[Audrey:] To breathe?
[speaker002:] A clear airway?
[Audrey:] A clear airway... have some causes of the airway, right what could stop?
[speaker002:] Tongue in the way Tongue
[Audrey:] The tongue well done
[speaker002:] Vomit Vomit
[Audrey:] vomit
[speaker002:] Foreign object
[Audrey:] foreign body, what did you say sorry?
[speaker002:] Hanging, strangulation
[Audrey:] Hanging, strangulation, that's right you can, don't forget you can block the airway from the outside as well as in
[speaker002:] Chest restriction Pressure of the
[Audrey:] Right, that's the next one, right, we also need chest movement... right what, what can stop the chest moving?
[speaker002:] Stab wounds
[Audrey:] Thrush, er chest, er stab wound
[speaker002:] restriction, weight on it
[Audrey:] restriction, well done you're [LAUGHTER] doing very well [] and overriding all this lot what do we need to
[speaker002:] Brain Brain
[Audrey:] The brain, right. I'm not going to go on to the things of the brain because we are going to do them further down the list. Sight and systems of asphyxia, what, how's a person he going to look?
[speaker002:] Blue
[Audrey:] Yes, they're going to look very pale with a blueish tinge
[speaker002:] Fingers
[Audrey:] Pardon?
[speaker002:] Fingers
[Audrey:] Yes extremities, the fingers, toes Pardon?
[speaker002:] Distressed
[Audrey:] Very distressed, yes, they can't breathe and your treatment for asphyxia? make sure the airway stays clear if they
[speaker002:] Breathe
[Audrey:] if they stop breathing?
[speaker002:] breath for them
[Audrey:] Breathe for your casualty, if they are unconscious what would you do with them?
[speaker002:] Put them in the recovery position
[Audrey:] Recovery position, right. Now the M here is for mind... and that includes obviously brain... now we come on first of all to the head injuries... head injury... there is a brain, now a pressure, accident which involves the head. It could be a break, this is the bone here, supposing there is a break there, pressing down on the brain, that is a head injury, this part here is the bolt by the way and that is a injury to the bolt of the brain, just the top. The base of skull injury is here, when you get somebody with that base. Can you see how thin that is there? It's very thick on the outside but almost, you can almost see through some of the bone in the base there and that can be caused by as, a blow on the head if it's the bolt of the erm brain that's caused, got the injury, or from the base of skull is usually caused by er landing on your feet from heights, and
[speaker002:] Jolts
[Audrey:] it's, it's the shock comes up the legs, if it doesn't break the ankles or feet or these it can break the bottom of the bone, a piece here, or it can travel up and break the base of the skull. Now either way, obviously it's a head injury and must be dealt with, but we're going to do an overall thing here by saying right, now the next one on the list is concussion... now concussion is shaking of the brain inside the skull... now there's noth no room for anything but the brain inside that skull, so if that's shaken the brain hits against the sides of the bra of the er bone, and bruises... so what actually happens here is the brain gets shaken and the nerve cells get damaged... now you've all seen this con and it's so easily done concussion, you can go through a whole list of things which can cause concussion, road traffic accident, sport, construction working erm anything that erm, heading ball, football that's another one that erm you get quite a bit of concussion and of course boxing
[speaker002:] Mm
[Audrey:] [LAUGHTER] as we could, as I was talking to our group yesterday well, now that is the one game they set out to make a, your partner unconscious by shaking the brain inside the skull and that's what exactly what they're doing. A blow on the chin, don't forget the chin is part of the skull, blow on the chin, shakes the brain, your casualty gets concussion and they go unconscious... now how's your casualty going to feel?
[speaker002:] Confused
[Audrey:] They're going to be confused yes, very confused, I mean on the football pitch you usually get the trainer run man and they're talking to the footballer and it's looking at them all the time and he will ask questions, erm what's your name? Where do you live? What were you doing?
[speaker002:] How many fingers?
