Health/Midterm Final

Miracle of Life worksheet

look at sheet/quiz

Differences between the Sexes with John Stossel

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Menarche

the first menstrual period

Labia (Majora and minora)

- A line of protection against pathogens entering the body and also have a function in sexual arousal - Inner folds extend forwards providing a hood-like covering over the clitoris - Outer folds on each side of the vaginal opening covered in pubic hair MAJORA IS OUTER, MINORA IS INNER

Clitoris

- A small nob of tissue in front of the vaginal opening - Main function is producing sexual arousal - Has indirect role in reproduction as well

Know the following skills:

- CPR - Conscious Choking - Unconscious Choking - Controlling Bleeding

Vas Deferens

- Connect the epididymus, which houses new sperm, to the urethra - After passing by the 3 glands, vas deferens become the - Help move sperm through the use of little hairlike fibers called cilia

2nd Stage of Labor

- Crowning = Baby's head appears - An episiotomy may be needed to enlarge the opening for delivery of the baby

Cervix

- Dilates and or opens to allow passage of the baby - The neck of the uterus - At the top of the vagina, acts as the entrance to the uterus

1st Stage of Labor

- Dilation of cervix (1st and longest stage) - The amniotic sac ruptures (water breaks)

Uterus

- Elastic muscle the size of a fist - The function the uterus is to hold nourish the developing embryo and fetus - The inner lining of the uterus is the endometrium, which fills up with blood tissue each month to prepare for possible pregnancy

Hymen

- Functions as the sign of a virgin - Sperm can penetrate the layer - First-time intercourse penetrates this membrane, which causes pain and bleeding

Seminal Vesicles

- Located above and on either side of the prostate gland - Secrete fluid into the ejaculatory duct that mixes with sperm - Functions: Make the sperm mobile

Prostate Gland

- Located just below the bladder - Secretes milky fluid that mixes with sperm and makes up major portion of semen - Function: Secrete fluid that neutralizes the acidity of the urethra and vagina in the female

Fallopian Tubes

- Long and narrow and lined with hair like projections called cilia - The fimbria are the finger-like projections at the end of the tubes that surround the top of the ovaries - Fertilization of the ovum occurs in the upper-third, which is the widest part of the fallopian tube near the ovaries

Epididymis

- On top and at back of testes - What does it do? * Holds mature sperm * Sperm mature in about 64 days - What happens to sperm not released from body? * Dies and are reabsorbed

Penis

- Organ located above the testes - Normally soft and hangs downward - Blood vessels in the penis fill up with blood, resulting in an erection - Functions of the penis: * Sexual Reproduction * Sexual Pleasure * Elimination of body waste - What causes an erection? * Signal from brain increases blood flow to tissue around penis - Can orgasm occur without erection? * No, however, not all erections lead to orgasm * 300million-400 million sperm released in one ejaculation

3rd Stage of Labor

- Placenta passes through vagina (afterbirth)

Chlamydia

- The most common STD - Chlamydia is caused by microorganisms similar to bacteria - It attacks the male and female reproductive systems * 500,000 cases reported annually * Rates are highest among people 15-19 years old - Symptoms: * When do symptoms appear? * A month after exposure * 70% of females and 10-15% of males with it have no symptoms * What do symptoms include? * For males: Unusual penile discharge and painful, burning, or frequent urination * For females: vaginal discharge, pain in pelvic area, bleeding between menstrual periods - Can a pregnant female pass it on to her baby? * Yes - What can this do? * Cause eye infection, blindness, and pneumonia in infants - Is it hard to diagnose? * Yes, often occurs at the same time as gonorrhea - What is the cure? * Since its an infection, antibiotics - Untreated Chlamydia * What can this lead to? * Nongonococcal urethritis * Pelvic inflammatory disease (PID) * What is PID? * Scar tissue causing infection of fallopian tubes or ovaries that may cause sterility * Symptoms: pelvic pain, chills, feet, irregular menstrual period, lower back pain * Nongonococcal Urethritis (NGU) * What is NGU? * Disease caused by several bacteria like organisms * Affects male urethra and female cervix * What about symptoms? * More obvious in males * Discharge from penis and mild burning during urination * Vaginal discharge and lower pelvic pain

Hormones

- The most important hormones made by the ovaries are known as female sex hormones (sex steroids) - and the two main ones are estrogen and progesterone. The ovaries also produce some of the male hormone, testosterone. - From puberty onwards, LH, FSH, estrogen and progesterone all play a vital part in regulating a woman's menstrual cycle, which results in her periods.

Hormones

- The primary hormones involved in the functioning of the male reproductive system are follicle-stimulating hormone (FSH), luteinizing hormone (LH) and testosterone. - FSH and LH are produced by the pituitary gland located at the base of the brain. FSH is necessary for sperm production (spermatogenesis), and LH stimulates the production of testosterone, which is necessary to continue the process of spermatogenesis. Testosterone also is important in the development of male characteristics, including muscle mass and strength, fat distribution, bone mass and sex drive.

Gonorrhea

- The second most common STD - How frequent? * 1 mission cases every year - What is it caused by? * Bacteria that live in warm moist areas of body - What does it do? * Attacks mucous membranes of penis, vagina, rectum, or threat - Symptoms: * When do they appear * 3 to 7 days after contact with infected person * Not always obvious in the female * Symptoms go away on their own but disease remains * What do they include? * Males: Whitish-yellow discharge from penis, burning during urination * Females: Yellow-green vaginal discharge, abdominal pain, frequent urination, burning during urination - Caused by bacteria that live in warm, moist areas of the body such as mucous membranes - Does everyone show symptoms? * No, 10% of men and 80% of women do not - Gonorrhea can lead to PID (Pelvic Inflammatory Disease) - Gonorrhea is confirmed by: * Males: Penile discharge examined by microscope * Females: Sample of cells of vagina examined under microscope - It is curable if its detected early * Treated with antibiotics such as penicillin or tetracycline * However, gonorrhea may be resistant to penicillin, so a different antibiotic would be used * A person can get gonorrhea again - Untreated Gonorrhea * Leads to damage * Males: Epididymitis and urethral damage * Females: PID * Both: Sterility, spread to other body parts causing damage to joints, heart tissue, and other organs * What about for pregnant females? * Increased chance of premature labor and stillbirth * During birth, bacteria that cause gonorrhea can enter baby's eyes

Urethra

- The tube that travels through the middle of the penis - Leads from the ejaculatory duct - Functions: * Serves as a passageway for sperm and urine - Urine and semen cannot be released at the same time

Scabies

- Tiny parasitic mites that burrow in the skin - Transmitted by close bodily contact or sexual contact - Itching occurs 4 to 6 weeks after infection - Scabies can be spread to other parts of the body - Hot baths and medicated creams can cure this problem

Menstruation

- Two events may happen in a woman's cycle: 1. Fertilized 2. Menstruation - If the ovum is not fertilized, menstruation occurs - The menstrual period usually lasts 4-7 days - Menstrual cramps may be caused by uterine contractions, which expel the lining - Menarche is called the first menstrual period - Menopause is when menstruation ceases - Exercise, age, stress, and eating disorders may cause menstruation to be irregular - Is there ever a "safe time" for intercourse * Yes and No * Yes, with a mature female * No, for females that aren't mature and if the female is ovulating - Days 1-8: It begins - Days 9-13: The egg is starting to mature in one of the ovaries - Day 14: Ovulation day - The day when the egg is released into one of the fallopian tubes - Days 15-28: The egg travels through the fallopian tubes to the uterus, if the egg is not fertilized the cycle starts over again

Ovaries

- Two female sex glands which produce and mature ovum and female hormones - Ovaries are connected to the fallopian tubes - Are known as the sex glands - They house the ova and produce estrogen and progesterone - Females are born with 200,000 to 300,000 ovum - Releasing one mature ovum per month into that ovary's fallopian tube is called ovulation - Ovaries can live for up to 2 days in a fallopian tube

Cowper's Glands

- What are the Cowper's Glands? * Located below the prostate * Secrete a clear sticky fluid that cleanses the urethra of acid * Function: From urine, thus allowing the safe passage of sperm - Does this fluid contain sperm? * Yes it does * Still can cause females to become pregnant even though the semen is never released * Secretion causes droplets to form at the end of the penis before ejaculation

Genital Warts

- What are these things? * Red warts that appear on genital * Transmitted only sexually and are very contagious * Caused by viruses * Grow on wet surfaces and in folds of skin - How ling does it take for them to appear? * Six months after exposure (average = 2-3 months) - Can they be spread before symptoms appear? * Yes - What do these things do? * Grow and blick openings of vagina, anus, or throat * Can cause pre-cancerous condition in women thats detected with a Pap smear - What is done to threat them? * Treated by removal with scalpel, laser surgery, freezing, or acid

Pubic Lice

- What are these? * Crablike insects that infect pubic hair and feed on human blood * Attach to hair follicles and deposit eggs near base of hairs - What are symptoms? * Primary one is itching * Appear 25-30 days after exposure - How are they spread? * Intimate physical contact * Die 24 hours after separation from human body * Eggs can live up to six days - What other ways can they be spread? * By coming into contact with infected bedding, cloths, or towels - How are they cured? * Special medicated shampoo * All infected sheets or laundry must be washed in hot water with detergent

Poisoning

A poison is any substance that causes injury, illness or death if it enters the body. Poisons can be ingested (swallowed), inhaled, absorbed through the skin or eyes, or injected. Practically anything can be a poison if it is not meant to be taken into the body. Even some substances that are meant to be taken into the body, such as medications, can be poisonous if they are taken by the wrong person, or if the person takes too much. Combining certain substances can also result in poisoning. Poisoning can happen anywhere, but most poisonings take place in the home. Children younger than 5 years, especially toddlers, are at the highest risk for poisoning. Children may be attracted to pretty liquids in bottles, sweet-smelling powders, berries on plants that look like they are edible, or medications or vitamins that look like candy. Additionally, very young children explore their world by touching and tasting things around them, so even substances that do not look or smell attractive are poisoning hazards among this age group. Older adults who have medical conditions that cause confusion (such as dementia) or who have impaired vision are also at high risk for unintentional poisoning. Box 7-2 lists common household poisons, and Box 7-3 describes strategies for reducing the risk for unintentional poisoning at home. Common causes of death as a result of poisoning include drug overdose (of over-the- counter, prescription and illicit or "street" drugs), alcohol poisoning and carbon monoxide poisoning (Box 7-4). Box 7-2. Household Poisons Many everyday household items can be poisonous if they are used incorrectly. Young children and older adults with medical conditions that are associated with confusion (e.g., dementia) or who have impaired vision are at particularly high risk for unintentional poisoning. Common causes of unintentional poisonings at home include: ■ Alcohol (found in many products, including hand sanitizer, mouthwash, perfume, cologne, aftershave and vanilla extract). ■ Medications (over-the-counter and prescription) and vitamins. ■ Cleaning products (detergent "pods" are especially attractive to children). ■ Glues and paints. ■ Insect and weed killers. ■ Car maintenance products (e.g., antifreeze, windshield washer fluid). ■ Plants (both houseplants and outdoor plants). ■ Oils, lubricants and polishes. ■ Personal care products. ■ Tobacco. ■ Heavy metals, such as lead (often found in old, peeling paint). Box 7-3. Lowering the Risk for Unintentional Poisoning If your household contains members who are at high risk for unintentional poisoning, there are simple steps you can take to help keep them safe: ■ Keep all medications and household products well out of reach of children or confused older adults, preferably up, away and out of sight. ■ Store potentially poisonous substances in locked cabinets. ■ Be aware that purses and bags may contain potential poisons (such as medications or hand sanitizer). Avoid putting bags or purses down where they are within reach of curious children or confused older adults. ■ Closely supervise children and confused older adults, especially in areas where potential poisons are commonly stored (such as kitchens, bathrooms and garages). ■ Keep medications and products in their original containers with their original labels in place. ■ Use poison symbols to identify potentially poisonous substances, and teach children the meaning of the symbols. ■ Be aware that a child or confused older adult may try to consume products that feature fruit on the label (e.g., cleaning products), so take care when storing these. ■ Never call a medicine "candy" to entice a child to take it, even if the medicine has a pleasant candy-like flavor. ■ Use child-resistant safety caps on containers of medication and other potentially dangerous products, but do not assume that children cannot open them. (There is no such thing as "childproof.") ■ Dispose of medications and other potentially poisonous substances properly. Check with your local government for procedures for the safe disposal of unused and expired medications and other hazardous materials. Box 7-4. Lethal Poisons There are many different types of poisoning, but three in particular warrant special mention because they are common and often fatal: drug overdose, alcohol poisoning and carbon monoxide poisoning. Drug Overdose Drugs (whether over-the-counter, prescription or illicit) are frequently a cause of death as a result of poisoning. Drug overdose may be accidental or intentional. Signs and symptoms will vary depending on the drug but may include loss of consciousness, changes in breathing and heart rate, and nausea or vomiting. If you suspect a drug overdose, call 9-1-1 or the designated emergency number if the person: ■ Is unresponsive or seems to be losing consciousness. ■ Is having difficulty breathing. ■ Has persistent pain or pressure in the chest or abdomen. ■ Is vomiting blood or passing blood. ■ Has a seizure, severe headache or slurred speech. ■ Is aggressive or uncooperative. While you are waiting for EMS personnel to arrive, try to find out from others at the scene what substance or substances the person may have taken. Keep the person covered to minimize shock. Opioid drugs, such as heroin and oxycodone, are a common cause of drug overdose in the United States. Signs and symptoms of opioid overdose include slowed breathing (or no breathing), extreme drowsiness or loss of consciousness, and small pupils. EMS personnel use naloxone (Narcan®) to reverse the effects of opioid drugs. In some states, lay responders can receive training in administering naloxone. For lay responder use, naloxone is supplied as a nasal spray. Alcohol Poisoning Alcohol poisoning is caused by drinking large quantities of alcohol in a short period of time (binge drinking). The National Institute on Alcohol Abuse and Alcoholism defines binge drinking as a pattern of drinking that brings a person's blood alcohol concentration (BAC) to 0.08 percent or more. This typically happens when a man consumes 5 or more drinks over a period of about 2 hours, or when a woman consumes 4 or more drinks over the same amount of time. Alcohol is a depressant that affects the central nervous system. Very high levels of alcohol in the bloodstream can affect the brain's ability to control breathing, heart rate and body temperature, resulting in death. Signs and symptoms of alcohol poisoning include loss of consciousness, slow or irregular breathing, vomiting, seizures and hypothermia. If you suspect alcohol poisoning, call 9-1-1 or the designated emergency number immediately. Place the person in the recovery position and take steps to keep the airway clear as needed until EMS personnel arrive. Carbon Monoxide Poisoning Carbon monoxide is a gas that is produced whenever a fuel such as gas, oil, kerosene, diesel, wood or charcoal is burned. When equipment that burns these fuels is ventilated properly, carbon monoxide is not a problem. But if the equipment or ventilation system is faulty, or if equipment that is only supposed to be run outdoors is run inside an enclosed area, toxic levels of carbon monoxide can build up quickly, leading to carbon monoxide poisoning. Carbon monoxide poisoning is often called a "silent killer" because the gas has no smell and you cannot see it. Signs and symptoms of carbon monoxide poisoning include drowsiness, confusion, headache, dizziness, weakness, and nausea or vomiting. A person with signs or symptoms of carbon monoxide poisoning needs fresh air and medical attention immediately. Remove the person from the area if you can do so without endangering yourself and call 9-1-1 or the designated emergency number. Signs and Symptoms of Poisoning Signs and symptoms of poisoning vary depending on the type and amount of poison taken into the body. The person may experience: ■ Gastrointestinal signs and symptoms, such as abdominal pain, nausea, vomiting or diarrhea. ■ Respiratory signs and symptoms, such as difficulty breathing or slow and shallow breathing. ■ Neurological signs and symptoms, such as changes in level of consciousness, seizures, headache, dizziness, weakness or irregular pupil size. ■ Skin signs and symptoms, such as an unusual skin color or sweating. Your scene size-up and check of the person will often yield clues that point to poisoning as the cause of the person's illness. For example, you may note an open or spilled container, an unusual odor, burns around the person's mouth, a strange odor on the person's breath or other people in the area who are also ill. If you think that a person has been poisoned, try to find out: ■ The type of poison. ■ The quantity taken. ■ When it was taken. ■ How much the person weighs. This information can help you and others to give the most appropriate care. If the person is showing signs and symptoms of a life-threatening condition (for example, loss of consciousness, difficulty breathing) or if multiple people are affected, call 9-1-1 or the designated emergency number. If the person is responsive and alert, call the national Poison Help hotline at 1-800-222-1222. When you dial this number, your call is routed to the regional poison control center that serves your area, based on the area code and exchange of the phone number you are calling from (Box 7-5). The poison control center staff member will tell you what care to give. General first aid care steps for poisoning include the following: ■ Remove the source of the poison if you can do so without endangering yourself. ■ Do not give the person anything to eat or drink unless the poison control center staff member tells you to do so. ■ If you do not know what the poison was and the person vomits, save a sample for analysis. Myth-Information. Myth: If a person has been poisoned, you should make the person vomit to get rid of the poison. Inducing vomiting in a person who has been poisoned often causes additional harm and is not recommended. Sometimes the person may vomit on his or her own, but you should never give the person anything to make him or her vomit unless you are specifically instructed to do so by the poison center staff member. There are 55 regional poison control centers in the United States. By dialing the national Poison Help hotline (1-800-222-1222), you will be put in touch with the poison control center that serves your area. The call is toll free, and the phone number works from anywhere in the United States. The poison control centers are staffed by medical professionals who have access to information about most types of poisoning. They can tell you what care to give if you think or know that someone has been poisoned. Callers are often able to get the help they need from the poison control center without having to call 9-1-1 or the designated emergency number. This helps to reduce the workload of EMS personnel and also reduces the number of emergency room visits. Of course, in some cases, the poison control center staff member may tell you to call 9-1-1 or the designated emergency number, and you should always call 9-1-1 or the designated emergency number first if the person is showing signs or symptoms of a life-threatening condition. Be prepared: Keep the telephone number of the national Poison Help hotline posted by every telephone in your home or office! The service is free and staff members are available 24 hours a day, 7 days a week.

