Elderly First Aid Handbook Book B

Emergency Medicine Interest Group

Emergency Medicine Unit, The University of Hong Kong

BOOK

B

Presents

ELDERLY FIRST AID HANDBOOK

Edited by KL Fan LP Leung

2

CONTENT

3

Foreword

3

Disclaimer

4

Process of Ageing

9 10 13 16 18

Basic Life Support Basic Life Support Compression-only Bystander CPR Conventional Bystander CPR Automated External Defibrillator (AED) Recovery Position

21 23 28 35 36 40

Limbs Soft Tissue Injuries Wounds Fractures Dislocation Fall and Fall Prevention Traumatic Spinal Cord Injury

42 46 48 50 51

Musculoskeletal Acute Gout Arthritis Osteoarthritis Lower back pain Neck pain and shoulder pain knee pain

53

Allergy & Anaphylaxis

56

Burn

62

Herps Zoster

65 68 76 80

Toxicology Drug Overdose Common and harmful overdose - Ingested poisons Common and harmful overdose - Chemical poisoning Snakebite and Envenomations

Content

1

2

82

Pain Management Common Pain Relief Methods

87 88 89 90 91 92 93

Bandaging and Wound Dressing Head Bandage Arm Sling Elevation Bandage Elbow Bandage Forearm Bandage Wrist Bandage Hand Bandage

94

Acknowledgement

95

Notes

FOREWORD

These two handbooks were written by a group of medical students of the University of Hong Kong (HKU) with the guidance from the academic staff of the Emergency Medicine Unit of the HKU. The students have formed an Emergency Medicine Interest Group with the vision of serving the community of Hong Kong through their knowledge in Emergency Medicine.

Ageing population is a worldwide phenomenon. It is expected that the proportion of people aged 65 orabove would rise from 13% in 2011 to 30% in 2041 in Hong Kong. With increasing number of senior citizens in the community, how to best respond to their healthcare demands should be everyone’s concern.

These two handbooks aim at guiding the readers across the vast topic of first aid for an ill or injured elderly. It is primarily written for the caretakers of the elderly in the community. But readers other than the caretakers of the elderly may also find the two handbooks useful if they come across an elderly who is acutely unwell. These two handbooks are neither authoritative nor comprehensive. It is hoped that readers would pursue further study on the topics in which they are interested and help themselves better respond to an ill or injured elderly under their care.

The Emergency Medicine interest Group and the Emergency Medicine Unit would like to thank the ‘We Are With You’ Fund for the support in the production of these handbooks.

KL Fan, LP Leung June 2016

Disclaimer Every effort has been made to ensure the accuracy of the content of these two handbooks. Nevertheless, the authors, the editors and publishers can make no warranties that the information contained herein is totally error-free. Readers are strongly advised to consult the relevant specialists or literature before following the recommendation in these two handbooks. The authors or any party involved in the production of these two handbooks disclaim any liability, loss, injury or damage resulting from the use of these two handbooks.

Foreword

3

PROCESS OF AGEING

Muscle - Reduced muscle mass (30-40%) and muscle power - Becoming fatigue earlier and more easily during exertion - Lower regenerative ability - More fat in muscle tissue

Skin - Wrinkling and sagging especially on face, neck and hands - Getting thin and pale - Wounds heal more slowly or may not heal at all - Reduced sensitivity to cold - Reduced sweating - Reduced resistance to UV light damage

General - Decrease in body mass - Decrease in the proportion of body fat

Eyes - Yellowing of lens - Higher prevalence in cataract - Lower light sensitivity - Poorer dark adaptation - Reduced tear production - Minimal decrease of visual acuity at rest but significant decrease of visual acuity with a moving target

Nervous system - Slower central processing and longer reaction time - Reduced sensitivity to vibration especially in feet - Less sensitivity to temperature - Modest loss of neurons - Slight decrease in brain mass

Skeleton - Both men and women lose bone mass during ageing - Women have faster loss in bone mass, which accelerates after menopause - Men have slower bone loss, as they start losing other tissues as well - Higher prevalence of osteoporosis in both genders

Physiology/Anatomy of Ageing Ageing is a term to describe the changes in our body functions when we get older. The changes affect every body system and are affected by environmental and genetic causes. The following are changes that appear in our body during the process of ageing.

4

5

PROCESS OF AGEING

Heart and blood vessels - No change in heart rate and contraction force at rest - Less increase in heart rate and contraction force during exercise - Moderate increase in heart size - Stiffer heart and blood vessel tissues - Increased blood pressure

Digestive system - More stomach acid production - More common to have constipation - Reduced absorption of nutrients - Decrease in liver mass

Respiratory system (breathing) - Decrease in diaphragm strength - Decrease in lung volume and air flow rate - Increase in residual air in lungs

Other systems - Impaired shivering - Decrease in sensitivity of smell - Decrease in thirst drive - Deterioration of balance - Loss of hearing in high-frequency tones

Immune system - More prone to infection - Reduced response to vaccination

Kidney, urinary and genital systems - Decrease in kidney filtration function, concentration ability and dilution of urine - Decrease in kidney mass - Incomplete bladder emptying leading to increase in residual urine - Less intense orgasms (both men and women) - Longer resting time between orgasm and next erection for men

6

7

BASIC LIFE SUPPORT

Basic Life Support (BLS) Basic Life Support is the combination of emergency procedures needed to ensure a person’s survival, including cardiopulmonary resuscitation (CPR), control of bleeding, treatment of shock and poisoning, stabilization of injuries and/or wounds, and basic first aid. In this chapter, we will cover CPR, recovery position, and automated external defibrillator (AED).

CPR

Recovery Pose

AED

Why Basic Life Support?

It is important to learn BLS because emergencies happen! There are a lot of things you can do with little or no equipment to deal with medical emergencies, and you could potentially save a life with these simple skills.

Why learn Bystander CPR? Because Bystander CPR is a simple and effective way to keep a person with sudden cardiac arrest alive. This is a series of actions to support the breathing and circulation of a person whose heart has stopped beating, and help maintain blood perfusion to the vital organs to a certain extent to buy time for more definitive treatment.

Average age

Witnessed

80 40%

30% CPRed

What is sudden cardiac arrest?

Sudden cardiac arrest (SCA) is when there is a sudden failure of the heart to contract effectively, so that the delivery of oxygen by blood to the body tissues, including the brain and the heart itself, is disrupted, or even stopped. This situation is very dangerous, and is one of the leading causes of death worldwide, especially in the elderly. The median age of SCA in Hong Kong is 80 years old. Two-thirds of the cases occur at home, and 40% occur witnessed. Yet, only about 30% of the elderly in Hong Kong get immediate CPR from a bystander.

This is very low compared to other developed countries, and many more lives could potentially be saved if more people step out to carry out CPR on an elderly with SCA.

Basic Life Support

9

Basic Life Support

10

How does Bystander CPR help?

Compression-only Bystander CPR

The Chain of Survival

CPR is one of the most important first aid techniques, it’s a series of actions to support the circulation of a person whose heart has stopped beating. This helps maintain blood perfusion to the vital organs to a certain extent to buy time for more definitive treatment.

The Chain of Survival is a closely packed series of five steps to keep the chances favorable for a SCA elderly to stay alive.

The steps are: 1) Early access to care (e.g. calling 999) 2) Early CPR 3) Early defibrillation (i.e. with an AED) 4) Early advanced care (by professionals) 5) Good post-resuscitation care Each one of these steps must be done well and early, and with the Bystander BLS routine, you will already be covering the first 3 key steps in saving the elderly.

Here is how to do it.

1 2 3

CPR

AED

If you have not been trained in CPR, or do not wish to have mouth-tomouth contact with a stranger, you can do compression-only CPR. It is as effective as the conventional bystander CPR. The approach can be remembered with a mnemonic of :

Danger + Check + Call + Chest Compression

1 Danger

Check if the environment is safe for you and the elderly

2 Check

Check the elderly for Responsiveness: call the elderly; shake the elderly’s shoulders

3 Call

IF the elderly is not responsive AND not breathing properly, call for help by - Dialing 999 - Asking a bystander to take the nearby AED for you

Breathing: observe if there are chest movements; listen for any breathing sound

Proceed to CPR (C A B)

4 Chest Compression

Basic Life Support

11

Basic Life Support

12

Compression-only Bystander CPR A. Position Place the heel of a hand on the breastbone at the center of the elderly’s chest.

C. Depth Using your body weight, press the elderly’s chest down hard for 5-6 cm (2 inches - 2.4 inches).

2

B. Posture Place the other hand on top of the first hand, and make your fingers interlocked.

Move your shoulders so that they are directly above your hands, keep your arms vertical and straight throughout. Do not bend them even as you apply pressure.

D. Frequency Press repeatedly and fast with the same posture at a frequency of 100-120 per minute. As a rule of thumb, run the song Staying Alive “Ha, ha, ha, ha, staying alive, staying alive…” in your head. Each beat roughly corresponds to one press.

Alternatively, follow the best of the song 急救進行中

x 100 - 120/mins

E. Recoil After each press, make sure you allow the chest of the elderly to recoil.

Repeat the procedure until - the elderly regains consciousness with normal breathing and heart rate - an ambulance has arrived - the AED has arrived - you are exhausted and cannot carry on.

Conventional Bystander CPR This is a series of actions to support the breathing and circulation of a person whose heart has stopped beating. The approach can be remembered with a mnemonic of :

Danger + Check + Call + C A B 1 Danger

Check if the environment is safe for you and the elderly

2 Check

Check the elderly for Responsiveness: call the elderly; shake the elderly’s shoulders

3 Call

IF the elderly is not responsive AND not breathing properly, call for help by - Dialing 999 - Asking a bystander to take the nearby AED for you

Breathing: observe if there are chest movements; listen for any breathing sound

Proceed to CPR (C A B)

4 C AB (CPR )

C - Circulation A - Airway B - Rescue Breaths

Basic Life Support

13

Basic Life Support

14

Conventional Bystander CPR

C

C for Circulation - Chest Compression (Optional) If you have been trained and confident in doing pulse check, check if there is a neck (carotid) pulse by placing two fingers on the side of the prominence at the front of the neck.

Check one side at a time.

A. Position Place the heel of a hand on the breastbone at the center of the elderly’s chest.

C. Depth Using your body weight, press the elderly’s chest down hard for 5-6 cm (2 inches - 2.4 inches).

2

B. Posture Place the other hand on top of the first hand, and make your fingers interlocked.

Move your shoulders so that they are directly above your hands, keep your arms vertical and straight throughout. Do not bend them even as you apply pressure.

D. Frequency Press repeatedly and fast with the same posture at a frequency of 100-120 per minute. As a rule of thumb, run the song Staying Alive “Ha, ha, ha, ha, staying alive, staying alive…” in your head. Each beat roughly corresponds to one press.