[Audrey:] That's it how many fingers? And all these are telling him whether the person is confused, concussed or what, whether he's able to go on, alright, erm check the memory... because that is a good indication. If your casualty, if you say to your casualty ooh what happened? How did this happen? And they say I can't remember it just happened so quick that I can't remember, they have been unconscious for a, it may be just a split second, it's affected the brain, they are concussed. So let's go through the signs and symptoms of concussion. They could have a headache depending on how it was caused, they could be confused, but not always and there could be that brief loss of consciousness and so you must check the memory recall... if they do know what's happened well then go back a little bit further to see if they can remember what they did last night or something but erm, make sure, on that memory recall. Now the face when you look at them... they're going to be very pale, cold and clammy... the eyes well, erm, unless they're really into concussion they're possibly normal. You see with these signs and symptoms remember you don't have to have the whole lot... a couple of them will give you an idea that this person is concussed. Their breathing will become shallow and the pulse rapid and weak... where's your casualty going?
[speaker002:] To the hospital
[Audrey:] Going to hospital... now concussion will lead us very nicely, have you finished that writing that yet?
[speaker002:] No No, not yet...
[Audrey:] Concussion will lead us very nicely onto compression and if anybody in your place of work has a head injury at all a knock on their head and they say, most people do don't they? Oh I'm alright don't worry about me I'm, they, the person at home, their family must be told as well as you making a note in your accident book that there has been somebody with a knock on the head however mi minor it is, it's got to be reported, because that knock could have repercussions, it could have broken a small vessel in the brain, it could still be bleeding and that is when compression takes over. Now a compression is, pressure on the brain, caused by fracture, bleed or blood clot... now if a person has been suffering from concussion and it's gone unnoticed, that bleed could be just carrying on and on and on and it could take up to four to five days before the compression shows itself... so perhaps a week later they're sitting down to breakfast saying ooh my head hurts, now the poor wife or husband, or whoever it is doesn't know about that knock on the head that they had previously, unless somebody's told them about it... mm, so your casualty now is going to have this headache and a beauty, they're going to be confused... their levels of consciousness it will deteriorate... face is very hot, dry... flushed... the pupils will become unequal and because of the pressure breathing becomes noisy... if you feel the pulse, it's going to be slow and strong... and you will get paralysis on the opposite side to the compression, what are, what are the signs and symptoms of?
[speaker002:] Stroke
[Audrey:] Who?
[speaker002:] Shock
[Audrey:] Stroke, stroke, not shock, what's the signs and symptoms of shock?
[speaker002:] Pass the body for bad circulation
[Audrey:] Yes, what's the signs and symptoms?
[speaker002:] Pale isn't it basic
[Audrey:] Pale, cold, clammy, yes, this is the opposite, you've got all the signs and symptoms here of a stroke, now if, this could go on with and erm if somebody, if something isn't done very quickly with this compression the person has still got this bleed, or clot in the head and eventually they just kind of all come up into the foetus position, literally all goes spastic, all these spastic movements... right, you finished writing?
[speaker002:] No Hang on a second
[Audrey:] Nearly?
[speaker002:] Nearly
[Audrey:] Nearly...
[speaker002:] That's where it all comes confusing cos there is things in there which still ascertains the shock in that as well as the other...