Syphilis

- What causes it? * A bacterium called spirochete - How threatening is it? * One of the most dangerous STDs - What does it do? * Enters body through vagina, anus, penis, or mouth * Enters bloodstream and may infect entire body - Untreated Syphilis * Can cause blindness, heart disease, paralysis, and insanity - Symptoms of Syphilis * When do they appear? * Within 10-90 days of intercourse with an infected person * Average is 3 weeks * Symptoms come and go away but the disease still remains * What are the names of the stages? * Primary, Secondary, Latent, and Neurosyphilis - Primary Stage * Small, red painless sore called a chancre * Appears where pathogen entered body * Male: Chancres appear on penis * Females: Chancres appear in vagina, on cervix, or in labia * Chancre disappears within one to five weeks - Secondary Stage * Symptoms appear including muscle/joint pain, swollen lymph nodes, nausea, headache, loss of appetite, fever, and general sick feeling * Flu-like symptoms, weight loss, hair loss, shows on hands and bottom of feet * Most common symptom is a highly contagious rash * Rash appears on females at the outer edge of vagina * Rash turns into sores, which ooze a clear fluid containing infectious spirochetes * Sores provide an exit or entrance for the virus that causes AIDS - Latent Stage * What happens? * Begins about two or more years after initial infection * Symptoms have disappeared * Infected person is still contagious - Neurosyphilis Stage * What happens in this stage? * Years after infection * Bacteria attack heart, blood vessels, bones, liver, CNS, and brain * Damage to tissue of these organs is slow and steady * Person may experience blindness or insanity

Testes

- What happens in the testes? * Production of sperm * Where in the testes? * Seminiferous tubules - How many sperm are produced per day? * 500 million, we produce 300m-500m per day - What is spermatogenesis? * Production of sperm by testosterone - When does sperm production begin? * At puberty * Continues to around 70 years of age * Close to 50,000 sperm produced per minute - Are internal until close to birth when they drop into the scrotum - What is it called when one or both do not drop at birth? * Undescended testicles (a.k.a. cryptorchidism) - When do the testes start production of testosterone? * At 8-10 production starts, but not mature until the ages of 12-14 via signals from the pituitary gland * Male sex characteristics develop * Testosterone is produced between the coils of the Seminiferous Tubules

Herpes Simplex Virus

- What is HSV? * In the past, herpes has been divided into HSV I (cold sores on mouth) and HSV II (genitals) * Both can cause sores on genitals and on mouth or other parts of the body * STD with blister like bumps or sores * For this class, when transmitted through sexual contact, the virus is referred to as HSV II - How does it spread? * When any part of the body makes contact with a cold sore on the mouth or a genital herpes sore - What are the symptoms? * 1st outbreak: Blisters/bumps two to 20 days after contact * Fever, headaches, fatigue * 1st infection lasts as long as three weeks * It can be contagious before and after the symptoms appear - What can happen when blisters aren't present? * Yes, both before and after blisters occur * Although blisters may go away, the disease remains in the body - Is it possibly to have only one outbreak? * Yes, but others may have many outbreaks * Disease is contagious before and after outbreaks - How is it tested and treated? * Tissue culture of an active blister * No known sure, but Acyclovir is used to suppress outbreaks, but not prevent them - Congenital problems? * Higher risk of miscarriage or premature birth * Higher death rate for babies born to mother with outbreak at time of birth * Higher risk of brain damage if babies pass through birth canal when mother's infection is active.

NGU

- What is NGU? * Disease caused by several bacteria like organisms * Affects male urethra and female cervix - What about symptoms? * More obvious in males * Discharge from penis and mild burning during urination * Vaginal discharge and lower pelvic pain

Ovulation

- When an egg is released from your ovaries to be fertilized - Day 14: Ovulation day - The day when the egg is released into one of the fallopian tubes

Scrotum

-A loose pouch of skin that holds the testicles * Keeps them the right temperature by expanding or contracting\ - Holds the testicles, which make sperm - Function: To regulate temperature - What is the right temperature? * 3-4 degrees less (94.6-95.6) - What is the boxer vs. brief theory? * Briefs are better because boxers allow more movement

Vagina

-Also referred to as the birth canal -Walls of vagina touch each other at rest -When aroused, the walls expand to allow penis to enter -Leads to cervix

HIV/AIDS

-HIV invades and destroys the cells that help us fight off infections * Person with aids may develop AIDS * A person with AIDS cannot fight off infection * A person can die from the infection * AIDS = Acquired immunodeficiency syndrome

Concerns

// Nocturnal Emissions * Known as a "wet dream" that happens during sleep that includes ejaculation for the male or vaginal wetness/orgasm for the female * Common during adolescence and early adult years, but can happen anytime once someone hits puberty * Absolutely nothing wrong with wet dreams, it is a normal thing //Hernias * What is a hernia? * When part of the intestines pushes through the intestine wall into the scrotum * Inguinal hernia - Occurs due to lifting incorrectly, corrected by surgery * Turn and cough //Sterility * In the male * Infertility due to weak, mal-formed sperm or no sperm formed at all * What causes it? * Temperature changes, exposure to chemicals, smoking, untreated STDs, improperly functioning epididymus, urethra * Testicular Cancer * What does testicular cancer effect? * Most common cancer for men ages 20-34 * Accounts for 12% of cancer deaths in this group * What can be done? * Self-examinations (3 minutes, once a month), early treatment is the best chance for recovery //Enlarged Prostrate/Prostrate Cancer * What causes prostate problems? * As man gets older, prostate gets bigger and may block urethra or bladder * May cause difficulty urinating or sexual functioning * Surgery may be needed to correct the condition //Prostate Cancer * Most common cancer in men * Symptoms include: frequent urination, difficulty urinating, pain or burning when urinating, blood in the urine, or pain in the back, hips, or pelvis * Only prevention is regular examination by doctor //Testicular Torsion * What is this condition? * Twisted testes * Spermatic cord which suspends testicle into scrotum becomes twisted during strenuous exercise, not wearing support during athletics, or while sleeping * Rare, but is an ER visit //Undescended Testes * One or both testicles remain inside body * If testicles don't drop into scrotum by age two, surgery is required * Higher rate of cancer exists for those with undescended testes //Uncircumcised Penis * Personal decision * Foreskin not taken off within time of leaving hospital * Must be cleaned regularly by pulling skin back //Care of Reproductive System * Wash penis and scrotum daily * No tight clothing * Testicular self-exam * See doctor yearly for check-ups when needed

Concerns

//PMS * Refers to a variety of symptoms that females experience before menstruation * Symptoms incude bloating, irritability, fatigue, depression, and mood swings * May be caused by chemicals in the brains of females with PMS being distributed by normal levels of ovarian hormones * Treatment may include changes in diet and exercise //Dysmenorrhea * Painful contrations in the uterus during menstruation * Light exercise or OTC pain relievers can help relieve cramps * Warm baths or heating pads may relax muscles //Amenorrhea * Lack of menstruation by age of 16 * OR * Stopping of the menstrual cycle in a female who previously menstruated * Often caused by excessive exercise, eating disorders, emotional distress, or starvation //Toxic Shock System * Caused by a bacterium called Staphylococcus aureus * Symptoms include high fever, vomiting, diarrhea, low blood pressure, dizziness, fainting, and a rash * Treated with antibiotics, fluids, and other supportive therapy * Another cause may be super-absortant tampons which create an o2-rich atmosphere in the vagina, allowing bacteria to produce toxins //Sterility * Causes of sterility in females: 1. Blocking of one or both fallopian tubes 2. No ovulation 3. Endometriosis - Endometrial tissue grows outside the uterus 4. STDs - Gonorrhea and chlamydia are most common //Cervical Cancer * Pap Smear is used to detect abnormal cells on cervix * Cells are examined on slide in laboratory * Treated with surgery, radiation, or chemotherapy * Risk Factors * Between 20-30 years old * Never having a pap smear * Having intercourse at an early age * Or having multiple sexual partners //Vaginitis * Refers to vaginal infections * Most vaginitis is the result of an imbalance of the organisms normally present in the vagina * Some vaginitis comes from sexual contact with an infected person //Yeast Infection * One of several forms of vaginitis * Symptoms include thick, white, odious discharge and genital itching * Treatment includes yeast-killing cream or suppository medication placed inside vagina //Nonspecific Vaginitis * Caused by bacteria * Symptoms include itching, odorless discharge, and burning during irritation * Treated with antibiotic prescribed by a doctor //Trichomoniasis * Occurs at end of menstrual period * Caused by a protozoan * Symptoms include odorless discharge, genital itching, and burning sensation during urination * Treated by doctor-prescribed antibiotics //Breast Cancer * Most common form of cancer in females * 2nd leading cause of death in females after lung cancer * Treatable and curable when detected early * Symptoms for both men and women include change in breast or nipple appearance, lump or swelling in the breast, and lump under the armpit * Family history plays a great role //Ovarian Cancer * Two types 1. One occurs in the lining of the ovary 2. The other type occurs i the egg-making cells of the ovary and is called a germ cell - Tumor of the ovary * Occurs in teenage girls or young women * Symptoms include deepened voice, unusual hair growth, pelvic pain, a hard tester mass in the lower abdomen, and painful intercourse * Family history plays a role //Female Reproductive Health * Breast Self-Examination * Yearly mammograms at age 40 * Pelvic Examination * Either at onset of sexual intercourse or at age 18

Know Asthma

Asthma Many people have asthma, a chronic illness in which certain substances or conditions, called triggers, cause inflammation and narrowing of the airways, making breathing difficult. Common triggers include exercise, temperature extremes, allergies, air pollution, strong odors (such as perfume, cologne and scented cleaning products), respiratory infections, and stress or anxiety. The trigger causes inflammation and swelling, which causes the opening of the airways to become smaller and makes it harder for air to move in and out of the lungs. People who have asthma usually know what can trigger an attack and take measures to avoid these triggers. A person who has been diagnosed with asthma may take two forms of medication. Long-term control medications are taken regularly, whether or not signs and symptoms of asthma are present. These medications help prevent asthma attacks by reducing inflammation and swelling and making the airways less sensitive to triggers. Quick-relief (rescue) medications are taken when the person is experiencing an acute asthma attack. These medications work quickly to relax the muscles that tighten around the airways, opening the airways right away so that the person can breathe more easily. Both long-term control medications and quick-relief (rescue) medications may be given through an inhaler, a nebulizer (Box 5-1) or orally. Signs and Symptoms of an Asthma Attack Even when a person takes steps to manage his or her asthma by avoiding triggers and taking prescribed long-term control medications, he or she may still experience asthma attacks occasionally. Signs and symptoms of an asthma attack include: ■ Wheezing or coughing. ■ Rapid, shallow breathing (or trouble breathing). ■ Sweating. ■ Being unable to talk without stopping for a breath in between every few words. ■ Feelings of tightness in the chest or being unable to get enough air into the lungs. ■ Anxiety and fear. First Aid Care for an Asthma Attack An asthma attack can become life threatening because it affects the person's ability to breathe. If the person has an asthma action plan (a written plan that the person develops with his or her healthcare provider that details daily management of the condition as well as how to handle an asthma attack), help the person to follow that plan. Encourage the person to use his or her prescribed quick-relief (rescue) medication, assisting if needed and if state or local regulations allow. (Skill Sheet 5-1 provides step-by-step instructions for helping a person to use an asthma inhaler.) If you have not already done so, call 9-1-1 or the designated emergency number if the person's breathing does not improve after taking the quick-relief (rescue) medication or if the person becomes unresponsive. Stay with the person and monitor his or her condition until the person is able to breathe normally or help arrives. Box 5-1. Asthma Inhalers and Nebulizers Metered Dose Inhalers (MDIs) An MDI delivers a measured dose of medication in mist form directly into the person's lungs. The person gently presses down the top of the inhaler. This causes a small amount of pressurized gas to push the medication out quickly. Sometimes a spacer (or chamber) is used to make it easier for the person to use the inhaler correctly. The medication goes into the spacer, and then the person inhales the medication through the mouthpiece on the spacer. For children, a spacer may be used with a face mask instead of a mouthpiece. Dry Powder Inhalers (DPIs) A DPI delivers a measured dose of medicine in a dry powder form directly into the person's lungs. Instead of pressing down on the top of the device to dispense the medication, the person breathes in quickly to activate the DPI and dispense the medication. Some people have difficulty using DPIs because they require the user to take in a quick, strong breath. Small-Volume Nebulizers Small-volume nebulizers convert liquid medication into a mist, which is delivered over several minutes. Nebulizers are especially helpful when the person is unable to take deep breaths, for children younger than 5 years and for older adults. They also are used for people who have trouble using inhalers and for those with severe asthma.

