9.6.

4 Drowning
Drowning is immediately brought to mind when one hears of water related
accidents. The process of drowning begins as a person struggles to keep afloat in the
water. He gulps in large breaths of air as he splashes about. When he can no longer keep
float and starts to submerge, he desperately tries for some more air. As he does so, water
may enter the airway and stop the air passage. The people who drown die from true
"asphyxia" or simply suffocation from lack of air.
Safety Measures
Ponds and well should be walled.
Swim with another person who would be able to help in an emergency.
Never swim when you are tired.
Don't swim at unknown rivers, ponds, lakes.
The care of children is necessary near water reservoirs.
Deep puddles or drains should be well-covered.
Know your limits before venturing into deep water.
Avoid swimming at night.
Leave the water as soon as a storm threatens.
First-Aid and Emergency Care: Unless you are a very good swimmer and trained in
water rescue, do not go into the water to save someone. The following aids can be
provided for the drowning:-
Remove the drowning person out of the water.
Anything that obstructs breathing should be removed from the mouth and nose.
Open the airways check breathing and pulse.
Provide mouth to mouth respiration if needed, as soon as possible.
The patient should be placed on his stomach to let the water out.
Cover the patient to conserve the body heat and complete a secondary survey.
Care should be provided for any problem or injuries detected during the survey, in
the order of their priority.
Transport the unconscious patient as soon as possible for medical help.
9.6.5 Burns
Countless people die or are severely injured every day through burns. Though it is
generally assumed that the main cause is fire, burns can also result through touching hot
object, scalding, harsh friction, electric shock, or accidental contact with chemicals.
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In most cases involving burns, the first thought is of injury to the skin, because the
skin is the outer part of the body constantly in direct contact with the environment. But
burns can do much more harm than simply injuring the skin. Injuries due to burns often
involve structures below the skin, including muscles, bones, nerves and blood vessels. In
addition to the physical damage caused by burns, patients also may suffer emotional and
psychological problems that had occurred during the time of emergency, which may last
for a lifetime.
Classification of Burns:- A burn is classified medically according to the depth that it
reaches into the skin. There are three types usually referred to as 'First', 'Second', and
'Third' degree burns. A burn involving only the epidermis is first degree burn; a burn
involving the epidermis and the dermis but not penetrating through the dermis is grouped
as second degree burn whereas, a full-thickness burn with damage extending through the
dermis is grouped as third degree burn.
Burn can be classified according to the agent causing the burn. The agent of the
burn can be:
(a) Thermal: Including flame, excessive heat from fire, steam, hot liquids and hot
objects.
(b) Chemical: Including various acids.
(c) Electrical: These are caused by electrical appliances.
(d) Radiation: These burns are usually from nuclear sources. Ultraviolet light also
can be considered to be a source of radiation burn.
Safety Measures: The best way to deal with
burns is to prevent them. The following
preventive or safety measures can be adopted:
Stub out cigarettes thoroughly in an
ashtray. Do not smoke in bed or near
inflammable objects.
Light match before turning on gas tap.
Never hang cloth over cooker.
Beware of light cotton fabric.
Replace frayed electric wires, loose
connection, trailing leads and fit correct fuses. Fig. 9.4:
Switch off or disconnect apparatus not in use. Always pull out the plug.
Do not connect heaters or irons to lamp sockets.
Matches and other potential hazards should be kept well out of young childrens
reach.
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The open fire should be kept unaired.
Plan and rehearse an escape route in case of fire.
First-Aid
If the patients clothes are on fire, lay him down and smother the flames by
pressing down with any thick cloth or water.
Immerse affected are in cold water for at least 10 minutes.
Ensure an open airway and assess breathing.
Look for airway injury and complete the patients assessment.
If there is a blister, it should not be punctured.
Do not clear debris but remove clothing and jewelry.
Cover the burnt area with a clean, dry dressing.
Do not apply any cream or ointments to the burn.
In severe cases, keep the patient lying down. Elevate the burnt limb to reduce
swelling.
Transport all burn patients to the hospital as soon as possible for medical
treatment.
9.6.6 Snakebite
Snakebites are very common in the Terai region of our country where many types
of poisonous snakes are found. Their bites are generally fatal if proper care and treatment
is not provided immediately. Snakebites require special care. The symptoms and signs of
poisoning may take several hours to develop. Very few people die of snakebites. Most
victims, who die later, normally survive at least one or two days.