[Audrey:] There's the shock
[speaker002:] Yeah, yeah
[Audrey:] right
[speaker002:] Right
[Audrey:] Yeah, but you're going to look at your casualty
[speaker002:] Yeah
[Audrey:] now there's no comparison in the pale cold clammy position that shock produces
[speaker002:] No
[Audrey:] to the hot dry flush that, that the stroke and the compression... so there's the conditions there, your compression and your stroke will be identical signs and symptoms because you've got pressure on the brain... concussion you will get all the sign and symptoms of shock... okay? Does it make sense to you? [LAUGHTER] All in favour say aye, how's that? Right, let's go on a bit further..., so we've just done concussion, compression... er the next one is an illness, epilepsy... now epilepsy, two types, you get the petit mal which is the small fit and the grand mal which is the erm large fit or the full, full fit. Now anybody can have erm within the areas if you like our part, no you don't have to have all the signs and symptoms to say that person has had an epileptic fit. With petit mal, the small fit, it used to called vaguely, you could talk to somebody and then go on nattering away and then suddenly the person would switch off and then just stare and then after a while they come back and talk to you and it's, they pick up exactly where they've left off, so as I say it used to be called day dreaming, now that's the low end of the scale, now we go to the other end of the scale and remember please that... there's no set type for an epileptic, anybody, anywhere, any age at any time can have an epileptic fit, you don't have to be that type, don't. Now what actually happens, now as I say I'm going to the far end, your casualty may literally shriek as they go down, now this is the person that has no warning at all, they may shriek as they go down and it's the air that's coming out of the body, they will go rigid as every muscle clenches, the teeth clench, the muscles go rigid, erm and they're going to be very, very blue because erm, because er they've stopped breathing which seems like an eternity. Now at this st this stage usually the do-gooders who don't know any better and put and insist that something should go in the mouth and it shouldn't, you never ever put anything in anybody's mouth at all. Somebody's car alarm's gone off... no, right, now this where lots and lots of people used to really moan, the, the person that was having a fit would absolutely go through hell because somebody at some stage had said oh you must put something in a person's mouth that has epilepsy. The answer is once they've clenched their teeth there's nothing you can do about it, if their tongue is there I'm afraid it's just hard luck. Tablets control epilepsy very, very well now and you can go for probably years without an epileptic fit, then all of a sudden erm somebody will think oh I'll try leaving off my medication and of course they have a fit. Erm, er, now of course to get back to the ambulance erm if somebody comes out of an epileptic fit and goes immediately back into another one, then you must call an ambulance, it takes so much from the person, it takes so much energy that the person can't possible go into one fit after another, erm without showing some affects and therefore you would have to get them to hospital, if you don't and they have two or three fits one after another they can die, so they must go to hospital. Now if your person were to say come round, said it's the first time they've had a fit you get, call an ambulance, it may be epilepsy but it could be anything else, it could erm... be, be the start of er something else in the brain because that's all an epileptic fit is, it's an electrical impulse, nobody actually knows why or when or how it's caused, but it happens... erm, but above all be very, very nice to your casualties, they'll want to get up and they'll run away, they want to get out, especially if it's outside, because they're embarrassed by it. Now this is the time when you must watch them, because it can take from two to two days, two hours from two, two hours to two days to regain control of the brain, depending on the person and if it's, happens outside and they want to get away, stress the fact you get up and run under a bus and they don't mean to obviously
[speaker002:] Mm
[Audrey:] but they're not in control of their body, so you must watch them, talk to them and if, if you can walk along the road with them, talking to them... now the, there is the other type where you get the aura, they know they're going to have a fit, so if somebody at your work place comes along and says to you I'm gonna have a fit in five minutes, I mean don't laugh at them and think ha ha, take them to a room where they're safe and this applies to all epileptic fits, they've got to be safe, so you're going to clear a room of any danger, they're laying down on the floor theirself because they've got time they know they're going to have this fit, if they've got something to put in their mouth alright they will put it in their mouths themselves and once again they've got five minutes to do it in and then that person will go through their fit, you stay with them, you comply by their wishes, if they say to you right, well just leave me when I come round I, don't touch me I'll be alright, they know, so you, you comply by their wish wishes, erm... but only go in when you feel it is necessary, if they say right, erm I, I should regain consciousness in ten minutes and they haven't, you're there, you stay there in case make sure they're safe, there's nothing there that can hurt them, then they'll probably get up at the end of the fit and erm go into a room for a rest and say thank you very much and er, erm that's it. Right that's epilepsy. Any questions?
[speaker002:] How do they, what sort of aura do they get that they know that they're going into a fit?