Alternatively, follow the best of the song 急救進行中

x 100 - 120/mins

E. Recoil After each press, make sure you allow the chest of the elderly to recoil.

A

A for Airway If neck injury is not suspected, head-tilt and chin-lift can be performed: Tilt the head back, and lift the chin up.

If neck injury is suspected, jaw thrust can be performed instead.

B

B for Rescue Breaths After 30 chest compressions, give 2 breaths.

Place your mouth on the elderly’s mouth so that it is airtight, and blow steadily into his/her mouth.

Each breath must last about 1 second.

Observe to see if his/her chest rises. If so, the rescue breath is effective.

In conventional bystander CPR, the cycle between chest compressions and rescue breaths in a 30:2 ratio, in which 30 chest compressions are followed by 2 rescue breaths.

Repeat the procedure until - the elderly regains consciousness with normal breathing and heart rate - an ambulance has arrived - the AED has arrived - you are exhausted and cannot carry on.

Basic Life Support

15

Basic Life Support

16

Automated External Defibrillator (AED) Commonly called AED, the device has a daunting full name Automated External Defibrillator. However, its principles and use are actually not difficult to grasp.

Sudden cardiac arrest, in which the heart stops beating suddenly, can cause death within minutes if untreated. The 2 major causes of sudden cardiac arrest, both triggering irregular heartbeats, are ventricular fibrillation and ventricular tachycardia. The commoner cause is ventricular fibrillation, in which the lower chambers (ventricles) of the heart quiver quickly and irregularly. The other cause is ventricular tachycardia, in which the ventricles have regular, fast beats that lasts for a short period of time.

The AED can be used in this condition to assess the heart rhythm and restore it to normal by administering electric shocks to the heart. CPR also helps the chance of survival.

AED sets usually come with spoken or visual instructions for the untrained user and are easy to use. An important point, though, would be to make sure that no one is touching the elderly when the shock is being administered.

AEDs can be found in many public places, such as shopping malls, airports, hotels and schools. You can find them directly under these signs

AED It’s important for the local EMS system and Community members to know where AEDs are located in the community. In the event of a sudden cardiac arrest emergency, you can find AED quickly.

There are many different brands of AEDs, but the same basic steps apply to all of them.

STEPS in using AED 1. Turn on the AED ON-OFF

ON-OFF

1

2

3

2. Attach defibrillation pads to the chest (Right side upper chest , Left side lower chest, wipe the chest dry if it’s wet) 3. Push the analyze button and the AED analyze heart rhythm 1 ON-OFF

2

3

If AED advises you to shock the person: 4. Make sure no one, including you, is touching the person Tell everyone to “STAND CLEAR!” 5. Push the “shock” button

Basic Life Support

17

Basic Life Support

18

Recovery Position If the elderly is unconscious without any suspected neck injuries and breathes spontaneously, he/she should be placed in the recovery position. The recovery position keeps the airway patent, and prevents the elderly from aspiration.

1. Kneel by the right side of the elderly.

2. Place the right arm of the elderly at right angle with his/her palm facing up.

6. Gently tilt the head back, and lift the chin (head-tilt and chin-lift), and perform the airway check of ABC again if you have not done so.

Stay with the person and monitor the elderly’s ABC continuously until an ambulance arrives.If the injuries are not too severe, turn the person to the other side after 30 minutes.

Basic Life Support

19

3. Hold the left hand of the elderly and place the back of the hand against his/her right cheek.

4. Grasp his/her left leg and bend to a right angle.

90˚

5. Keep his/her left hand on the right cheek. Pull the bent leg towards you to make the elderly roll to your side. His/her left arm should prevent the elderly from rolling too far.

LIMBS

Soft Tissue Injuries Background

Soft tissue injuries can be classified into bruises, strains and sprains.

Injuries can either be acute, which happens suddenly, or overuse injury, which is caused by repetitive tasks over a long period of time or bad postures. Ankle sprain and back strain are the most common soft tissue injuries as a result of improper physical activity.

Bruises can be a result of an injury by a blunt force leading to bleeding in the soft tissue. Strains can be due to overstretching of muscles and tendons leading to tearing of muscles & tendons.

Sprains can be caused by forcing joints beyond normal range of motion leading to overstretching of ligaments.

Symptoms and signs

- Bruise - Pain - Swelling - Limited movement in injured part

! Severe pain & swelling ! ! Unable to move, walk or ! bear weight on injured limb

Limbs

21

Limbs

22

- Relieve symptoms by medication and physical method Do’s

As a first aider

1. Soft tissue injuries should be treated with “RICE”: Rest Rest the injured part and avoid moving it Ice Apply ice or cold compress (wrapped in a towel) on the injured part Compression Provide comfortable support

Compression with elastic bandage Elevation Elevate the injured limb 2. Simple painkillers such as paracetamol could be used to relieve pain as instructed by doctor Don’ts 1. Move the injured part unnecessarily 2. Apply heat to the injured part 3. Apply herbs without prior medical consultation

Wounds

Background

Good wound care is especially important for elderly with chronic diseases, as they have an increased risk of wound infection.

Common types of wound are minor cuts, scratches, deep cuts/ penetrating wounds, and skin tear.

! Wounds that are large or deep ! Wounds contaminated by foreign bodies ! Wounds caused by animal bite ! Wound occurring over joints ! Wound with large skin loss ! Wounds not treated for 8 or more hours

! ! ! ! ! !

Limbs

23

Limbs

24

As a first aider

- Stop bleeding from the wound - Prevent wound infection - Recognize red flags as they require medical attention, for example, tetanus prophylaxis Do’s 1. Stop bleeding (if any), using gauze for compression 2. Clean wound 3. For minor injuries, rinse the wound surface with running water 4. For deep injuries, rinse the wound with running water, then disinfect the wound 5. For skin tear, disinfect both the wound surface and the underside of the skin tear using Hibitane, then rinse with saline 6. Cover and dress wound 7. The preferred method is open method. Non-waterproof adhesive dressing is the most convenient to use 8. For large skin tear, lay the skin flap back on the wound and cover the entire area with gauze. Seek medical attention IMMEDIATELY Don’ts 1. Cover wound with emulsifying ointment (豬油膏), toothpaste, vinegar or soy sauce 2. Clean wound with alcohol or hydrogen peroxide 3. Rip off a bandage too quickly, which may reopen a healing wound

Types of disinfectants

Remarks

Solution Hibitane

Cetrimide

Ingredient: Chlorhexidine gluconate Effect: Disinfectant effect

Ingredient: Cetrimide in addition to chlorhexidine gluconate Effect: Detergent effect

Dry powder spray Betadane It is sprayed over the wound and forms a protective layer Ingredient: Povidone iodine Effect: Disinfect the wound and absorb any exudate that comes from the wound

Limbs

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Limbs

26

Types of dressings Closed Method Change the dressing every 2-3 days to avoid infection and allow any exudate to leave

Fine Tulles

CoarseTulles

Fine tulles have smaller holes.

Cover the wound with a single layer

Coarse tulles are more common on the market and they have larger holes. Cover the wound with two layers

Waterproof adhesive dressings

Open Method This is the preferred method for most wounds. The dressings (besides silicon) should be changed after showering or after coming in contact with water Non-adhesive dressings

Non-waterproof adhesive dressings

Silicon dressings

It can be changed every 7 days because the dressing has holes that allow exudate to flow away

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Limbs

28

Fractures

Background

Fractures usually occur in acute events such as falls and accidents. It can also be a form of overuse injury. Elderly is prone to fracture even in trivial injuries due to brittle bones.

Common fracture sites include the hip, upper arm, wrist, spine and ribs.

Elderly are prone to fall as a result of reduced muscle power and balancing ability. With ageing, the density of bone drops (osteoporosis) and the bones become brittle. Elderly

Symptoms and signs

-

can fracture their upper end of thigh bone from a simple move or minor injury. Hip fracture is one of the top injuries in elderly. Wrist fracture is another common injury from a fall on to an outstretched hand. It results in a forced backward displacement of hand and fracture of the bone in forearm.

Osteoporosis, physical inactivity, smoking, drinking and steroid therapy are risk factors of fractures.

Snap sound heard as bone breaks Pain Swelling Deformity at fractured site Inability to move the injured limb For an open fracture, a wound, possibly with bone visible

- Recognize that there is a fracture and seek medical consultation as soon as possible - Prevent further injury

As a first aider

Do’s 1. Immobilize the injured limb with a splint if available 2. If no splint is available, use a triangular bandage for support if it is the upper limb that is injured 3. Cover the wound, if present, with a clean dressing Don’ts 1. Move the injured limb unnecessarily 2. Apply heat locally 3. Apply herbs locally 4. Try to reduce any deformity 5. Try to push back any visible bone if it is an open fracture

Limbs

29

Upper Limb Splint

Remarks

Things to check beforehand 1. Locate site of possible fracture 2. Check circulation below fracture site Symptoms & signs of Poor circulation are: - Weak/absent pulse below the fracture site, e.g. radial pulse in case of arm fracture.

- Pale, white or bluish skin - The distal limb is cool.

- Numbness or tingling of limbs Materials

Triangular bandage x 3 Splints: rigid boards, sticks x 2 Padding: blankets, clothes x 1 Folding method of triangular bandage into longitudinal bandages 1

Triangular bandage

2

Fold the of the triangle down so that the tip of the triangle touches the base – Cravat (1-fold)

3

Fold the top edge down so that it touches the base – Cravat (2-folded)

Steps 1

Lie down the victim supine with the injured arm resting next to the trunk.

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30

Upper Limb Splint Placing bandages Fold three cravats into longitudinal bandages, and push them under natural body curvature. a / above the fracture site b / below the fracture site c / at the site wrapping from the wrist to the contralateral pelvis.

(Avoid pressing directly on the suspected fracture site)

2

a b c

4

5

14

15

19

6

16

7

17

8

18

Check circulation Observe the limb below the cravats for signs of impaired circulation after securing all the three cravats.

Signs and symptoms of poor circulation - Cooler temperature - Bluish color change of skin - Increasing pain - Numbness or tingling sensation - Reduced or absent of movement - Weaker or absence of pulse

Limbs

31

Apply padding Place paddings between the fractured upper limb and the trunk that are going to be splinted.

3

9

10

11

Wrap around Wrap the cravats from the injured limb to the contralateral side of the trunk one by one.

20 Finish!

Dial 999 to call for ambulance

12

13

Tie knots Tie the ends of each cravat in a non slip knot on the contralateral side of trunk and away from the causality. The cravat should be tight enough to hold the fracture upper limb securely in place, but not tight enough to interfere with blood circulation.

Limbs

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Lower Limb Splint Before splinting 1. Avoid moving the fractured limb 2. Check for a / Touch sensation b / Ability to move c / Pulse Materials

Triangular bandage x 4 Splints: rigid boards, sticks x 2 Padding: blankets, clothes x 1

Steps 1

a

Slide three triangular bandages under both legs: a / above the site of fracture, b / below the site of fracture c / under the knees.

b c

2

Place a splint or padding between the legs. It should be long enough to extend from the thigh to the ankles.

