hypersensitivity or allergic reaction. It is caused by an antigen-antibody response. Causes include allergy to insect stings, medicines or foods (nuts, berries, sea-food), etc.

Sign and Symptoms of Shock

• Cool, clammy skin
• Pallor and cyanosis
• Dilated pupils, eyes appear to stare
• Blurring of vision
• Vomiting/nausea
• Feeling weak
• Confusion
• Excitement
• Anxiety
• Shallow/slow breathing or rapid/ deep breathing
• Weak and rapid pulse
• Profuse sweating
• Dizziness or fainting
• Loss of consciousness
• Low or no urinary output

First Aid Management of Shock

• Immediately reassure and comfort the casualty.
• Place the patient in the head-low position.
• Warm the patient with blankets.
• If external bleeding is present, stop immediately.
• Give stimulants like tea, coffee if there is no brain injury and the patient is not in coma.
• Assess the causes of shock.
• Loosen tight clothing to help the circulation and assist breathing.
• If breathing and heart beat stops, then establish an airway and begin resuscitation immediately.
• Do not move the casualty unnecessarily.
• Transfer to hospital if condition does not improve. 

Fracture

A fracture is a structural break in the normal continuity of bone or fracture is a condition of bone in which the continuity of the tissue of the bone is broken.

Causes of Fracture

Direct Force: A bone can be fractured directly at the point where the force of a blow is applied.

Indirect Force: A bone breaks away from the spot of application of force e.g. fracture of collar bone after a fall on the out stretched hand.

Force of Muscular Action: Violent condition of group of muscles may pull pieces of bone away from the point where the muscle is attached i.e. fracture of knee cap after powerful tight muscles jerk.

Force of Ligament: Twisting of a joint can cause its ligament to pull so hard at the joint arthat causes fracture on one of the bones to which the ligament are attached e.g. Fracture of lower leg bone at the ankle after stumbling.

Types of Fracture

• Simple fracture: It is the break of the bone into two clean margins.
• Compound and complicated fracture: It break of the bone in more than one part and tearing of the body part by the broken end e.g. blood vessels, nerves, muscle and other bony organs.
• Greenstick fracture: It is the break of the bone on only one side.
• Open fracture: It extends through the skin and mucous membrane.
• Closed fracture: The broken ends of the bone do not cut open the skin and show on the outside. The fracture is straight across the bone.
• Transverse fracture: The fracture is straight across the bone.
• Spiral: A fracture twisting around the shaft of the bone.
• Communicated: Fracture in which bone has splintered into several fragments.
• Depressed: The fracture in which fracture fragments are in driven.
• Pathologic: It is a fracture which is occurred due to disease condition. Or fracture occurs in diseased bone (such as cancer, osteoporosis), with no or only minimal trauma.
• Incomplete: Fracture involves only a portion of the cross-section of the bone. One side breaks; the other usually just bends (greenstick).
• Complete: Fracture line involves entire cross-section of the bone, and bone fragments are usually displaced.

Signs and Symptoms of Fracture

Remember the word PULSE

P - Pain at or around the site of the fracture.

U - Unusual shape and deformity

L - Loss of function; difficulty of movement; loss of mobility or abnormal movement and function

S - Swelling, tenderness, shock

E - Extra movement, cripitus sound on the fracture site.

First Aid Management of Fracture

• Assess the victim by assessing ABCDE.
• Give rest to the fractured part to prevent further damage, make the patient line on a flat surface.
• Treat difficulty of breathing, bleeding and shock if present. ud ovom
• Immobilize and support the injured part by using bandages or by using splints wherever available so that no movement is possible.
• Never tie a knot over the fracture site.
• If available, use splints to support the injured part.
• Handle the broken limbs gently.
• Raise the injured part after immobilizing it to minimize discomfort and swelling.
• Apply ice to reduce pain/swelling Prevent from shock or treat shock.
• Do not move the injured part unnecessarily.
• Arrange for transfer to hospital immediately.