Paramedic Aid for Unarmed Combat Injuries

VItal Parameters

For Life to sustain, following are required ƒ

• Cardiac Output – 5 L/min depends on external water 3L & salt 1tsp intake/24hr
• BP 120/80mm, BP less than 80/40 is Shock
• Pulse is 60-100/min, more than 100 may shows dehydration, ƒ
• UO-Urine Output of 500-2000ml/24hrs, less than 300ml is Renal failure

Wounds ƒ

• Bruise by Blunt object without break in skin– only massage to prevent haematoma ƒ
• Incised wound by sharp object – First Arrest bleeding then Suture or Tape 2 ends of wound ƒ
• CLW – Open wound by Blunt Object breaking skin
  • ƒArrest Bleeding
  • Clean surrounding skin
  • Scrub dirt from inside wound
  • ƒSuture /Tape – Single & Double Mattress technique
  • Dress to close ƒ
• Open Fracture, Abdominal Stab, Deep Muscular wounds – Hospital Needed

Water & Electrolyte Balance

• ƒWater – you require 3 litre a day, 1 L of this from comes from food
• Add 1 L for losses due to sweating in Exercise causing dehydration
• For every 1 hour of moderate exertion, you need
  • ƒ1L or 5 gasses of Fluids (Water) +
  • 1⁄2 tsp Salt (Sodium & Chloride) +
  • 1 small ball Jaggery, honey or fruit (Potassium) +
  • 1 tbsp / 3 tsp Sugar (Glucose) +
• Every 10 Km – I cheese cube or 1 glass Milk (Calcium)

ƒOne may preload these nutrients or consume after recovery of exertion, in the next meal.

Electrolytes

• ƒWater: Deficiency causes weakness & giddiness, Normal Reqt-3L/day ƒ
• Sodium Chloride: Salt- Deficiency causes fall in BP, giddiness, calf pains. Normal Reqt- 1tsp /day ƒ
• Potassium: Deficiency causes Nausea & Vomiting, Bloating, Disorientation Normal Reqt- 1 Fruit/day
• ƒCalcium: Deficiency causes Facial Tics, Foot & Hand spasms, Fits Reqt: 2 equiv of Milk ƒ
• (Lactic acids: Excess causes muscle soreness & pains)

Blood PH

• ƒNormal 7.32 to 7.42 Alkaline ƒ
• Eating Acidic Sour Food will cause Acidosis: Joint Pains, Sprains & Muscle tears, make one injury prone, all disease will worsen. Exercise causes Lactic Acidosis.
• ƒEating Raw Green Salad/ Vegetable juices will cause Alkaline restora- tion: All disease will heal rapidly, Joint Pains will disappear. ƒ
• AVOID: Pickle, Tamarind, Kokum, Sour Curds, Citrus Fruits, Chinese food withVinegar, Non veg foods for a while till injury heals

Severe Pain Occurs in:

Acute Abdomen, Stab Wounds, Severe Head Injury, Amputation Injury, Heart Attack, Bullet wounds, etc.

Signs of Severe Pain

Severe Pain in Body is indicative of Serious Disease within the Body like Heart attack, Renal Stone Colic, Appendicitis & Stab Injury.

• ƒSEVERE PAIN ƒ
• PALLOR &
• WHITENESS of SKIN
• NAUSEA & VOMITING
• ƒSWEATING ƒ
• FEVER ƒ
• HIGH PULSE RATE ƒ
• SHOCK & LOW BP

Treat with a) Pain Relief b) Arresting Bleeding c) Treatment of Shock Pain Relief is with Fortwin (Morphine) Injections, causes Vomiting, treat with anti emetic.

