First aid

Anaphylactic shock

Anaphylactic shock is an allergic reaction that can occur shortly after an insect sting, eating certain foods (for example, a peanut), or taking a particular drug. It is a potentially fatal condition in which chemical substances that dilate blood vessels and constrict air passages are released into the blood. The result is that blood pressure drops dramatically and breathing is impeded. The face and neck can swell, increasing the risk of suffocation, and the amount of oxygen reaching vital organs is severely reduced.

A casualty with anaphylactic shock urgently needs oxygen and a life-saving injection of adrenaline, often in the form of an Epipen auto-injector. An Epipen should only be used on the person for whom it has been prescribed (or from stock, if necessary, in an emergency). It is intended for immediate self-administration and the person should be encouraged to administer the injection his or herself. However, in an emergency, it may be necessary to help with this.

Resuscitation (adults)

When attempting to resuscitate a casualty, the sequence to remember is DRABC.

D — danger. Check whether you or the casualty are in any danger before you start the assessment

R — response. If the casualty appears unconscious, shout “Can you hear me?” and “Open your eyes”, and gently shake the casualty's shoulders. If there is no response to this, follow the ABC procedure

A — airway. To open the airway, place two fingers under the point of the chin and place your other hand on the casualty's forehead. At the same time, lift the chin and gently tilt the head back

B — breathing. Spend 10 seconds checking that the casualty is breathing. See if the chest is rising and falling, listen for breathing and feel for breath against your cheek

C — circulation. Check for a pulse by placing two fingers on the carotid pulse (in the neck, to one side of the windpipe) for 10 seconds

Resuscitation (child or baby)

In all cases in this article, a baby is considered to be under 1 year of age and a child to be between 1 and 7 years.

D — danger. Make sure that the situation is safe for you and for the baby/child, then assess the casualty

R — response. If the baby/child appears to be unconscious, check by calling his or her name and by gently rocking the child's shoulders (never shake a baby) or by tapping the sole of the baby's foot. If there is no response proceed to ABC

A — airway. To open the airway, place the baby or child on any firm surface, place two fingers under the point of the chin (for a baby use one finger) and place your other hand on the baby/child's forehead. Do not press on the soft tissue under the chin. At the same time, lift the chin and gently tilt the head back

B — breathing. Spend 10 seconds checking to see if the casualty is breathing. Look to see if the chest is rising and falling, listen for breathing and feel for breath against cheek. If the baby/child is breathing, place him or her in the recovery position. If the baby or child is not breathing, give five breaths of mouth-to-mouth ventilation (child) or mouth-to-mouth/nose ventilation (baby) and then check circulation

C — circulation. For a baby, check the pulse inside the upper arm by lightly pressing two fingers towards the bone for 10 seconds. For a child, check the pulse by placing two fingers on the carotid pulse in the neck for 10 seconds

Mouth-to-mouth ventilation

Adults Carefully remove any obvious obstruction from the mouth with your finger but do not probe blindly. Open the airway, pinch the nose firmly closed, take a deep breath and seal your lips around their mouth. Blow into the mouth until the chest rises, then remove your mouth and allow the chest to fall. Continue at a rate of 10 breaths a minute and check for a pulse after every 10 breaths. If the pulse is absent, commence cardiopulmonary resuscitation (CPR). If breathing starts, place in recovery position.

Mouth-to-mouth/nose ventilation

Children Carefully remove any obvious obstruction from the mouth. Do not probe blindly or touch the back of the throat with your fingers. Open the airway, seal your lips around the child's mouth while pinching the nose. Blow gently into the lungs, looking along the chest as you breathe. Take shallow breaths and do not empty your lungs completely. As the chest rises, stop blowing and allow it to fall. Do this at a rate of 20 breaths per minute until help arrives.

Check the pulse after every 20 breaths. If it is still present, continue mouth-to-mouth ventilation. If not, commence CPR. If breathing starts, place the child into the recovery position.

Babies Carefully remove any obvious obstruction from the mouth. Do not probe blindly or touch the back of the throat with your fingers. Open airway and seal your lips around the baby's mouth and nose. Blow gently into the lungs, looking along the chest as you breathe. Fill your cheeks with air and use this amount each time. As the chest rises, stop blowing and allow it to fall. Do this at a rate of 20 breaths per minute. Continue until help arrives, checking the pulse after every 20 breaths. If the pulse is still present and above 60 per minute, continue mouth-to-mouth/nose ventilation. If the pulse is absent or below 60 per minute, commence CPR. If breathing starts, place the baby into the recovery position.

