The same article is also available in Nepali and Hindi
Life is beautiful. But we never know when it gets interrupted by emergencies and accidents. Most accidents and poisoning occur when the child becomes curious about the environment and are able to reach for objects, from around 1 year to 5 years.
Accidents decline after 5 years when the child becomes aware of the surroundings and harmful household items. Intentional poisoning and accidents occur in teenagers when they try dangerous experiences. This article is about first-aid for five common emergencies fits/seizures, drowning, poisoning, snake bite and choking.
Witnessing a child having any of the following emergencies can be terrifying, but it is essential to remain calm. I suggest you read “what to do always?” in the “injuries and accidents” article again, as same principles need to be followed in the emergencies below.
In all the following emergencies, the victim needs to be taken to the hospital, immediately after the first aid. Although this article is mainly for children, the treatment principles are similar for adults.
First aid for fits/seizures
How do you know it is a fit?
Fits can occur in many forms like staring episodes or involuntary movement of the arms and legs. The child will be unconscious and will not respond to anyone. During the episode, they may pee or poop as well.
What to do if your child has fits?
- Ask for help. Use the phone if no one is around
- To prevent injuries, place the child on the floor or ground.
- To prevent him/her from choking, lay the child on the side. If he vomits, remove it gently with a finger
- If you have midazolam spray (nidcip, nayzilam etc.), you should spray it once into either nostril if the seizure does not stop in around 3 mins
- Do not give water or food to the child even after the fit until he gets his normal consciousness
- If it does not delay treatment, you should record or ask someone to record the video of the event to show to a doctor. Many abnormal movements are often mistaken for fits and they are mistakenly treated with anti-fits drugs with no effect.
Drowning again occurs in two age groups. Toddlers get drowned in bathrooms in buckets (yes they get drowned by even half a bucket water if their head dips into it!) or tubs when left unsupervised. Another high-risk age for drowning is teenagers. They get drowned in swimming pools and rivers.
Notify a lifeguard, if available. If you are alone, follow the steps of cardiopulmonary resuscitation (CPR) below.
1. Take the person out of water
2. Check for breathing by placing your ear next to the person’s mouth and nose. Do you feel the air on your cheek or the chest is moving? (seen best through this position). If the person is not breathing, check pulse for 10 seconds. If there is no pulse, start CPR.
3.To start CPR, carefully place the person with the back on a hard surface4. For an adult or child, place one hand on top of the other interlocking the digits. The heel of one hand should rest on the center of the chest at the nipple line. For an infant (a child less than 1 year), place two fingers on the breastbone.
5. For an adult or child press down at least 2 inches. For an infant, press down 1 inch. Make sure not to press on the end of the breastbone or ribs. Give chest compressions at 100-120 per minute. Let the chest rise completely between pushes.
6. Check to see if the person has started breathing after completing 2 minutes. Repeat if the victim Is still not breathing.
7. Pinch the nose of the victim to close it. Take a normal breath, cover the victim’s mouth with yours to create an airtight seal, and then give 2 one-second breaths as you watch for the chest rise
8.Give 2 breaths followed by 30 chest compressions. Continue this cycle of 30 compressions and 2 breaths until the person starts breathing or emergency help arrives. In children. In less than 15 years, when two rescuers are available the cycle is 15:2. In adults, in all scenarios and in children when only one rescuer is there, the cycle is 30:2. (in the age less than 15, and 2 rescuers are there, the ratio is 15:2).
9.If you are not confident of following the steps above, remember that any attempt of CPR is better than no CPR.
10. If you are unwilling to put your mouth into the victim’s mouth do compressions alone.
11. In movies they try to remove water by pressing into the abdomen, this is ineffective and wastes valuable time. The water entered in the lungs is the problem, not that in the stomach.
First aid for fainting
If you feel like fainting
- Lie down or sit down. To reduce the chance of fainting again, don’t get up too soon (lay down at least for 5 mins)
- Place your head between your knees if you sit down.
If you witness someone else (or a child) fainting
- Position the child on his or her back. If there are no injuries and the child is breathing, raise the person’s legs above the heart level by about 1 feet. Loosen belts, collars and other tight clothing.
- To reduce the chance of fainting again, keep the child lying down for at least 5 mins. If the person doesn’t regain consciousness within one minute, call and get help from your local emergency number.
- Check for breathing. If the person isn’t breathing, begin CPR as explained above. Continue CPR until help arrives or the person begins to breathe or help arrives.
- If the child has history of fainting in the past, take the child to be evaluated by a doctor on the next possible day.