Know call first situations and care first situations

Box 1-8. Call First or Care First? Most of the time, you will call first and then give care. But if you are alone, you may have to decide whether to call first or care first. If you are ALONE: CALL First (call 9-1-1 or the designated emergency number before giving care) for: ■ Any person about 12 years or older who is unresponsive. ■ A child or an infant whom you witnessed suddenly collapse. ■ An unresponsive child or infant known to have heart problems. CARE First (give immediate care, then call 9-1-1 or the designated emergency number) for: ■ An unresponsive infant or child younger than about 12 years whom you did not see collapse. ■ A person who is choking. ■ A person who is experiencing a severe allergic reaction (anaphylaxis) and has an epinephrine auto injector. ■ A person who has severe, life-threatening bleeding.

Know about burns

Burns A burn is a traumatic injury to the skin (and sometimes the underlying tissues as well) caused by contact with extreme heat, chemicals, radiation or electricity (Figure 6-3). Burns range in severity from minor to critical. A critical burn is one that is life threatening or potentially disfiguring or disabling, and it requires immediate medical attention. When evaluating whether a burn is critical or not, consider the following factors: ■ The depth of the burn. Burns can be classified according to depth (Figure 6-4). Superficial burns only involve the epidermis (the top layer of skin). Partial-thickness burns involve the epidermis and the dermis (the layer of skin underneath the epidermis that contains blood vessels, nerves, hair follicles and glands). Full- thickness burns involve both layers of skin and may extend into the subcutaneous tissue, muscle or bone underneath. Generally speaking, the deeper the burn, the greater the severity. ■ The percentage of the body's surface area that is burned. A burn that covers more than one part of the body or covers a large percentage of the person's total body surface area requires medical attention. Even a superficial burn can be a critical burn if it affects a large percentage of the person's total body surface area. ■ The location of the burn. Burns that affect the hands, feet or groin; those that involve the head, neck, nose, or mouth or affect the person's ability to breathe; and circumferential burns (i.e., those that go all the way around a limb) are considered critical burns. ■ The age of the person. If the person is younger than 5 years or older than 60 years, the burn should be considered critical, unless it is very minor. ■ The cause of the burn. Burns caused by electricity, exposure to chemicals, exposure to nuclear radiation or an explosion are considered critical burns. If you think that a person has a critical burn, call 9-1-1 or the designated emergency number immediately. Signs and Symptoms of Burns Burned areas can appear red, brown, black (charred) or white. The burned area may be extremely painful or almost painless (if the burn is deep enough to destroy the nerve endings). There may be swelling, blisters or both. The blisters may break and ooze a clear fluid. Burns involving blistering or broken skin should be evaluated by a healthcare provider. First Aid Care for Burns Myth-Information. Myth: Soothe a burn with butter. Not a good idea! Putting butter, mayonnaise, petroleum jelly or any other greasy substance on a burn is not effective for relieving pain or promoting healing. In fact, applying a greasy substance to the burn can seal in the heat and make the burn worse. First aid for burns involves three general steps—stop, cool and cover: ■ Stop. First, after sizing up the scene, stop the burning by removing the source of the injury if it is safe for you to do so. Depending on the cause of the burn, this may involve removing the person from the source or removing the source from the person. ■ Cool. Next, cool the burn and relieve pain using clean, cool or cold water for at least 10 minutes. Use water that you could drink. Never use ice or ice water to cool a burn because doing so can cause more damage to the skin. If clean cool or cold water is not available, you can apply a cool or cold (but not freezing) compress instead. Cooling a burn over a large area of the body can bring on hypothermia (a body temperature below normal), so be alert to signs and symptoms of this condition (see Chapter 7). ■ Cover. Finally, cover the burn loosely with a sterile dressing. Make sure that whatever you use to cover the wound is sterile or at least clean, because burns leave the person highly susceptible to infection. Burns of all types, especially if they cover a large percentage of the body, can cause a person to go into shock, so monitor the person closely. When caring for a burn, do not remove pieces of clothing that are stuck to the burned area, do not attempt to clean a severe burn and do not break any blisters. Chemical Burns The general care for a chemical burn is the same as for any other type of burn: stop, cool, cover. However, there are some special considerations for the "stop" step. Because the chemical will continue to burn as long as it is on the skin, you must remove the chemical from the skin as quickly as possible. ■ Dry chemicals. If the burn was caused by a dry chemical, such as lime, brush off the powder or granules with gloved hands or a cloth, being careful not to get any of the chemical on your skin or on a different area of the person's skin. Carefully remove, or help the person to remove, any clothing that was contaminated with the chemical. Then flush the area thoroughly with large amounts of cool water for at least 15 minutes or until EMS personnel arrive. Liquid chemicals. If the burn resulted from a liquid chemical coming into contact with the skin, flush the affected area with large amounts of cool water for at least 15 minutes or until EMS personnel arrive. If the chemical is in the person's eye, flush the eye with water until EMS personnel arrive. Tilt the person's head so that the affected eye is lower than the unaffected eye as you flush. Electrical Burns First aid for electrical burns also follows the general principle of "stop, cool, cover," but as with chemical burns, there are some special care considerations when electricity is the cause of the burn. As always, check the scene for safety before entering. Make sure 9-1-1 or the designated emergency number has been called, and if possible, turn off the power at its source. Do not approach or touch the person until you are sure he or she is no longer in contact with the electrical current. Once you have determined that it is safe to approach the person, provide care as needed until help arrives. Because the electrical current that caused the burns can also affect the heart's rhythm or the person's ability to breathe (causing the person to go into cardiac arrest), be prepared to give CPR and use an AED if you are trained in these skills. Anyone who has experienced an electrical burn should be evaluated by a healthcare provider because the person's injuries may be more extensive than they appear. Although the person may only have a small burn wound where the electrical current entered or left the body, there may be significant internal injuries caused by the current passing through the body.

CPR

CPR, or cardiopulmonary resuscitation, is a skill that is used when a person is in cardiac arrest to keep oxygenated blood moving to the brain and other vital organs until advanced medical help arrives. Although full CPR (compressions and rescue breaths) is preferred, if you are unable or unwilling for any reason to give full CPR, you can give compression-only CPR instead. Giving CPR to an Adult: 1. Verify that the person is unresponsive and not breathing. - Shout to get the person's attention, using the person's name if you know it. If the person does not respond, tap the person's shoulder and shout again while checking for normal breathing. - If the person does not respond and is not breathing or only gasping, continue to step 2. 2. Place the person on his or her back on a firm, flat surface. Kneel beside the person. 3. Give 30 chest compressions. - Place the heel of one hand in the center of the person's chest, with your other hand on top. Position your body so that your shoulders are directly over your hands. - Keeping your arms straight, push down at least 2 inches, and then let the chest return to its normal position. - Push hard and push fast! Give compressions at a rate of 100-120 compressions per minute. 4. Give 2 rescue breaths. - Place the breathing barrier over the person's nose and mouth. - Open the airway. (Put one hand on the forehead and two fingers on the bony part of the chin and tilt the head back to a past-neutral position.) - Pinch the nose shut and make a complete seal over the person's mouth with your mouth. - Take a normal breath and blow into the person's mouth for about 1 second, looking to see that the chest rises. - Take another breath, make a seal, then give the second rescue breath. Note: If the first rescue breath does not cause the chest to rise, re-tilt the head and ensure a proper seal before giving the second rescue breath. If the second breath does not make the chest rise, an object may be blocking the airway. After the next set of chest compressions and before attempting rescue breaths, open the mouth, look for an object and, if seen, remove it using a finger sweep. Continue to check the person's mouth for an object after each set of compressions until the rescue breaths go in. 5. Continue giving sets of 30 chest compressions and 2 rescue breaths until: - You notice an obvious sign of life. - An AED is ready to use and no other trained responders are available to assist you with the AED. - You have performed approximately 2 minutes of CPR (5 sets of 30:2) and another trained responder is available to take over compressions. - EMS personnel take over. - You are alone and too tired to continue. - The scene becomes unsafe. Giving CPR to a Child: 1. Verify that the child is unresponsive and not breathing. - Shout to get the child's attention, using the child's name if you know it. If the child does not respond, tap the child's shoulder and shout again while checking for normal breathing. - If the child does not respond and is not breathing or only gasping, continue to step 2. 2. Place the child on his or her back on a firm, flat surface. Kneel beside the child. 3. Give 30 chest compressions. - Place the heel of one hand in the center of the child's chest, with your other hand on top. Position your body so that your shoulders are directly over your hands. (Alternatively, in a small child, you can use a one-handed CPR technique: place the heel of one hand in the center of the child's chest.) - Keeping your arms straight, push down about 2 inches, and then let the chest return to its normal position. - Push hard and push fast! Give compressions at a rate of 100-120 compressions per minute. 4. Give 2 rescue breaths. - Place the breathing barrier over the child's nose and mouth. - Open the airway. (Put one hand on the forehead and two fingers on the bony part of the chin and tilt the head back to a slightly past-neutral position.) - Pinch the nose shut and make a complete seal over the child's mouth with your mouth. - Take a normal breath and blow into the child's mouth for about 1 second, looking to see that the chest rises. - Take another breath, make a seal, then give the second rescue breath. Note: Same note for when giving adults CPR. 5. Continue giving sets of 30 chest compressions and 2 rescue breaths until: - You notice an obvious sign of life. - An AED is ready to use and no other trained responders are available to assist you with the AED. - You have performed approximately 2 minutes of CPR (5 sets of 30:2) and another trained responder is available to take over compressions. - You have performed approximately 2 minutes of CPR (5 sets of 30:2), you are alone and caring for a child, and you need to call 9-1-1 or the designated emergency number. - EMS personnel take over. - You are alone and too tired to continue. - The scene becomes unsafe. Giving CPR to an Infant: 1. Verify that the infant is unresponsive and not breathing. - Shout to get the infant's attention, using the infant's name if you know it. If the infant does not respond, tap the bottom of the infant's foot and shout again while checking for normal breathing. - If the infant does not respond and is not breathing or only gasping, continue to step 2. 2. Place the infant on his or her back on a firm, flat surface. Stand or kneel next to the infant. 3. Give 30 chest compressions. - Place one hand on the infant's forehead. - Place the pad of two fingers on the center of the infant's chest, just below the nipple line. - Compress the chest about 11⁄2 inches, and then let the chest return to its normal position. - Push hard and push fast! Give compressions at a rate of 100-120 compressions per minute. 4. Give 2 rescue breaths. - Place the breathing barrier over the infant's nose and mouth. - Open the airway. (Put one hand on the forehead and two fingers on the bony part of the chin and tilt the head back to a neutral position.) - Make a complete seal over the infant's nose and mouth with your mouth. - Take a normal breath and blow into the infant's nose and mouth for about 1 second, looking to see that the chest rises. - Take another breath, make a seal, then give the second rescue breath. Note: Same as for adult and child CPR, but use your pinky during the finger sweep. 5. Continue giving sets of 30 chest compressions and 2 rescue breaths until: - You notice an obvious sign of life. - An AED is ready to use and no other trained responders are available to assist you with the AED. - You have performed approximately 2 minutes of CPR (5 sets of 30:2) and another trained responder is available to take over compressions. - You have performed approximately 2 minutes of CPR (5 sets of 30:2), you are alone and caring for an infant, and you need to call 9-1-1 or the designated emergency number. - EMS personnel take over. - You are too tired to continue. - The scene becomes unsafe.