Cardiopulmonary resuscitation

Adults Place the middle and index fingers two fingers width above the junction of the rib margin and breastbone. Place the heel of the other hand on top and interlock fingers. Keeping your arms straight and your fingers off the chest, press down about 4 to 5cm. Release pressure, keeping your hands in place. Repeat the compressions 15 times, aiming for a rate of 100 per minute. Give two breaths of mouth-to-mouth ventilation and continue resuscitation at a rate of 15 compressions to two breaths. Only check the pulse if the casualty's colour improves. If a pulse is present, stop the chest compressions but continue mouth-to-mouth ventilation, if necessary.

Children Place one hand two fingers width above the junction of the rib margin and breastbone. Use the heel of that hand and press down to a third of the depth of the chest. Press five times at a rate of 100 compressions a minute. After five compressions, blow gently into the lungs once. Continue resuscitation (five compressions to one breath) for one minute then, if alone, call for an ambulance. Continue resuscitation without stopping until help arrives. If the child's colour improves, check the pulse. If a pulse is present, stop the chest compressions but continue to ventilate, if necessary.

Babies Place the baby on a firm surface. Locate a position one finger's width below the nipple line, in the middle of the chest. Use two fingers and press down sharply to a third of the depth of the chest. Press five times at a rate of 100 compressions per minute. After five compressions, blow gently into the lungs once. Continue resuscitation (five compressions to one breath) for a minute then, if alone, dial for an ambulance. Then carry on without stopping until help arrives. If the baby's colour improves, check the pulse. If the pulse is present and above 60 per minute, stop the chest compressions but continue to ventilate, if necessary.

Recovery position

Adults An unconscious casualty who is breathing and has no other life-threatening conditions should be placed in the recovery position. Turn the casualty on to his or her side, lift the chin forward to open airway and adjust the hand under the cheek as necessary. Check that the casualty cannot roll forwards or backwards. Check breathing and pulse frequently — if either stop, take the appropriate action.

Children The adult recovery position should be used. However, it may be more practical to hold smaller children in the same recovery position as you would a baby.

Babies Hold the baby face down in your arms on your lap, with the head held low.

Heart Attack

A heart attack may be recognised by some or all of the following symptoms:

If the casualty is conscious, make him or her as comfortable as possible in a half-sitting position. Make the casualty chew one aspirin slowly. Telephone for an ambulance. If the casualty becomes unconscious, follow the DRABC resuscitation sequence.

Adults Encourage the casualty to cough. Check the mouth and remove obvious obstructions. If the casualty stops coughing or breathing, stand to the side slightly behind him or her and give five sharp slaps to the back between the shoulder blades. Check the mouth. If this fails to dislodge the obstruction, you will need to perform abdominal thrusts: stand behind the casualty and place your arms around the abdomen, bend him or her slightly forwards and put your fist just below the base of the breastbone. Put your other hand on top and pull sharply inwards and upwards five times. Listen for the obstruction being dislodged and check mouth. Repeat this three times. If the obstruction does not clear, call for an ambulance. Repeat the cycle until help arrives.

Children If the child is breathing, encourage them to cough. If the casualty becomes weaker or stops coughing, bend them forwards with the head lower than the chest. Give up to five firm slaps to the back between the shoulders. Check the child's mouth. Remove any obvious obstruction with one finger. If this fails to dislodge the obstruction, you will need to perform chest thrusts: stand or kneel behind the child. Make a fist and place it against the lower breastbone. Grasp it with your other hand and press into the chest with a sharp inward thrust. Give up to five of these thrusts at a rate of one every 3 seconds. Check the child's mouth. If chest thrusts have failed to dislodge the obstruction, make a fist and place it against the child's central upper abdomen. Grasp it with your hand. Press into the abdomen with a sharp inward thrust up to five times. If the abdominal thrusts have not removed the blockage, repeat the steps three times. Check the mouth and, if necessary, call for an ambulance, repeating the above steps until help arrives.

Babies Lay the baby face down on your forearm, supporting back and chin. Give up to five sharp slaps on the baby's back. Check the baby's mouth. Remove any obvious obstruction with one finger but do not feel blindly down the throat. If this fails to dislodge the obstruction, turn the baby face up on your arm or lap. Give up to five sharp thrusts into the baby's chest. Check the baby's mouth again and remove any obvious obstruction. Do not use abdominal thrusts on a baby. If the obstruction still has not cleared, repeat the above steps three times, then take the baby with you and call for an ambulance. If the baby becomes unconscious, follow the resuscitation sequence (DRABC). Repeat steps above until help arrives.