Children usually get poisoned with household items like kerosene, camphor, nephthalene balls, detergents, rat killer poison or medicines. Always keep these items away from the reach of children.
When to suspect if a child is poisoned?
If the child has “sudden onset” vomiting, drowsiness, unresponsiveness or fits. Note that I have highlighted sudden onset as the key feature of all accidents, animal bites and poisoning is sudden onset symptoms in a previously healthy child.
What to do?
Take to the hospital immediately. If the agent is visible on the skin sometimes poisoning occurs by absorption through skin. It is a good practice to take the poisoning agent to the hospital to show to the doctor.
What not to do?
Most of the household treatment methods like attempting to vomit are ineffective and potentially dangerous. If the poisonous agent is visible In the mouth, the parents may attempt to remove it. Attempt to vomit out detergents, kerosene, camphor, naphthalene balls may corrode food pipe (esophagus).
First aid for snake bite
What to do?
Keep calm, anxiety increases the heart rate and hence poison circulation. The first aid can be remembered by mnemonic RIG.
R-Reassure the patient or child. Around 85% of the bites are by non-poisonous snakes and in the remaining 50%, the snake fails to inject the venom. Remove shoes, shocks, jewelry.
I – Immobilise the bitten limb. Any movement of the limb causes venom circulate faster. Anything can be used to immobilize like stick, umbrella, cricket bat. Use bandage or cloth to tie whole limb to the immobilizing object firmly (like a fractured limb). Do not use rope or ligatures. Venom goes to the heart through veins. Then it circulates to different organs. Firm bandaging is enough to occlude veins which are just beneath skin.
A tight ligature c blocks the blood supply to the bitten limb which can cause severe limb damage which can even results in amputation of the limb. Keep the bitten limb below the level of the heart while transport.
G- Go to the hospital immediately. Take the patient by a vehicle or if not available, carry him or her. If however you are the victim and are alone, walk slowly. Do not run or walk briskly.
What not to do?
Most of the treatments people use (and popular in movies) lie sucking out venom, burning the limb, electric shock, cutting at the wound are ineffective and are potentially harmful.
- Walk at night with knee length sturdy footwear (gumboot) and use a torch! Wear boots, full-sleeved shirts, and pants. When walking, walk with a heavy step as snakes can detect vibration and will move away!
- Carry a stick when grass cutting or picking fruit or vegetables or clearing the base of trees. Use the stick to move the grass or leaves first. Give the snake a chance to move away. If collecting grass that has previously been cut and placed in a pile, disturb the grass with the stick before picking the grass up.
- Keep animal feed and rubbish away from your house. They attract rats and snakes will follow.
- Avoid sleeping on the ground.
- Keep plants away from your doors and windows. Snakes like cover and plants help them climb up and into windows.
- While walking through forests stay on marked tracks.
Choking (foreign body inhalation)
Toddlers are again prone to foreign body aspiration and choking. Foreign bodies include anything smaller than the child’s mouth like coins, nails, peanuts, safety pins. The best way to prevent these accidents is not to give anything to the child to play which is smaller than his mouth and keep them away from the toddler’s reach.
1. If the object is visible in the mouth, attempt to remove it by a finger sweep. If it is not visible, do not try to remove it. as doing so may push the object further in.
2. If the person is able to cough forcefully, he must be allowed to continue coughing. If the person is choking and cannot talk or you must deliver the first aid.
3. In adults and children > 1 year, wrap your arms around the waist. · Make a fist with one hand and position it slightly above the person’s navel.
4. Grasp the fist with the other hand. Press hard into the abdomen with a quick, upward thrust — as if trying to lift the person up. Perform 5 abdominal thrusts and check in victim’s mouth. Continue the above process until the blockage is dislodged.
5. In children < 1 year (infants), Put the baby face down on your forearm so the baby’s head is lower than his or her chest. Support the baby’s head in your palm, against your thigh. Use the heel of one hand to give up to 5 back slaps between the baby’s shoulder blades.
6. If the object does not pop out, support the baby’s head and turn him or her face up on your thigh. Keep the baby’s head lower than his or her body. Place 2 or 3 fingers just below the nipple line on the baby’s breastbone and give 5 quick chest thrusts (Keep giving 5 back slaps and 5 chest thrusts until the object comes out
7. If the person who has inhaled an object becomes unconscious, lay the person on his or her back on the ground, perform CPR. If the object becomes visible in the mouth, reach a finger in and sweep it out. If the object remains stuck or it is not visible, continue CPR till he becomes conscious or help arrives. In most Indian states the phone number for emergency ambulance service is 108 or 111.
The following are the links for the books on first-aid in infants and children