Conscious Choking

Choking occurs when the airway becomes either partially or completely blocked by a foreign object, such as a piece of food or a small toy; by swelling in the mouth or throat; or by fluids, such as vomit or blood. Caring for an Adult who is Choking: 1. Verify that the person is choking by asking the person to speak to you. - If the person is able to speak to you or is coughing forcefully: Encourage the person to keep coughing, but be prepared to give first aid for choking if the person's condition changes. - If the person is unable to speak to you or is coughing weakly: Send someone to call 9-1-1 or the designated emergency number and to obtain an AED and first aid kit. Continue to step 2 after obtaining consent. 2. Give 5 back blows. - Position yourself to the side and slightly behind the person. - Place one arm diagonally across the person's chest (to provide support) and bend the person forward at the waist so that the person's upper body is as close to parallel to the ground as possible. - Firmly strike the person between the shoulder blades with the heel of your hand. 3. Give 5 abdominal thrusts. - Have the person stand up straight. Stand behind the person with one foot in front of the other for balance and wrap your arms around the person's waist. - Using two fingers of one hand, find the person's navel. With your other hand, make a fist and place the thumb side against the person's stomach, right above your fingers. - Cover the fist with your other hand. - Pull inward and upward to give an abdominal thrust. 4. Continue giving sets of 5 back blows and 5 abdominal thrusts until: - The person can cough forcefully, speak, cry or breathe. - The person becomes unresponsive. Note: If the person becomes unresponsive, gently lower him or her to the floor and begin CPR if you are trained, starting with compressions. After each set of compressions and before attempting rescue breaths, open the person's mouth, look for the object and remove it if seen. Never put your finger in the person's mouth unless you actually see the object. Caring for a Child who is Choking: 1. Verify that the child is choking by asking the child to speak to you. - If the child is able to speak to you or is coughing forcefully: Encourage the child to keep coughing, but be prepared to give first aid for choking if the child's condition changes. - If the child is unable to speak to you or is coughing weakly: Send someone to call 9-1-1 or the designated emergency number and to obtain an AED and first aid kit. Continue to step 2 after obtaining consent. 2. Give 5 back blows. - Position yourself to the side and slightly behind the child. Place one arm diagonally across the child's chest (to provide support)and bend the child forward at the waist so that the child's upper body is as close to parallel to the ground as possible. Depending on the child's size, you may need to kneel. - Firmly strike the child between the shoulder blades with the heel of your hand. 3. Give 5 abdominal thrusts. - Have the child stand up straight. Stand behind the child with one foot in front of the other for balance (or kneel) and wrap your arms around the child's waist. - Using two fingers of one hand, find the child's navel. With your other hand, make a fist and place the thumb side against the child's stomach, right above your fingers. - Cover the fist with your other hand. - Pull inward and upward to give an abdominal thrust. 4. Continue giving sets of 5 back blows and 5 abdominal thrusts until: - The child can cough forcefully, speak, cry or breathe. - The child becomes unresponsive. Note: If the child becomes unresponsive, gently lower him or her to the floor and begin CPR if you are trained, starting with compressions. After each set of compressions and before attempting rescue breaths, open the child's mouth, look for the object and remove it if seen. Never put your finger in the child's mouth unless you actually see the object. Giving care to an Infant who is Choking: 1. Verify that the infant is choking by checking to see if the infant is crying or coughing forcefully. - If the infant is crying or coughing forcefully: Allow the infant to keep coughing, but be prepared to give first aid for choking if the infant's condition changes. - If the infant is unable to cry or is coughing weakly: Send someone to call 9-1-1 or the designated emergency number and to obtain an AED and first aid kit. Continue to step 2 after obtaining consent. 2. Position the infant. - Place your forearm along the infant's back, cradling the back of the infant's head with your hand. - Place your other forearm along the infant's front, supporting the infant's jaw with your thumb and fingers. - Turn the infant over so that he or she is face-down along your forearm. - Lower your arm onto your thigh so that the infant's head is lower than his or her chest. Note: Always support the infant's head, neck and back while giving back blows and chest thrusts. 3. Give 5 back blows. - Firmly strike the infant between the shoulder blades with the heel of your hand. Keep your fingers up to avoid hitting the infant's head or neck. 4. Reposition the infant. - Place one hand along the infant's back, cradling the back of the infant's head with your hand. - While continuing to support the infant's jaw with the thumb and fingers of your other hand, support the infant between your forearms and turn the infant over so that he or she is face-up along your forearm. - Lower your arm onto your other thigh so that the infant's head is lower than his or her chest. 5. Give 5 chest thrusts. - Place the pads of two fingers in the center of the infant's chest on the breastbone, just below the nipple line. - Press down about 11⁄2 inches and then let the chest return to its normal position. 6. Continue giving sets of 5 back blows and 5 chest thrusts until: - The infant can cough forcefully, cry or breathe. - The infant becomes unresponsive. Note: If the infant becomes unresponsive, lower him or her to a firm, flat surface and begin CPR if you are trained, starting with compressions. After each set of compressions and before attempting rescue breaths, open the infant's mouth, look for the object and remove it if seen. Never put your finger in the infant's mouth unless you actually see the object.

Know sudden illness

General Approach to Sudden Illness An acute illness is an illness that strikes suddenly and usually only lasts for a short period of time. A chronic illness is an illness that a person lives with on an ongoing basis and that often requires continuous treatment to manage. When a person becomes suddenly ill, it may be the result of an acute illness, or it may be an acute flare-up of a chronic condition. Signs and Symptoms of Sudden Illness The signs and symptoms of sudden illness vary widely, depending on the cause of the illness. The person may have: ■ Trouble breathing. ■ Pain, such as chest pain, abdominal pain or a headache. ■ Changes in level of consciousness, such as being confused or unaware of one's surroundings, or becoming unresponsive. ■ Light-headedness or dizziness. ■ Nausea, vomiting, diarrhea or stomach cramps. ■ A fever. THE PROS KNOW. _______ Be sure to look for a medical identification tag or digital medical identification on the person's phone when you are checking the person. It may offer a valuable clue as to the cause of the person's sudden illness. General Approach to Sudden Illness An acute illness is an illness that strikes suddenly and usually only lasts for a short period of time. A chronic illness is an illness that a person lives with on an ongoing basis and that often requires continuous treatment to manage. When a person becomes suddenly ill, it may be the result of an acute illness, or it may be an acute flare-up of a chronic condition. ■ Pale or very flushed skin, which may be excessively sweaty or dry, or excessively hot or cold. ■ Problems seeing or speaking (e.g., blurred vision or slurred speech). ■ Numbness, weakness or paralysis. ■ Seizures. To gain a better understanding of the situation, interview the person (or bystanders, if necessary) using SAMPLE, and then check the person from head-to-toe (see Chapter 2). Signs and symptoms like trouble breathing, pain that is persistent or severe, problems seeing or speaking, problems feeling or moving, seizures or unresponsiveness require a call to 9-1-1 or the designated emergency number. If you are unsure about the severity of the illness, it is better to call for help early than to wait for the illness to progress. First Aid Care for Sudden Illness Fortunately, you do not need to know exactly what is wrong to provide appropriate first aid care. If your initial check of the person reveals any life-threatening conditions (see Chapter 1, Box 1-5), make sure that someone calls 9-1-1 or the designated emergency number right away, and then provide care according to the signs and symptoms that you find and your level of training. Follow the same general guidelines as you would for any emergency: ■ Do no further harm. ■ Monitor the person's breathing and level of consciousness. ■ Help the person rest in the most comfortable position. ■ Keep the person from getting chilled or overheated. ■ Reassure the person that you will help and that EMS personnel have been called (if appropriate). ■ Give care consistent with your knowledge and training as needed, and continue to watch for changes in the person's condition.

HPV

HPV is the most common sexually transmitted infection (STI). HPV is a different virus than HIV and HSV (herpes). 79 million Americans, most in their late teens and early 20s, are infected with HPV. There are many different types of HPV. Some types can cause health problems including genital warts and cancers. But there are vaccines that can stop these health problems from happening.

Know soft tissue injuries

Injuries to the muscles, bones and joints include sprains, strains, dislocations and fractures. ■ A sprain occurs when a ligament is stretched, torn or damaged. Ligaments connect bones to bones at the joints. Sprains most commonly affect the ankle, knee, wrist and finger joints. ■ A strain occurs when a tendon or muscle is stretched, torn or damaged. Tendons connect muscles to bones. Strains often are caused by lifting something heavy or working a muscle too hard. They usually involve the muscles in the neck, back, thigh or the back of the lower leg. Some strains can reoccur, especially in the neck and back. ■ A dislocation occurs when the bones that meet at a joint move out of their normal position. This type of injury is usually caused by a violent force that tears the ligaments, allowing the bones to move out of place. ■ A fracture is a complete break, a chip or a crack in a bone. Fractures can be open (the end of the broken bone breaks through the skin) or closed (the broken bone does not break through the skin).

Controlling Bleeding

Internal bleeding (bleeding that occurs inside the body, into a body cavity or space) can be a consequence of traumatic injury and may be life threatening. A wound is an injury that results when the skin or other tissues of the body are damaged. Wounds are generally classified as open or closed. Using Direct Pressure to Control External Bleeding 1. Cover the wound with a sterile gauze pad and apply direct pressure until the bleeding stops. - If blood soaks through the first gauze pad, put another one on top and apply additional direct pressure (press harder than you did before, if possible). It may take several minutes for the bleeding to stop. 2. When the bleeding stops, check for circulation (feeling, warmth and color) beyond the injury. 3. Apply a roller bandage. Wrap the bandage around the wound several times to hold the gauze pad(s) in place. - Tie or tape the bandage to secure it. - Check for circulation (feeling, warmth and color) beyond the injury. If there is a change in feeling, warmth or color (indicating that the bandage is too tight), gently loosen it. 4. Remove your gloves and wash your hands. Note: If the bleeding does not stop with the application of direct pressure, call 9-1-1 or the designated emergency number if you have not already, and give care for shock if necessary. Using a Commercial Tourniquet 1. Place the tourniquet around the limb, approximately 2 inches above the wound. Avoid placing the tourniquet over a joint. 2. Secure the tourniquet tightly in place according to the manufacturer's instructions. 3. Tighten the tourniquet by twisting the rod until the flow of bright red blood stops. 4. Secure the rod in place using the clip or holder. 5. Note and record the time that you applied the tourniquet and give this information to EMS personnel when they arrive. - Once you apply a tourniquet, do not loosen or remove it. To care for a minor open wound, put on latex-free disposable gloves and other personal protective equipment (PPE) as necessary. Apply direct pressure with a gauze pad to stop the bleeding. It may take several minutes for the bleeding to stop. After the bleeding stops, wash the area with soap and warm water. Rinse under warm running water for about 5 minutes until the wound appears clean and free of debris, and then dry the area. Apply a small amount of antibiotic ointment, cream or gel to the wound if the person has no known allergies or sensitivities to the ingredients. Then cover the area with a sterile gauze pad and a bandage, or apply an adhesive bandage. When you are finished providing care, wash your hands with soap and water, even if you wore gloves. Myth-Information. Myth: Use hydrogen peroxide to clean a wound and prevent infection; the bubbles mean it is working to kill germs. Although applying hydrogen peroxide to a wound will kill germs, it also can harm the tissue and delay healing. The best way to clean a wound is with soap and warm, running water or saline. Myth-Information. Myth: Letting a wound "breathe" by exposing it to air helps it to heal. A better strategy to promote wound healing is to keep the wound moist (with an antibiotic ointment, cream or gel) and covered (under a dressing and bandage). A major open wound (for example, one that involves extensive tissue damage or is bleeding heavily or uncontrollably) requires prompt action. Call 9-1-1 or the designated emergency number immediately and then take steps to control the bleeding until help arrives. A tourniquet is a device placed around an arm or leg to constrict blood vessels and stop blood flow to a wound. In some life-threatening circumstances, you may need to use a tourniquet to control bleeding as the first step instead of maintaining direct pressure over several minutes. Examples of situations where it may be necessary to use a tourniquet include: - Severe, life-threatening bleeding that cannot be controlled using direct pressure. - A physical location that makes it impossible to apply direct pressure to control the bleeding (e.g., the injured person or the person's limb is trapped in a confined space). - Multiple people with life-threatening injuries who need care. - A scene that is or becomes unsafe. Although tourniquets may have slightly different designs, all are applied in generally the same way. First, place the tourniquet around the wounded extremity about 2 inches above the wound, avoiding the joint if possible. Secure the tourniquet tightly in place according to the manufacturer's instructions. Twist the rod (windlass) to tighten the tourniquet until the bright red bleeding stops, then secure the rod in place. Note and record the time that you applied the tourniquet and be sure to give EMS personnel this information when they arrive. Once the tourniquet is applied, it should not be removed until the person reaches a healthcare facility. A hemostatic dressing is a dressing treated with a substance that speeds clot formation. As is the case with tourniquets, hemostatic dressings are used when severe life-threatening bleeding exists and standard first aid procedures fail or are not practical. Typically, hemostatic dressings are used on parts of the body where a tourniquet cannot be applied, such as the neck or torso. A hemostatic dressing can also be used to control bleeding from an open wound on an arm or a leg if a tourniquet is ineffective. The hemostatic dressing is applied at the site of the bleeding (possibly inside of the wound) and is used along with direct pressure. In some cases, the object that caused the wound may remain in the wound. If the embedded object is large (for example, a large piece of glass or metal), do not attempt to remove it. Instead, place several dressings around the object to begin to control blood loss, and then pack bulk dressings or roller bandages around the embedded object to keep it from moving.