3

Bring the two ends of the triangular bandage under the knee together.

4

Tie the knot of the triangular bandage over the knee of the uninjured leg. Make sure the bandage is tight enough so that no movement is possible.

5

Take another triangular bandage and fold it in half three times, so that it is half the width of the other triangular bandages. Slide this bandage under the ankles.

6

Next, tie a figure of eight bandage around the ankle.

Tie the triangular bandage around the feet and cross over at the dorsum of the feet. Wrap the bandage around the feet one more time.

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Limbs

34

Lower Limb Splint 7

Tie the knot of the triangular bandage over the uninjured foot.

8

Tie the remaining two triangular bandages, tying knots over the uninjured leg.

9

After tying all four bandages, check for touch sensation, ability to move and pulses again. Note the color and temperature of the skin.

Dislocation

Background

Symptoms and signs

Dislocations are caused by a force (from falls, collisions, accidents) resulting in the bone being moved into an abnormal position and articulation. Anterior shoulder dislocation, which is results from fall on outstretched hand or direct impact to shoulder, is the most common site of dislocation. Closed reduction must be done quickly by experienced personnel.

-

Snap sound heard as bone breaks Pain Swelling Deformity in the injured area Unable to move the joint

! Loss of sensation, motion ! or circulation beyond injured part

- Recognize the condition and seek medical help immediately Do’s

As a first aider

1. Seek emergency medical help immediately for reduction 2. Advise the casualty to stay still 3. Support the injured limb in position of comfort Don’ts Attempt to reduce the joint if not trained

Limbs

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Limbs

36

Fall

Background

Falls are the most common cause of injury in the elderly. It can cause significant immobility, morbidity, and mortality. The outcome of the fall may be determined more by the underlying reasons (such as existing diseases, or compromised body functions) than the actual injuries.

Risk factors for fall include history of fall, gait and balance problems, impaired mental status, drugs (more than four types, or antihypertensive, pain-killing, diuretic, psychotropic drugs), neurological diseases and weakness of legs (e.g. stroke, Parkinson’s, etc.), impaired sight (e.g. glaucoma, cataract, etc.), problems with foot (calluses, nail disease, joint problems), alcohol, low blood pressure and environmental hazards.

Fall Prevention

Background

There are two approaches to preventing falls. Primary fall prevention concerns itself with avoiding fall, and secondary fall prevention focuses on detecting the risk of fall. Both preventions have been intensively studied, and secondary prevention has been shown to be the most efficient. It is difficult to prevent falls completely, and repeated falls are more dangerous to the patient than the risk of falls alone.

An efficient secondary prevention involves the education to the elderly and their caregiver. All elderly with the age above 70 should be counseled for the specific measures of fall prevention if they have one of more risk factors as above. They are encouraged to exercise at the level compatible with their physical fitness.

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The most successful preventive approach is to assess multiple factors and take measures targeting the risk factors in the elderly. It encompasses the following aspects: - Medications: review and reduction (esp. psychotropic drugs) if necessary - Balance and gait training - Exercise to strengthen muscles - Postural blood pressure monitoring - Home hazards modifications 1

4 2

6 5

3 7

15

8 9

12 10

11

13 14

Reduce your risk of falling at home Bedroom Livingroom 1. Keep a light - a lamp, light 10. Move cords and other switch or night light - near objects out of walkways your bed 11. Remove rugs or securely 2. Sit down to get dressed. tape down their edges 3. Keep loose items off the floor 12. Use a cushion or a seat riser if your favorite chair is too Bathroom low to easily stand from 4. Install grab bars near toilet and shower Kitchen 5. Put a riser seat on the toilet 13. Use dining chairs that have 6. Use a shower chair and arm rests and no wheels handheld shower head while 14. Don’t clean with high-gloss bathing wax floor protector 15. Move things so they are Stairs and Hallways within easy reach 7. add handrails on both sides of the stairs 8. Install anti-slip strips on each stair 9 make sure pathways are well-lit and clear of tripping hazards

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Particular attention must also be paid to these items, and they should be corrected as soon as possible: - Inappropriate footwear inducible to slipping and loss of balance - Inappropriate use of walking aids - Uncorrected vision impairments For elderly living alone, it is helpful to install an emergency alarm system (see Section 5 - Call for help). On the other hand, there is evidence that a supplement of vitamin D can help prevent falls and fractures in older people. Consider asking a doctor for advice.

Exercise is an effective method of countering certain ageing effects, preventing falls, and enhancing quality of life in general, and is beneficial no matter the person falls or not. Some of the other benefits include, but are not limited to: - Slowing bone and muscle loss - Decrease cognitive impairment and improve function - Decrease constipation and incontinence - Improve blood sugar control - Enhance sleep The amount of exercise can vary according to the relative fitness of the person. For a high-fitness elderly, 30-60 minutes of moderate activity (such as brisk walking, light cycling or badminton) 5-7 days per week may be suitable. For low-fitness elders, moderate activity of less than 10 minutes may be permitted, but a gradual increase in duration is recommended.

There is also a large amount of evidence pointing to the importance of balance training in fall prevention, such as dancing or Tai-Chi. Other simpler balance exercises also exist. Consult your doctor or physiotherapist for more information.

Steps to Get Up After Fall 1

After fall, try to find a chair for facilitating you to climb up. If possible, try to crawl near the chair.

2

Use one hand to hold the chair as supporting for lifting up your body.

3

Then use both hands to grab the chair. Try to lift up on leg stepping on the ground while the other leg knees on the ground.

4

Try to stand up with both legs.

5

Sit on the chair and take a rest.

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Traumatic Spinal Cord Injury Symptoms and signs

- Numbness (loss of sensation) in any part of the body - Weakness of muscle after trauma - Urinary or faecal incontinence with loss of feeling around the anus.

- Neck pain elicited by touching

! Be extremely gentle when touching ! the back of the patient with suspected spinal cord injury

Do’s Seek medical help as soon as possible.

As a first aider

Don’ts Unless the patient is in a dangerous place, do not move the patient.

MUSCULOSKELETAL

Musculoskeletal

42

Acute Gout Arthritis Background

Symptoms and signs

Acute gout is a condition of acute inflammatory arthritis — a red, tender, hot, swollen joint. It affects 5% of Hong Kong population and the hospitalization rate is significantly higher among elderly patient.

Under-excretion of uric acid by the kidney is the primary cause of hyperuricemia in about 90% of cases, while overproduction is the cause in less than 10%. However, only 10% hyperuricemia patients develop gouty arthritis.

Acute gout is induced by excess uric acid in blood leading to crystal formation in joints. It could happen in uric acid overproduction, excess consumption of high-purine foods like meat and fish, consumption of alcohol, medications such as diuretics, under-excretion of uric acid, and renal failure.

The risk factors for acute gout include overweight, high blood pressure, purine rich diet (like meat and fish), consumption of alcohol, and medications such as diuretics.

During a gout attack: - Sudden burning pain and stiffness in a joint (affects the big toe in 50% of cases, may also happen in ankle and knee) - Redness Pain and swelling are worst at the beginning of gout attack. Most occur during night time

! Affecting a joint not usually involved ! High fever with chills and rigors ! History of diabetes mellitus or any compromised states

! ! !

All these suggest it may not be a simple gouty attack but infection of the joint.

- Symptomatic relief by medication and physical method - Bring the patient to consult family doctor early for definitive care

As a first aider

Do’s 1. Rest the affected joint until the attack subsides and for the next 24 hours 2. Elevate affected joint 3. Use ice to reduce swelling 4. Seek further medical help if it is the first attack 5. For recurrent attack medications, (for example, NSAIDs, colchicine) may be taken as instructed by doctor. Treatment should start as soon as possible for more rapid and complete resolution of symptoms 6. Stick to a low purine diet Don’ts 1. Apply warm pad to affected joint 2. Discontinue allopurinol if taking it regularly 3. Delay medical consultation if symptoms do not respond promptly to treatment of gout

Musculoskeletal

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Musculoskeletal

44

Remarks

Dietary control is important to reduce the risk of recurrent gouty attacks. It should contain vegetables, fruits and low-fat dairy products. Drink enough water daily to keep body well-hydrated.

Consumption of fish, poultry and lean meat should be kept to 4-6 ounces per day. Dietitian advice is desirable.

High-purine food and beverage that should be avoided: Meat – Fishes – especially fatty red meat, goose sardines, mackerel, salmon and organ meats

Shellfishes – Mussels, clams, scallops, shrimps

Mushrooms, asparagus, cauliflower, spinach

Alcohol

Yeast

High fructose corn syrupsweetened sodas, beverages, or foods

Food and beverage that are safe to consume (low in purines): Green vegetables and Fruits tomatoes

Breads and cereals that are not whole-grain

Butter, buttermilk, cheese, and eggs

Chocolate and cocoa

Peanut butter and nuts

Coffee, tea, and carbonated beverages

Dairy products that may lower your risk of gout: - Low-fat or nonfat milk - Low-fat yogurt

Musculoskeletal

45

Musculoskeletal

46

Osteoarthritis

Background

Osteoarthritis is a common disease among the elderly population with 1 in 3 people aged 70 and older being affected. It is also one of the leading causes of disability particularly in elderly population.

the bones begin to break down, causing pain and swelling upon joint movement.

Osteoarthritis is caused by degeneration of joints. It usually affects knees, hips, lower back, neck, joints of fingers and toes.

The risk factors for osteoarthritis include ageing, overweight, trauma to joint due to repetitive movements. In particular, squatting and kneeling are common risk factors of knee osteoarthritis.

In the early stage, cartilages that help reduce friction between

Symptoms and signs

In the later stage, bone spurs may form on the joint causing further inflammation and damage to the joint.

- Limited range of motion due to pain and stiffness joints - Clicking / cracking sound when moving a joint - Mild swelling around the affected joint

! Affecting a joint not usually involved ! High fever with chills and rigors ! History of diabetes mellitus or any compromised states

! ! !

- Relieve the patient’s symptoms by medication and physical method - Consult family doctor for persistent symptom

As a first aider

Do’s 1. For swelling in joints: a / Rest the joint b / Apply cold pad to affected joint for 20 minutes every few hours c / Compress the joint with elastic bandage d / Elevate the limb 2. For stiffness in joints: a / Apply hot pad to affected joint for 20 minutes every few hours if the joint is not red and hot 3. Lifestyle changes such as light exercise (e.g. Tai Chi, stretching) and weight reduction may help in managing in osteoarthritis 4. Physiotherapy – for suitable exercise routines 5. Occupational therapy – for assistive devices to improve mobility 6. Simple pain killer and anti-inflammatory medication can be used as instructed by doctor Don’ts Delay medical consultation if symptoms do not respond promptly to treatment

Musculoskeletal

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Musculoskeletal

48

Lower Back Pain See further medical attention immediately if there is any of the following warning signs.

