First aid rules that everyone needs to know

First aid is defined as the immediate care given to an acutely injured or ill person.  It can literally be life-saving so it behooves all of us to know some basic principles.

What follows are some rules that cover common conditions and general practices:

  1. Don’t panic.  Panic clouds thinking and causes mistakes.  When I was an intern and learning what to do when confronted with an unresponsive patient, a wise resident advised me when entering a “code blue” situation to always “take my own pulse first.”  In other words, I needed to calm myself before attempting to intervene.  It’s far easier to do this when you know what you’re doing, but even if you encounter a situation for which you’re unprepared, there’s usually some good you can do.  Focus on that rather than on allowing yourself an unhelpful emotional response.  You can let yourself feel whatever you need to feel later when you’re no longer needed.
  2. First, do no harm.  This doesn’t mean do nothing.  It means make sure that if you’re going to do something you’re confident it won’t make matters worse.  If you’re not sure about the risk of harm of a particular intervention, don’t do it.  So don’t move a trauma victim, especially an unconscious one, unless not moving them puts them at great risk (and by the way, cars rarely explode).  Don’t remove an embedded object (like a knife or nail) as you may precipitate more harm (e.g., increased bleeding).  And if there’s nothing you can think to do yourself, you can always call for help.  In fact, if you’re alone and your only means to do that is to leave the victim, then leave the victim.
  3. CPR can be life-sustaining.  But most people do it wrong.  First, studies suggest no survival advantage when bystanders deliver breaths to victims compared to when they only do chest compressions.  Second, most people don’t compress deeply enough or perform compressions quickly enough.  You really need to indent the chest and should aim for 100 compressions per minute.  That’s more than 1 compression per second.  If you’re doing it right, CPR should wear you out.  Also, know that CPR doesn’t reverse ventricular fibrillation, the most common cause of unconsciousness in a patient suffering from a heart attack.  Either electricity (meaning defibrillation) or medication is required for that.  But CPR is a bridge that keeps vital organs oxygenated until paramedics arrive.  Which is why…
  4. Time counts.  The technology we now have to treat two of the most common and devastating medical problems in America, heart attacks and strokes, has evolved to an amazing degree, but patients often do poorly because they don’t gain access to that technology in time.  The risk of dying from a heart attack, for example, is greatest in the first 30 minutes after symptoms begin.  By the time most people even admit to themselves the chest pain they’re feeling could be related to their heart, they’ve usually passed that critical juncture.  If you or someone you know has risk factors for heart disease and starts experiencing chest pain, resist the urge to write it off.  Get to the nearest emergency room as quickly as you can.  If someone develops focal weakness of their face, legs, or arms, or difficulty with speech or smiling, they may be having a stroke, which represents a true emergency.  Current protocols for treatment depend on the length of time symptoms have been present.  The shorter that time, the more likely the best therapies can be applied.
  5. Don’t use hydrogen peroxide on cuts or open wounds.  It’s more irritating to tissue than it is helpful.  Soap and water and some kind of bandage are best.
  6. When someone passes out but continues breathing and has a good pulse, the two most useful pieces of information to help doctors figure out what happened are:  1) the pulse rate, and 2) the length of time it takes for consciousness to return.
  7. High blood pressure is rarely acutely dangerous.  First, high blood pressure is a normal and appropriate response to exercise, stress, fear, and pain.  Many patients I follow for high blood pressure begin panicking when their readings start to come in higher.  But the damage high blood pressure does to the human body takes place over years to decades.  There is such a thing as a hypertensive emergency, when the blood pressure is higher than around 200/120, but it’s quite rare to see readings that high, and even then, in the absence of symptoms (headache, visual disturbances, nausea, confusion) it’s considered a hypertensive urgency, meaning you have 24 hours to get the pressure down before you get into trouble.
  8. If a person can talk or cough, their airway is open.  Meaning they’re not choking.  Don’t Heimlich someone who says to you, “I’m choking.”
  9. Most seizures are not emergencies.  The greatest danger posed to someone having a seizure is injury from unrestrained forceful muscular contractions.  Don’t attempt to move a seizing person’s tongue.  Don’t worry—they won’t swallow it.  Move any objects on which they may hurt themselves away from the area (including glasses from their head) and time the seizure.  A true seizure is often followed by a period of confusion called “post-ictal confusion.”  Your reassurance during this period that they’re okay is the appropriate therapy.
  10. Drowning doesn’t look like what you think it does.  For one thing, drowning people are physiologically incapable of crying out for help.  In fact, someone actually drowning is usually barely moving at all (I strongly encourage everyone to click on this link to learn more about how to recognize what drowning does look like).

Alex Lickerman is an internal medicine physician at the University of Chicago who blogs at Happiness in this World.  He is the author of The Undefeated Mind: On the Science of Constructing an Indestructible Self.

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  • http://www.nurturedmoms.com Heather Johnson/ Nurtured Moms

    Great advice! I learned in my red cross CPR class that effective compressions are often deep enough to break ribs (!?). Is that true? And what about a portable AED? Lots of places have them now and they give fairly clear instructions. Is that something that should be used if available or should it be saved for the professionals?

  • http://jflahiff.wordpress.com Janice Flahiff

    Hello Heather,

    The American Red Cross has a great Web site about the new CPR guidelines at…

    http://www.heart.org/HEARTORG/CPRAndECC/CPR_UCM_001118_SubHomePage.jsp

    Also learned at..

    http://www.heartcentertraining.com/blog/top-10-cpr-myths..

    That while one may possibly break someone’s ribs during CPR, remember, it is better to risk breaking someone’s ribs than not give CPR…..

    The AED devices, to the best of my knowledge..are for anyone to use…that’s why one doesn’t have to “break in” to use the AED…I looked at one once, the directions are surprisingly simple…and were developed that way for anyone to use, not just professionals…

    …Many states have Good Samaritan laws..so if you do your best to give first aid, and the person is injured while you are giving first aid, you cannot be sued or have charges brought against you (that is nothing can be done to you via a criminal or civil case)….this is what I think is true…might want to double check with experts in this field…maybe even try asking at a law library or a public library or ask folks at the Red Cross…

    The above Web page link (http://…) also tells you how to find a CPR class…something worth considering… I learned more taking a class than reading how to do it, much more…and there’s nothing like a personalized answer to a question!

    Anyways, you can contact me (my email is at the about page at http://jflahiff.wordpress.com) if you think I can help further…

    Hoping this helps some!

    Janice

  • http://thedocsquawk.com thedocsquak

    I have some interesting hearsay about older AEDs. For non-shockable rhythms they may have a display that reads “SHOCK IF UNCONSCIOUS”. The problem is that the display only shows one word at a time. There has been at least one case where someone was defibrillated inappropriately because the operator read “SHOCK” and hit the big red button before the rest of the words came out. One example of the importance of after market research.

  • J.T. Wenting

    here the rules have by now been condensed into:
    1) call 911
    2) don’t touch the patient or you may end up sued when it turns out he got harmed

  • http://www.aneurysmsupport.com/ Mike

    The drowning article is interesting. Despite spending time on or near the water I honestly did not know that drowning victims are physiologically incapable of crying out. Good information to know.

    It also reminded me of something I learned many years ago in the Boy Scouts (in the days when they did things other than fund raisers) regarding the rescue of a drowning person. While your first instinct might be to swim out to the person this is actually the last thing you should do. When attempting a rescue you should use this order, Reach, Throw, Row, Go. They are pretty much self-explanatory and might help a rescuer from becoming a victim themselves.