Know about disease transmission in first aid

Lowering the Risk for Infection Giving first aid care is a hands-on activity. Providing this care can put you in close contact with another person's body fluids (such as saliva, mucus, vomit or blood), which may contain pathogens (harmful microorganisms that can cause disease). Pathogens can be spread from person to person through direct or indirect contact. In direct transmission, the pathogen is passed from one person to another through close physical contact. In indirect transmission, the pathogen is spread by way of a contaminated surface or object. Some pathogens that you could be exposed to when providing first aid care pose particular risk because of their long-term effects on your health if you become infected (Box 1-6). ■ Bloodborne pathogens are spread when blood from an infected person enters the bloodstream of a person who is not infected. Bloodborne illnesses that are of particular concern include human immunodeficiency virus (HIV) infection and hepatitis B, C and D. Fortunately, although bloodborne pathogens can cause serious illnesses, they are not easily transmitted and are not spread by casual contact. Remember, for infection to occur, an infected person's blood must enter your bloodstream. This could happen through direct or indirect contact with an infected person's blood if it comes in contact with your eyes, the mucous membranes that line your mouth and nose, or an area of broken skin on your body. You could also become infected if you stick yourself with a contaminated needle (a "needlestick injury") or cut yourself with broken glass that has been contaminated with blood. ■ Airborne pathogens are pathogens that are expelled into the air when an infected person breathes, coughs or sneezes. Infection spreads when a person who is not infected inhales respiratory droplets containing the pathogens. Examples of airborne illnesses include tuberculosis and influenza. Box 1-6. Bloodborne and Airborne Illnesses Although the risk of catching a disease when giving first aid care is very low, whenever you give care, there is the potential to be exposed to an infectious disease. Of particular concern are diseases that are not easily treated and can have long-term effects on your health, should you become infected. Using personal protective equipment (PPE) reduces your risk for catching an infectious disease significantly. Bloodborne Illnesses ■ HIV is a virus that invades and destroys the cells that help us to fight off infections. A person who is infected with HIV may look and feel healthy for many years. However, during this time, the virus is breaking down the person's immune system. Eventually, a person who is infected with HIV may develop acquired immunodeficiency syndrome (AIDS). A person with AIDS is unable to fight off infections that a healthy person would be able to resist or control. The person dies from one of these infections. Although medications have been developed to help slow the progression of HIV infection, currently there is no cure. ■ Hepatitis is inflammation of the liver, an organ that performs many vital functions for the body. There are many different types and causes of hepatitis. Hepatitis B, hepatitis C and hepatitis D are caused by infection with bloodborne viruses. Chronic infection with the viruses that cause hepatitis B, C or D can lead to liver failure, liver cancer and other serious conditions. Airborne Illnesses ■ Tuberculosis is a bacterial infection of the lungs that is spread through the air from one person to another. Although tuberculosis primarily affects the lungs, it can also affect the bones, brain, kidneys and other organs. If not treated, tuberculosis can be fatal. Treatment is complex and involves taking many different medications over an extended period of time. Limiting Your Exposure to Pathogens There are two main steps you can take to limit your exposure to pathogens and your risk for contracting a communicable disease while giving first aid care: use personal protective equipment (PPE) and wash your hands after giving care. Personal Protective Equipment Personal protective equipment (PPE) is equipment used to prevent pathogens from contaminating your skin, mucous membranes or clothing. Articles of PPE that are commonly used when giving first aid care include latex-free disposable gloves and CPR breathing barriers. Face masks and protective eyewear are other types of PPE that may be used in a first aid situation. Latex-Free Disposable Gloves Disposable gloves are meant to be worn once and then discarded. Never clean or reuse disposable gloves. Disposable gloves should fit properly and be free of rips or tears. Wear latex-free disposable gloves: ■ When providing care, especially whenever there is a possibility that you will come in contact with a person's blood or other potentially infectious materials. ■ When there is a break in the skin on your own hands (cover any cuts, scrapes or sores before putting on the gloves). ■ When you must handle items or surfaces soiled with blood or other potentially infectious materials. When you are wearing gloves, try to limit how much you touch other surfaces with your gloved hands. Pathogens from your soiled gloves can transfer to other items or surfaces that you touch, putting the next person who handles the item or touches the surface at risk for infection. If possible, remove soiled gloves and replace them with a clean pair before touching other surfaces or equipment in your first aid kit. When you are finished providing care, remove your gloves using proper technique to avoid contaminating your own skin (Skill Sheet 1-1), dispose of the gloves properly and wash your hands. When multiple people are in need of care, remove your gloves, wash your hands and replace your gloves with a clean pair before assisting the next person. CPR Breathing Barriers CPR breathing barriers are used to protect you from contact with saliva and other body fluids, such as blood, as you give rescue breaths. Breathing barriers also protect you from breathing the air that the person exhales. The most basic and portable type of breathing barrier is a face shield, a flat piece of thin plastic that you place over the person's face, with the opening over the person's mouth. The opening contains a filter or a valve that protects you from coming into contact with the person's body fluids and exhaled air. A pocket mask is a transparent, flexible device that creates a tight seal over the person's nose and mouth to allow you to give rescue breaths without making mouth-to-mouth contact or inhaling exhaled air. Breathing barriers sized specifically for children and infants are available. Always use equipment that is sized appropriately for the injured or ill person. Hand Washing Wash your hands thoroughly with soap and warm running water when you have finished giving care, even if you wore disposable gloves. Wash for a minimum of 20 seconds and make sure to cover all surfaces of both hands: your wrists, the palms and backs of your hands, in between your fingers and underneath your fingernails. If soap and water are not available, you may use an alcohol-based hand sanitizer to decontaminate your hands. When using an alcohol-based hand sanitizer, use the amount of product recommended by the manufacturer. Rub it thoroughly over all surfaces of your hands, including your nails and in between your fingers, until the product dries. Wash your hands with soap and water as soon as you have access to hand-washing facilities. Cleaning and Disinfecting Surfaces and Equipment Reusable equipment and surfaces that have been contaminated by blood or other potentially infectious materials need to be properly cleaned and disinfected before the equipment is put back into service or the area is reopened. Clean and disinfect surfaces and equipment as soon as possible after the incident occurs. Remember to wear appropriate PPE. If blood or other potentially infectious materials have spilled on the floor or another surface, prevent others from accessing the area. If the spill contains a sharp object (e.g., shards of broken glass), do not pick the object up with your hands. Instead, use tongs, a disposable scoop and scraper, or two pieces of cardboard to remove and dispose of the object. Wipe up or absorb the spill using absorbent towels or a solidifier (a fluid-absorbing powder). After wiping up the spill, flood the area with a freshly mixed disinfectant solution of approximately 11⁄2 cups of bleach to 1 gallon of water (1 part bleach to 9 parts water, or about a 10 percent solution). When using a bleach solution, always ensure good ventilation and wear gloves and eye protection. Let the bleach solution stand on the surface for at least 10 minutes. Then use clean absorbent materials (such as paper towels) to wipe up the disinfectant solution and dry the area. Dispose of all materials used to clean up the blood spill in a labeled biohazard container. If a biohazard container is not available, place the soiled materials in a sealable plastic bag or a plastic container with a lid, seal the container and dispose of it properly. Chapter 1 Before Giving Care | 15 | First Aid/CPR/AED Participant's Manual © 2011, 2016 The American National Red Cross. All rights reserved. Cleaning and Disinfecting Surfaces and Equipment Reusable equipment and surfaces that have been contaminated by blood or other potentially infectious materials need to be properly cleaned and disinfected before the equipment is put back into service or the area is reopened. Clean and disinfect surfaces and equipment as soon as possible after the incident occurs. Remember to wear appropriate PPE. If blood or other potentially infectious materials have spilled on the floor or another surface, prevent others from accessing the area. If the spill contains a sharp object (e.g., shards of broken glass), do not pick the object up with your hands. Instead, use tongs, a disposable scoop and scraper, or two pieces of cardboard to remove and dispose of the object. Wipe up or absorb the spill using absorbent towels or a solidifier (a fluid-absorbing powder). After wiping up the spill, flood the area with a freshly mixed disinfectant solution of approximately 11⁄2 cups of bleach to 1 gallon of water (1 part bleach to 9 parts water, or about a 10 percent solution). When using a bleach solution, always ensure good ventilation and wear gloves and eye protection. Let the bleach solution stand on the surface for at least 10 minutes. Then use clean absorbent materials (such as paper towels) to wipe up the disinfectant solution and dry the area. Dispose of all materials used to clean up the blood spill in a labeled biohazard container. If a biohazard container is not available, place the soiled materials in a sealable plastic bag or a plastic container with a lid, seal the container and dispose of it properly. Aid/CPR/AED Participant's Manual © 2011, 2016 The American National Red Cross. All rights reserved. Cleaning and Disinfecting Surfaces and Equipment Reusable equipment and surfaces that have been contaminated by blood or other potentially infectious materials need to be properly cleaned and disinfected before the equipment is put back into service or the area is reopened. Clean and disinfect surfaces and equipment as soon as possible after the incident occurs. Remember to wear appropriate PPE. If blood or other potentially infectious materials have spilled on the floor or another surface, prevent others from accessing the area. If the spill contains a sharp object (e.g., shards of broken glass), do not pick the object up with your hands. Instead, use tongs, a disposable scoop and scraper, or two pieces of cardboard to remove and dispose of the object. Wipe up or absorb the spill using absorbent towels or a solidifier (a fluid-absorbing powder). After wiping up the spill, flood the area with a freshly mixed disinfectant solution of approximately 11⁄2 cups of bleach to 1 gallon of water (1 part bleach to 9 parts water, or about a 10 percent solution). When using a bleach solution, always ensure good ventilation and wear gloves and eye protection. Let the bleach solution stand on the surface for at least 10 minutes. Then use clean absorbent materials (such as paper towels) to wipe up the disinfectant solution and dry the area. Dispose of all materials used to clean up the blood spill in a labeled biohazard container. If a biohazard container is not available, place the soiled materials in a sealable plastic bag or a plastic container with a lid, seal the container and dispose of it properly. Handling an Exposure Incident If another person's blood or other potentially infectious material comes into contact with your eyes, the mucous membranes of your mouth or nose, or an opening or break in your skin, or if you experience a needlestick injury, then you have been involved in an exposure incident. In the event of an exposure incident, follow these steps immediately: ■ Decontaminate the exposed area. If your skin was exposed, wash the contaminated area with soap and water. For splashes into your mouth or nose, flush the area with water. For splashes into the eyes, irrigate the eyes with water, saline or a sterile irrigant for 15 to 20 minutes. ■ Report the exposure incident to EMS personnel or your healthcare provider. ■ If the exposure incident occurred in a workplace setting, notify your supervisor and follow your company's exposure control plan for reporting the incident and receiving post-exposure follow-up care

Pregnancy and Birth

Prenatal Development - Fertilization * Sperm cell meets an ovum * Takes place in upper 1/3 of fallopian tube - Zygote * Fertilized ovum (0-2 weeks) - Blastocyst * After cell division the zygote becomes a ball of cells with a cavity - The zygote and blastocyst implant in the lining known as the endometrium - Ectopic pregnancy * When the zygote implants outside the uterus Embryonic Development - Embryo * When the blastocyst becomes implanted in the uterine lining, it is called an embryo (2, 8-10 weeks) - The brain is one of the first organs to develop * Neurons appear around 18 days after fertilization - Amnion * A fluid-filled sac around the embryo known as the bag of waters - Placenta * Structure that forms along the lining of the uterus as the embryo implants * Transfers oxygen and nutrients from the mother's blood to the embryo's blood - Umbilical Cord * Tube that connects the embryo to the placenta * Blood vessels from the embryo connect to blood vessels that go through the umbilical cord and into the placenta * The blood of the embryo and mother never mix Fetal Development - Fetus * Developing baby from 10th week until birth - The fetus has all major organs and tissues Determining a Pregnancy - Human chorionic gonadotropin (HCG) * Stimulates release of estrogen and progesterone, which prevent the ovaries from releasing more ova - Pregnancy tests check urine for presence of HCG - Radioimmunoassay * Test that checks for HCG in urine or blood as early as a week before the menstrual period Girl or Boy? - Two kinds of sex chromosomes * X and Y - Sperm cells carry an X or Y - Ova only carry X - Ovum fertilized by sperm with an X chromosome = female (XX) - Ovum fertilized by sperm with a Y chromosome = male (XY) - Father determines sex of the child Genes and Heredity - Chromosomes are made up of genes - Genes * Units of hereditary that determine which traits, or characteristics, we inherit from our parents - Genes control mostly all of our traits - For some kind of traits there are dominant and recessive genes Hereditary Diseases - The gene for some hereditary diseases is dominant - Then only one parents needs to contribute the gene to their child for that child to have the disease - Huntington's Chorea * Causes progressive loss of mental functions is such a disease - Other genetic diseases results from both parents passing on the recessive gene - This may occur even if neither parent has the disease - Sickle-cell anemia * Deprives vital organs of their blood supply and is such a disease Genetic Counseling - Process in which the genetic histories of the male and female are studied to predict or determine the presence of certain inherited diseases Prenatal Care: Characteristics of a Pregnancy - 1st Trimester * Breasts begin to get fuller and tender * Abdomen may become enlarged due to bloating of intestines * Fatigue occurs after little exertion - 2nd Trimester * Swollen abdomen is apparent due to fetus * Appetite increases * Fetal movement can be detected - 3rd Trimester * Most females have gained 25-40 pounds Nutrition and Exercise - A female needs to eat extra protein during pregnancy for development of the placenta, amnion, and extra blood - She needs calcium for strong bones and teeth - Vitamin E for tissue growth and red blood cells - Iron for red blood cells - Caloric intake should be increased by 300-500 calories - Doctor will discuss exercise during pregnancy Medical Complications - PIH and Preeclampsia: * PIH is normal and harmless for most * If accompanied by weight gain, swelling from water retention, and protein in the urine, it may be preeclampsia * Preeclampsia can lead to blurred vision and coma in the mother and mental retardation in the fetus - 5-10% of females develop prolonged high blood pressure during pregnancy Dangers to the Fetus - Alcohol - May lead to Fetal Alcohol Syndrome - FAS - Physical, mental, and behavioral abnormalities and birth defects that result when a pregnant woman drinks alcohol - Tobacco - Babies born to females who smoke have a greater chance of being born premature and thus have lower birth weights - Medications and drugs - Any medicines or natural supplements must only be taken if approved by a health professional - Caffeine - Another possible hazard to the fetus Test During Pregnancy - Ultrasound: * Reflects sound waves off organs and bones to produce picture * Used to check baby's position * Can confirm date of conception - Amniocentesis: * Procedure used to reveal chromosomal abnormalities and metabolic disorders in the fetus * Needle is inserted into amniotic fluid - Chorionic Villi Sampling (CVS): * Used to reveal chromosomal abnormalities * A piece of membrane is removed from the chorion, or tissue that develops in the placenta Birth Defects - There are more than 2,000 known types of genetic conditions and birth defects - Birth Defects - Defects present at birth, including genetic conditions or problems caused by environmental factors Childbirth: Stages of Labor - 1st Stage: * Dilation of cervix (1st and longest stage) * The amniotic sac ruptures (water breaks) - 2nd Stage * Crowning = Baby's head appears * An episiotomy may be needed to enlarge the opening for delivery of the baby - 3rd Stage: * Placenta passes through vagina (afterbirth) Delivery by Cesarean - Cesarean birth - Method of childbirth in which a surgical incision is made through the abdominal wall and uterus - Reasons for C-Section: * Baby may not be positioned correctly or failed to descend into the birth canal * Mother may also have an STD Medication During Labor - Demerol - Common analgesic given to female in labor - Other drugs include tranquilizers such as Valium and Vistaril - Epidural block-medication injected through a tube inserted between the vertebrae of the spine * Numbs the female from the waste down After Delivery - Prolactin - Stimulates milk production - For the first few days after birth, the breasts secrete colostrum - Colostrum and milk contain antibodies - Breast milk is more easily digested than formula - No baby is allergic to breast milk - Postpartum period - Period of time from the birth of a baby until the female begins her menstrual period again Childbirth: Options and Trends - Prepared Childbirth Training: * Classes offered in Lamaze Method and Bradley Method - Doctors and midwives recommend that expectant mothers and fathers take classes - Father assumes the role of coach - Many women are choosing natural childbirth rather than using pain-killing medicines Where to Give Birth - Birthing Centers - Birthing facilities with homelike settings separate form regular hospitals and that offer medication-free births - Hospitals are another option * Hospitals allow for rooming-in with the mother, father, and baby all present

