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Paediatric First Aid

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PaediatricFirst AidDavid Olley

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AED 13Anaphylaxis 31Asthma 26Bites and Stings 45BLS Child 8BLS Infant 10Bleeding 24Burn Injury 37Care of the Child 2Care Principles 4Choking 16Croup 36Diabetes 35Drowning 20Electric Shock 21Eye Injury 49Febrile Convulsions 34First Aid Kit 50Fractures 39Head Injury 42Internal Bleeding 25Meningitis 28Recovery Position 15Seizure 33Shock 22Skull Fracture 40Spinal Injury 41                                3rd EditionThis handbook is ideal for use insupport of a properly structured rstaid course. It will also prove invaluableas ongoing reference for someonewho has completed the course.PaediatricContents

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First AidPaediatric First aid is, quite simply, the initial treatment given to a baby or childwho suers injury or sudden illness.If the injury or illness is minor then it may be the only help that the child receives orneeds. If the condition is more serious then rst aid may be given until the child ishanded over to a better qualied person or medical practitioner, who could be aparamedic or doctor.The basic principle of rst aid is to keep the child alive, to prevent their conditionfrom deteriorating and to hand them over in the best possible condition in thecircumstances.The Paediatric First Aider should possess the following skills, and be able to:▪ deal with conditions which are immediately or potentially life-threatening.▪ provide rst aid for conditions which may not be life-threatening but will requiretreatment to prevent further harm, before the emergency medical services arrive▪ provide rst aid response in cases where injuries are minor and the treatmentmay be all the child requires▪ provide reassurance to the patient as well as other children in the vicinity▪ record all actions and interventions and pass this information on when handingover to better qualied persons▪ be aware of the location and contents of emergency rst aid kits▪ be aware of the need for and competent in, raising the alarm or callingemergency services in a timely manner▪ Make themselves aware of any pre-existing conditions suered by children in theircare▪ display the personal skills needed, including composure, competence and self-condence, while understanding their limitations▪ be prepared to do what is necessary to maintain their knowledge and skills to therequired level▪ work only within the scope of their training and competence.▪ A neonate is birth to one month▪ An infant is one month to one year▪ A child is one year to puberty.If you are unsure whether a child may have reached puberty, treat them as an adult.Denition2Paediatric First Aid

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Thankfully, when caring for children it is rare to have to give rstaid for anything other than trivial accidents or injuries. However,on occasions accidents may occur or children may become illand you may be called upon to oer rst aid or even medicaltreatments.It is therefore very important that you plan for these events.You will need to develop your own emergency plan whichmeets your specic requirements. The plan should cov-er all situations that might occur when you have chil-dren in your care.The Emergency PlanPoints to consider▪ Access to a telephone, with a backup should the telephone be out of action.▪ The services of someone to care for the remaining children whilst you deal withthe emergency.▪ Access to the following telephone numbers for you or someone else who mayneed to take action in an emergency:▪ Access to children’s individual record forms to take to hospital with the child orfor someone else to use to contact the parents.▪ First aid kit. This should be properly labeled and quick and easy for others tond.▪ Have you completed an appropriate rst aid course and do you have theknowledge and skills to react appropriately in an emergency?▪ Are parents aware of your emergency plan and what to expect if there is anemergency?▪ Are they aware of what would be expected of them?○ child’s parents (home and work numbers)○ child’s doctor and your own doctor.○ local health centre and local hospital.○ emergency backup person.3Paediatric First Aid

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1. Ensure the safety of yourself, other responders/practitioners, yourpatients and the public:consider all environmental factors and approach a scene only when it is safe to doso.identify potential and actual hazards and take the necessary precautions.request assistance as required.ensure the scene is as safe as is practicable.take standard infection control precautions.2. Identify and manage life-threatening conditions:locate all patients – if the number of patients is greater than available resources,ensure additional resources are sought.assess the patient’s condition appropriately.prioritise and manage the most life-threatening conditions rst.provide a situation report to Ambulance Control Centre (112/999)3. Ensure adequate Airway, Breathing and Circulation.4. Control all external haemorrhage.5. Monitor and record patient’s vital observations.6. Identify and manage other conditions.7. Place the patient in the appropriate posture8. Ensure the maintenance of normal body temperature.9. Provide reassurance at all times.Care Principles4Paediatric First Aid

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Injuries that require rst-aid may result from dangerous occurrences. The problemsthat caused the accident may persist and oer a threat to rst aiders andsubsequent rescuers.It is vital that the rst-aider is aware of this when attending an accident scene.First aiders should not knowingly place themselves in a dangerous situation.You cannot help the casualty if you become a casualty yourself.As you approach the scene, look for threats to your own safety.These may be obvious threats, such as moving trac, re or unstable structures orthey may be much less obvious such as escaping gas or electricity. It is essentialthat you use all of your senses to alert you to danger and remember that althoughit may be safe to approach now, things can change quickly so remain alert andcontinue to monitor the situation.Personal and scene safetyOnce you have ensured that it is safe then you need to assess the situation from arst-aid point of view. You will need to know:▪ How many patients there are.▪ Their current condition.▪ Will you need assistance and is assistance available?▪ Will you need equipment and is it available?▪ What resources are available to call for help?▪ Do any patients that appear in imminent danger of death?▪ What or who are your priorities?▪ Can you perform appropriate rst-aid until the arrival of emergency medicalservices?Scene assessmentAssessment of the patient’s condition is usually performed in two parts▪ The primary survey▪ The secondary surveyThe primary survey is conducted to nd and simultaneously treat conditions thatare potentially life-threatening.The secondary survey should take place only after the primary survey and whenyou are sure that any life threatening conditions have been treated eectively. Theobjective of the second reassessment is to nd and, where appropriate, treat otherconditions in order of priority.Patient assessment5Paediatric First Aid

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Approach withcare▪ Be aware of potential danger to yourself, bystanders or thechild.▪ Think about infection control procedures,Assess response▪ Do they open their eyes to speech?▪ Do they open their eyes to a gentle movement or a tap?▪ If unresponsive, shout for help and request an AED if one isavailable.Open the airway▪ Check that their airway is clear and open.▪ If necessary, open the airway with head tilt/chin lift.▪ Consider possible cervical spine injury.If the airway isobstructed▪ Take measures to clear the airway.Check for normalbreathing▪ If unresponsive and not breathing normally start CPR.▪ If unresponsive and breathing normally, place them carefullyInto the recovery position and continue to monitor theircondition.▪ Conduct secondary survey and treat serious injury ifappropriate.Check for seriousbleeding or bloodloss▪ Control serious bleeding with direct pressure.▪ Use elevation if injuries permit.▪ Apply a wound dressing if available.▪ Look for and be prepared to treat, blood loss shock.Maintain care▪ Ensure professional help has been called.▪ Continue to monitor their condition.▪ Reassure them continuously.▪ Perform rst aid procedures as necessary.▪ Hand over to an appropriate practitioner.Primary surveyThe steps for primary survey can be remembered by using D.R.A.B.C.DANGER – RESPONSE – AIRWAY – BREATHING – CIRCULATIONSecondary surveyThe secondary survey is undertaken to discover the extent of the child’s injuries orillness, or to assess the eectiveness of treatment given during the primary survey.There are three elements to the secondary survey:▪ History / Mechanism Of Injury (M.O.I.)▪ Signs▪ Symptoms6Assessment