Symptoms of Poisonous Snakebites:- The symptoms and signs of snakebite may
include:
+ A noticeable bite on the skin. This may appear as nothing more than a
discoloration;
+ Pain and swelling in the area of the bite. This may be slow to develop from 30
minutes to several hours;
+ Rapid pulse and laboured breathing;
+ Progressive general weakness;
+ Vision problem (dim or blurred);
+ Nausea, vomiting and diarrhoea;
+ Convulsions and drowsiness or unconsciousness;
+ There may be salivation and sweating in an advanced stage.
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Fig.9.3:
Safety Measure:- The following measures can be adopted for snakebite:
- The environment around the house should be kept clean.
- Shoes outside should be used while walking (anywhere).
- Grasses, bushes of the surroundings of residential area should be cleared.
- Light or torchlight should be used while walking at night.
First-Aid
Keep the patient calm.
Treat for shock and conserve body heat.
Locate the fang marks and clean the site with soap and water.
Remove any rings, bracelets or other constricting items from the bitten extremity.
Keep any bitten extremities immobilized.
Apply a light constricting band above and below the wound, each band about two
inches from the wound.
Sometimes a cut is required to be made at the spot of the bite so as to let the blood
flow. But do not cut into the bite unless you are directed to do so by a physician.
Never suck the venom from the wound using your mouth. Instead, use a suction
cup.
If breathing starts to fail, artificial respiration should be given.
Transport the patient to the hospital for medical help, carefully monitoring the
vital signs.
9.6.7 Electric Shock
A traumatic physical state caused by the passage of electric current through the body
is called Electric shock. It usually involve an accidental contact with exposed parts of
electric circuits in home appliances and domestic power supplies, but may also result
from lightning or contact with high voltage wires. High frequency current produces more
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heat and can cause burns, coagulation and necrosis (death of most or all of the cells) of
affected body parts. Low frequency current can burn tissues if the area of contact is small
and concentrated. Severe electric shock commonly causes unconsciousness, respiratory
paralysis, muscle contractions, bone fractures and cardiac disorder.
Safety Measures:- The following safety measures can be helpful to prevent the accident
of electric shock:
- Turn off the main electric supply before starting any work on the house wiring
circuit, and disconnect any appliance that you are about to mend.
- Do not handle any switches, plugs or appliances with wet hands.
- Do not overload sockets with adaptors. Try to have only one appliance per socket
and remember to turn off sockets when not in use.
- Make sure that your electric appliances and home wiring are in good condition.
- Naked wire should be covered properly.
- Replace frayed electric wires, loose connections, trailing leads and fit correct fuse.
First-Aid
Turn the electricity supply off at
the main point. Do not touch the
victim until you have done this.
If you cannot turn the current off,
use a dry implement made of non-
conductive material, like broom or
chair. Act quickly.
Make certain that you and the
patient are in a safe zone.
When the victim is free, check Fig. 9.4:
whether he is breathing or not. If the victim stops breathing at any time give him
artificial breathing.
If the victims heart stops beating then give him a heart massage.
Care should be provided for spinal injuries, head injuries and severe fractures.
Cool the burnt areas and apply dry sterile dressing to the burn sites.
Treat for shock.
Do not allow crowd to gather around the patient. Make sure he/she is warm and
comfortable.
Transport as soon as possible to the hospital for medical help.
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8.6.8 Altitude Sickness
Altitude or mountain sickness can develop at any altitude above 2000 metres.
It is well known that as we ascend to higher altitudes the total barometric pressure,
pressure of oxygen and density of air decreases because of the decreased weight of the
atmosphere. The decrease in the oxygenation of the blood induces a functional disorder
known as altitude sickness.
Sign and Symptoms:- The major sign and symptoms for the recognition of altitude
sickness are as follows:-
o Nausea and vomiting;
o Headache and acceleration of heart rate;
o Lack of appetite;
o Deterioration of neuro-muscular co-ordination;
o Fatigue and general weakness;
o Diminution of visual acuity;
o Lowered stamina.
Safety Measures:- The following safety measures can be helpful to prevent altitude
sickness:
Never trek alone. If you have no friends, consider hiring a guide or porter.
Carry a light pack and use a porter to protect you from excessive exertion.
You should adjust your schedule.
Take a warm sleeping bag, warm jackets and good quality sunglasses.
Oxygen cylinder should be taken.
Sleeping pills, sedative and alcohol should not be used at high altitude.
Drink 3 to 4 litres of fluid per day to avoid dehydration.