Symptoms and signs

Serious cause of lower back pain

Warning sign

Cancer

- Previous history of cancer - Unexplained weight loss

Pott’s disease (tuberculosis of spine)

- Low grade fever - Chronic cough with bloody sputum - Night sweat

Cauda equina syndrome (compression of the nerve in spinal cord)

- Urinary and faecal incontinence - Weakness in muscle and or sensory abnormalities - Loss of sensation in the inner thigh buttocks

Compressed nerve

- Muscle weakness / wasting - Numbness of limbs

Fracture

- Severe trauma: fall from height - Corticosteroid use - Osteoporosis (women in menopause) - Pain in spine relieved by lying down

Infection

- Severe pain after surgery in nearby site - Fever - Urinary tract infection - Immunosuppression - Intravenous drug user - Previous cancer

Do’s

As a first aider

Paracetamol and NSAIDs may be beneficial. Use cautiously as instructed by the doctor.

Don’ts There is a common misconception that lower back pain requires bed rest. However, if the pain is not due to trauma, active lifestyle is actually what the patient needs. Yoga, stretching and core strength building exercises may also be useful.

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Musculoskeletal

50

Neck and Shoulder Pain Background

Muscle strains, degeneration, incorrect postures or even cancer can lead to neck and shoulder pain. In some cases, the neck and shoulder pain may radiate to the head, causing headache.

! Numbness and tingling sensation ! Traumatic injury ! Weakness in the limbs ! Unexplained weight loss ! Previous cancer ! Dysphagia

! ! ! ! ! !

Do’s

As a first aider

- Apply heat pads to relieve pain - Exercise and correction of positioning may treat the neck and shoulder pain - Consult doctor for further check-up if symptoms persist or worsen Don’ts - Over-twisting the neck to prevent further injury - Over-straining the neck and the shoulder

Knee Pain Knee pain is extremely common in the elderly population.

However the causes of knee pain may vary.

Background

Causes - Bursitis - Torn ligaments or tendons - Bleeding into the joint - Gout - Septic arthritis (infected knee joint) - Soft tissue damage/ inflammation

! An extremely painful red hot ! knee may indicate septic arthritis, which is a medical emergency. Medical advice must be sought immediately or the knee joint may risk being damaged by the bacteria. ! ! Inability to walk may also indicate serious problems and urgent medical advice should also be sought.

Remarks

Treatments - Simple analgesics may be helpful.

- Rest the affected knee.

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ALLERGY & ANAPHYLAXIS

Background

Allergy is a hypersensitive reaction of the immune system against a foreign substances (antigens). People who have allergy are sensitive to particular types of antigen.

Anaphylaxis is a severe allergic reaction. It can be life-threatening if not treated promptly. Death can be prevented if anaphylaxis is recognized immediately and cared for quickly.

Food ingestion is a common cause of allergic reaction in individuals with hypersensitivities to those foods. The most life threatening allergic reactions to food is usually caused by peanut. Seafood, cow’s milk, eggs, soy and wheat are other examples.

Some people are allergic to particular chemicals and drugs, with the most common ones being antibiotics, sulpha drugs and latex.

Common triggers to allergic reaction include bee stings or insect venom, certain medications, pollen and dust.

Allergic reactions can range from mild to severe.

Symptoms and signs

Signs and symptoms for mild to moderate allergic reaction, which may precede anaphylaxis - Swelling of the lips, face, eyes - Hives, itching, rash - Weakness - Nausea - Stomach cramps - Vomiting - Dizziness Some common triggers to allergic:

Medications

Bee stings

Food

Allergy & Anaphylaxis

53

Allergy & Anaphylaxis

54

! Hives, weals and body redness. ! ! Swelling of face and tongue ! ! Tightness in throat, ! hoarseness ! Shortness of breath, noisy ! breathing, wheeze, persistent cough ! Shock ! ! Loss of consciousness !

- Recognize the signs and symptoms of anaphylaxis - Seek emergency medical help immediately

As a first aider

Do’s 1. Seek emergency medical help , call 999 immediately if you suspect anaphylaxis 2. If the elderly is unconscious: Check for airway, breathing and circulation and perform CPR as indicated 3. If the elderly is conscious: a / Help him or her into a comfortable position, usually sitting b / Calm and reassure the elderly c / Check if the elderly has their own medication for allergy, assist them to take their medication d / If the elderly carries an auto-injector of adrenaline, help them to use it 4. A second dose of auto-injector can be used if there are no improvement after five to ten minutes 5. Monitor the level of response, breathing and pulse until medical help arrives Don’ts 1. Leave the elderly unattended, as they may get worse quickly 2. Delay the administration of adrenaline, as it is the mainstay of emergency treatment in anaphylaxis

BURNS

Burns

56

Background

Burns and scalds are damage to the skin and tissue caused by heat. The severity depends on depth, type of burn and site of involvement. The outcome is correlated with age, extent of burn and co-existing inhalation injury.

Majority of burn injuries among elderly occur in a domestic setting, particularly in the kitchen and bathroom. Flame and scald injuries are the most common cause of major burns in elderly. Direct contact with hot surfaces (e.g., stoves), electrical and chemical burns are less frequent.

Different types of burn and causes: Type of Burn

Common causes

Dry burn

Fire, Hot objects

Scald

Steam, Hot liquid

Chemical burn Various chemicals used in domestic and industrial setting Electrical burn

High-voltage and low-voltage currents

Radiation burn

Sunburn, sun lamp

- Assessment For Severe Burn - The severity of a burn can be classified by its area and depth.

Symptoms and signs

1 2

3 Epidermis

Dermis

Subcutaneous

Muscle

Classification of burn Superficial burn (First degree burn) Depth Burn affects only the outermost layer of skin Symptoms - Redness - Swelling - Mild pain

1 Partial-thickness burn (Second degree burn) Depth Affecting deeper layers of skin Symptoms - Redness - Swelling - Extreme pain - Blisters

2 Full-thickness burn (Third degree burn) Depth Affecting all layers of the skin, may even damage underlying fat, muscle and blood vessels Symptoms - The skin may appear waxy or charred - Very little to no pain

3

Burns

57

Burns

58

Area Rule of Nines The surface area of an adult body can be divided into 9% sections. 9% each for the head and each upper limb. 18% each for the front of the body, the back of the body and each lower limb.

4.5%

4.5%

Rule of Palm The area of the patient’s palm roughly equals 1% of their total body surface area

4.5%

4.5%

4.5%

4.5%

9%

9%

9%

9% 1%

9%

9%

Burns

59

! Any full-thickness burns ! Any burn affecting the mouth and throat ! All burns involving the face, hands, feet or genital area ! All partial-thickness larger than the area of patient’s hand ! Any burns caused by chemicals, electricity or explosions

As a first aider

! ! ! ! !

- Ensure the safety for elderly and yourself - Recognize red flags symptoms above and seek emergency medical help - Relieve symptoms Do’s 1. Seek emergency medical help. Call 999 if burn: a / involves airway b / involves hands, face, feet or genitals c / is deep or larger than a 10% surface area d / a full-thickness burn e / a burn caused by chemicals, explosions or electricity f / or whenever you are in doubt 2. Stop the burning by removing the person from the source of heat 3. Cool the area with running water for at least 10 minutes, or until the pain is reduced 4. Remove any clothing or jewelry that may cause constrictions if the affected area swells 5. Cover the area loosely with clean cling film to protect the area Don’ts 1. Apply lotions, ointment, oily dressings, soy sauce or toothpaste to the burn area 2. Touch the injured areas or puncture any blisters 3. Remove anything sticking to the burn area 4. Over-cool the patient 5. Apply ice or ice water to any burn area 6. Use towels, cotton wool, blankets or adhesive dressings directly on the burn 7. Try to clean a severe burn wound

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60

Remarks

Clothing on Fire - Stop the casualty running as any movement may fan the flames - Drop the casualty on the ground. If available, use a fire blanket to wrap the casualty tightly - Roll the casualty on the ground to smother all flames Chemical Burn - Protect yourself with plastic gloves when helping the casualty - If possible, brush off any chemicals using glove hands and ask the casualty to remove any contaminated clothing - Flush the area with large amount of water - Be careful not to spread chemical - Arrange transport to hospital Electrical Burn - Turn off the power source - Make sure the casualty is no longer in contact with the power source - If in doubt, do not approach - Care for any life-threatening conditions and treat any burn In any situation, ensure your own safety first.

HERPES ZOSTER

Herpes Zoster

62

Herpes Zoster Background

This condition is caused by a virus called herpes zoster virus. After an episode of chickenpox, the virus will remain inactive in the nerve cells. When the immune system becomes weak, the virus reactivates and causes the red rash in the same dermatome.

- Reddening of skin with vesicles along one dermatome - Common in weak elders with poor immunity.

Symptoms and signs

les

vesic

Do’s

As a first aider

- Seek medical help for anti-viral medication as soon as possible - Over the counter medication like paracetamol may be able to relieve mild pain - After the acute episode has resolved, the affected area may be painful. Seek medical advice to relieve the neuropathic pain caused by the virus Don’ts - Avoid contact with the vesicles to prevent infection - Advise the patient not to rub the affected area and contact pregnant woman and young children

TOXICOLOGY

Toxicology

64

Drug Overdose Background

Symptoms and signs

Elderly is prone to drug poisoning with a number of risk factors.

As elderly people are more likely to suffer from chronic illnesses such as hypertension and diabetes, they may need to take multiple medications prescribed for a long period of time. In the process of ageing, their abilities of metabolizing and eliminating drugs may decrease, which can increase the chance of developing side effects of medications. Polypharmacy, defined as the use of 5 or more prescription medications at the same time, is common amongst elderly in Hong Kong (42.5%) and increases the risks of adverse drug reactions and undesirable interactions between drugs. In addition, memory loss and dementia are also the risk factors for drug overdose in elderly.

- Drowsiness, nausea and/or vomiting - Burning pain in the digestive tract - Odors on breath - Local irritation (e.g. skin, eyes) - specific toxidrome

! Difficulty breathing ! Sudden collapse ! Change in consciousness

! ! !

- Recognize the symptoms and signs of drug overdose - Look for environmental clues for suspected drug overdose - Seek medical help immediately

As a first aider

Do’s 1. If the elderly is unconscious: a / Call 999 IMMEDIATELY, inform the operator that there is a suspected poisoning b / Maintain an open airway c / Monitor the vital signs (respiratory rate, pulse rate, consciousness) d / Perform CPR if necessary 2. If the elderly is conscious and stable: a / Call 999 IMMEDIATELY, inform the operator that there is a suspected poisoning b / Help the elderly into a comfortable position (Lying the elderly on his left side can reduce initial absorption of toxin into the intestine) c / Assess the nature of poisoning d / Suicide attempt or unintentional poisoning? e / Type and the amount of drugs/poison taken? f / Time of dosing? g / Look for clues (e.g. opened drug container) in the environment. h / Continue to monitor the elderly’s vital signs (respiratory rate, pulse rate, consciousness) i / Keep samples of the vomitus and other clues (e.g. drug container) Don’ts 1. Attempt to induce vomiting 2. Eat wild plants or fungus collected from the countryside

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Remarks

Panadol, a common over-the-counter drug, is potentially toxic upon large dose ingestion. In adult, 7.5-10g of Panadol has potent toxicity.