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Examining the casualty just means looking carefully at them. It is important thatthe casualty is examined for signs of obvious injury, and for their general appearanceand demeanour. The results of the examination put together with the history and thesymptoms described by the casualty are often enough to suggest what might be wrongwith them and also to suggest an appropriate course of action.Bleeding▪ Have a good look at the child from top to bottom looking for obvious signs of bleeding.▪ Look for signs of hidden bleeding such as bruising or swelling.▪ Pale cold skin or signs of shock?▪ Have they got blood on their clothing?▪ Control any serious bleeding as a priority.Head and neck▪ Are there any signs of injury to the head such as lumps, bruising or bleeding?▪ Swelling or bruising around the eyes?▪ Blood, or pale coloured liquid leaking from the ears or nose?▪ Does the accident suggest a neck injury? If so assume it.Torso and limbs▪ Are there any obvious signs of injury?▪ Does the casualty seem to have trouble breathing?▪ Do they experience pain on breathing or coughing?▪ Does the history of the incident suggest a blow or crushing injury to the torso?▪ Are their arms and legs the correct shape and pointing in the right direction?▪ Are they showing signs of bleeding or shock with no obvious external bleeding?Secondary survey - Cont.The unresponsive childAny child or baby who is unconscious is in danger, due to the threat of a blockedairway. The airway could become blocked by food, blood, saliva, vomit or theirOwn tongue. You can judge the level of response by using the AVPU scale.AAlertAwake with eyes open. Reacts normally if you speak to them or touchthem.VVerbalMay appear asleep but will open their eyes to the sound of your voice.PPainAppears asleep with eyes closed. Will only respond to touch ormovement.UUnresponsiveAppears asleep with eyes closed. They do not open their eyes to anystimulusAny child with a level other than “A” will require emergency medical help.7Assessment

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Approach with CAREIf they RESPOND▪ If the child responds by opening their eyes, speaking or trying to move:▪ keep them in the position that you nd them.▪ Check for other injuries and treat any conditions that are immediately life threat-ening.▪ Send for help or raise the alarm.▪ Continue to monitor their condition until the arrival of trained help.Make sure that there is no danger to yourself, the child or bystanders.Check for RESPONSE▪ Speak loudly to them, ask them to open their eyes.▪ Gently stimulate them by tapping them on the shoulder.▪ Never forcefully shake the child.▪ Watch their face for signs of eye opening ormovement.If there is NO RESPONSE▪ If someone is nearby, ask them to bring an AED▪ If you are alone, shout for help loudly to try to attract attention, but do not leavethem.Open the AIRWAY▪ Place one hand on their forehead and press gentlydownward.▪ Place the tips of the ngers under the bony part ofthe jaw to lift and support the chin.▪ Rotate the head gently backward.Check for NORMAL BREATHINGKneel next to them, with your cheek over their nose andmouth looking down the chest towards the toes.▪ Look – for chest movement.▪ Listen – for breath sounds.▪ Feel – for breath on the cheek.▪ Take no more than 10 seconds to check.8Basic Life Support

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If they are BREATHING NORMALLY▪ Treat any immediately life-threatening injury.▪ Turn them into the recovery position as soon as it ispractical to do so.▪ Continue to monitor until the arrival of help.If they are NOT BREATHING NORMALLY▪ Give ve rescue breathsEnsure that the airway isopen (head tilt – chin lift)Be careful not to overextend the neckPinch the soft part ofthe nose with the indexnger and thumb of thehand which is pressingon the forehead.Take a breath and place yourlips around their mouth,ensuring that you have agood seal. Blow steadily intotheir mouth for about onesecond, until you see thechest rise.Lift your head away whilst maintaining head tilt – chin lift and allow the air to come outof their mouth.Airway obstructionIf you have diculty achieving an eective breath it probably means that the airway isobstructed.▪ Re-check their mouth and remove any obvious obstruction▪ Make sure the head is tilted and the jaw is lifted properly.▪ Make sure you are making a good seal around the mouth.▪ Repeat up to ve attempts to give eective inations.▪ If unsuccessful move on to chest compressions.Start CHEST COMPRESSIONS▪ The objective of chest compression is to use the child’s own heart as a mechanicalpump.▪ as you compress it blood is forced out, when pressure is released the elastic natureof the heart means that blood is drawn back into it.▪ The child should be on a rm at surface for chest compressions to be fully eective.9Basic Life Support

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Place the heel of one hand over thelower third of the child’s breastbone.Lift the ngers to ensure that you donot press on the ribs.▪ In larger children or with small rescuers this may be done with both hands, as inadult chest compression.▪ Repeat at a rate of 120 compressions a minute.▪ Give 30 eective chest compressions.Position yourself with your shoul-der over the chest and with yourarm straight.Push vertically downward withenough force to compress thechest by one third of its depth.Combine CHEST COMPRESSION and RESCUE BREATHING▪ After 30 chest compressions stop and give two more rescue breaths.▪ Alternate 30 compressions with two rescue breaths.▪ If there is no response after one minute, and nobody has called for help, stop anddial 999 for an ambulance.▪ When you know that help is coming, continue with rescue breathing/chestcompressions at a ratio of 30 to 2 until help arrives and someone takes over.▪ If there is more than one rescuer present, change over every two minutes.▪ Try to keep the chest compressions at a regular speed and depth.▪ Keep pauses or stoppages as short as possibleApproach with CARE▪ Make sure that there is no danger to yourself, the baby or bystanders.Check for RESPONSE▪ Gently stimulate the baby by speaking loudly to themand by moving a limb or tapping them on the foot.▪ Never shake a baby!Basic Life Support - Infant10Basic Life Support

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If they RESPONDIf the baby responds by opening their eyes or trying to move:▪ keep them in the position that you found them.▪ check for other injuries and treat any conditions that are immediatelylife-threatening.▪ send for help or raise the alarm.▪ continue to monitor their condition until the arrival of trained help.If there is NO RESPONSE▪ Shout “HELP” and start A.B.C.Open the AIRWAYPlace one hand on the baby’s fore-head and press gently downward torotate the head backward.Place the tip of one nger under thebony part of the jaw to lift and sup-port the chin.Be careful not to over extend theneck.The nished position should be withthe baby’s eyes pointing straight up-ward.Check BREATHINGPlace your ear closely over the noseand mouth of the baby.Look down the chest towards the toes.Look for movement of the chest or abdo-men.Listen for breath sounds.Feel for breath on the cheek. Take nomore than 10 seconds to check.11Basic Life Support

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CHEST COMPRESSIONS - infant▪ Place the tips of two ngers over the lowerthird of the baby’s breastbone.▪ Press down on the breastbone to a depth ofone third of the depth of the baby’s chest.▪ Release the pressure keeping your ngersin contact with the baby’s chest.▪ Give 30 compressions at a speed of 120compressions a minute.Give 30 chest compressions▪ After 30 chest compressions deliver 2 rescue breaths▪ Take a breath and place your lips around the baby’snose and mouth ensuring that you have a good seal.▪ Blow out gently into the baby’s mouth untilyou see the chest rise.▪ Lift your head away from the baby while maintaininghead tilt – chin lift. and allow the air to come out ofthe baby’s mouth.▪ Repeat this sequence.Combine CHEST COMPRESSIONS with RESCUE BREATHINGCombine rescue breathing with chestcompressions at a ratio of 30 chestcompressions to 2 rescue breaths.Maintain CPR until:▪ The baby shows signs of recovery.▪ The AED arrives▪ Someone else takes overWhen to go for HELP▪ It is vital to raise the alarm as soon as possible.▪ If there is more than one rescuer, one should start CPR whilst the other goes forhelp.▪ If you are on your own, perform CPR at 30: 2 for two minutes before going forhelp.12Basic Life Support

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Thankfully it is rare to have to use an AED on a child. Their use however can belife-saving in some circumstances. Standard AEDs are suitable for use on childrenolder than eight years and the rescuer should use the same procedures and tech-niques as for adults. Special paediatric pads that reduce the power delivered areavailable and should be used if possible. On some AEDs there is a switch for loweringthe power output paediatric levels If not, then using adult pads is better than doingnothing.When the AED arrivesOne person should continue with CPR whilst another prepares theAED for use and attaches the pads. In older children, where the chestarea is large enough, the pads can be attached with the one pad overthe upper right chest and the otherpad below the left armpit on the sideof the chest. For very small children orinfants then one pad should beplaced centrally on the front of thebaby’s chest and the other pad placedon the back, between the shoulderblades.Debrillation and childrenOnce the pads are attached, stop CPR and allow the AED to analyse.Do not touch the child whilst the machine is analysing.AnalyseCheck electrodesIf “check electrodes” indicated then check pads are properly xed and making goodcontact with the chest wall.No shock indicatedIf no shock is indicated then restart CPR and continue for two minutes.Listen to and follow the voice prompts.Shock indicatedIf shock is indicated then ensure no one else is touching the child.Press the ashing shock button until the shock is delivered.Allow the machine to analyse.Listen to and follow voice prompts.13Basic Life Support