If possible carry the Gamow bag.
As soon as the symptoms are seen in a person, stop climbing and descend.
First-Aid
= With the development of mild symptoms, you must stay at the altitude.
= If you are resting at the same altitude and your symptoms are becoming worse,
then it is necessary to descend.
= Use Gamow bag for significant benefits.
= If the patient is conscious give him/her warm drinks.
= Put the patient warm.
= Take the patient to hospital for medical aid.
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9.6.9 Foreign body in Throat
Fish bones, peanuts and other pieces of food are the usual culprits in this case. A
foreign body may irritate the throat and cause a tightening of the vocal cord muscles. This
cause noisy and difficult breathing and the victim can easily be suffocated.
First-Aid
As long as the patient can cough vigorously, do not interfere.
If the patient is not able to dislodge the object by vigorous coughing, bend him/her
over and slap hard with the palm of your hand between the shoulder and blades.
If the object is still in its place and the patient is becoming weak, give abdominal
thrusts.
In the case of a small child, hold him/her head down, lying on your partly bent
thigh and slap on his/her back. Use two to three fingers only.
If the patient stops breathing begin artificial breathing.
If the patient faints or vomits, put him/her in the recovery position.
The patient should be seen by a doctor or sent to a hospital for observation as soon
as possible.
9.6.10 Sprain
A sprain is an injury that affects the ligaments, tendons and the muscles. A
ligament injury at or near, a joint, is most frequently caused by a wrenching movement at
the joint that tears the surrounding tissues. Muscles and their tendons may be over
stretched and torn by violent or sudden movements. Common sites of sprain are ankle,
wrist, knee, shoulder and other similar joints.
Safety Measure: The following safety measures can be helpful to prevent sprains:
1 Individuals should be careful while walking, stepping and playing.
1 Never lift, hold or move heavy objects that are beyond the capability.
1 Warm up before any strenuous physical exercise.
1 Haphazard running, jumping and throwing should be avoided.
Sign and Symptoms:- The major sign and symptoms for recognition of sprain are as
follows:
Pain, acute tenderness over injury site.
Joint, instability in severe cases.
Inflammatory reaction.
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Difficulty with efficiency of extensor mechanism.
Local evidence of bruises. Or, Evidence of brushing.
First-Aid
1 Rest, steady and support the injured part in the most comfortable position.
1 Cool the area by applying an ice pack or cold compress.
1 Wrap a crepe or elasticized bandage around the injured area.
1 Raise and support the injured limb to reduce the blood flow to the injury.
1 Check the bleeding and open wound.
1 Take or send the patient to hospital, or if the injury seems very minor, advise
him/her to keep the injure part
EXERCISE
A. Very Short Answer Type Questions
1. What are the most important elements of Primary health care?
2. Name a service that comes under Primary health care.
3. When was the first conference of Alma Ata held?
4. Where do most injuries occur?
B. Short Answer Type Questions
1. List out any five importance of Primary health car.
2. List out the aspect of Primary health care.
3. Write any five safety measures to be followed at home.
4. What is drowning? What can be done for the prevention of drowning?
5. What is allergy? List out the basic symptoms of allergy.
6. Write the importance of safety education in the context of Nepal.
7. Write the importance of Primary health care in the context of Nepal.
C. Long Answer Type Questions.
1. Explain the meaning of Primary health care.
2. What is safety education? List out any five importance of safety education and explain.
3. Explain the safety measures on road.
4. What is First-Aid? Discuss the main objectives of First-Aid.
D. Write Short Notes on:
(a) Burns (b) Sprain (c) Altitude sickness
(d) Snakebite (e) Drowning
E. Multiple Choice: Tick (-) the best Answer.
1. What is the purpose of First-Aid?
(a) To learn bandaging (b) To preserve life
(c) To prevent further injury (d) To promote recovery
2. What is a correct treatment of a burn?
(a) Applying a soothing ointment. (b) Making the victim vomit.
(c) Cover the burns with a sterile dressing. (d) Running the burnt part under cold water.
3. In the case of a drowned casualty you should
(a) Bend the head forward and blow air into the lungs.
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(b) Clear the mouth, pull the head back and blow into the lungs.
(c) Not take the pulse because you are wasting time.
(d) Remove the drowning person out of water.
4. What is done to the wounded people first?
(a) Taken to hospital (b) Stop bleeding
(c) Leave as it is (d) Stitch the wound yourself
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