Know breathing emergencies

Respiratory Distress Respiratory distress, or difficulty breathing, is evidenced by signs and symptoms such as shortness of breath, gasping for breath, hyperventilation (breathing that is faster and shallower than normal), or breathing that is uncomfortable or painful. Respiratory distress can lead to respiratory arrest (absence of breathing). Causes of Respiratory Distress A number of different conditions can cause respiratory distress, including acute flare-ups of chronic respiratory conditions such as asthma or chronic obstructive pulmonary disease (COPD); lung and respiratory tract infections (such as pneumonia or bronchitis); severe allergic reactions (anaphylaxis); heart conditions (such as a heart attack or heart failure); trauma; poisoning; drug overdose; electrocution; and mental health conditions (such as panic disorder). Signs and Symptoms of Respiratory Distress A person who is experiencing respiratory distress is, understandably, often very frightened. The person may feel like he or she cannot get enough air and may gasp for breath. Because the person is struggling to breathe, speaking in complete sentences may be difficult. You might hear wheezing, gurgling or high-pitched noises as the person tries to breathe. You may also notice that the person's breathing is unusually slow or fast, unusually deep or shallow, or irregular. The person's skin may feel moist or cool, and it may be pale, ashen (gray), bluish or flushed. Lack of oxygen can make the person feel dizzy or light-headed. First Aid Care for Respiratory Distress When a person is experiencing a breathing emergency, it is important to act at once. In some breathing emergencies, the oxygen supply to the body is greatly reduced, whereas in others the oxygen supply is cut off entirely. If breathing stops or is restricted long enough, the person will become unresponsive, the heart will stop beating and body systems will quickly fail. Recognizing that a person is having trouble breathing and providing appropriate first aid care can save the person's life. You usually can identify a breathing problem by watching and listening to the person's breathing and by asking the person how he or she feels. If a person is having trouble breathing, do not wait to see if the person's condition improves. Call 9-1-1 or the designated emergency number and provide appropriate first aid care until help arrives: ■ If you know the cause of the respiratory distress (for example, an asthma attack or anaphylaxis) and the person carries medication used for the emergency treatment of the condition, offer to help the person take his or her medication. ■ Encourage the person to sit down and lean forward. Many people find that this position helps to make breathing easier. Providing reassurance can reduce anxiety, which may also help to make breathing easier. ■ If the person is responsive, gather additional information by interviewing the person and performing a head-to-toe check. Remember that a person having breathing problems may find it difficult to talk. Try phrasing your questions as "yes" or "no" questions so the person can nod or shake his or her head in response instead of making the effort to speak. You may also be able to ask bystanders what they know about the person's condition. ■ Be prepared to give CPR and use an AED if the person becomes unresponsive and you are trained in these skills. Certain behaviors can put a person at risk for choking, such as talking or laughing with the mouth full or eating too fast. Medical conditions (such as a neurological or muscular condition that affects the person's ability to chew, swallow or both) can increase risk for choking. So can dental problems or poorly fitting dentures that affect the person's ability to chew food properly. Children younger than 5 years are at particularly high risk for choking (Box 4-1). Infants and toddlers explore by putting things in their mouths and can easily choke on them. Even some common foods can be choking hazards in young children. For example, a young child can choke on small foods (such as nuts and seeds);round, firm foods (such as grapes, hot dogs and hard candies); and sticky foods (such as peanut butter). This is because young children do not have the skills needed to chew these foods thoroughly, so they often try to just swallow them whole. Laughing, talking or running with the mouth full can also lead to choking. Signs and Symptoms of Choking A person who is choking typically has a panicked, confused or surprised facial expression. Some people may place one or both hands on their throat. The person may cough (either forcefully or weakly), or he or she may not be able to cough at all. You may hear high-pitched squeaking noises as the person tries to breathe, or nothing at all. If the airway is totally blocked, the person will not be able to speak, cry or cough. The person's skin may initially appear flushed (red), but will become pale or bluish in color as the body is deprived of oxygen. First Aid for Choking If you are with a person who starts to choke, first ask the person if he or she is choking, or check to see if an infant is crying or making other noises. If the person can speak or cry and is coughing forcefully, encourage him or her to keep coughing. A person who is getting enough air to speak, cry or cough forcefully is getting enough air to breathe. But be prepared to act if the person's condition changes. If the person is making high-pitched noises or coughing weakly, or if the person is unable to speak or cry, the airway is blocked and the person will soon become unresponsive unless the airway is cleared. Have someone call 9-1-1 or the designated emergency number immediately while you begin to give first aid for choking.

Unconscious Choking

Same as above; however, the person becomes unconscious or unresponsive due to the lack of oxygen. If a person who is choking becomes unresponsive, carefully lower him or her to the ground and, if you are trained, begin CPR, starting with chest compressions. After each set of chest compressions and before attempting rescue breaths, open the person's mouth and look for the object. If you see an object in the person's mouth, remove it using your finger (Figure 4-3). Never put your finger in the person's mouth unless you actually see the object. If you cannot see the object and you put your finger in the person's mouth, you might accidentally push the object deeper into the person's throat.

Shock

Shock Shock is a progressive, life-threatening condition in which the circulatory system fails to deliver enough oxygen-rich blood to the body's tissues and organs. As a result, organs and body systems begin to fail. Common causes of shock include severe bleeding and severe allergic reactions (anaphylaxis), but shock can develop quickly after any serious injury or illness. A person who is showing signs and symptoms of shock needs immediate medical attention. Signs and Symptoms of Shock A person who is going into shock may show any of the following signs and symptoms: ■ Restlessness or irritability ■ Altered level of consciousness ■ Nausea or vomiting ■ Pale, ashen (grayish), cool, moist skin ■ Rapid breathing ■ Rapid, weak heartbeat ■ Excessive thirst First Aid Care for Shock When a person who has been injured or is ill shows signs and symptoms of shock, call 9-1-1 or the designated emergency number immediately, if you have not already done so. Shock cannot be managed effectively by first aid alone, so it is important to get the person emergency medical care as soon as possible. While you are waiting for help to arrive: ■ Have the person lie flat on his or her back. ■ Control any external bleeding. ■ Cover the person with a blanket to prevent loss of body heat. ■ Do not give the person anything to eat or drink, even though he or she may complain of thirst. Eating or drinking increases the person's risk for vomiting and aspiration (inhalation of foreign matter into the lungs). Aspiration can cause serious complications, such as pneumonia. ■ Provide reassurance, and help the person rest comfortably. Anxiety and pain can intensify the body's stress and speed up the progression of shock. ■ Continue to monitor the person's condition and watch for changes in level of consciousness.

Know the body's anatomy as it relates to first aid and care for injuries to muscles, bones, and joints.

Signs and Symptoms of Muscle, Bone and Joint Injuries Muscle, bone and joint injuries can be extremely painful. Sometimes the injury will be very obvious— for example, you may see the ends of a broken bone protruding through the skin, or the injured body part might appear bent or crooked (deformed). If a joint is dislocated, you may see an abnormal bump, ridge or hollow formed by the displaced end of the bone. Other times, signs and symptoms of injury may be more subtle, such as swelling or bruising. Usually, the person will try to avoid using the injured body part because using it causes pain. In some cases, the person may be unable to move the injured body part. The person might also report feeling or hearing "popping" or "snapping" at the time of the injury, or "grating" when moving the injured part. Sometimes when a person has a muscle, bone or joint injury, you will be able to tell right away that you need to call 9-1-1 or the designated emergency number. But not all muscle, bone or joint injuries result in obvious injuries, and some are not serious enough to summon emergency medical services (EMS) personnel. In general, call 9-1-1 or the designated emergency number if: ■ A broken bone is protruding through the skin. ■ The injured body part is bent, crooked or looks deformed. ■ There is moderate or severe swelling and bruising. ■ The person heard or felt "popping" or "snapping" at the time of the injury. ■ The person hears or feels "grating" when he or she moves the injured body part. ■ The person cannot move or use the injured body part. ■ The injured area is cold and numb. ■ The injury involves the head, neck or spine. ■ The person is having difficulty breathing. ■ The cause of the injury (for example, a fall from a height or getting hit by a vehicle) makes you think that the injury may be severe, or that the person may have multiple injuries. ■ It is not possible to safely or comfortably move the person to a vehicle for transport to a healthcare facility. First Aid Care for Muscle, Bone and Joint Injuries If you have called 9-1-1 or the designated emergency number and are waiting for EMS personnel to arrive, have the person rest without moving or straightening the body part. If the person can tolerate it, apply a cold pack wrapped in a thin, dry towel to the area to reduce swelling and pain. RICE In some cases, it may only be necessary for the person to see his or her healthcare provider to have the injury evaluated. If calling EMS is unnecessary, the mnemonic RICE can help you remember how to care for a muscle, bone or joint injury: R stands for rest. Limit use of the injured body part. ■ I stands for immobilize. Stabilize the injured body part with an elastic bandage or a splint to limit motion. ■ C stands for cold. Apply a cold pack wrapped in a thin, dry towel to the area for no more than 20 minutes at a time, and wait at least 20 minutes before applying the cold pack again. ■ E stands for elevate. Propping the injured part up may help to reduce swelling, but do not do this if raising the injured part causes more pain. Myth-Information. Myth: Apply heat to a muscle, bone or joint injury to speed healing. Although applying heat is commonly used to relieve pain associated with chronic muscle, bone and joint conditions such as arthritis, it is not the best treatment for an acute muscle, bone or joint injury. Applying heat causes the blood vessels in the area to dilate (widen), bringing more blood to the area and increasing swelling. Cold, on the other hand, causes blood vessels to constrict (narrow), reducing blood flow to the area, helping to reduce swelling. In addition, applying cold slows nerve impulses, helping to reduce pain. Splinting Splinting is a way to prevent movement of an injured bone or joint. It can also help reduce pain. However, you should only apply a splint if you must move the person to get medical help, and if splinting does not cause the person more pain or discomfort. Splinting involves securing the injured body part to the splint to keep it from moving. Commercial splints are available. You can also make a splint using soft materials (such as blankets, towels or pillows) or rigid materials (such as a folded magazine or a board). You can even use an adjacent part of the body as a splint (for example, you can splint an injured finger to the uninjured finger next to it). This is called an anatomic splint. Triangular bandages are handy to keep in your first aid kit in case you need to make a splint. A triangular bandage can be used to make a sling (a special kind of splint that is used to hold an injured arm against the chest) and to make ties to hold other kinds of splints in place. A "cravat fold" is used to turn a triangular bandage into a tie (Figure 6-5). The general rules for applying a splint are the same no matter what type of splint you use: ■ Splint the body part in the position in which you found it. Do not try to straighten or move the body part. ■ Make sure the splint is long enough to extend above and below the injured area. If a joint is injured, include the bones above and below the joint in the splint. If a bone is injured, include the joints above and below the bone in the splint. If you are not sure what is injured, include both the bones and the joints above and below the injured area in the splint. ■ Check for feeling, warmth and color beyond the site of injury before and after splinting to make sure that the splint is not too tight.

Know Check, Call, Care

Taking Action: The Emergency Action Steps In any emergency situation, there are three simple steps to take to guide your actions. If you ever feel nervous or confused, remember these three emergency action steps to get you back on track: 1. CHECK the scene and the person. 2. CALL 9-1-1 or the designated emergency number. 3. CARE for the person. Check First, check the scene. Then check the person. Check the Scene Before rushing to help an injured or ill person, conduct a scene size-up and form an initial impression. Try to answer these questions: ■ Is the scene safe to enter? Check for hazards that could jeopardize your safety or the safety of bystanders, such as fire, downed electrical wires, spilled chemicals, an unstable building or traffic. Do not enter bodies of water unless you are specifically trained to perform in-water rescues (Box 1-7). Avoid entering confined areas with poor ventilation and places where natural gas, propane or other substances could explode. Do not enter the scene if there is evidence of criminal activity or the person is hostile or threatening suicide. If these or other dangers threaten, stay at a safe distance and call 9-1-1 or the designated emergency number immediately. Once professional responders make the scene safe, you can offer your assistance as appropriate. ■ What happened? Take note of anything that might tell you the cause of the emergency. If the person is unresponsive and there are no witnesses, your check of the scene may offer the only clues as to what happened. Use your senses to detect anything out of the ordinary, such as broken glass, a spilled bottle of medication or an unusual smell or sound. Keep in mind that the injured or ill person may not be exactly where he or she was when the injury or illness occurred—someone may have moved the person, or the person may have moved in an attempt to get help. ■ How many people are involved? Look carefully for more than one injured or ill person. A person who is moving or making noise or who has very visible injuries will likely attract your attention right away, but there may be a person who is silent and not moving or a person obscured by debris or wreckage that you do not notice at first. It also is easy to overlook a small child or an infant. In an emergency with more than one injured or ill person, you may need to prioritize care (in other words, decide who needs help first). ■ What is your initial impression about the nature of the person's illness or injury? Before you reach the person, try to form an initial impression about the person's condition and what is wrong. For example, does the person seem alert, or confused or sleepy? Look at the person's skin—does it appear to be its normal color, or does it seem pale, ashen (gray) or flushed? Is the person moving, or motionless? Does the person have any immediately identifiable injuries? Look for signs of a life-threatening illness or injury, such as loss of consciousness, trouble breathing or severe bleeding. If you see severe, life- threatening bleeding, use the resources available to you to control the bleeding as soon as possible Is anyone else available to help? Take note of bystanders who can be of assistance. A bystander who was there when the emergency occurred or who knows the injured or ill person may be able to provide valuable information about the situation or the person. Bystanders can also assist in other ways, such as by calling 9-1-1 or the designated emergency number, waiting for EMS personnel and leading them to the site of the emergency, getting needed items (such as an AED and first aid kit), controlling crowds and reassuring the injured or ill person. Check the Person When you reach the person, you can conduct a more thorough check to determine what is wrong and what care is needed. If the person is awake and responsive, obtain consent and then begin to gather additional information about the nature of the person's illness or injury. Chapter 2 provides more detail about how to check a person who is responsive. If the person appears to be unresponsive, shout, using the person's name if you know it. If there is no response, tap the person's shoulder (if the person is an adult or child) or the bottom of the person's foot (if the person is an infant) and shout again while checking for normal breathing. Check for responsiveness and breathing for no more than 5 to 10 seconds. If the person does not respond to you in any way (such as by moving, opening his or her eyes, or moaning) and the person is not breathing or is only gasping, the person is unresponsive. If the person responds and is breathing normally, the person is responsive, but may not be fully awake. Give care according to the conditions that you find and your level of knowledge and training (see Chapter 2). Unresponsiveness, trouble breathing and severe bleeding are all signs of a life-threatening emergency. If your initial check of the person reveals these or any other life-threatening conditions (see Box 1-5), make sure that someone calls 9-1-1 or the designated emergency number right away. Also have someone bring an AED and a first aid kit, if these items are available. Call If you decide it is necessary to summon EMS personnel (see Box 1-5), make the call quickly and return to the person. If possible, ask someone else to make the call so that you can begin giving care. The person making the call should be prepared to give the dispatcher the following information: ■ The location of the emergency (the address, or nearby intersections or landmarks if the address is not known) ■ The nature of the emergency (e.g., whether police, fire or medical assistance is needed) ■ The telephone number of the phone being used ■ A description of what happened ■ The number of injured or ill people ■ What help, if any, has been given so far, and by whom The caller should stay on the phone until the dispatcher tells him or her it is all right to hang up. The dispatcher may need more information. Many dispatchers also are trained to give first aid and CPR instructions over the phone, which can be helpful if you are unsure of what to do or need to be reminded of the proper care steps. If you are alone and there is no one to send to call 9-1-1 or the designated emergency number, you may need to decide whether to call first or give care first (Box 1-8). Call First situations are likely to be cardiac arrest. In cardiac arrest, the priority is getting help on the scene as soon as possible because early access to EMS personnel and an AED increases the person's chances for survival. Care First situations include breathing emergencies and severe life-threatening bleeding. In these situations, there are immediate actions that you can take at the scene that may prevent the person's condition from worsening. After you take these actions, call 9-1-1 or the designated emergency number to get advanced medical help on the way. Care The final emergency action step is to give care according to the conditions that you find and your level of knowledge and training. Follow these general guidelines: ■ Do no further harm. ■ Monitor the person's breathing and level of consciousness. ■ Help the person rest in the most comfortable position. ■ Keep the person from getting chilled or overheated. ■ Reassure the person by telling the person that you will help and that EMS personnel have been called (if appropriate). ■ Give care consistent with your knowledge and training as needed, and continue to watch for changes in the person's condition. Generally speaking, you should avoid moving an injured or ill person to give care. Unnecessary movement can cause additional injury and pain and may complicate the person's recovery. However, under the following three conditions, it would be appropriate to move an injured or ill person: ■ You must move the person to protect him or her from immediate danger (such as fire, flood or poisonous gas). However, you should only attempt this if you can reach the person and remove him or her from the area without endangering yourself. ■ You must move the person to reach another person who may have a more serious injury or illness. ■ You must move the person to give proper care. For example, it may be necessary to move a person who needs CPR onto a hard, flat surface. If you must move the person, use one of the techniques described in Appendix A, Emergency Moves. If the person does not have a life-threatening illness or injury, you may decide to take the injured or ill person to a medical facility yourself instead of calling for EMS personnel. Never transport a person yourself if the person has or may develop a life-threatening condition, if you are unsure of the nature of the injury or illness, or if the trip may aggravate the injury or cause additional injury. If you decide it is safe to transport the person yourself, be sure you know the quickest route to the nearest medical facility capable of handling emergency care. Ask someone to come with you to help keep the person comfortable and monitor the person for changes in condition so that you can focus on driving. Remember to obey traffic laws. No one will benefit if you are involved in a motor-vehicle collision or get a speeding ticket on your way to the medical facility. Discourage an injured or ill person from driving him- or herself to the hospital. An injury may restrict movement, or the person may become faint. The sudden onset of pain may be distracting. Any of these conditions can make driving dangerous for the person, passengers, other drivers and pedestrians.