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AEDAnalysesrhythmNO shock advisedResume CPRFor 2 minutesResume CPRFor 2 minutesContinue until they startTo breathe normallyGive one shockShock advisedAED summary14Basic Life Support

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The aim of the recovery position is to maintain the airway by placing the child in aposition on their side, with the head lower than the chest. This allows the tongue to fallforward and allows drainage of blood, saliva or stomach contents from the mouth, bygravity.▪ Before attempting to move them make sure that there is nothing in the immediatearea which may be dangerous.▪ Have a good look at them checking for obvious injuries, these may not preventyou from moving them but they may modify the way it is done.▪ Remove their spectacles if worn and any sharp or bulky items from their pockets.▪ Kneel beside them.▪ Open their airway with head tilt/chin lift.The Recovery PositionTake the arm nearest toyou and place it at rightangles to the body withthe elbow bent and thepalm of the hand upper-most.Bring the furthest armacross the chest and placethe back of the handagainst their nearestcheek, holding it there withyour hand.The Recovery PositionWith your other hand,grasp the furthest leg justabove the knee and pull itup, bending the knee butkeeping the foot on theoor.Keeping the child’s handagainst their cheek, pull onthe leg to roll them to-wards you onto their side.Adjust the upper leg sothat hip and knee formright angles.Tilt the head back andopen the airway.Adjust the hand underthe chin to keep theirhead tilted back.15The Recovery Position

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The majority of choking events occur whilstthe child is eating or playing, often when acarer is present. If these events are witnessed,treatment is usually carried out quickly whilstthe child is still conscious.When a child chokes the immediate responseis coughing. This is likely to be the mosteective and safest way of removing theobstruction. If coughing is not eectivehowever, or the foreign body completely obstructs the airway, treatment needs to beimmediate.You might suspect choking on a foreign body if:▪ the child develops very sudden breathing problems.▪ there are no other signs of illness or other obvious explanation.▪ the child was playing with small objects or eating immediately prior to the event.Airway ObstructionChoking - general signsEective cough▪ Loud cough.▪ Able to speak or cry.▪ Able to breathe before coughing.▪ Fully conscious.Ineective cough▪ Silent or quiet cough.▪ Unable to speak or cry.▪ Unable to breathe.▪ Decreasing level of consciousness.▪ Blue colouration (cyanosis).Eective cough - treatmentIf the child is coughing you do not need to do anything. The cough is the best way toclear the airway so encourage them to cough and monitor their condition continuously.If the cough becomes non-eective, start treatment to clear the airway.Back blows▪ Bend them forward.▪ Support them with your other hand.▪ Give ve rm blows between the shoulder blades.▪ Check the mouth and remove any foreign objects.▪ If the back blows don’t work give ve abdominal thrusts.Ineective cough - treatment16Foreign Body Airway Obstruction

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Abdominal thrusts▪ Stand behind them and place a st over the upper abdomenbeneath the rib cage.▪ Grasp the st with your other hand and pull sharply upwardand inward, up to ve times.▪ Check the mouth and remove any foreign objects.▪ If this is unsuccessful, revert to back blows and repeat thecycle.▪ If the airway is still not clear call an ambulance and continuewith the cycle▪ Of ve back blows and ve abdominal thrusts until theambulance arrives or the airway is cleared.Ineective cough - unconscious child▪ Place them on a rm at surface.▪ Call or send for help if possible, but do not leave the child.▪ Open the mouth and look for any obvious foreign object.▪ If you see one, attempt to remove it.▪ Attempt to give ve rescue breaths (make ve attempts ifnecessary).▪ Give thirty chest compressions.▪ Re-check the mouth and remove any object which hasbeen dislodged.▪ Give two rescue breaths.▪ Repeat the cycle for one minute.If unsuccessful:▪ call an ambulance▪ continue the cycle of 30 compressions to 2 breaths untilthe ambulance arrives17Foreign Body Airway Obstruction

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Ineective cough - conscious infant▪ Give ve back blows▪ Lay the baby face down along the thigh, supporting the head withthe hand.▪ Make sure the head is lower than the body.▪ Give up to ve blows in the middle of the baby’s back,using the heel of the other hand.▪ If the obstruction is relieved it is not necessary togive all ve blows.▪ Check the baby’s mouth and remove any foreignmaterial found.▪ If back blows are unsuccessful, give ve chest thrusts▪ Turn the baby over onto their back.▪ Feel for the breastbone with two ngers and place thengertips about a ngers width above the point where theribs meet.▪ Give up to ve sharp downward thrusts, similar to chestcompressions but sharper and at a slower rate.▪ Check the baby’s mouth for any foreign objects, whichshould be removed.▪ If necessary repeat the sequence of back blows andchest thrusts three times and if still unsuccessful take the baby with you to thetelephone and call an ambulance.Ineective cough - unconscious infant▪ Place them on a rm at surface. Call or send for help ifpossible, but do not leave the baby.▪ Open the mouth and look for any obvious foreign object.▪ If you see one attempt to remove it.▪ Attempt to give up to ve rescue breaths.▪ Assess the eectiveness of each breath, if the breathdoes not make the chest rise re-position the head beforeattempting the next breath.If the chest does not rise:▪ Immediately start chest compressions combined withrescue breathing at a ratio of thirty compressionsfollowed by two breaths.▪ When opening the airway to give rescue breaths checkthe mouth for obstructions and remove them ifpossible.▪ Repeat the cycle for one minute.▪ If still unsuccessful, call an ambulance.18Foreign Body Airway Obstruction

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Airway obstruction - summary of actions                             Drowning is a signicant cause of death and disability in children, second only toaccidental injury. At least one third of survivors are likely to suer from moderateto severe brain damage.Drowning is usually dened as death from asphyxia within 24 hours of submersionin water. Near drowning refers to survival (even if temporary) beyond 24 hours aftera submersion episode.In immersion injury, time is critical. The temperature of the water may also make adierence. Immersion in cold water (water temp less than 20 deg. C.) will often havea better outcome than immersion in warm water.Drowning may also be due to other factors such as a simple faint or possibly aseizure and may hide other conditions such as hypothermia.Whatever the cause the treatment should follow the three ‘R’sRecognitionRescueResuscitationDrowning and near drowning19Foreign Body Airway Obstruction

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Drowning awarenessChildren love to play in and around water but can getinto trouble frighteningly quickly. A child can drown in aslittle as 20 seconds and in just a few inches of water insuch things as paddling pools, puddles or even baths,buckets or toilet bowls. For this reason children shouldnever be left unattended or unobserved around water orin bathrooms.A drowning child may be unable to shout for help so look out for:▪ waving arms▪ head tilted back with the mouth open▪ oating face down in the waterAlthough the temptation to jump in after a drowning child is very strong, unless youknow the water is shallow or not dangerous to you it should be resisted. It will notbenet the child if you become a victim, particularly if you are the only potentialrescuer.▪ Shout to alert bystanders and get them to call the emergency services or callthem yourself.▪ If possible, lay down at the edge and try to reach, or use something like a stickor belt to extend your reach.▪ If the child is conscious try to throw something buoyant to them.▪ If you have to enter the water try to wade rather than swim and where possibletake a buoyancy aid with you.▪ If carrying them from the water try to keep them horizontal or even slightly headdown to keep them from inhaling water.Immersion - rescueImmersion - treatmentImmediately upon rescue check to see if they are conscious and breathing.If they are conscious make sure that they are kept warm andmonitor their condition.If they are unconscious but breathing place them into therecovery position to avoid inhalation of water.If they are unconscious and not breathing start CPR with 5breaths and maintain it at 30:2 for one minute before going forhelp.Following immersion in cold water it can be dicult to tell ifthey are breathing normally or not, they will have all of theappearances of death. If in doubt start CPR and maintain it until you are relieved.All accidental immersion victims need medical attention, even though they seem tohave made a good recovery or been unaected. They may have inhaled smallamounts of water and this can lead to a very serious breathing problem up to 24 hrslater, avoidance is better than cure.20Immersion Injury