[Audrey:] Erm, sometimes they get a certain er whiff of something er, you know an imaginary smell
[speaker002:] Smell
[Audrey:] erm, something may flash across the, the face you know eyes or whatever, it's er an aura that there is particular to them or peculiar to them.
[speaker002:] My husband feels as though somebody is co chasing him
[Audrey:] Yeah
[speaker002:] and he says he's after me and he just puts his arm round me and then he's alright after that
[Audrey:] Yeah
[speaker002:] and then he has a sleep for half an hour
[Audrey:] That's right, most people with epilepsy they're much better if they go to sleep and you don't wake them up, if you wake the person up from a sleep that's just had an epileptic fit they'll be vomiting, but if you let them sleep through it then erm, then they're usually fine. Right, next one is poison... must get a move on cos we're running a bit late... so as we're going to poisons later I'll just go on to say here that there's four ways poisons can get into the body. You can breathe it in through the lungs... you can swallow it through the mouth, you can inject it through the skin and you can also absorb it through the skin. Now breathing, breathing in erm poisons, we'll go over this in more detail erm, there's so many things as we've already gone through that can cause us asphyxia, one of them's poison in itself isn't it? You've got to get your casualty from the cause, but make sure it's safe for you, now if it is a, a place where you've got to get your casualty out and you haven't got a lifeline and I must express this really that there must be two of you and if you are going in you only go in if you think it is safe to go in and you must have a line attached to you and there's somebody outside, so that if you do get erm overcome by fumes or whatever, they can pull you out, you are safe, they'll see to you, if there is no hope, you don't try to be the hero, what you do is go and make a phone call and get the professionals in, because they don't want to come along and have to deal with two casualties, when there's only one. So make sure it's safe, take your casualty from the cause, you may have to resuscitate, now if a person swallows something by mouth, there's two types of poisons, one can go by mouth and one is er corrosive and the other is non-corrosive, but at the same time you have a liquid or tablets, now if it's a corrosive liquid that you have swallowed or somebody has swallowed, it's burning as it's going down, and may I say in first aid you never ever on any circumstances make anybody sick... er especially poisons, can you imagine if it's burnt going down it's probably perforated the food pipe and somebody comes along and overdoses on the water, because you can give sips of water for corrosive, well it's because you're trying to keep the airway open, if it's burning, corrosive is burning you'll get swelling, so this is why you give sips of water, but if you give too much your casualty will be sick and if it's burnt going down and perforated the tubes and they're bringing it up again it's gonna burn coming up and go into those perforations that and cause further damage. So what you're going to do with your casualty that's swallowed poison is, is sips of water while they are conscious, don't forget nothing by mouth once anybody is unconscious, and get them to hospital as quickly as you can. Now if, don't wait, if you know somebody has swallowed a poison whatever it is, get them to a hospital don't wait for the signs and symptoms to appear, get them to a hospital. Now if it's tablets they've taken... we don't do whatever Angie did years ago in, in Eastenders and, and then she's walked up and down and given gallons of coffee, what you do is keep your casualty at rest, nil by mouth because you, if you give them any fluid whatsoever it's going to dilate, dilute the tablets that are in the stomach, and once they're diluted they've gone into the system quicker, mm, so there's nil by mouth, now if you're going to get up and walk them up and down because come on you must walk up and down, what's happening to this per these tablets?
[speaker002:] Going into system Being pumped
[Audrey:] They're being pumped around the body even faster so therefore that's going to take hold of the person faster, so you keep them at rest, into recovery position if possible and get help, don't forget to er collect any evidence of what the poison is, it must go with the casualty. Now injection, two types of people inject, the drug addict and the diabetic. Would you know if you came across somebody and erm... could you tell the difference between a diabetic person and the, a per drug addict if they were unconscious?
[speaker002:] Smell their breath Smell their breath Proof of identification perhaps
[Audrey:] You could look for identification if, yeah
[speaker002:] Pupils
[Audrey:] Pardon?
