This may be a life-threatening emergency and every second is precious. In choking, a thing (food bolus or any foreign body like marble etc.) that the child has put into his mouth sometimes may go into the windpipe. As a result there is a partial or complete obstruction of the windpipe and the child is deprived of Oxygen.
The usual history is that the child will have an excessive bout of coughing in an attempt to expel the foreign body out, failing which the colour of the lips and tongue of the child may turn blue. In most cases, the child is able to eject the foreign body out and usually no intervention is required. But if the child is having breathing problems and the colour turns blue or ashen; it is a very serious emergency. There are certain don’ts that the parents should never attempt.
• Never attempt a blind finger sweep of the throat of the child in an attempt to remove the foreign body. Your finger may push the object even downwards and may convert a partial obstruction of the windpipe into a complete one.
• The following manoeuvre (described in detail below) should be undertaken only if the child is showing no breathing and is aphasic (i.e. cannot bring any sound from his throat or in other words cannot vocalise at all). Under no circumstance should it be tried if the child is having some respiratory efforts. If you try it in a child who is having some breathing of his oivn you may dislodge the foreign body and convert a partial obstruction into a complete one, with fatal results.
It is different in children under 1 year and those above 1-year.
Child less than one year: Give 4 blows on the back of the child followed by 4 blows to the front of the child’s chest. The blows are given with the heel of the hand. The child is positioned face downwards on the rescuer’s arm, so that the face is lower than the rest of the body. After giving these blows, the child’s mouth shoidd be opened and the back of the throat examined for any foreign body.
If visualised it can be removed by forceps or even by a “scoop” of the finger (remember here you are able to visualise the object and therefore it is not blind finger sweeping, which as mentioned above is contra indicated). In case the object is not visualised, then the rescuer should give artificial respiration to the child (described below) and then repeat the same sequence of events.
Back blows and chest thrusts to relieve foreign-body airway obstruction in the infant.
Child more than one year: In this case, instead of chest thrusts, abdominal thrusts are used. The child is made to lie down on his back with the head end lower than the rest of the body. The heel of one hand is kept on the abdomen between the navel and the end of the breastbone. The heel of the other hand is placed on top of the first hand and a thrust is given in an upward and inward direction. 6 rapid thrusts are recommended after which the mouth is visualised as stated above. If the object is not seen, artificial respiration is given and the sequence is repeated. Abdominal thrusts can also be given in a standing position with the rescuer standing behind the victim.
The best way to give artificial respiration-is mouth to mouth. The patient is made to lie down on a flat surface. Firstly the rescuer should position himself at the head end of the patient and do what is called “jaw thrust”. In this, the rescuer puts both his thumbs below the angle of the jaws, and then lifts both the jaws forward by applying steady pressure in an upward direction. (Chin lift and head tilt is another way of making the airway patent). Once this is done, the rescuer comes to the side of the patient and with one hand pinches the nose of the patient tightly shut.
With the thumb of the other hand on the chin of the patient, he opens the mouth of the patient slightly. After this he puts his own mouth over the patient’s mouth so as to completely make an air tight seal. Then he blows air into the patient’s mouth. His eyes should be looking at the patient’s chest and as he blows in air, the patient’s chest should rise as it does in normal breathing. If it doesn’t rise, either the pressure that the rescuer is using in blowing the air is less or the seal between the lips is not air tight; as a result of which air is escaping from there rather than going into the patient’s lungs.
Once the chest rises, the rescuer should terminate his blowing in of the air and open the nose of the patient by taking his hand off it. The patient will passively exhale as can be judged by the downward movement of the risen chest wall. Once this is accomplished, the rescuer should again seal the nose of the patient and blow in the air. There is no need to take the mouth off the patient’s mouth, because then the rescuer will have to make an air tight seal between the lips again.
The rate of artificial respiration should be 30 breaths/min for a child and 20 breaths/minute for an adult. Artificial respiration (i.e. mouth to mouth) is also of prime importance in a nearly drowned patient or in one who has suffocated due to inhalation of some noxious fumes, smoke etc.
These things require practical training and parents keen on learning artificial respiration and other life saving measures should enrol themselves in courses on these.
FIRST AID IN CUTS AND BRUISES
Children suffer, off and on, from minor scratches, abrasions, bruises etc. These usually are minor. If the wound is having dirt, parents should clean it with soap and water and then apply some antiseptic like dettol, betadine, spirit etc. followed by sterile dressing. In dirty wounds, risk of contracting tetanus is there and therefore the child should be taken to a doctor; who will give a shot of tetanus toxoid, unless the child has been fully immunised against it.
Sometimes wounds may be big, lacerated or gaping in nature and bleed a lot, causing anxiety in the parent’s minds. Actually it is quite simple to control bleeding. The golden principle is use of pressure. Put clean cotton, handkerchief or any piece of clean cloth over the bleeding source and tightly compress it with your hands. Sometimes the cloth you have put may get soaked right through and blood may start oozing from it also. There is no need to panic. Over the soaked cloth, put another clean cloth and again apply firm and steady pressure over it.
Never remove the soaked cloth and replace it with another cloth. Instead go on layering one piece of cloth over the other. Keep the pressure maintained for at least 8-10 minutes before you ease it to see whether the bleeding has stopped; i.e. the soakage of the cloth by blood has decreased to a great extent. Even if the bleeding has stopped, don’t remove the cloth covering over the wound. Instead take the patient to the nearest medical centre.
The only first aid required is to minimise motion of the fractured parts to lessen the excruciating pain. Splinting the fractured part does this. A splint can be anything, which is stiff. Usually the most common material used is a piece of broad wood. The splint should ideally be also supporting the joints before and the joint after the fracture, in addition to the fractured site. For example in a suspected fracture of the forearm, the splint should extend beyond the wrist (i.e. the joint before) and the elbow (i.e. the joint after the fractured part).
Don’t try to manipulate the bones or “straighten” them or “fix” them. Instead put the splint parallel to the fractured part and then wrap both the fractured part and the splint together with clothes. For practical purposes, even three handkerchiefs, one each tied around the two ends and one in the middle will suffice. During transport to the hospital take care that the fractured part is kept as motionless as possible and not jostled too much.
In any case of a trauma patient, while handling the patient, take great care that you don’t 1) extend or flex his neck 2) the spine i.e. the backbone should not undergo any motion (flexion, extension or rotation). In other words, the patient should be lifted by at least 4 persons in the same state that he was lying on the ground, particularly avoiding any motion of the neck or backbone relative to the rest of the body-Otherwise it can lead to an injury or severing of the spinal cord and result in paralysis.