Know Heat and Cold-related illness

Thermoregulation, or the body's ability to maintain an internal temperature within an acceptable range despite external conditions, is important for human survival. The body uses various methods to achieve thermoregulation. For example, sweat evaporating from the skin helps to cool the body, and the muscle contractions caused by shivering help to warm the body. Usually the body is able to maintain a normal body temperature despite exposure to hot or cold external temperatures. However, under certain conditions (such as prolonged exposure to heat or cold, heavy exertion, inadequate fluid intake, or exposure to extreme heat or extreme cold), the body's thermoregulatory mechanisms can become overwhelmed, leading to life-threatening illness. People who are at increased risk for experiencing a first aid emergency due to exposure to heat or cold include: ■ Those who work or exercise outdoors. ■ The elderly and the young. ■ Those with medical conditions that cause poor blood circulation. ■ Those who take diuretics (medications that promote the elimination of water from the body). Heat-Related Illnesses Heat-related illnesses are caused by overexposure to heat and the loss of fluids and electrolytes. While being outdoors is a risk factor for developing a heat-related illness, these illnesses can also affect people who are indoors. People who live or work in buildings that are inadequately cooled or ventilated are at risk, as are those who perform indoor jobs in hot environments (e.g., kitchen and laundry workers, factory workers). People who habitually work or exercise in hot environments tend to become more tolerant of the heat over time but may still be at risk for developing heat-related illnesses, especially when environmental temperatures are very high (e.g., greater than 100° F or 38° C). Although extremely high environmental temperatures increase the risk for heat-related illnesses, these illnesses can also occur at more moderate environmental temperatures. For example, a person who is doing strenuous work and is clothed in heavy protective clothing may be at risk for experiencing a heat-related illness at a lower environmental temperature. Similarly, a person who is unaccustomed to doing strenuous labor or exercising in the heat may develop a heat-related illness at lower environmental temperatures. Other factors, such as humid air, inadequate fluid intake and personal characteristics (e.g., the presence of certain medical conditions, the person's age) can increase the risk for heat-related illness. The three types of heat-related illnesses (in order from least to most severe) are heat cramps, heat exhaustion and heat stroke. Heat Cramps Heat cramps (painful muscle spasms, usually in the legs and abdomen, caused by loss of fluids and electrolytes as a result of sweating) are often the first sign that the body is having trouble with the heat. If appropriate care measures are not taken, heat cramps can turn into heat exhaustion or heat stroke. To care for heat cramps, help the person move to a cool place to rest, and have him or her sip a drink containing electrolytes and carbohydrates (such as a commercial sports drink, coconut water or milk). If a drink containing electrolytes and carbohydrates is not available, have the person drink water. Lightly stretch the muscle and gently massage the area to relieve the cramps. When the cramps stop, the person usually can resume his or her activity as long as there are no other signs or symptoms of illness. Encourage the person to keep drinking plenty of fluids, and watch the person carefully for additional signs or symptoms of heat-related illness. Myth-Information. Myth: When a person has heat cramps, you should give the person salt tablets to replenish lost sodium. Salt tablets are not an effective treatment for heat cramps. Consuming a concentrated form of salt can promote loss of fluid from the body, which will make the person's condition worse, not better. Heat Exhaustion Heat exhaustion occurs when fluids lost through sweating are not replaced. The body's primary mechanism of cooling itself is through sweating. As sweat evaporates from the body, it takes body heat with it, cooling the body. If a person does not take in enough fluids, the body does not have what it needs to make adequate amounts of sweat. Humid environments and environments without good air circulation can make it difficult for the sweat to evaporate. Under these conditions, a person may develop heat exhaustion. Heat exhaustion is often accompanied by dehydration, as the body's excessive production of sweat in an attempt to cool itself depletes fluid levels in the body. Signs and Symptoms of Heat Exhaustion The person's skin will be cool and moist, and pale, ashen (gray) or flushed. The person may complain of a headache, nausea, dizziness and weakness. First Aid Care for Heat Exhaustion Move the person to a cooler environment with circulating air. Loosen or remove as much clothing as possible and apply cool, wet cloths to the person's skin or spray the person with cool water. Fanning the person may also help by increasing evaporative cooling. If the person is responsive and able to swallow, have the person drink a cool electrolyte- and carbohydrate-containing fluid (such as a commercial sports drink, coconut water or milk). Give water if none of these are available. Do not let the person drink too quickly. Encourage the person to rest in a comfortable position, and watch carefully for changes in his or her condition. Call 9-1-1 or the designated emergency number if the person's condition does not improve. The person should wait for several hours after he or she is no longer having signs and symptoms to resume activity. If the person is unable to take fluids by mouth, has a change in level of consciousness or vomits, call 9-1-1 or the designated emergency number, because these are indications that the person's condition is getting worse. Stop giving fluids and place the person in the recovery position. Keep the person lying down and continue to take steps to lower the person's body temperature. Monitor the person for signs and symptoms of breathing problems and shock. Heat Stroke Heat stroke is the least common but most severe heat-related illness. It occurs when the body's cooling system is completely overwhelmed and stops working. Heat stroke is a life-threatening emergency. Signs and Symptoms of Heat Stroke The person will have mental status changes (such as confusion or loss of consciousness) and may have trouble seeing or a seizure. The person's skin will be hot to the touch. It may be wet or dry and appear red or pale. The person may vomit. The person's breathing may be rapid and shallow, and his or her heartbeat may be rapid and weak. First Aid Care for Heat Stroke Send someone to call 9-1-1 or the designated emergency number immediately. While you wait for help to arrive, take steps to rapidly cool the person's body. The preferred way of doing this is to immerse the person up to his or her neck in cold water, if you can do this safely. Alternatively, place ice water-soaked towels over the person's entire body, rotating the towels frequently. If bags of ice are available, place these on the person's body, over the towels. If you are not able to measure and monitor the person's temperature, apply rapid cooling methods for 20 minutes or until the person's condition improves or EMS personnel arrive. Give care as needed for other conditions that you find. Cold-Related Illnesses and Injuries Exposure illnesses and injuries can also result from exposure to cold temperatures (Box 7-1). Hypothermia In hypothermia, the body loses heat faster than it can produce heat, causing the core body temperature to fall below 95° F (35° C). Hypothermia can result from exposure to cold air or water temperatures, or both. Just as with heat-related illnesses, the air or water temperature does not have to be extreme (e.g., below freezing) for hypothermia to occur. Prolonged exposure to cold, wet or windy conditions and wet clothing increase risk for hypothermia, even at moderate environmental temperatures. As with heat-related illnesses, children and older adults are especially susceptible to hypothermia. Hypothermia can be fatal if the person does not receive prompt care. Signs and Symptoms of Hypothermia A person who has hypothermia may seem indifferent, disoriented or confused. You may notice that the person has a "glassy" stare. Initially, the person may shiver, but as the hypothermia progresses, the shivering may stop. This is a sign that the person's condition is worsening and he or she needs immediate medical care. In advanced cases of hypothermia, the person may become unresponsive, and his or her breathing may slow or stop. The body may feel stiff because the muscles became rigid. First Aid Care for Hypothermia Call 9-1-1 or the designated emergency number immediately for any case of hypothermia. If the person is unresponsive and not breathing or only gasping, give CPR and use an automated external defibrillator (AED) if you are trained in these skills. Raising the body temperature must be accomplished gradually. Rapid rewarming (for example, by immersing the person in a hot bath or shower) can lead to dangerous heart rhythms and should be avoided. To gradually rewarm the person, gently move the person to a warm place. Remove any wet clothing, dry the person, and help the person to put on dry clothing (including a hat, gloves and socks). Then wrap the person in dry blankets and plastic sheeting, if available, to hold in body heat. If you are far from medical care, position the person near a heat source or apply heating pads or hot water bottles filled with warm water to the body. If you have positioned the person near a heat source, carefully monitor the heat source to avoid burning the person. If you are using heating pads or hot water bottles, wrap them in thin, dry cloths to protect the person's skin. If the person is alert and able to swallow, you can give the person small sips of a warm, non-caffeinated liquid such as broth or warm water. Continue warming the person and monitor the person for changes in condition (including changes in breathing or level of consciousness and the development of shock) until EMS personnel arrive. Myth-Information. Myth: Giving a person with hypothermia an alcoholic drink can help the person to warm up. Never give alcohol to a person who has hypothermia. Although alcohol may temporarily make the person feel warmer, it actually increases loss of body heat. You should also avoid giving a person who has hypothermia beverages containing caffeine, because caffeine promotes fluid loss and can lead to dehydration. Frostbite Frostbite is an injury caused by freezing of the skin and underlying tissues as a result of prolonged exposure to freezing or subfreezing temperatures. Frostbite can cause the loss of fingers, hands, arms, toes, feet and legs. Signs and Symptoms of Frostbite The frostbitten area is numb, and the skin is cold to the touch and appears waxy. The skin may be white, yellow, blue or red. In severe cases, there may be blisters and the skin may turn black. First Aid Care for Frostbite If the frostbite is severe or the person is also showing signs and symptoms of hypothermia, call 9-1-1 or the designated emergency number. Give care for hypothermia, if necessary. If the frostbite has caused blisters, do not break them. Monitor the person's condition, and if you see that the person is going into shock, give care accordingly. If the frostbite is mild, you may be able to care for it using first aid. When providing first aid care for frostbite, handle the affected area gently. Never rub the frostbitten area, because this can cause additional damage to the tissue. Remove wet clothing and jewelry (if possible) from the affected area and care for hypothermia, if necessary. Do not attempt to rewarm the frostbitten area if there is a chance that the body part could refreeze before the person receives medical attention. Once the rewarming process is started, the tissue cannot be allowed to refreeze because refreezing can lead to tissue necrosis (death). Skin-to-skin contact (for example, cupping the affected area in your hands) may be sufficient to rewarm the frostbitten body part if the frostbite is mild. Alternatively, you can rewarm the affected body part by soaking it in warm water until normal color and warmth returns (about 20 to 30 minutes). The water temperature should not be more than 100° F-105° F (38° C-40.5° C). If you do not have a thermometer, test the water with your hand. It should feel warm (about body temperature), not hot. After rewarming, loosely bandage the area with a dry, sterile bandage. If the fingers or toes were affected, place cotton or gauze between them before bandaging the area (Figure 7-1).