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Children may suer electric shock from playing with orpoking things into unguarded electrical sockets, or evenfrom biting into electrical leads. Electrical injury mayvary in severity from minor thermal burns to deepserious burn injury, multiple organ failure, unconscious-ness and death.Electricity also poses a risk to the rescuer as well asto the victim.Do not attempt to touch the child until the source of theelectricity has been disconnected. This may be achievedby switching o or unplugging the appliance (make surethat it is the correct switch or plug, in the heat of themoment it is easy to make mistakes).If the child has suered a shock from very high voltageequipment found outside, do not approach them untilyou have been informed by a responsible person thatthe power supply has been switched o. High voltageelectricity can jump a gap of at least ten feet so you don’teven have to touch it.What you should always do is dial 999/112 for an ambulance.Remember, you can not help the child if you have been electrocuted.Electric shock - treatmentUnconsciousness – if the child is unconscious:see pages 7-8Not breathing – if the child is not breathing: see pages 8-12No heartbeat – if the heart is not beating: see pages 9-13Other injuriesThe force of the electric shock may cause the child to be thrown some distance andthey may suer injuries to the head, spine or other parts of the body as a result.Sometimes the muscle spasm caused by the electricity may be so strong that it pullson the bones hard enough to break them.Keep the child in the position found until the arrival of medical help.BurnsIf the child has suered burns see the general treatment on page 46, butremember that all electrical burns, even small ones, require urgent medicalattention.Electric shock21Electrical Injury

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Shock is a condition which results from the failure of the circulation to supply oxygenand nutrients to the tissues and to remove waste products from them.Shock in children is potentially fatal and probably the most important element ofrst-aid is early recognition and appropriate medical treatment.Circulatory ShockCausesFluid loss:following injury such as bleeding wounds, burns or broken bones, the level of uidcirculating in the system may becomerapidly reduced. This means that the remaininguid will not be circulated as eectively and will not be able to carry sucientquantities of oxygen to the tissues.Other causes of uid loss could include persistent diarrhoea and vomiting.Anaphylaxis:Anaphylaxis is a generalised acute or sudden allergic reaction which may aect partor all of the body. An eect of anaphylaxis is that blood vessels become relaxed andleaky so blood can leak out of the vessels into surrounding tissues, leading to lesseective circulation.Within the circulation a pump (the heart) delivers nutrients and oxygen dissolved inliquid (the blood) via a network of delivery pipes (the blood vessels) to the body’stissues. If there is a breakdown in any part of the system, shock can result.Heart problems:Thankfully, most children don’t suer from heart problems or disease. Some childrenhowever may have been born with a heart defect or may have acquired a defect. Ifthe pump is not working adequately the circulation may fail.Sepsis:Sepsis is a very serious and important cause of shock in children. It is a condition ofoverwhelming generalised infection that can cause damage to blood vessels, organsor other tissues. It may follow a specic infection, such as a wound infectionfollowingaccident or even surgery or it may stem from a specic infection such as tonsillitisor a respiratory tract infection. Sepsis can interfere with all three mechanisms.The most important aspect of sepsis and septic shock is early recognition.Sepsis recognitionLethargic or dicult to wakePale mottled skin, cold to touch.Rapid shallow breathingPossible seizureA rash or purple blotches that do not fade under pressure.Sepsis treatmentIf you have any reason to suspect a child may be suering from sepsis orseptic shock, call 999 immediately and insist on transfer to hospital as anemergency.22Circulatory Shock

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Shock - recognition▪ Appropriate history (cause).▪ Pale cold clammy skin.▪ Cyanosis (mottled appearance toarms and legs)▪ Listless or weak, but may beagitated.▪ Rapid weak pulse.▪ Rapid shallow breathing.▪ Cold and shivering.▪ Thirst or dry mouth.▪ Confused or disorientated.▪ Yawning & sighing.▪ May not have passed urine forsome time.Shock - treatment▪ Treat the cause where possible.▪ Give lots of reassurance.▪ Lay them down and elevate theirlegs, if their injuries permit.▪ Loosen tight clothing at the neckand waist.▪ Keep them warm but do notapply any heat source such as hotwater bottles.▪ Give nothing to eat or drink butmoisten their lips if theycomplain of thirst.An important indicator of shock in children is the amount oftime it takes for blood to rell blood vessels, after it hasbeen squeezed out.To measure it squeeze the child’s nger or press on theirarm or leg for a few seconds.The area you are pressing on will go white as the blood issqueezed out of the small blood vessels, or capillaries.When you release the pressure the area should go back toa normal colour as the capillaries rell. This should take lessthan three seconds. If it takes longer, this would mean thechild’s circulation is not functioning eectively and that theywill need emergency medical attention urgently.Delayed capillary rellDial 999/112 for urgent medical attention.23Circulatory Shock

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This is the easiest to see and the easiest to treat.Blood will be visible, owing from a wound on thesurface of the body.Bleeding and Blood LossWhen we discuss blood loss we are actually referring to blood lost from thecirculatory system. We may therefore be talking about internal or external bleeding.External bleedingExternal bleeding - treatmentDirect pressure: this is pressure which is applied directly over the bleeding point.It may be applied over a pad of absorbent materialor directly by the ngers or thumbs. The aim ofdirect pressure is to slow down the ow of bloodsuciently and for long enough to allow the for-mation of a blood clot. Blood clotting takes placein 5 to 10 minutes in normal circumstances andfor this reason pressure should be maintained forat least 10 minutes to be condent that clottinghas taken place. The most common reason for thefailure of direct pressure to work is the temptationto lift the dressing to check on progress every fewminutes. As soon as it becomes available a clean dry dressing should be applied tothe wound and held in place by a bandage, applied tightly enough to apply pressureto the wound but not so tightly as to interferewith the circulation of the blood below the band-age.Elevation: to reinforce the eect of pressure,wherever possible the aected limb should beelevated above the level of the heart to reduceblood ow, paying due consideration to otherinjuries.Minor wounds▪ Wash carefully with clean water▪ Dry thoroughly▪ Apply a clean dry dressing▪ Make a record24Bleeding and Blood Loss

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▪ Select a dressing of an appropriate size for the wound.▪ Handle the dressing by the bandage, do not touch the face of the dressing, to keepit clean.▪ Tie the dressing rmly in place by knotting the two ends.▪ If blood soaks through the dressing apply another dressing on top of the rst.▪ If blood soaks through the second dressing remove both and re-apply a newdressing, making sure that pressure is applied directly over the wound.Internal bleeding occurs when blood is lost from theblood vessels but retained within the body, usuallywithin one of the body cavities such as the skull, thorax,abdomen and large muscles. It may follow injury such asa blow. a fractured bone or penetrating wound or it maybe as a result of illness.Internal bleeding may remain concealed or maysubsequently become revealed by visible bloodappearing from one of the body openings such as themouth, nose, ears or rectum.Internal BleedingInternal bleeding - recognition▪ History, may include history of violentinjury or medical condition.▪ Pain and tenderness over the aectedarea.▪ Bruising or discolouration over theaected area.▪ The appearance of blood at one ofthe body openings.▪ Signs and symptoms of blood lossshock with no obvious bleedingInternal bleeding - treatment▪ Assess the situation and deal withimmediate danger.▪ Assess the level of consciousness andtreat appropriately.▪ Lay them down with limbs elevated.▪ Reassure them and keep them calm.▪ Keep them warm and loosen any tightclothing.▪ Give nothing by mouth.▪ Get medical help as a matter ofurgency.25Bleeding and Blood Loss