[speaker002:] pupils
[Audrey:] Yes you could do but the point is the, it's where a person injects, a drug addict always injects into a vein so therefore they get these pin marks over veins, not necessarily, the veins go between fingers and toes and wherever, but they go into a vein where the diabetic goes into the muscle, into the arms, round the stomach area or the thigh. Now if you know that somebody is a drug addict and they've just had an injection you keep away from them, erm if they're having a bad trip, whatever they call it, because you don't, they become very violent, they can do a lot of damage, now the only time you will step in and help is when they go unconscious, but at the same time remember protect yourself, we're talking about needles here and probably shared needles, you must be terribly careful that you do not get pricked by a needle, especially if, they have a habit of sticking needles under lapels, so always be aware of this, if a person is a drug addict, in fact if you can find some easier way of turning them into the recovery position, do so, erm, you can then obviously either call the ambulance. Now the diabetic, I'll leave that for a moment because I'll do that in a moment, erm the absorption, usually gardeners, agricultural people that have, dealing with ordinary insecticides, pesticides, herbicides and all the other -cides that er, are about today, they're usually protected, but sometimes either you get somebody in a garden with and using all these things and they, they don't read packets do they any more? They think ah look there's a bit of drop of water in, there's a packet of something let's stick it in and stir it up, they never read a packet to see what it could do. Now if somebody has got a load of chemical open and it is being absorbed, you must protect yourself first, if they are still conscious well then they will take off their own clothing, you do not unless you have got protective clothing on. Once they've, you've got their clothing off they can probably stand in a shower, but remember to take their boots off or whatever or shoes of because if you don't they're going to stand in a, in a dilute solution of whatever it is that's being absorbed by the skin. Anybody working with chemicals should know, they are very silly to work with a chemical that they don't know what it could do, the first aid treatment, in fact, erm, anybody here work with chemicals? So you all know the correction regulations yes? And you know it from cover to cover?
[speaker002:] No
[Audrey:] [LAUGHTER] Well I think you should because erm, remember it's up to you... you should know. Now if you're going to put somebody under a shower as I say be care be very careful that you're not splashed and get the ambulance on the way. Some of these chemicals don't mix with water and this is why I did mention COSHH because they are working in er conditions and with chemicals that probably don't mix with water, but you should know what the buffer is, yeah?
[speaker002:] Yeah you spoke to, you, you should be carrying the antidote anyway
[Audrey:] Yes, erm... no I won't spend any more time on that... because we'll probably come back to that anyway. But, now let me get onto diabetes, the other, the other illness what injects... now diabetics are very, very clean, they know exactly where they're going to inject, in fact they alternate, because if they keep to one spot then it's, gets a bit sore. Now with diabetes there's two types, too much sugar and too little sugar... now diabetes erm, Irene said to you, erm is controlled by the insulin in the pancreas in the stomach, it throws out this insulin the liver throws out the sugar and I'm not going into actual detail, but if there is too little insulin then it is allowing the liver to send out too much glucose, so if, if the person has got this erm pancreas that isn't churning out insulin or too little then your person will have sugar diabetes. Now the one we are going to talk about first of all is the too little sugar... where your person has been stabilized and they're taking insulin injections. Now hypoglycaemia, hypo meaning too little, glycaemia sugar. This one comes on very quickly and this is the one you are likely to have to deal with. Now say your diabetic has stabilized as they have done for, a couple of years or so with their insulin injection in the morning and their breakfast and that's how they carry on then till their tea break or lunch time they know exactly how much they're taking. Now they've come out the front door and the bus is running er coming down the road so they're running for that bus, so they're using up their energy, the insulin level's there, but the energy level is going down. They get to work, it started off one of these days didn't it so the lift's out of order and they work on the top floor, so they've now got to run up all those stairs, the energy is being used up. Now gradually the energy level is so low that the in although the insulin level is there, there's no sugar for it to work with, so now your casualty will start showing signs of too little sugar. First of all they'll go very pale and they'll start sweating and the pulse will be very rapid and the breathing will be shallow, now what are they going into?