Bad Signs of Abdominal Injury

• Severe Pain
• Patient Immobile
• Hard Board Abdomen ƒ
• Nausea, Vomiting, Sweating, Fever ƒ
• Blood in Vomit or Stool or Urine. ƒ
• Shock ƒ
• No passage of Stools & Gas in 24 hours

TREATMENT – NIL BY MOUTH, IV FLUIDS

Bad Signs of Chest Injury

• ƒ Severe Pain, ƒ
• Patient Immobile ƒ
• Shallow Breaths ƒ
• Nausea, Vomiting, Sweating, Fever
• Shock
• No movement of Chest during breathing on one or both sides of chest

ƒCoughing out Blood TREATMENT – NIL BY MOUTH, IV FLUIDS

Bad Signs of Head Injury

Within 24 hours after Injury LOOK for ƒ

• HEADACHE
• VOMITING
• DOUBLE VISION
• ƒUNCONSCIOUSNESS
• FITS

Treatment for HEAD INJURY – There may be internal bleeding and Emergency Hospitalization is needed.

Diagnosis of Fracture

• ƒSevere Pain as below ƒ
• Irregularity of bony surface ƒ
• Deformity may be present / absent ƒ
• Swelling will come in a few hours ƒ
• Immobility of Affected part ƒ
• Unnatural movement may be elicited with Crepitus

Signs of Internal Bleeding

In Internal Bleeding, the Blood may make its appearance via ƒ

• COUGH – Hemoptysis ‘Red Stained Frothing’ ƒ
• VOMIT – Hemetemesis ‘Cofee color’ ƒ
• URINE – Hematuria ‘Bloody Urine’
• ƒSTOOL – Dysentry ‘Bloody Stool’ ƒ
• SKIN – Echymosis ‘Blood under Skin’ ƒ
• A falling BP, rising HR (Pulse), Unconsciousness & Urine Output less than 300ml/24hrs are Danger Signals (SHOCK)

Shock

ƒCauses: Dehydration or Water Loss via

• Vomiting
• Diarrhoea
• Bleeding
• Sweating
• Heat Stroke ƒ

Diagnosis: Low BP (less than 80 systolic), Altered Consciousness / Confusion, Cold Pale Hands, Feet & Face, No Urine for 12 hours

Treatment:

• Give Head Low by raising feet ƒ
• Warm extremities ƒ
• Give Water & Electrolytes ƒ
• Blood Transfusion may be needed

First Aid Principles

• DIAGNOSIS
• Clear AIRWAY
• LIFE SUPPORT – CPR ƒ
• Arrest BLEEDING ƒ
• Treat SHOCK – Circulation ƒ
• Treat TRAUMA Wounds & Fractures ƒ
• Treat PAIN ƒ
• DISPOSE – To Hospital, Clinic or Home

FIRST AID for UNARMED COMBAT

1. Incident Approach

a. To the patient – ignore initially and don’t sympathize
b. To the crowd – disperse
c. To yourself – Be calm because your vibration goes to the patient

2. Bruise (Heamatoma)

Apply pressure to reduce heamatoma

3. Abrasion & Superficial Open Wound

• Arrest Bleeding
  • Apply Pressure with Cloth
  • Apply more Pressure
  • Raise the part
  • Forcep Clamp bleeding points
  • Suture ends to arrest bleeding
  • Electro cautery burning (in the hospital)
  • Tie Tourniquet above wound with Rubber band / hanky
  • Release every 20 mins for 3 min
• Scrub roughly with Savlon / soap & water (saline)
• Clean with Hydrogen Peroxide for O2-to displace dirt & foreign body
• Clean with spirit –to remove the oily grit
• Disinfect the surrounding skin with Betadine
• Apply sterile gauze with Soframycin cream
• For limbs- tie roller bandage(mobile parts)
• For trunk & head –dress with sticking tape on the gauze
• DOC (Drug Of Choice): TETANUS TOXOID Injection
• DOC (Drug Of Choice): Oral Antibiotics to treat INFECTION

4. Head Injury

a. Examine for CLW (Contused lacerated wound) requiring sutures.
b. Apply compression to reduce heamatoma.
c. Make sit (to reduce BP to the head)
d. Test for concussion – Disorientation of TSP

5. Nose Injury

a. Stop bleeding – Pinch tip
b. Apply Anterior nasal pack with Adrenaline
c. Examine for continuity of nasal bridge for possible fracture

6. (Black Eye) Injury

a. Apply ice compresses
b. Check for cuts and bleeds in Eyelids & conjuctiva.
c. Check for equality of pupils with torch.
d. Check for Vision Loss after sometime.