Know your role in the EMS system

Understanding Your Role in the EMS System The emergency medical services (EMS) system is a network of professionals linked together to provide the best care for people in all types of emergencies (Box 1-2). As a member of the community, you play a major role in helping the EMS system to work effectively. Your role in the EMS system includes four basic steps: 1. Recognizing that an emergency exists. 2. Deciding to take action. 3. Activating the EMS system. 4. Giving care until EMS personnel take over. Recognizing that an Emergency Exists Sometimes it will be obvious that an emergency exists—for example, a scream or cry for help, a noxious or unusual odor, or the sight of someone bleeding severely or lying motionless on the ground are all clear indications that immediate action is needed. But other times, the signs of an emergency may be more subtle, such as a slight change in a person's normal appearance or behavior, or an unusual silence. Your eyes, ears, nose and even your gut instincts can alert you that an emergency situation exists (Box 1-3). Deciding to Take Action Once you recognize an emergency situation, you must decide to take action. In an emergency, deciding to act is not always as simple as it sounds. Some people are slow to act in an emergency because they panic, are not exactly sure what to do or think someone else will take action. But in an emergency situation, your decision to take action could make the difference between life and death for the person who needs help. Your decision to act in an emergency should be guided by your own values and by your knowledge of the risks that may be present. However, even if you decide not to give care, you should at least call 9-1-1 or the designated emergency number to get emergency medical help to the scene. Chapter 1 Before Giving Care | 7 | First Aid/CPR/AED Participant's Manual © 2011, 2016 The American National Red Cross. All rights reserved. Many different fears and concerns can cause a person to hesitate to respond in an emergency. Understanding these fears and concerns can help you to overcome them: ■ Being uncertain that an emergency actually exists. Sometimes people hesitate to take action because they are not sure that the situation is a real emergency and do not want to waste the time of the EMS personnel. If you are not sure what to do, err on the side of caution and call 9-1-1 or the designated emergency number. ■ Being afraid of giving the wrong care or inadvertently causing the person more harm. Getting trained in first aid can give you the confidence, knowledge and skills you need to respond appropriately to an emergency. If you are not sure what to do, call 9-1-1 or the designated emergency number and follow the EMS dispatcher's instructions. The worst thing to do is nothing. Assuming that the situation is already under control. Although there may be a crowd of people around the injured or ill person, it is possible that no one has taken action. If no one is giving care or directing the actions of bystanders, you can take the lead. If someone else is already giving care, confirm that someone has called 9-1-1 or the designated emergency number and ask how you can be of help. ■ Squeamishness related to unpleasant sights, sounds or smells. Many people feel faint or nauseated when confronted with upsetting sights, sounds or smells, such as blood, vomit or a traumatic injury. You may have to turn away for a moment and take a few deep breaths to regain your composure before you can give care. If you still are unable to give care, you can volunteer to help in other ways, such as by calling 9-1-1 or the designated emergency number and bringing necessary equipment and supplies to the scene. ■ Fear of catching a disease. In today's world, the fear of contracting a communicable disease while giving care to another person is a real one. However, although it is possible for diseases to be transmitted in a first aid situation, it is extremely unlikely that you will catch a disease this way. Taking additional precautions, such as putting on latex-free disposable gloves and using a CPR breathing barrier, can reduce your risk even further. ■ Fear of being sued. Sometimes people hesitate to get involved because they are worried about liability. In fact, lawsuits against lay responders (nonprofessionals who give care in an emergency situation) are highly unusual and rarely successful. The majority of states and the District of Columbia have Good Samaritan laws that protect people against claims of negligence when they give emergency care in good faith without accepting anything in return (Box 1-4). Activating the EMS System In a life-threatening emergency, activating the EMS system is an important thing for you to do. Activating the EMS system (Box 1-5) will send emergency medical help on its way as fast as possible. The sooner emergency personnel arrive, the better the chance for a positive outcome. At times you may be unsure if advanced medical personnel are needed. You will have to use your best judgment—based on the situation, your assessment of the injured or ill person, and information gained from this course and other training you may have received—to make the decision to call. When in doubt, make the call. Most people in the United States call 9-1-1 for help in emergencies. But in some areas of the United States and in many workplaces, you many need to dial a designated emergency number instead. If you live or work in an area where 9-1-1 is not the number you should call in an emergency, make sure you know what the designated emergency number is. Phone carriers are required to connect 9-1-1 calls made from a mobile phone, even if the phone does not have an active service plan. In most areas, you cannot text 9-1-1. You must call! Unless you have confirmed that the 9-1-1 call center in your area supports texting, you should always call. Giving Care Until EMS Personnel Take Over First aid care can be the difference between life and death. Often it makes the difference between complete recovery and permanent disability. This manual and the American Red Cross First Aid/ CPR/AED courses provide you with the confidence, knowledge and skills you need to give care to a person in an emergency medical situation. In general, you should give the appropriate care to an injured or ill person until: ■ Another trained responder or EMS personnel take over. ■ You are too exhausted to continue. ■ The scene becomes unsafe. Obtaining Consent to Help Before giving first aid care, you must obtain consent (permission) from the injured or ill person (or the person's parent or guardian if the person is a minor) (Figure 1-2). To obtain consent: ■ State your name. ■ State the type and level of training that you have (such as training in first aid or CPR). ■ Explain what you think is wrong. ■ Explain what you plan to do. ■ Ask if you may help. With this information, an ill or injured person can grant his or her consent for care. Someone who is unresponsive, confused or mentally impaired may not be able to grant consent. In these cases, the law assumes the person would give consent if he or she were able to do so. This is called implied consent. Implied consent also applies when a minor needs emergency medical assistance and the minor's parent or guardian is not present. An injured or ill person may refuse care, even if he or she desperately needs it. A parent or guardian also may refuse care for a minor in his or her care. You must honor the person's wishes. Explain to the person why you believe care is necessary, but do not touch or give care to the person if care was refused. If you believe the person's condition is life threatening, call EMS personnel to evaluate the situation. If the person gives consent initially but then withdraws it, stop giving care and call for EMS personnel if you have not already done so. If you do not speak the same language as the injured or ill person, obtaining consent may be challenging. Find out if someone else at the scene can serve as a translator. If a translator is not available, do your best to communicate with the person by using gestures and facial expressions. When you call 9-1-1 or the designated emergency number, explain that you are having difficulty communicating with the person, and tell the dispatcher which language you believe the person speaks. The dispatcher may have someone available who can help with communication.

Know about AED use

Using an AED Different types of AEDs are available, but all are similar to operate and use visual displays, voice prompts or both to guide the responder. If your place of employment has an AED on site, know where it is located, how to operate it and how to maintain it (Box 3-3). Also take note of the location of AEDs in public places that you frequent, such as shopping centers, airports, recreation centers and sports arenas. When a person is in cardiac arrest, use an AED as soon as possible. Skill Sheet 3-4 describes how to use an AED step by step. Environmental and person-specific considerations for safe and effective AED use are given in Box 3-4. Using an AED on an Adult To use an AED, first turn the device on. Remove or cut away clothing and undergarments to expose the person's chest. If the person's chest is wet, dry it using a towel or gauze pad. Dry skin helps the AED pads to stick properly. Do not use an alcohol wipe to dry the skin because alcohol is flammable. Next, apply the AED pads. Peel the backing off the pads as directed, one at a time, to expose the adhesive. Place one pad on the upper right side of the person's chest and the other pad on the lower left side of the person's chest below the armpit, pressing firmly to adhere (Figure 3-7). Plug the connector cable into the AED (if necessary) and follow the device's directions. Most AEDs will begin to analyze the heart rhythm automatically, but some may require you to push an "analyze" button to start this process. No one should touch the person while the AED is analyzing the heart rhythm because this could result in a faulty reading. Next, the AED will tell you to push the "shock" button if a shock is advised. Again, avoid touching the person, because anyone who is touching the person while the device is delivering a shock is at risk for receiving a shock as well. After a shock is delivered (or if the AED determines that no shock is necessary), immediately resume CPR, starting with compressions. The AED will continue to check the heart rhythm every 2 minutes. Listen for prompts from the AED and continue giving CPR and using the AED until you notice an obvious sign of life or EMS personnel arrive. If you notice an obvious sign of life, stop CPR but leave the AED turned on and the pads in place on the person's chest, and continue to follow the AED's prompts. Using an AED on a Child or Infant The procedure for using an AED on a child or infant is the same as the procedure for using an AED on an adult. Some AEDs come with pediatric AED pads that are smaller and designed specifically to analyze a child's heart rhythm and deliver a lower level of energy. These pads should be used on children up to 8 years of age or weighing less than 55 pounds. Other AEDs have a key or switch that configures the AED for use on a child up to 8 years of age or weighing less than 55 pounds. If pediatric AED pads are not available or the AED does not have a pediatric setting, it is safe to use adult AED pads and adult levels of energy on a child or infant. (Note that the opposite is not true—you should not use pediatric AED pads or the pediatric setting on an adult because the shock delivered will not be sufficient if the person is older than 8 years or weighs more than 55 pounds.) Just as when you are using an AED on an adult, apply the AED pads to the child's bare, dry chest, placing one pad on the upper right chest and the other pad on the lower left side of the chest below the armpit. If you cannot position the pads this way without them touching (as in the case of an infant or a small child), position one pad in the middle of the chest and the other pad on the back between the shoulder blades (Figure 3-8). Then follow the standard procedure for using an AED. Box 3-4. Considerations for Safe and Effective AED Use Environmental Considerations ■ Flammable or combustible materials. Do not use an AED around flammable or combustible materials, such as gasoline or free-flowing oxygen. ■ Metal surfaces. It is safe to use an AED when the person is lying on a metal surface, as long as appropriate precautions are taken. Do not allow the AED pads to contact the metal surface, and ensure that no one is touching the person when the shock is delivered. ■ Water. If the person is in water, remove him or her from the water before using the AED. Once you have removed the person from the water, be sure there are no puddles of water around you, the person or the AED. ■ Inclement weather. It is safe to use AEDs in all weather conditions, including rain and snow. Provide a dry environment if possible (for example, by sheltering the person with umbrellas), but do not delay defibrillation to do so. Remove wet clothing and wipe the person's chest dry before placing the AED pads. Avoid getting the AED or AED pads wet. Person-Specific Considerations ■ Pregnancy. It is safe to use an AED on a woman who is pregnant. ■ Pacemakers and implantable cardioverter-defibrillators (ICDs). A person who has a known arrhythmia (irregular heartbeat) may have a pacemaker or an ICD. These are small devices that are surgically implanted under the skin to automatically prevent or correct an irregular heartbeat. You may be able to see or feel the outline of the pacemaker or ICD in the area below the person's collarbone, or the person may wear medical identification indicating that he or she has a pacemaker or ICD. If the implanted device is visible or you know that the person has a pacemaker or ICD, adjust pad placement as necessary to avoid placing the AED pads directly over the device because doing so may interfere with the delivery of the shock. However, if you are not sure whether the person has an implanted device, place the pads as you normally would. ■ Transdermal medication patches. Some types of medications, including nitroglycerin (used to relieve chest pain caused by cardiovascular disease) and smoking- cessation medications, are delivered through patches applied to the skin. Remove any medication patches that you see before applying AED pads and using an AED. Wear gloves to prevent absorption of the drug through your own skin. ■ Chest hair. Time is critical in a cardiac arrest situation and chest hair rarely interferes with pad adhesion, so in most cases, you should proceed as you normally would—attach the AED pads, pressing firmly to attach them. However, if the person has a great deal of thick chest hair and it seems like the chest hair could interfere with pad-to-skin contact, quickly shave the areas where the pads will be placed and then attach the pads. ■ Jewelry and body piercings. You do not need to remove the person's jewelry or body piercings before using an AED, but you should avoid placing the AED pads directly over any metallic jewelry or piercings. Adjust pad placement if necessary. Using an AED Note: Do not use pediatric AED pads on an adult or on a child older than 8 years or weighing more than 55 pounds. However, adult AED pads can be used on a child younger than 8 years or weighing less than 55 pounds if pediatric AED pads are not available. 1. Turn on the AED and follow the voice prompts. 2. Remove all clothing covering the chest and, if necessary, wipe the chest dry. 3. Place the pads. ■ Place one pad on the upper right side of the chest and the other on the lower left side of the chest below the armpit. ■ If the pads may touch (e.g., on an infant or small child), place one pad in the middle of the chest and the other pad on the back, between the shoulder blades. 4. Plug the connector cable into the AED if necessary 5. Prepare to let the AED analyze the heart's rhythm. ■ Make sure no one, including you, is touching the person. Say, "EVERYONE CLEAR!" in a loud, commanding voice. ■ If the AED tells you to, push the "analyze" button to start this process. 6. Deliver a shock, if the AED determines one is needed. ■ Make sure no one, including you, is touching the person. Say, "EVERYONE CLEAR!" in a loud, commanding voice. ■ Push the "shock" button to deliver the shock. 7. After the AED delivers the shock, or if no shock is advised: ■ Immediately begin CPR, starting with compressions. Continue giving CPR (about 2 minutes, or 5 sets of 30:2) until prompted by the AED. ■ Continue giving CPR and following the AED's prompts until you see an obvious sign of life or EMS personnel arrive.

Know the Cardiac Chain of Survival

When a person experiences cardiac arrest, quick action on the part of those who witness the arrest is crucial and gives the person the greatest chance for survival. The Cardiac Chain of Survival describes five actions that, when performed in rapid succession, increase the person's likelihood of surviving cardiac arrest (Box 3-2). In the Cardiac Chain of Survival, each link of the chain depends on, and is connected to, the other links. Four out of every five cardiac arrests in the United States occur outside of the hospital. That means responders like you are often responsible for initiating the Cardiac Chain of Survival. When you complete the first three links in the Cardiac Chain of Survival—recognizing cardiac arrest and activating the EMS system, immediately beginning CPR and using an AED as soon as possible—you give the person the best chance for surviving the incident. For each minute that CPR and use of an AED are delayed, the person's chance for survival is reduced by about 10 percent. If you think that a person is in cardiac arrest: ■ Have someone call 9-1-1 or the designated emergency number immediately. ■ Begin CPR immediately. ■ Use an AED as soon as possible. Box 3-2. The Cardiac Chain of Survival Adult Cardiac Chain of Survival ■ Recognition of cardiac arrest and activation of the emergency medical services (EMS) system. The sooner someone recognizes that a person is in cardiac arrest and calls 9-1-1 or the designated emergency number, the sooner people capable of providing advanced life support will arrive on the scene. ■ Early CPR. CPR circulates oxygen-containing blood to the brain and other vital organs, helping to prevent brain damage and death. ■ Early defibrillation. Defibrillation (delivery of an electrical shock using an AED) may restore an effective heart rhythm, significantly increasing the person's chances for survival. ■ Early advanced life support. Provided by EMS personnel at the scene and en route to the hospital, early advanced life support gives the person access to emergency medical care delivered by trained professionals. ■ Integrated post-cardiac arrest care. After the person is resuscitated, an interdisciplinary team of medical professionals works to stabilize the person's medical condition, minimize complications, and diagnose and treat the underlying cause of the cardiac arrest to improve survival outcomes. Pediatric Cardiac Chain of Survival ■ Prevention. Because cardiac arrest in children often occurs as the result of a preventable injury (such as trauma, drowning, choking or electrocution), the Pediatric Cardiac Chain of Survival has "prevention" as the first link. ■ Early CPR. CPR circulates oxygen-containing blood to the brain and other vital organs, helping to prevent brain damage and death. ■ Activation of the emergency medical services (EMS) system. The sooner someone recognizes that a person is in cardiac arrest and calls 9-1-1 or the designated emergency number, the sooner people capable of providing advanced life support will arrive on the scene. ■ Early advanced life support. Provided by EMS personnel at the scene and en route to the hospital, early advanced life support gives the person access to emergency medical care delivered by trained professionals. ■ Integrated post-cardiac arrest care. After the person is resuscitated, an interdisciplinary team of medical professionals works to stabilize the person's medical condition, minimize complications, and diagnose and treat the underlying cause of the cardiac arrest to improve survival outcomes.

Know when to call 911

When to Activate the EMS System Call 9-1-1 or the designated emergency number for any of the following emergency situations and conditions. Emergency Situations ■ An injured or ill person who needs medical attention and cannot be moved ■ Fire or explosion ■ Downed electrical wires ■ Swiftly moving or rapidly rising flood waters ■ Drowning ■ Presence of poisonous gas ■ Serious motor-vehicle collision Emergency Conditions ■ Unresponsiveness or an altered level of consciousness (LOC), such as drowsiness or confusion ■ Breathing problems (trouble breathing or no breathing) ■ Chest pain, discomfort or pressure lasting more than a few minutes that goes away and comes back or that radiates to the shoulder, arm, neck, jaw, stomach or back ■ Persistent abdominal pain or pressure ■ Severe external bleeding (bleeding that spurts or gushes steadily from a wound) ■ Vomiting blood or passing blood ■ Severe (critical) burns ■ Suspected poisoning that appears to be life threatening ■ Seizures ■ Signs or symptoms of stroke (e.g., drooping of the face on one side; sudden weakness on one side of the body; sudden slurred speech or difficulty speaking; or a sudden, severe headache) ■ Suspected or obvious injuries to the head, neck or spine ■ Suspected or obvious broken bone If you are alone and there is no one to send to call 9-1-1 or the designated emergency number, you may need to decide whether to call first or give care first (Box 1-8). Call First situations are likely to be cardiac arrest. In cardiac arrest, the priority is getting help on the scene as soon as possible because early access to EMS personnel and an AED increases the person's chances for survival. Care First situations include breathing emergencies and severe life-threatening bleeding. In these situations, there are immediate actions that you can take at the scene that may prevent the person's condition from worsening. After you take these actions, call 9-1-1 or the designated emergency number to get advanced medical help on the way.

Menopause

when menstruation ceases; exercise, age, stress, and eating disorders may cause menstruation to be irregular