Panadol toxicity can be divided into 4 phases based on the presentation of symptoms.

Phase

Phase 1 (from 0.5 hour to 1 day after ingestion)

Symptoms and signs

- Can be asymptomatic - Anorexia - Nausea - Vomiting - Malaise

Phase 2 (18 hours to 3 days after ingestion)

- Right upper quadrant abdominal pain - Anorexia - Nausea - Vomiting - Urine output may decrease

Phase 3 Hepatic Phase (3 to 4 days after ingestion)

- Nausea - Vomiting - Abdominal pain - Jaundice, coagulopathy, hypoglycemia and hepatic encephalopathy suggestive of hepatic necrosis - Acute renal failure

Phase 4 Recovery Phase (4 days to 3 weeks after ingestion)

- Resolution of symptoms and organ failure

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Common and Harmful Overdose: Ingested Poisons Ingested poisons include herbal medicine, wild plants, mushroom and fish (ciguatera).

Herbal Medicine

Background

It is well documented that certain herbal medicines are highly toxic. Therefore, you should always follow your Traditional Chinese Medicine (TCM practitioner’s advice in the preparation and consumption of these herbs.

Poisoning by Chinese medicine is usually caused by one of the three reasons - Misuse, Poor Quality Control and Erroneous substitution.

Misuse - This is usually caused by overdose, excessive duration of use and improper decoction. Decoction is a MUST for aconitine containing herbs such as 草烏, 川烏. The process removes a significant amount of toxicity.

Poor Quality Control - Impurities in Chinese herbs can account for unexpected poisoning. In some cases, Western medicine is illegally added into Chinese medicine to enhance their effect.

Erroneous substitution - Some herbs have confusing names or appearances, it is not uncommon for a toxic herb to be substituted for another harmless herb.

Here are some common examples: Different Chinese herbal medicines with the same name should not substitute each other.

Herbs with similar physical appearance should be differentiated carefully.

Aristolochiaceae Radix Aristolochiae Fangchi * (Prohibition of sale in Hong Kong since 1 June 2004)

Solanaceae Flos Daturae Metelis * (Chinese herbal medicine listed in Schedule 1 of the Chinese Medicine Ordinance)

VS

Menispermaceae Radix Stephaniae Tetrandrae * (Chinese herbal medicine listed in Schedule 2 of the Chinese Medicine Ordinance)

VS

Bignoniaceae Flos Campsis * (Chinese herbal medicine listed in Schedule 2 of the Chinese Medicine Ordinance)

* Images from Chinese Medicine Division, Department of Health, Government of the HKSAR

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Herbal Medicine Some common herbs with potent toxicity: Unprocessed Radix Aconiti Kusnezoffii

Unprocessed Radix Aconiti

Flos Rhododendri Mollis *

Unprocessed Semen Strychni *

Arsenic Trioxide *

Cinnabaris * (Cinnabaris in lumps)

Mylabris

Flos Daturae Metelis *

* Images from Chinese Medicine Division, Department of Health, Government of the HKSAR

Symptoms and signs

- Nausea, vomiting, diarrhea, abdominal pain - Chest discomfort, fast or irregular heartbeat - Shortness of breath - Headache, dizziness, numbness, blurred vision - Depends on the nature of toxicity Herb

Active Compound

Toxicities

Aconitine alkaloids

(FAST ACTING) - Numbness, - Burning sensation in mouth & GI tract, - Low blood pressure, chest pain, - Nausea, vomiting, diarrhea, - Shortness of breath, headache, sweating

Aristolochic Acid

- Cancer of the urinary tract, - Kidney damage

Processed Radix Aconiti Processed Radix Aconiti Kusnezoffii Processed Radix Aconiti Lateralis Radix Aristolochiae Fangchi Herba Aristolochiae Mollissimae Rhizoma Atractylodis

Scopolamine and Atropine impurities

- Dry skin, dry mouth, - Blurry vision, - Hallucination, - Rapid heartbeat

Semen Strychni

Strychnine, Brucine

- Muscle spasm, convulsion, - Nausea, vomiting, - Loss of consciousness

Folium Sennae

Anthraquinone

- Abdominal pain, - Nausea, vomiting, diarrhea, - GI tract bleeding, kidney damage

Various powdered herbs

Prednisolone

- Cushingoid features

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72

Mushroom Some mushroom have potent toxicity, which can be catergorized as follows:

Background

Mushroom types: Lactarius torminosus

Russula emetica

(photo by Tocekas via Wikipedia)

(photo by Eric Smith via Mushroom Observer)

Coprinus comatus

Pulveroboletus ravenelii

(photo by Glen van Niekerk (primordius) via Mushroom Observer)

(photo by Ron Pastorino (Ronpast) via Mushroom Observer)

Body systems involved: Gastrointestinal system Toxicities: Nausea, vomiting, diarrhea, and abdominal cramps Mushroom types: Gyromitra esculenta (photo by Toffel via Wikipedia)

Body systems involved: Hematological system Toxicities: Jaundice, hematuria, hemolysis

Mushroom types: Amanita pantherina

Amanita solitaria

(photo by George Chernilevsk via Wikipedia)

(photo by Luridiformis via Wikipedia)

Body systems involved: Nervous system Toxicities: Confusion

Mushroom types: Amanita verna

Amanita virosa

(photo by Pieria via Wikipedia)

(photo by Ben DeRoy via Wikipedia)

Body systems involved: Liver Toxicities: Jaundice

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Ciguatera Fish Poisoning Ciguatera is one of the commonest neurotoxins causing food poisoning in Hong Kong.

Background

The common coral fish associated with ciguatera fish poisoning include: Black Fin Red Snapper *

Tiger Grouper *

Lyretail *

Areolated Coral Grouper *

Morey Eel *

Leopard Coral Grouper *

* Images from Centre for Food Safety, Government of the HKSAR

Symptoms and signs

Symptoms of ciguatera can arise quickly, shortest at 30 minutes, after ingestion of ciguateric fish: - Vomiting - Diarrhea - Nausea - Abdominal pain - Tingling of lips, hands and feet, - Skin itching - Change in temperature perception - Fatigue - Muscle and joint pain

- Recognize the symptoms and signs of drug poisoning - Seek medical help immeidately

As a first aider

Do’s 1.If the elderly is unconscious: a / Call 999 IMMEDIATELY, inform the operator that there is a suspected poisoning b / Maintain an open airway c / Monitor the vital signs (respiratory rate, pulse rate, consciousness) d / Perform CPR if necessary 2. If the elderly is conscious and stable: a / Call 999 IMMEDIATELY, inform the operator that there is a suspected poisoning b / Help the elderly into a comfortable position (Lying the elderly on his left side can reduce initial absorption of toxin into the intestine) c / Assess the nature of poisoning d / Suicide attempt or unintentional poisoning? e / Type and the amount of drugs/poison taken? f / Time of dosing? a / Look for clues (e.g. opened drug container) in the environment. g / Continue to monitor the elderly’s vital signs (respiratory rate, pulse rate, consciousness) h / Keep samples of the vomitus and other clues (e.g. drug container) Don’ts 1. Attempt to induce vomiting 2. Eat wild plants or fungus collected from the countryside

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Common and Harmful Overdose: Chemical Poisoning Household Cleaners and Corrosives

Background

Symptoms and signs

In Hong Kong, approximately 100 cases of household product poisoning are reported every year, and common accidental poisoning happens with the swallowing or inhaling of household cleaners, such as bleach and stainless steel cleaner.

- Burning sensation in mouth - Pain in throat and stomach - Swelling of throat - Vomiting - Blood in stools - Recognize the symptoms and signs of possible poisoning - Seek medical help and call 999 immediately - Identify possible agent of poisoning

As a first aider

Do’s 1. Seek medical help and call 999 immediately 2. If the elderly is still conscious: a / Keep the elderly calm b / Help him or her in a comfortable position Don’ts 1. Attempt to induce vomiting 2. Give drinks or food to the elderly

Inhaled Poisoning Common inhaled poisons include toxic fumes (e.g. chlorine), gas canisters (e.g. bug sprays), and carbon monoxide

Background - Coughing - Chest tightness

Symptoms and signs

As a first aider

- Labored respiration - Dyspnea

In the case of carbon monoxide poisoning, the following may occur: - Headache - Dizziness - Tiredness - Nausea - Blurred vision - Impaired coordination - Unconsciousness - Assess the possible danger of the environment and apply protective measures on yourself - Recognize the symptoms and signs of inhalation poisoning - eek help and call 999 immediately - Inform others of the incident Do’s 1. Ask for help 2. Ensure your own safety before any attempt to treat the elderly 3. Maintain good ventilation of environment 4. If safe, provide basic life support measures Don’ts 1. Enter an affected premises without assessing the danger 2. Perform mouth to mouth rescue breath

Remarks

Carbon monoxide poisoning is encountered in suicidal attempts by charcoal burning. Carbon monoxide is a non-irritating, colourless, tasteless and odourless gas. Poisoning can be recognized sleepiness, weakness, headache and characteristic cherry-red skin.

It is life-threatening, victims must be sent to a hospital as soon as possible.

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Snakebite and Envenomations Snakebite

Background

Symptoms and signs

Bamboo snake is the most common cause of venomous snakebites in Hong Kong. A bite from any type of poisonous snake is always considered a medical emergency. Bites from non-venomous snakes can sometimes result in severe allergic reactions.

- Paired puncture marks - the bite may be painless - Redness, swelling, warmth and pain at the bite site - Nausea and vomiting - Disturbed vision - Increased salivation and sweating - Difficulty breathing

As a first aider

- Apply first-aid and seek immediate medical help - Poisonous snakes are difficult to identify - some nonpoisonous snakes have markings very similar to venomous ones - Leave all snakes alone and always assume that a snake is venomous Do’s 1. Call 999 IMMEDIATELY. Always have snakebites treated by a doctor even if the snake is known to be non-venomous 2. If the elderly is conscious: a / Tell the elderly to remain still and calm b / Lie the elderly down, raise the head and shoulders Immobilize the bitten area and keep it below than the level of the heart c / Wash the bite with soap and water as soon as possible d / Apply a pressure bandage at the site of the bite if there is no pain. Do not remove clothing from around the site since this can speed up the absorption of the venom e / Apply another pressure bandage to extend from the bite as far up the limb as possible f / Mark the site of the bite. Immobilize the limb by securing it to the other leg with broad- and narrow- fold bandages g / Check the circulation after bandaging. Make the bandage loose enough for a finger to slip underneath h / Monitor and record vital signs while waiting for help to arrive 3. If the elderly is unconscious or loses consciousness: a / Open the airway and check breathing b / Perform CPR if necessary Don’ts 1. Apply a tourniquet or tie a bandage too tightly. If a bandage is too tight, it can cut off blood supply completely and lead to permanent disability.