7. Solar Plexus Impact (diaphragm punch)

a. Reduce movements of diaphragm by making him touch his toes
b. Vomiting is a bad sign

8. Groin Impact

a. Check for displaced testes in position from inguinal canal to the scrotum
b. Restore position by making him lie prone & deep breathe
c. Pain goes in about 5 mins. If severe pain persists, torsion testes has to be considered.

9. Vasovagal Attack (Fainting)

Occurs in weak individuals on empty stomach
a. Lie down 10 mins
b. Elevate feet to raise BP
c. Give oral Glucose & Salt

10. Injury Management

a. Arrest bleeding.
b. Remove Foreign Body
c. Clean Wound
d. Approximate edges
e. Change / dressing every 48 hrs.

11. Shin Injury hairline fracture

a. Examine for continuity
b. Apply pressure.

12. Finger Twist/ Dislocation

a. Give Traction (Pull) with minimal force in a straight line to realign
b. Splint with next finger with tape
c. Tape across the joint affected.

13. Wrist Sprain

a. Give flexion position for relaxing injured ligament
b. Strap with crepe

14. Ankle Sprain

a. Give flexion position for relaxing injured ligament
b. Strap with crepe bandage

15. Knee Sprain

a. Use Ice compresses
b. Give flexion position for relaxing injured ligament
c. Put knee cap
d. Give Anti Inflammatory Tabs- Ibuprofen 400mg
e. Advice bed rest for 1-2 days

16. Bleeding / Hemorrhage Management – First Aid

a. Pressure
b. Elevation
c. Torniquet / Press the Pressure points

17. Cardio Fatigue – Outwinding

a. Stop activity
b. Squatting to kink veins of legs and reduce venous return to heart in order to rest it
c. Deep breathing near an open window to recover breath

18. Hysteria

a. Ignore
b. Threaten (to Hospitalize)
c. Give pungent irritants to smell (Ammonia, Onion)

19. Fracture Forearm

If Open fracture – treat like open wound, Hospital needed
If Closed – a) Traction b) Splint c) Plaster
POP technique – Dip in water & roll
Healing: Young man – 3 months & Older man – 6 months
a. Ice compress
b. Check continuity
c. Splint with 2 Foot Rulers
d. Strap with Crepe bandage
e. String around neck with Roller bandage

20. Shoulder Sprain

a. Sling around neck with Roller bandage

21. Toe Nail Avulsions

a. Use Pressure
b. Cut overhanging nail
c. Clean and Tape it up

22. Avulsion of tooth

a. Wash with clean water gently ( without scraping)
b. Place tooth back into bleeding socket
c. Press and hold the tooth for 30 mins (till clot forms)

23. Treatment of Pain

TREATMENT OF SEVERE PAIN MILD – Local Anesthetic Ointment, Brandy, Pain Balms
MODERATE – Oral Pain Anti inflammatory Drugs / Brufen Tabs
SEVERE – Pain Killing Injections
LIFE THREATENING – Intravenous Opiods Injections
Remember Pain can also be suppressed by Psychological Determination

24. CPR – Cardio Pulmonary Resuscitation

In short, this involves following steps
i. Ascertain the heart has stopped by confirming lack of pulse & heart beat and loss of breathing & consciousness. CPR is not indicated in “Chest Pains & Heart Attacks” where patient is conscious. CPR is indicated only within the first few minutes after Cardiac arrest, before brain death.
ii. Check & Clear blocked airway if any
iii. Give mouth to mouth breaths
iv. Thump the chest, followed by external cardiac massage
v. Continue for few minutes till consciousness, pulse & breathing restores.

25. Immediate Diagnosis of death

a. No consciousness
b. No Pulse, Heartbeat & BP
c. No Breathing
d. Cold & Pale Limbs
e. No Pupillary Reflex
f. No reaction to Painful stimulus
g. No effect of CPR