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Asthma is a condition that aects the lungs. It is the most common chronic chest diseasein children.In an acute asthma attack the tiny airpipes which carry air to the air sacs in thelungs, become narrow due to inamma-tion of the lining and muscle spasm of thewall of the pipe.This leads to diculties in passing airthrough the pipe, causing a feeling atightness in the chest and diculty inbreathing, particularly in breathing out. Asthe air is forced through the narrow pipesit causes a whistling sound and this whis-tling or wheezing is quite characteristic.Most asthma suerers will have been diagnosed by their doctors and will be receivingtreatment in the form of drugs which suppress the con-dition (avoidance) and drugs which relax the spasm ofthe air pipes (treatment)These drugs are usually given in the form of an inhaleror puer which squirts a mist of drug into the mouth,which is then inhaled into the lungsAsthma - recognition▪ Known history of the disease.▪ Severe respiratory distress.▪ Noisy whistling or wheezing breathing,particularly on breathing out.▪ Coughing.▪ Cyanosis or a blue tinge to the skin.▪ Anxiety and distress.AsthmaticbronchioleNormalbronchioleAsthma - treatment▪ Place them at rest in a sitting position, leaning slightly forward.▪ Reassure them continuously.▪ Encourage them to use their own medication as appropriate.▪ If the inhaler does not work quickly, repeat the dose.▪ If it still does not work or if the attack is more severe than normal call an ambulanceor take the child to an accident and emergency department.Asthma26Medical Conditions

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Asthma - medicationIf a patient is having an acute attack they require a drug whichwill relax their spasm. This will be in a blue inhaler.Children over the age of about eight years will be able touse a normal inhaler but this requires careful timingbetween the release of the drug and breathing in.Using an inhaler▪ Remove the cap from the mouthpiece and shake theinhaler▪ If you haven’t used the inhaler for a while make onespray into the air to make sure it is working▪ Take a few breaths and then breathe out▪ Immediately place the mouthpiece in the mouthbetween the teeth and make a seal around it with yourlips▪ Start to breathe in slowly and deeply through the mouthand at the same time press down on the inhaler canisterto deliver a dose of medicine▪ Continue to breathe in to make sure the medicine getsright into the lungs▪ Try to hold your breath for 5 to 10 seconds and then breatheout slowly.Young children may nd it easier to use a spacer.This is a hollow plastic cylinder into which the drug is squirted. The childcan then breathe it in when they are ready.▪ Push the mouthpiece of the inhaler into theend of the spacer▪ Breathe out and put the mouthpiece of thespacer into the mouth between the teeth▪ Make a good seal around the mouthpiece withthe lips▪ Press the metered dose inhaler down once torelease a spray of medicine▪ The spray will be trapped in the spacer▪ Breathe in slowly and deeply to draw themedicine into the lungs.▪ Hold your breath for 5 to 10 seconds and thenbreathe out slowly.Asthma - using a spacer27Medical Conditions

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MeningitisMeningitis is inammation of the membranes which cover the brain. It can be causedby many things such as bacteria, viruses or fungi.Some bacteria that cause meningitis may also get into the bloodstream and causeblood poisoning (septicaemia) this is most often seen with meningococcal meningitis,causing meningococcal septicaemia. The time between being exposed to the bacteriaand the appearance of the disease (incubation period) is usually 2 to 10 days. Theincubation period for viral meningitis is up to 3 weeks. Once established the conditionmay progress very rapidly and may become life-threatening in just a few hours.Anyone suspected of having meningitis requires urgent medical attention.Recognition of meningitis can be dicult in the early stages as it can mimic theappearance of u. The following signs do not appear in any particular order. Somemay not appear at all.Signs - infantsBabies and the very young are at the highest risk for meningitis andmeningococcal septicaemia. Know the signs and symptoms and trust your instincts.Unusual cry, Fever with coldhands and feetPale blotchyskin/rash.Refusing foodand vomiting.Fretful, dislike ofbeing handled.Tense bulgingfontanelleDrowsy, oppy,unresponsiveConvulsions orseizures.Neck stiness,dislike of brightRapid breathingor grunting.The signs and symptoms of meningitis can appear in any order and some maynot appear at all, so do not wait until you see all of the signs and symptoms.28Medical Conditions

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Severe musclepainFever with coldhands and feetSevereheadachePale blotchyskin.Refusing foodand vomiting.Drowsy, dicultto wake.Sti neck. Confusion andirritability.Dislike of brightlights.Convulsions orseizuresSigns - older childrenOlder children and teenagers are the second highest risk group for meningitis andmeningococcal septicaemia.Meningitis / septicaemiaAnyone suering from septicaemia may displayall of these signs, but in addition may develop adistinctive rash. This may start anywhere on thebody as a cluster of small red spots, like pinpricks.Left untreated the rash will spread and thepinpricks may join together to form purpleblotches.To decide whether a rash may be due tosepticaemia, press the side of a cleardrinking glass against the skin.Most rashes will fade under pressure buta septicaemic rash does not fade whenyou press on it.29Medical Conditions

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Meningitis rst aidThere is very little that rst aid can do to help meningitis.By far the most important thing is recognising it early and getting medicalattention as soon as possible.The problem is that it can be dicult to recognise in the early stages. It starts in asimilar way to colds or u but the casualty’s condition can deteriorate very rapidly.The best advice is to be suspicious and follow your instincts.If you suspect meningitis do not wait to see if other signs and symptoms occur, getmedical attention immediately.Tell the doctor/hospital/ambulance controller that you suspect meningitis and beprepared to stand your ground and demand attention.The signs and symptoms of meningitis can appear in any order and some may notappear at all so do not wait until you see all of the signs and symptoms.▪ Trust your instincts.▪ Dial 999/112 for an ambulance or, if appropriate, take the childimmediately to the nearest accident and emergency department.▪ Do not take no for an answer.30Medical Conditions

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Anaphylaxis - triggersChildren can be allergic to many things.Food: especially nuts, sh or shellsh and many kinds offruit such as strawberries, bananas, kiwi fruit and eventomatoes or potatoes.Medicines: particularly antibiotics such as penicillin.Insects: particularly bees and wasps, where these cause problems ina part of the body which has not been stung. If you just get a largeswelling at the site of the sting, this is probably not anaphylaxis.AnaphylaxisAnaphylaxis is a serious and rapid allergic reaction, often involving more than onepart of the body.Anaphylaxis - recognition▪ Faintness or loss of consciousness, due to avery low or sudden drop in blood pressure▪ Swelling of the face and neck and of the throat,that may cause problems in swallowing andbreathing.▪ Asthma symptoms.▪ Vomiting / stomach cramps / diarrhoea.▪ Tingling in the mouth and lips, particularly if thecause was food.▪ Sudden collapse due to airway obstruction orto the sudden drop in blood pressure (anaphylactic shock).▪ An itchy rash like a nettle rash, sometimes called hives.Not everyone who suers an anaphylactic reaction will have all of these signs andsymptoms and the reaction can vary from very mild to very severe and may happenwithin seconds or could take an hour or more. It is probably safest to assume thatanyone who has an anaphylactic reaction is in danger and to treat them all as serious.It can be dicult to tell if the child is having an anaphylactic reaction or if it is someother problem such as fainting, as they can be similar in the early stages. Anyonewho feels faint with swelling or a rash starting quickly is probably having ananaphylactic reaction and should be treated for it.31Medical Conditions