2. Slash the wound with a knife or suck out the venom with your mouth. Any incisions on or around the bite wound may introduce bacteria into the body, causing infection.

3. Try to catch the snake for identification

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Insect Sting

Background

Insect stings are usually not dangerous. However, the venom from insect can cause anaphylaxis which is a medical emergency. (Refer to Chapter 11 Allergy & Anaphylaxis for details)

- Redness, swelling, heat and pain around the area

Symptoms and signs

! Hives, weals and body redness.! ! Swelling of face and tongue ! ! Tightness in throat, hoarse of ! voice ! Shortness of breath, noisy ! breathing, wheeze, persistent cough ! Shock ! ! Loss of consciousness !

Do’s

As a first aider

1. Seek emergency medicine help if the above red flags are present 2. Raise the affected part 3. Apply an ice pack for 10 minutes to minimize swelling 4. Monitor the vital signs and watch for signs of an allergic reaction bee stinger Don’ts 1. Cut or suck the sting wound

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PAIN MANAGEMENT

Common Pain Relief Methods Medication

Simple analgesics can be used to relieve pain. a / Paracetamol should be started with dose of 5001000mg (1-2 tablets). If instructed by doctor, higher dose can be taken. b / Alternatively, NSAIDs such as ibuprofen can be used. However, some NSAIDs may cause stomach discomfort and bleeding. It should be avoided for people who have bleeding disorders or gastrointestinal symptoms.

Cold pad

Cold pad is used to decrease inflammation.

Used first during injury. Avoid direct contact with ice to prevent frostbite.

Heat pad

To increase circulation in the area, so that tissue repair and heal can take place more efficiently. Hot towel (40 degrees) can be applied on the affected surface. For trauma, it is best used after inflammation has subsided (use when the affected area is no longer hot).

40˚C

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84

Stretching

With the help of an elastic band anchoring the knee of one leg and mid shin, separate the two legs against resistance to train the muscle of the leg.

1

2

x 5-10 Lying down with your face down, slowly raise your leg up as shown in the picture above slowly. After 5-10 cycles, switch side and raise the leg of the opposite leg.

1

2

x 5-10 Sitting with your face facing upward, slowly flex your thigh up to your chest as shown above. Then slowly return to the original position.

Repeat for 5-10 times according to your physique.

1

2

x 5-10

Aerobic exercises

Examples include swimming and fast walking. Aerobic exercise is the best for relieving chronic pain.

Resistance exercises

Resistance exercises increase muscle strength, which can help stabilise joints. This can be good for joint pain (consult phyiotherapist for exercises that can prevent further damage of joint).

Transcutaneous electrical nerve stimulation (TENS)

By stimulating the nerve using electric current, pain signals in your brain can be modulated or suppressed to relieve pain.

CH1

CH2

99 99 150 bps

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85

BANDAGING AND WOUND DRESSING

Head Bandage Materials Triangular Bandage X 1 Dressing X 1 Steps 1

2

front Apply a dressing to the wound.

front Fold the base (longest edge) of the bandage inwards, and put it at the centre of the forehead, above the eyebrows.

3

front

side

back

Cross the ends of the bandage behind the head.

4

5

front Take the ends over the forehead and tie them.

back Pull and tuck the bandage behind the head.

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88

Arm Sling Materials Triangular Bandage X 1

Steps 1

2 Point

Ask the victim to support his injured arm. Place the triangular bandage. The point of the bandage should be at the elbow of the injured side. Slide the upper end of the bandage under the injured arm, and wrap around the neck to the shoulder of the injured side.

Bring the lower end of the bandage over the forearm to the shoulder of the injured side.

3

4

5

Tie the ends with a knot at the collar bone of the injured side, and tuck the ends under the knot.

Twist the point and tuck it above his elbow.

Final position

Elevation Bandage Materials Triangular Bandage X 1

Steps 1

2

Ask the victim to support his injured arm. The fingers of the injured side should be on the opposite shoulder.

4

3

Place the triangular bandage. The point of the bandage should be at the elbow of the injured side, and the edge along the injured arm.

5

Ask the victim to stop supporting the arm. Tuck the base of the bandage under the injured arm.

6

back

back

Bring the lower end of the bandage up across his back, meeting the other end at his shoulder.

Tie the ends with a knot at the collar bone of the opposite side, and tuck the ends under the knot.

Twist the point and tuck it above his elbow.

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Bandaging and Wound Dressing

90

Elbow Bandage Materials 2-inch gauze roll bandage X 1 Dressing x 1

Steps 1

Elevate the wound above heart level.

Cover it with a dressing.

3

Wrap around the elbow at level slightly below and above the wound alternately

2

Using a 2-inch gauze roll bandage, wrap it around the elbow from the level of dressing, from inside to outside of the limb

4

Fasten the end of the bandage with pins or tape

Forearm Bandage Materials 2-inch gauze roll bandage X 1 Dressing x 1

Steps 1

2

x2

Elevate the wound above heart level.

Cover it with a dressing.

3

Wrap continuously in spiral turns up towards the elbow covering the dressing, rolling over 2/3 of previous turn each time.

Wrap with a 2-inch gauze roll bandage.

Wrap twice at the bottom end of the wound from inside to outside of the limb.

4

Wrap until the entire dressing is covered.

Fasten the bandage with pins or tape.

Bandaging and Wound Dressing

91

Bandaging and Wound Dressing

92

Wrist Bandage Materials 2-inch gauze roll bandage X 1 Dressing x 1 Steps 1

Elevate the wound above heart level. Cover it with a dressing.

4

Straight across underneath the fingers, and diagonally back across the back of the hand to the outside of the wrist.

2

Using a 2-inch gauze roll bandage, wrap it around the wrist twice from inside to outside of the limb.

5

Pass the bandage under their wrist and repeat the diagonal over the back of the hand like a figure-ofeight, each time covering 2/3 of previous layer.

3

Wrap the bandage from the inside of the wrist, diagonally across the back of hand up to the nail of little finger

6

Once the entire hand is covered, wrap straight around the wrist twice.

Hand Bandage Materials Triangular Bandage X 1 Dressing X 1 Steps 1

a

2

b

c For severe bleeding of the palm, elevate the wound above heart level and ask the elderly to hold the dressing in a fist to cover the wound. Using a partially unfolded triangular bandage, place the center of bandage against the top of the fist.

3

4

Cross the two ends of bandage at the wrist.

5

back Wrap each end of bandage around the wrist to the back of hand and cover 3 fingers for each end before reaching back to the wrist.

After crossing the two ends over the wrist again.

Wrap around the wrist and tie on the back of hand.

Bandaging and Wound Dressing

93

Acknowledgement

94

These books are funded by the grant from the ‘We Are with You’ project. This grant allowed us to convene a series of basic life support workshops, exhibitions and talks to the public, and these two books reflect our vision to serve the community, especially the old and the underprivileged, with our knowledge and expertise in Emergency Medicine. We would like to acknowledge and thank all the students of the Emergency Medicine Interest Group for their devotion to serve others and making these two books a success.

KL Fan LP Leung

Notes

95

Notes

96

97

急症醫學 興趣小組

香港大學 急症醫學部

出版

長者急症

ABC

編輯 樊潔玲醫生 梁令邦醫生

2

目錄

3

前言

3

免責聲明

4

衰老過程

9 10 13 16 18

基本生命支援術 基本生命支援術 按壓式心肺復甦術 常規旁觀者心肺復甦術 自動體外心臟去顫器 (AED) 復原臥式

21 23 28 35 36 40

四肢 軟組織損傷 表皮傷口 骨折 脫臼 跌倒及預防跌倒 創傷性脊髓損傷

42 46 48 50 51

肌肉骨骼疼痛 痛風 骨關節炎 腰痛 頸部疼痛和肩部疼痛 膝關節疼痛

53

敏感症與系統性過敏症

56

燒傷

62

帶狀皰疹(生蛇)

65 68 76 78

中毒 服藥過量 普遍及有害的服藥過量：攝入的毒物 普遍及有害的服藥過量：化學品中毒 蛇咬與蟲螫

目錄

1

目錄

2

83

痛楚管理 常見的止痛方法

87 88 89 90 91 92 93

繃帶包紮法及傷口敷料 頭部包紮 臂懸帶 肩懸帶 手肘包紮 前臂包紮 腕部包紮 手掌包紮

94

鳴謝

95

筆記

前言

早前，一群香港大學醫科生組成了急症醫學興趣小組，盼以其專業 知識服務香港社會。在香港大學急症科教學人員之指導下，他們更 撰寫了《銀齡急救基本法》、《長者急症ABC》二書。 人口老化是全球普遍國家須面對之課題。本港亦不例外，65歲或以 上的人口比例，預計由2011年的百分之十三，將迅速遞增至2046 年的百分之三十，情況不容忽視。隨著社區年長人口數字之攀升， 普羅大眾愈趨積極尋求長者醫療保健妙法，回應有關訴求為本書寫 作之因由。 本書涉獵層面甚廣，原意為照顧長者之人士提供不同急救方法，與 此同時希望一般社會大眾受惠；倘若遇上危急情況，他們亦可藉本 書內容，及時為身體不適或受傷的長者施救。恕本書涵蓋之內容 未見全面，亦算不上為權威性刊物，只盼為讀者帶來啟發，引發其 興趣，對有關議題作延伸學習；若遇上突發情況，他們能藉有關知 識，迅即作出應對之策。 最後，本人謹代表香港大學急症醫學部及急症醫學興趣小組，藉此 感謝「We Are With You」基金，鼎力支持本書之編制工作。

樊潔玲醫生 梁令邦醫生 二零一六年六月

免責聲明 作者、編者及出版商盡力確保本書之準繩度；然而，也不能保證資訊完全正確無誤， 絕不負責相關內容為任何人士所帶來之損失。在採納本書之建議前，讀者宜先諮詢有 關專家之意見或再三查證文獻資料。

前言

3

衰老過程

肌肉 - 力量和質量﹙約30 - 40％﹚下降 - 容易疲勞 - 復原力下降 - 肌肉組織中的脂肪含量較高

皮膚 - 皺紋和鬆弛現象出現 - 皮膚變薄及呈暗黑 - 在面部、頸部、手部的變化更為明顯 - 傷口癒合緩慢、皮膚出現潰瘍甚至不 能康復 - 對寒冷靈敏度下降，排汗量減少 - 容易受紫外線的傷害