[speaker002:] Shock
[Audrey:] Shock, but after a while their limbs' ll start trembling and they become very confused, now a person, a perfectly nice person, oh, you know, always very helpful and kind can suddenly become aggressive and they really do become aggressive and, if they go to violence their strength, oh where they get it from god only knows, but they could literally throw a person across the room. Now if you see somebody going into this state, you must give them sugar, it's no good waiting till they've fainted or become unconscious because you can't give them anything then, can you?
[speaker002:] No
[Audrey:] You can't give anything by mouth to an unconscious casualty because they'll, you'll choke them, they can't swallow.
[speaker002:] Do you have safety first, they'll be able to throw you across the room?
[Audrey:] Pardon?
[speaker002:] They'll throw you across the room
[Audrey:] Oh yes [LAUGHTER] you'll probably have to get somebody else as well, mm. Now if you've had, if you know you're a diabetic and see this happening in the, in the... get this, getting this, the size the shock, go up to them and say you know, have you had your right amount or have you taken some sugar and very often they'll pull up and ah yes I've overdone it. Now if you've got sugar on you when you're out give them sugar, four cubes of sugar and they're marvellous, they come round just like that and erm then they'll got off and stabilize themselves. As I say if they've gone unconscious then, or fainted, you've got to call an ambulance.
[speaker002:] See a chap at work he's sort of day dream, you'll be talking to him and he's miles away
[Audrey:] Yeah
[speaker002:] Yeah
[Audrey:] Was that one of his signs of
[speaker002:] Yeah
[Audrey:] yes, but you knew
[speaker002:] Yeah, but you had to sort of force him to go and take some
[Audrey:] Yeah, oh you will yes, yes
[speaker002:] cos he wasn't interested in taking any
[Audrey:] no, no, but once he's taken it and then he's come round and erm he realizes what it's, what he's done, yeah. So once a person becomes unconscious, remember they've got to go to hospital because they can only get worse, right, there isn't any, enough sugar in that body to, to be able to work properly so they'll only get worse. They must go to hospital. Now the other side, the hyperglycaemia... that is too much sugar, now whatever one it is, if you don't know the difference, the treatment is the same, you will give sugar even though this person has got too much, but this one comes on very slowly and quite honestly the person should realize themselves it's so slow. Their skin will be very flushed and dry... you'll get deep sighing and this is the one you'll get the smell of acetone, not always, you know the nail varnish smell, the pear drops, and then from there they'll get, they'll go into gradual I've put coma there, but gradual unconsciousness... treatment the same sugar, if it's sugar they want they'll come round almost immediately, if it's, they've already got too much well you have, that little bit's not going to make them any worse, they've got to go to hospital anyway. If a diabetic is unconscious urgently to hospital... okay, now that diabetes by the way comes under the A of our coma here, which is an illness, okay? Any other and I put diabetes in there... asthma is an illness which erm you may come across, it's the clogging up, it's something irri irritates the tubes, the windpipe and the bronchial tube and the person cannot draw air in, well they can draw it in but they can't get it out and they're, and they're trying very hard [groan] and the noise, has anybody heard anybody with an asthma attack?
[speaker002:] Yeah
[Audrey:] You can hear them from a long way [groan] [groan] now what you do is you sit them down and let them take up their own particular position, you can, if they've got their medication their Ventilin or whatever, you can put it beside them, they will know if they need to take it or not, get them with the fresh air and let them take up their own position which is usually leaning forward so that it expands their lungs, talk to them about something different because sometimes well they've got to think of what to answer you, it's relaxing those tubes, now if they're taking their medication and it doesn't work within about five minutes get them to hospital, because the only people that really die with asthma are those that have taken medication and keep saying I'll give it a few more minutes, give it a few more minutes and if they're getting worse and worse they're leaving it too long. So all, as I say erm, never used to be able to die with asthma there was but very few, but now it seems to be more common because people are not going for help when they need it. Right, I think we've been going on long enough and I think you've been sitting there long enough, ha