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There is only one treatment which is eectivein all cases of anaphylaxis, regardless of causeand that is adrenaline (sometimes called epine-phrine) given by injection. In severe reactions itis vital that the suerer has an injection ofadrenaline as soon as possible, as the earlier itis used the more eective it is likely to be.As giving injections is not a normal part of rstaid this may not be available to you, howeverbecause this injected adrenaline is so importantin anaphylaxis, children who have a history of severe reactions will often carry aspecial injection device known as an EpiPen or Jext injector which is preloaded witha single dose of adrenaline and delivers the injection automatically.Anaphylaxis - treatmentThis is available to parents, teachers and other responsible adults to administer to thechild in an emergency and so could be available to child carers. Before using it anagreement must be reached between the child’s carer, the child’s parents and the child’sdoctor concerning the circumstances in which the injector would be used, how it wouldbe used and what appropriate training should be given.In a life threatening emergency anyone may administer the injection by following theinstructions on the pen.If adrenaline is not available or while you are waiting for it, the following rst aidprocedures should be carried out:Position the childIf the child is tired or feels faint lay them down. If they do not feel faint but their faceor throat is swelling, sit them up to help breathing and to avoid making the swellingworse. If they feel faint and their throat is swelling decide which is worse and treataccordingly. If they are sleepy or become unconscious, put them into the recoveryposition.Dial 999/112 for an ambulanceAn ambulance paramedic will be able to inject adrenaline as well as to give oxygen andother important treatments. They will also ensure rapid and safe transport to hospital.Be prepared to oer life supportRemember the ABC of basic life support and be prepared to act accordingly.32Medical Conditions

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Be suspicious of cardiac arrest in any patient presenting with seizure and carefullyassess their breathing following the seizure. Be prepared to oer life support asappropriateCall an ambulance if:▪ You know it is their rst seizure▪ The seizure lasts for more than ve minutes▪ They are injured during the seizure▪ You believe they need urgent medical attention▪ They have repeated seizures▪ You know they have diabetes or they are pregnantDo▪ Protect them from injury (remove or cushion dangerous objects)▪ Cushion or protect the head▪ Time the seizure, if it lasts for more than ve minutes call an ambulance.▪ When the movement stops, protect their airway with the recovery position.▪ Stay with them until they are fully recovered▪ Remain calm and reassuringDon’t▪ Attempt to restrain them or stop them from moving.▪ Try to move them unless they are in danger▪ Put anything in their mouth▪ Attempt to wake them up or bring them round▪ Give them anything to eat or drink until they are fully recovered.A seizure is caused by an abnormal electrical disturbance in the brain.It can cause changes in body movement or function, sensation, awareness or behaviourand can last from just a few seconds to a condition which will not stop.Seizure – Recognition▪ Possible known history of seizures.▪ They may appear uneasy or nervous immediately prior to the t.▪ They may fall to the ground with a loud cry.▪ Breath holding or irregular breathing.▪ Cyanosis / congestion of the face.▪ Muscle rigidity, followed by uncontrolled movements of limbs and trunk.▪ Sometimes the lips or tongue may be bitten and there may be ecks of foam orblood on the lips.Seizure / epilepsy33Medical Conditions

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Febrile convulsionsSometimes very young children may have ts if theirtemperature becomes too high, usually over 39°C.These are called febrile convulsions and often happenat the start of an infectious illness such as u. They arelikely to aect children in the age range of six months tove years.Febrile convulsions - recognition▪ The child will lose consciousness.▪ The body, legs and arms will go sti.▪ The legs and arms start to jerk and thehead may be thrown back.▪ The skin may be pale or even appear blue.▪ The convulsion lasts for a few minutes andgradually subsides.▪ The child will be limp at rst and thennormal colour and consciousness returns.Febrile convulsions - treatment▪ Treat as for a seizure.▪ Let the convulsion follow it’s course, whilst protecting the child from injury orharm.▪ Place the unconscious child in therecovery position.▪ If the seizure is prolonged or thechild suers repeated seizures, dial999 or 112 for an ambulance.▪ Always consult the child’s doctorfollowing a seizure.▪ You can help to lower the child’stemperature by removing excessclothing or bed clothing and openingwindows. It is not recommended to spongethe child’s skin with cold water as this maylower the temperature too quickly.34Medical Conditions

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DiabetesDiabetes is a condition where the child can not produce enough of the hormoneinsulin to regulate the sugar levels in the blood. It may start slowly with the changeshappening over several weeks.Diabetes - recognition▪ Thirst▪ Weight loss▪ Frequent urination▪ Tiredness▪ Headaches▪ Tummy painsDiabetes - ongoing careIf the child has been diagnosed they will almost always be treated with insulin givenby injection. The amount will be carefully worked out by their doctor or hospitalteam. Most small children will need frequent doses of fast acting insulin, olderchildren may use a continuous insulin pump.The important thing in treating diabetes is to keep the sugar level in the bloodstable, not too high or too low. If the levels are too high the child may experiencethe symptoms above, but if the levels drop too low it can have a much more suddeneect that can become rapidly life-threatening if not treated. This is called hypogly-caemia or hypo for short. It happens when the child has their insulin but doesn’t eatenough sugar to balance the eect. It can also happen if the child burns up a lot ofsugar with exercise.Signs of hypoglycaemia▪ Pallor.▪ Dizziness or shaking.▪ A feeling of weakness or hunger.▪ Irritability or even aggression.▪ Rapid heartbeat.▪ Confusion.▪ Convulsions.▪ Loss of consciousness.Hypoglycaemia - treatmentIf you suspect that the child may be suering from a low blood sugar, give themsugar immediately. This can be in the form of glucose sweets or tablets or sweetenedjuice or soft drinks (a can of normal soft drink contains around six teaspoons ofsugar). If the child becomes very sleepy or unconscious an ambulance should becalled.The ambulance paramedic may give glucose by injection into a vein or may injectGlucagon, a hormone that stimulates the production of glucose. A serious hyposhould be treated in hospital.35Medical Conditions

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CroupCroup refers to a group of conditions whichinvolve inammation of the upper airwayand lead to a harsh “barking” cough.Croup is usually caused by a viral infectionbut may be caused by bacteria or even anallergic reaction. It most commonly aectschildren between three months and veyears old and tends to be most severe inthose under three years old. It is mostcommon in the autumn and winter.Croup - recognitionThe condition often starts like a cold with astuy or runny nose and a slightly raisedtemperature. As the condition develops, thechild’s voice may become hoarse and they may start to cough with thecharacteristic sharp barking sound. The condition becomes dangerous when theupper airway becomes swollen to the point where it is dicult for the child tobreathe.Signs of severe croupCroup - treatmentTreatment is generally to relieve the symptoms. Breathing in moist air or steamis often suggested to relieve the symptoms but has not been shown to be eective.If the child’s condition appears to be worsening they will require hospitalisationalthough most cases remain fairly mild.Sit the child in a comfortable position to aid breathing and reassure. Refer tomedical attention if their condition is getting worse.▪ Distressed or rapid breathing▪ Excessive movement of the belly▪ when breathing▪ The skin between the ribs beingsucked inward when breathing in▪ Noisy rasping breathing (stridor)▪ Pale grey or blueish tinge,particularly around the mouth▪ Diculty in swallowing or drooling▪ Inactivity / looks ill▪ Condition appears to be getting▪ worse36Medical Conditions

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Burns and scalds are a major cause of serious injury in children up to fourteen yearsold. Children under four years of age are at most risk, especially those aged betweenone and two years. Children burn very easily because their skin is very thin and fragileScaldsScalds are burns caused by hot liquidsor steam. Any hot substances can scalda child, in fact everyday items cause themost scalds. These will include hotdrinks such as cups of tea and coee,hot tap water, bath water, hot cookingoil, hot food, saucepans of hot liquid,steam and vapour.A severe scald can inict serious injuryand may mean a long stay in hospital. It may also require painful skin grafts andyears of treatment and can result in permanent scarring.A severe scald over a large skin area can kill.Be very aware of the temperature of water coming from a hot water tap. Most scaldsto small children happen in the bathroom and result from hot water tap tempera-ture being too high. The average temperature of domestic hot water is 70°C. Amuch safer temperature for domestic hot water is 50°C. This is because water thatis at a lower temperature takes longer to cause injury.▪ At 60°C it takes one second for hot water to cause serious burns▪ At 55°C it takes ten seconds▪ At 50°C it takes ve minutes to cause serious burnsRemember that the maximum bathing temperature recommended for youngchildren is 37-38°C so cold water should be run into the bath rst and then mixedwith water from the hot tap to bring it up to a safe temperature.Caused by hot bath water▪ keep hot drinks and cup handles outof reach.▪ keep hot drinks away from the edgeof the table or bench.▪ never carry hot drinks whilst childrenare playing underfoot.▪ give toddlers their own special mugso that they don’t drink from an adultmug or cup that may contain liquidthat is too hot.▪ it is safer to serve cold drinks whenchildren are present and to have yourtea break when toddlers are sleeping.Burns and ScaldsOther measures to reduce the risk may include:37Burn Injury