一般 - 體重下降 - 身體脂肪比例下降

免疫系統 - 容易受感染 - 對疫苗反應減少/減慢

心臟和血管 - 心跳率及心臟收縮力在靜止狀態時沒有變化 - 運動時心跳率及心臟收縮力只會輕微增加 - 心臟發大 - 心臟和血管組織硬化 - 血壓上升

眼 - 水晶體變黃 - 較容易患上白內障 - 對光暗適應力變慢 - 淚液分泌減少 - 靜態視力靈敏度輕微下降 - 動態視力靈敏度顯著下降

老化的生理/剖析 衰老過程是指身體功能隨年齡增長而有所轉變，增加患病機會。在環境及遺傳因素的改變下，這是相 當複雜的自然現象。在這過程中，我們身體的各個器官及系統會呈現不同程度的變化。以下是各項的 描述：

4

5

衰老過程

骨骼 - 骨質流失 - 女性在更年期後骨質流失加速 - 男性骨質流失較慢 - 骨質疏鬆症的發病率較高

神經系統 - 反應遲緩 - 觸覺及振動靈敏度下降，特別是腳部 - 對溫度靈敏度下降 - 神經元損失 - 腦體積縮小

呼吸系統（呼吸） - 橫隔膜強度下降 - 肺容量和肺活量下降 - 肺部殘餘氣體增加

其他系統 - 受損顫抖 - 嗅覺靈敏度下降 - 口渴感覺減少 - 平衡力下降 - 對高頻音調靈敏度下降

腎臟、泌尿及生殖系統 - 過濾功能削弱 - 濃縮和稀釋尿液功能削弱 - 腎臟體積縮小 - 膀胱功能削弱引致排尿不清 - 男性及女性對性高潮感覺遲緩 - 男性在性愛後需要更多時間休息才能再次勃起

消化系統 - 胃酸量增加 - 便秘次數增加 - 營養吸收力減少 - 肝臟體積縮小

6

7

基本生命 支援術

基本生命支援術 (BLS) 「基本生命支援術」包含多個急救程序，如心肺復甦術、控制出血情況、治療休克、 中毒、穩定受傷和/或傷口狀況，及施以基本急救。其他項目會在稍後的章節中討論； 在此章節中，我們將主要討論的是心肺復甦術、復原臥式狀況及自動體外心臟去顫器 之使用方法。

心肺復甦術 復原臥式

自動體外 心臟去顫器

為什麼認識基本生命支援術? 認識基本生命支援術是非常重要的，因為意外及危急情況隨時發生！事實上，在只有少 量設備或沒有任何設備的情況下都可以處理緊急醫療情況。只要認識這些簡單技巧，任 何人都可以拯救別人寶貴生命。

為什麼要學習旁觀者心肺復甦術？ 施行旁觀者心肺復甦術既不複雜，又能確保提高突發性 心臟驟停患者的存活率，有關系列之動作能支援突發性 心臟驟停患者維持其呼吸及血液循環，並有助保持血液 通往各大器官，讓其換取更多時間，獲得更多治療機會。

患者平均年齡 有目擊者在場

71.5 50% 獲得用心肺復甦術協助

15%

突發性心臟驟停是什麼? 突發性心臟驟停(SCA) 是指心臟突然不能有效收縮，不 能提供血液輸送氧氣到身體各組織器官，包括大腦和心 臟本身出現擾亂，或甚至停止情況。這種情況非常危 險，而這亦是全球人口中，引發死亡的主要原因之一， 而在長者人口中情況更為顯著。在香港，突發性心臟驟 停患者平均年齡為 71.5 歲，約三分之二的病例發生在 家中，當中50%是有目擊者在場。可是只有 15%的患者 獲得旁觀者施以心肺復甦術等協助；與其他已發展國家 相比，這數字是非常之低。故此，只要更多市民願意認 識及學習施行心肺復甦術，將可拯救更多突發性心臟驟 停患者的生命。

基本生命支援

9

基本生命支援

10

旁觀者心肺復甦術如何幫助?

按壓式心肺復甦術

生存鏈

假如施援者沒有受過心肺復甦術的訓 練，或不希望跟陌生人口部接觸，你 可以嘗試施行按壓式心肺復甦術。 這跟常規的旁觀者心肺復甦術一樣 有效。

可以下列口訣謹記施行步驟：

生存鏈緊密串連，涵蓋五大步驟，為突發性 心臟驟停患者增加存活機會。步驟如下: 1. 及早尋求協助（如撥打999） 2. 及早施行心肺復甦術 3. 及早進行除顫程序（即配合自動體外心臟 去顫器急救） 4. 及早提供專業護理（由專業人員處理） 5. 良好及後護理 上述每一個步驟必須及早完成。按旁觀者心 肺復甦術常規，施援者已施行首3個關鍵步 驟。下列展示有關應用步驟：

1 2 3

評估現場 + 檢查 + 電話求援 + 胸部按壓

1 評估現場 2 檢查

評估現場環境，對施援者及長者是否安全

檢查長者 反應： 呼叫長者；搖動長者的肩膀

呼吸： 觀察長者胸部，看其有否出 現呼吸異常；或檢查長者有 否發出任何呼吸聲音

3 電話求援 如果長者沒有反應及呼吸異常，要立刻尋求援助，如： － 撥打 999 － 要求旁人協助，把自動體外心臟去顫器（AED）送達現場 進行胸外按壓

4 胸外按壓

基本生命支援

11

基本生命支援

12

按壓式心肺復甦術 胸外按壓 假如施援者訓練充足及具備信心檢查脈搏，可用兩隻手指放在患 者頸部前側，檢查其脈搏情況。

A. 位置 施援者跪在長者身旁，將一隻手放在長 者胸骨中心。

C. 深度 利用體重，用力向下按長者的胸部約 5-6厘米（2英寸以上） 。

2

B. 姿勢 再將手置於另一隻手上面，將手指緊扣， 雙臂保持垂直，謹記施壓時不可彎曲雙臂。

D. 頻率 重複及快速按壓，速率約每分鐘 100-120次。

x 100 - 120/分鐘

E. 回彈 確保每次按壓後，長者胸腔有足夠回彈。

重複此過程直到 － 長者恢復意識，有正常的呼吸和心跳 － 救護車抵達 － 自動體外心臟去顫器被送達現場 － 施援者累極並不能繼續

常規旁觀者心肺復甦術 與按壓式心肺復甦術施行之方法類似，可以下列口訣記着有關方法：

評估現場 + 檢查 + 電話求援 + C A B 1 評估現場 2 檢查

評估現場對施援者及長者是否安全

檢查長者 反應： 呼叫長者；搖動長者的肩膀

呼吸： 觀察長者胸部，看其有否出 現呼吸異常；或檢查長者有 否發出任何呼吸聲音

3 電話求援 如果長者沒有反應及呼吸異常，要立刻尋求援助，如： － 撥打 999 － 要求旁人協助，把自動體外心臟去顫器（AED）送達現場 進行胸外按壓

C - 胸外按壓 4 CAB （心肺 A - 暢通氣道 復甦術） B - 人工呼吸

基本生命支援

13

基本生命支援

14

C

常規旁觀者心肺復甦術

C - Circulation 血液循環 胸外按壓 假如施援者訓練充足及具備信心檢查脈搏，可用兩隻手指放在患 者頸部前側，檢查其脈搏情況。

A. 位置 施援者跪在長者身旁，將一隻手放在長 者胸骨中心。

C. 深度 利用體重，用力向下按長者的胸部約 5-6厘米（2英寸以上） 。

2

B. 姿勢 再將手置於另一隻手上面，將手指緊扣， 雙臂保持垂直，謹記施壓時不可彎曲雙臂。

D. 頻率 重複及快速按壓，速率約每分鐘 100-120次。

x 100 - 120/分鐘

E. 回彈 確保每次按壓後，長者胸腔有足夠回彈。

A

A - Airway 暢通氣道 如能確認長者的頸部沒有受過損傷， 可用按額提頦法： 頭向後仰，頦向上翹。

如懷疑長者的頸部曾受損傷， 可以下顎推力代替。

B

B - Rescue Breaths 人工呼吸 每30次按壓，進行人工呼吸2次 施援者與長者進行口對口吹氣時，應盡量使口部密封並緩緩吹氣 每次吹氣至少持續1秒 假如長者的胸部回復上升，這次人工呼吸便是有效

在常規的旁觀者心肺復甦術中，胸外按 壓和人工呼吸的比例為30：2，即30次 按壓，然後2次人工呼吸，然後30次按壓 ⋯⋯

重複此過程直到 － 長者恢復意識，有正常的呼吸和心跳 － 救護車抵達 － 自動體外心臟去顫器被送達現場 － 施援者累極並不能繼續

基本生命支援

15

基本生命支援

16

自動體外心臟去顫器（AED） 它的原理和使用技巧其實並不難掌握。

突發性心臟驟停患者，其心臟突然停止跳 動。假如患者在數分鐘內得不到治療，可 引發死亡。 突發性心臟驟停（SCA）主要有兩大成因， 但都涉及心臟不規則跳動，也被稱為心律 不正。最常見的成因是心室纖維性顫動 （V-FIB） ，即下心室顫動快速而不規則。 另一個原因是心室撲動，這是指心室 持續在短時間內快速跳動。 在這種情況下，自動體外心臟去顫器 （AED）可以幫助心律及心跳恢復正常。 心肺復甦術亦有助增加生存機會率。 自動體外心臟去顫器在公共場所非常普 及，如商場、機場、酒店、學校亦有安 裝。只要根據這些圖象指示，便可找到。

AED 它是本地緊急醫療系統（EMS）不可缺少的 一環，社區成員知道其位置所在亦十分重 要。在遇上突發性心臟驟停的情況，市民 亦可以快速找到自動體外心臟去顫器。

市面上充斥不同品牌的自動體外心臟 去顫器，但使用步驟都是大同小異。

ON-OFF

1

2

3

使用自動體外心臟去顫器（AED）的步驟 1. 開啟自動體外心臟去顫器（AED） ON-OFF

2. 將兩塊可傳電的軟墊貼在患者胸部（胸的右上方，胸的左下方） （若長者身體是濕的，則須擦乾胸部） 3. 按下分析按鈕，讓自動體外心臟去顫器（AED）分析心律 ON-OFF

1

2

3

如果自動體外心臟去顫器（AED）建議震動患者： 4. 確保沒有人，包括施援者，其身體沒有接觸患者， 並告訴大家： 「不要接近！」 5. 按「震動」鍵

基本生命支援

17

基本生命支援

18

復原臥式 如果長者不省人事，但其頸部沒有受傷及仍然可呼吸，這情況下應以復原臥式擺放長者 的身體。這樣可以防止任何口腔分泌或嘔吐物阻塞長者之呼吸道，確保其呼吸暢通。