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Do not:▪ burst blisters.▪ use fats, ointments or creams on a burn.▪ use adhesive dressings or tapes.▪ touch the burn.▪ cough or sneeze on the burn.▪ remove anything which is stuck to the burn.Do:▪ Deal with the source of the heat.▪ Cool the burn with clean cool water or other bland liquid for at least 10minutes.▪ Remove constrictions around the burn before swelling becomes a problem.▪ Cover with a clean dry non-uy dressing. Clinglm or polythene is ideal.Get medical attention for:▪ anything other than a very minor burn.▪ any electrical injury.▪ any chemical burn.▪ anything you are concerned about.38Burn Injury

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Greenstick fracture▪ Because children’s bones aresofter and more pliable thanadults, they tend to bend ratherthan break.▪ Sometimes part of the bonebreaks.▪ This incomplete fracture isknown as a greenstick fracturebecause it breaks like agreen branch or twig.▪ The general treatment for fractures is to avoid any further damage by keepingthem still.Suspected fracture - recognition▪ Deformity.▪ Pain at the site.▪ Tenderness at the site.▪ Swelling and bruising.▪ May be unable or unwilling tomove the aected part.Suspected fracture - treatment▪ Move the child as little as possible.▪ Keep the aected part in the position that you nd it.▪ Stop the bleeding and cover any open wounds.▪ Do not apply splints or bandages to the aected part.▪ Use soft material such as pillows or folded clothing to support the injury.▪ Any injury other than minor injuries to the hand or arm would require anambulance.▪ Be prepared to anticipate and treat shockSuspected Fracture39Fractures

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Skull fractureThe skull is a bony box that contains andprotects the brain.It is a strong rigid structure and it usuallyrequires signicant force to break it.Given this amount of force applied to thehead, there may well be other injury,particularly to the brain, or possibly to theneck.Fractures to the skull are most often causedby direct force or violence, such as a blow to the head or striking the head againsta solid object. The fracture may be pushed inward or depressed, like the shell of anegg.Children will most commonly suer this type of injury when running around andplaying. They may suer a fall and bang their head or possibly fall o a fence orfrom a tree.▪ Deformity, possibly a lump or dent.▪ Bruising or swelling on the head▪ Headache▪ Confusion or disorientation▪ Dizziness▪ Nausea or vomiting▪ Loss of consciousness▪ Clear uid or blood running from thenose or ears▪ Bruising around the eyes (panda eyes)Skull fracture - recognition▪ Assess and monitor their level of consciousness.▪ Carefully maintain an open airway if necessary.▪ Immobilise the head and neck.▪ If they are conscious and cooperative, tell them to keep still.▪ If they are unconscious and have breathing diculties or if they appear tovomit, then place them carefully into the recovery position.▪ Be prepared to oer life support as appropriate.Skull fracture - treatment40Fractures

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Spinal injuryFractures of the spine in themselves may befairly moderate injuries. They become majorproblems if an injury to the spinal cord isinvolved and in any injury to the spine thiscannot be discounted.Damage to the spinal cord may aect allthose parts of the body below the site of theinjury, so obviously the higher on the spineinjury occurs the more potentiallydangerous it is for the casualty.This is a condition where inappropriatehandling could turn a small injury into amajor problem.Do not rely on looking at or pressing on thecasualty’s spine looking for abnormal-ities. Most rst aiders are not skilledenough to detect or discount, spinal injury.If the nature of the incident suggests the possibility of a spinal fractureassume it to be the case and treat accordingly.Spinal cordinjuryVertabralfracture▪ History of violence▪ Blow to the spine or fall from height▪ Head injury▪ Pain at the site▪ Numbness, pins and needles orburning sensation in arms and legs▪ Lack of movement or uncontrolledmovement below the injury site▪ Loss of bowel or bladder controlSpinal fracture - recognition▪ Dial 999/112 for an ambulance▪ Keep them in the position found▪ Try to stabilise the neck and spine▪ Reassure them continuously▪ Ask them to keep still and not toattempt to move▪ Stabilise the next rst▪ Immobilise by supporting the head,trunk and legs▪ Be prepared to place them into therecovery position if they have aproblem maintaining their airway orthey start to vomit▪ Roles like a solid log▪ Avoid twisting or bendingSpinal fracture - treatmentDo not move them unless it is to save or preserve their life.41Fractures

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Head InjuryHead injuries can be divided into two types:▪ Concussion.▪ Compression.Both types of injury can result from a blow to the head or from sudden violentmovement.ConcussionUsually results from a blow to the head orviolent movement that causes the brain tobe shaken and to be damaged by contactwith the inside of the skull.Concussion - recognitionThe eects may be immediate or may occur later. They may include:▪ Brief unconsciousness▪ Mild to moderate headache▪ Drowsiness, dizziness, or loss of balance▪ Nausea or vomiting▪ Change in mood (restless, sad, or irritable)▪ Trouble thinking, remembering things, or concentrating▪ Ringing in the ears▪ Short-term loss of newly learned skills, such as toilet training▪ Changes in sleeping patternThe eects are usually of short duration and the child will almost always make a goodrecovery, but any child that is or has been unconscious must be seen by a medicalprofessional as soon as possible.Concussion - treatment▪ Assess consciousness, if unconscious check ABC.▪ Dial 999/112 for an ambulance.▪ Oer life support as appropriate.▪ Place a breathing unconscious casualty into the recovery position.▪ Continue to monitor vital signs.▪ Most concussion victims make a rapid and full recovery with the only treatmentrequired being rest and observation.42Head Injury

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Occurs due to swelling or bleedinginside the skull, following a blow to thehead or violent movement such asshaking. This causes an increase inpressure within the skull leading topressure being applied to the brain andlocalised brain damage. Over time thepressure rise will also prevent the heartfrom supplying blood to the rest of thebrain.Compression injury - recognitionCompression injuries are usually slow to become apparent. The child mayappear ne immediately after the incident but their condition may worsen overthe next few hours. The eects may include:▪ headache, getting worse over time.▪ skin is dry and warm.▪ child looks ushed.▪ deep sighing breathing.▪ pulse is slow and strong.▪ pupils may look unequal.▪ decreasing level of awareness.▪ unconsciousness.CompressionCompression injury - treatment▪ Assess consciousness.▪ Give life support as appropriate.▪ Dial 999/112 for an ambulance.▪ If conscious, place in a half sitting position was head and shoulders raised.▪ Support the neck.▪ If unconscious, place in the recovery position.▪ Continue to monitor their condition and vital signs.Compression injury may not become a problem for several days after the event soit is vital that any child who suered a head injury of any type is monitoredcarefully over this period and medical attention is sought urgently if there is anyreason to suspect an ongoing problem.Blood ClotBrain injuryPressure onbrain43Head Injury

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A poison is any substance which has a bad eect on the person exposed to it.The eect could be anything from a skin rash to a headache to sudden death.Most children are poisoned by swallowing poison substances such as plantmaterial from the garden, other people’s tablets and medicines or cleaningmaterials.Depending upon the type of poison it may have to be absorbed from the digestivesystem and will then have its eect on dierent parts of the body (systemicpoison) or it may burn the mouth and throat (corrosive poison)Another way for poison to enter the child’s body would be absorption through theskin following an accidental spillage, although this would be rare.Corrosive poisons▪ The major threat is from burns to the mouth and the airway.▪ Wipe or wash any residual chemical from the face and mouth.▪ Give frequent sips of water, milk or other bland liquid to wash the chemicalfrom the mouth.▪ Do not make the child vomit as the chemical may burn on the way up.▪ Call a doctor and tell them what chemical is involved so that they can advise onappropriate treatmentIf the child becomes unconscious▪ Call an ambulance.▪ Check ABC.▪ Be prepared to oer life support.▪ Place a breathing child in the recovery position.PoisonsSystemic poisonsThese may include tablets and medicines, alcohol or plant material such astoadstools or laburnum seeds.There may be a short delay between swallowing the poison and the start ofsymptoms as the poison is absorbed from the digestive system. Try to get asmuch information as possible about what has been swallowed, how much andhow long ago. Try to obtain containers, bottles or samples of the poison.Call a doctor or ambulance and pass on this information so that they can adviseon the correct course of action.If they become unconscious:▪ call an ambulance.▪ check ABC.▪ be prepared to oer life support.▪ place a breathing child in the recovery position.44Poisons

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Absorbed poisonsMay result from spilling chemicals on the skin. If you suspect an accidentalspillage wash as much chemical as possible from the skin with large amounts ofwater.Try to get as much information as possible about the chemical from containers,labels etc.Call a doctor or ambulance and pass on this information so that they can adviseon the correct course of action.If they become unconscious:▪ call an ambulance.▪ check ABC.▪ be prepared to oer life support.▪ place a breathing child in the recovery position.Insect stingsA sting occurs when venom is injected through ahollow tube into the skin or underlying tissue.Most insect bites and stings in Ireland are likely tocause discomfort rather than danger but beingstung or bitten is possibly painful and may causethe child to become distressed.Insect stings - recognitionThe most common stinging insects in Ireland are the bee,wasp or hornet and the sting will often cause animmediate and possibly intense burning pain at the site,followed very quickly by swelling and redness around thesting. This will usually ease after a few hours. The biggestthreat from such a sting would be a severe allergic reaction,or anaphylaxis (see page 33)A less serious allergic response may lead to localisedswelling. The swelling and redness may spread to beseveral centimetres across or may even involve a wholearm or leg. It will usually go away over a few days. It is notdangerous unless it aects the airway but in severe casesit may cause blister formation or infection, if the skinbreaks down.A wasp will not usually leave its sting behind and may stingmore than once but a bee’s sting is barbed and will remainin the skin, with its venom sac attached. It is important notto press on this as it will push more venom into the wound.45Poisons / Bites and Stings

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If the child has been stung by a bee and thesting is still in the skin it should be removedas soon as possible. Delay could lead to morevenom being pushed into the tissues,It is important not to try to grip or squeezethe sting as this may squeeze more poisonfrom the sac.The best method is to scrape the sting outusing something like the edge of a card, theback of a knife or your ngernail.▪ If you see any signs of a general allergic reaction then get medical helpurgently. Phone 999 or 112 for an ambulance.▪ Be alert for swelling in or around the mouth and lips.▪ If the child has been stung multiple times they require the same urgent medicalattention.▪ Apply a cold compress to the site. Ice or frozen peas wrapped in a cloth or acold wet annel. Repeat as required.▪ If there is a localised allergic reaction with swelling, redness and itching then theymay benet from an anti histamine either by mouth of as a cream or ointment,Check with their parents or Doctor.▪ If there is a small local reaction (most commonly) then after the cold compress theitching and swelling will go away over time.Insect biteA biting insect does not inject venom whenit bites, but there is often an allergicreaction to the insect’s saliva.Some biting insects, such as mosquitosfeed from blood and may inject an antiblood clotting agent which may increasethe allergic reaction.Blood feeding insects may also carry andpass on other diseases, such as malaria inthe mosquito and Lyme disease from ticks.Although rare in Ireland remember that children may go on foreign holidays andvisits and may have been bitten whilst away.Insect sting - treatment46Bites and Stings

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▪ Insect bites are often painless at the time, although horsey bites may be verypainful.▪ A small itchy and red lump may formas much as 24 hours later.▪ A weal ( a small uid lled blister) maydevelop immediately after the bite butis usually followed by a small itchylump up to 24 hours later.▪ If the allergic response is strongerthere may be an enlarged area ofredness and swelling.▪ Sometimes the itching will lead to thechild scratching the aected area andthis can lead to infection, causing redness, swelling and heat a few days laterTick bitesTicks are transferred to the skin fromleaves or grass and cling onto the skinwith their jaws. As they feed on bloodtheir bodies swell, often taking on agrey appearance.Tick bites tend to be painless.Ticks may carry a germ that could go onto cause Lyme disease which can bevery serious. For this reason anyonewho has suered a tick bite shouldreceive medical attention. Early signs ofLymes disease is a rash developing at the site of the bite a few days later, alongwith a raised temperature up to a month after the bite.Insect bitesCommon biting insects include:▪ Gnats and mosquitos▪ Ticks▪ Fleas, lice and bedbugs▪ Flies and horseies.It is quite common to suer multiple bitesor clusters of bites.Insect bites - recognition47Bites and Stings

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▪ Insect bites can cause severe itching,particularly where there are multiplebites from such things as eas or bedbugs.▪ Cool compresses can help in the earlystages but there may be a requirementfor antihistamine creams or ointmentsor even tablets, check this with theDoctor.▪ Calamine lotion can be soothing oninamed skin.▪ Observe the site carefully for redness or swelling for several days after the bite.This may be an allergic response orpossibly skin infection, particularly if thechild has been scratching a lot.▪ Ticks should be removed with a pair ofne tweezers.▪ This is probably best done by someonewith experience as it is easy for the tickto break, leaving the head partembedded. This invariably leads to alocalised infection at the site.Animal biteMost bites are inicted by dogs and possibly cats. Even small animals can causea nasty injury and large animals can be particularly dangerous.If the bite has broken the skin or drawn blood then :▪ Control bleeding and treat shock.▪ Wash small wounds with clean water.▪ Arrange for medical attention.There is always a risk of infectionfrom a bite and in addition theremay be a requirement for tetanusprotection.Insect bite - treatment48Bites and Stings

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This technique may be used to remove loose particles of dust or dirt, if the child willcooperate, but it must always be done in cases of corrosive material in the eye.▪ The head should be placed with the aected side downward.▪ Clean water or eye wash should be poured across the eye from the insideoutward, allowing the water to run away safely.▪ Make sure that contaminated water is not allowed to enter the good eye.Eye InjuryThe eye is a very delicate organ and is easily damaged. For this reason, most eyeconditions should be seen and treated by a medical professional.In addition, children may not like anyone to go near to their eyes and this maymake them uncooperative, which could make the problem worse, so treatment isusually best left to an expert.Eye irrigation49Eye Problems

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1-10 11-25 26-50personsAdhesive Plasters 20 20 20 40Sterile Eye Pads(no 16) with Bandage 2 2 2 4Individually Wrapped TriangularBandages2 2 6 6Safety Pins6 6 6 6Sterile unmedicated Wound DressingsMedium (No 8) (10 X 8 Cm)1 2 2 4Sterile unmedicated wound dressingsextra large (No 3) (28 x 17.5 cm)1 2 3 4Individually wrapped disinfectant wipes 10 10 20 40Paramedic shears 1 1 1 1Examination gloves, pairs 3 5 10 10Sterile water (where there is no cleanrunning water)2X20mls 1X500ml 2X500ml 2X500mlPocket facemask1 1 1 1Water-based burn dressing, small (10 x10 cm)1 1 1 1Water-based burn dressing, large 1 1 1 1Crêpe bandage (7 cm) 1 1 2 3Materials Travel kit First Aid BoxFirst aid kits – contentsThe table below shows the recommended contents of rst aid boxes and travelkits.Table provides a general guide on the recommended contents of rst aid boxesand kits based on numbers .Quantities indicated in the table are minimum numbers and can be increased.Sizes should be adjusted to a size more suitable to the children being cared for.50First Aid Kits

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51Notes

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52Notes

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PaediatricFirst Aid▪ Contains simple, accurate and up-to-date information▪ Conforms to all latest guidelines▪ Filled with clear easy to follow instructions▪ Ideal is an ongoing reference book