1. 跪在長者右方。

2. 屈曲長者的右手，使其手肘成90度平 放在地上。

6. 頭向後仰，頦向上翹。 假如先前沒有為長者暢通氣道 + 施行人工呼吸 + 心肺復甦術，現在應該進行有關步驟。

保持監測長者的氣道 + 呼吸，直到救護人員到達。 如果長者情況不太嚴重，在30分鐘後可轉動身體到另一側。

基本生命支援

19

3. 握住長者左手並使其手背貼在臉頰。

4. 提起長者的左腿，使其膝蓋屈成90度。

90˚

5. 讓長者的左手貼近右臉頰，抓緊其膝蓋，彎曲其腿部，拉向施援者，使長者轉向右 邊。施援者可利用長者的手臂，以防長者滾動。

四肢

軟組織損傷

背景

軟組織損傷可以分為瘀傷、扯傷和扭傷。 軟組織受傷一般分為急性、突發性的情況，或在過度勞損情況下形成。 由於長期重複某動作或姿勢不正確，造成慢性軟組織受傷。足踝關節 扭傷和背部拉傷是最常見的軟組織損傷。 原因： 瘀傷︰因暴力撞擊，引起軟組織出血 扯傷︰肌肉和肌腱過度拉張或用力，引致撕裂或斷裂 扭傷︰關節超出正常活動範圍，導致韌帶撕裂或斷裂

症狀

- 青腫 - 疼痛 - 腫脹 - 受傷部位不能正常活動

！劇烈疼痛和腫脹 ！ ！無法活動，步行或受傷！ 位置不能背負重物

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－ 通過藥物治療和物理治療，舒緩病人的症狀 應該

急救員目標

1. 軟組織損傷時，應利用「RICE」進行處理 休養（R） ：避免移動患處， 讓其休息 冰敷（I）：用冰塊（裹在毛巾）冰敷或冷敷患處 固定（C） ：協助傷者固定受傷位置 提高（E）：抬高傷者受傷肢體（高於心臟位置） ，避免腫脹及 瘀傷惡化 2. 使用由醫生處方的止痛藥，可以用來緩解疼痛症狀 避免 1. 胡亂移動傷處 2. 熱敷 3. 胡亂敷用草藥

表皮傷口 對長期病患長者來說，良好傷口處理是非常重要。因為他們的表皮傷 口很容易受感染。

背景

傷口類型 － 輕微割傷，如擦傷 － 深度割傷，如穿透性傷口 － 皮膚撕裂

！穿透性傷口範圍大且深！ ！傷口有受感染跡象， ！ 如連續2-3天出現紅腫 及有濃液。 ！傷口在關節出現， ！ 如癒合不良會導致 行動不便。 ！大面積皮膚撕裂 ！

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急救員目標

－ 止血 － 用水/消毒劑清潔傷口 － 覆蓋傷口 － 預防傷口感染 應該 1. 止血（如有的話） ，蓋上紗布 2. 清潔傷口 a / 對於輕傷：用清水沖洗傷口表面 b / 對於嚴重損傷：用水喉水沖洗傷口，然後消毒 c / 對於皮膚撕裂：用氯己定消毒傷口表面及內層，然後用生理 鹽水清洗 3. 覆蓋及包紮傷口 a / 首選開放式的方法，利用非防水黏合敷料包紮最為方便 b / 如果皮膚撕裂面積很大，首先應該將皮瓣回傷口，並用紗布 覆蓋整個受傷範圍，然後立即求醫 避免 1. 利用乳化軟膏（豬油膏） 、牙膏、醋或醬油覆蓋傷口表面 2. 利用酒精或過氧化氫清潔傷口 3. 拆繃帶時速度過快，這會弄傷已經癒合的傷口

消毒劑的種類

備註

溶液 洗必泰

西曲溴銨

成份： 葡萄糖酸氯己定 功效： 消毒

成份： 西曲溴銨除洗必泰 功效： 清潔作用

乾粉噴霧 必妥碘 被噴傷口上會形成一層保護膜。 成份： 聚維酮碘 功效： 消毒傷口，並吸收來自傷口滲出 的液體

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敷料的類型 閉合式方式 每隔2至3天須更換敷料，以避免傷口感染，並可讓任何液體滲出。 網眼紗布

粗紗布

網眼紗布設有較微細小孔，以單 層覆蓋傷口表面。

粗紗布容易在市面上購得，它設有 較大的孔，以兩層覆蓋傷口表面。

防水膠黏敷料

開放式方法 這是最為常用的方法，應在沐浴後或與水接觸後，立即更換敷料（除矽） 。 非黏性敷料

不防水的黏合劑敷料

矽敷料

可以每7天才更換1次，因為敷料 設有小孔，可以排出液體。

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骨折 骨折可以是由於嚴重意外，如跌倒所引起。而重複性動作令骨骼過度 勞損，亦可引起骨折情況。

背景

骨折在長者羣中更是普遍現象，因為他們骨骼脆弱，往往輕微的意外 便會引起骨折。 常見骨折的部位包括臀部、上臂、手腕、脊柱和肋骨。 原因： － 創傷 － 跌倒是髖部骨折常見原因 － 手腕骨折通常是由於跌倒時， 傷者用手掌支撐，致使手腕 出現撕裂

症狀

風險因素 － 骨質疏鬆 － 缺乏運動 － 吸煙與飲酒 － 接受類固醇治療

－ 骨骼發出斷裂聲音 － 疼痛 － 腫脹 － 骨折位置出現畸形 － 受傷肢體不能移動 － 開放性骨折，骨骼會於傷口下外露 － 了解患者病情，並立即尋求骨科醫生協助 － 固定受傷的肢體，以避免進一步受到傷害

急救員目標

應該 1. 立即撥打999，尋求緊急醫療幫就助 2. 協助傷者止血﹙如有需要﹚ 3. 治療休克狀況﹙如有需要﹚ 4. 固定受傷的四肢 5. 固定患處 6. 監測病人，直至其他救援人員到達 避免 1. 試圖移動傷者 2. 嘗試推回外露骨骼

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上肢夾板

備註

事先檢查事項 1. 找出可能骨折的位置 2. 檢查骨折位置以下的血液循環狀況 血液循環差的症狀： － 骨折位置以下沒有或僅存微弱的脈搏，如在手臂骨折 情況下，觀察橈動脈脈搏情況 － 蒼白，且發青的膚色 － 肢體末端冰冷 － 肢體刺痛或麻木 物料

三⻆繃帶 X 3 夾板 : 硬板、直棒 X 2 軟墊 : 毛氈、布料 X 1 把三⻆繃帶摺疊成縱向繃帶的方法 1

三⻆繃帶

2

把三⻆形的頂端摺 疊至三⻆繃帶的底 部（1 摺）

3

把頂邊向下摺疊至 三⻆繃帶的底部 （2 摺）

步驟 1

躺下 讓傷者仰臥，將受傷的手臂平放在身體兩側

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上肢夾板 放置繃帶 把三條三⻆繃帶摺疊成縱向繃帶，用於能彎曲之關節上： a / 在骨折位置上方 b / 在骨折位置下方 c / 從腕部包裹到對側的骨盆位置 (避免直接按壓疑似骨折的部位)

2

a b c

4

5

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6

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檢查血液循環 觀察繃帶下肢體血液循環的狀況 血液循環差的症狀： － 溫度較低 － 膚色變藍 － 疼痛增加 － 肢體刺痛或麻木 － 移動能力減弱或不能移動 － 脈搏轉弱，甚至失去脈搏

8

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運用軟墊 將軟墊置於骨折的上肢與身軀之間，準備上夾板的位置

3

9

10

11

包裹 利用三角繃帶，沿着受傷的上肢，朝向 身軀對端方向進行包紮

20 完成

撥999，急召救護車服務

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13

打結 在身體的對端，利用三角繃帶綁成死結，繃帶 必須鬆緊適宜，既能穩固地固定骨折的上肢， 又不會阻礙血液循環

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下肢夾板 夾板前 1. 避免移動骨折的下肢 2. 檢查 a / 觸覺 b / 移動的能力 c / 脈搏 物料

三⻆繃帶 X 4 夾板 : 硬板、棒 X 2 軟墊 : 毛氈、布料 X 1

步驟 1

a

在兩腳底下，滑入三條三⻆繃帶： a / 在骨折位置之上方 b / 在骨折位置之下方 c / 在膝部以下的位置

b c

2

在兩腳之間放置夾板或軟墊， 其長度須足以從大腿伸展至腳踝

3

將膝部下三⻆繃帶的兩端放在 一起

4

將三⻆繃帶的結打在沒有受傷 的腿部（膝蓋位置） ，確保繃帶 結實綁緊，導致雙腿完全不能 移動

5

取另一條三⻆繃帶，摺疊三次， 其寬度是其他三⻆繃帶的一半 將它滑入腳踝下

6

用八字形包紮法包紮足踝，收帶尾 時於足踝再繞一圈作固定

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下肢夾板 7

在沒有受傷的腳上打結

8

綁緊餘下兩條三⻆繃帶，在沒有 受傷的腳上打結

9

綁緊四條繃帶後，再次檢查傷者 之觸覺、移動能力和脈搏等；注 意皮膚的顏色和溫度

脫臼

背景

症狀

脫臼的成因眾多，長者多因跌倒、 碰撞及不同事故，導致骨骼移位。 遇上有關情況，必須安排有經驗人 士盡快進行「閉合復位術」 。而前 肩關節脫臼是最為常見的。

原因： － 創傷 － 跌倒時不慎弄傷手部及肩部， 造成前肩關節脫臼

－ 疼痛 － 腫脹 － 骨折的位置出現畸形情況 － 關節無法活動

！受傷部分位置失去 感覺及活動能力

！

－ 了解患者病情，並立即尋求骨科協助 應該

急救員目標

1. 立即尋求緊急醫療幫助 2. 勸告傷者保持放鬆 3. 協助傷者以最舒適的姿勢休息 避免 1. 不要試圖把骨骼推回原位（針對沒有急救經驗之人士）

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跌倒

背景

跌倒是引致長者受傷最常見的原因。 1. 長者在跌倒後，全身可能動彈不得，亦有可能引發死亡及其他病發危機。 2. 跌傷的嚴重性主要取決於不同誘發因素，多於跌倒造成之傷害。 誘發因素 － 曾跌倒的紀錄 － 步行姿勢和平衡問題 － 精神狀態受損 － 藥物（超過四種，如降壓、止 痛、利尿、精神藥品等） － 神經疾病和腳部乏力（如中 風、柏金遜症等）

－ 視力受損（如青光眼、白內障等） － 足部問題（如老繭、腳甲病變、 關節問題等） － 酒精 － 低血壓 － 環境危機（於下文解釋）

預防跌倒 背景

預防長者跌倒主要有兩種方法，主要分為「初級預防」和「二級預防」 。 「初級預防」意指關注自身，避免跌倒， 「二級預防」則重點檢測引起跌倒 的風險因素。在各界深入研究後，「二級預防」已被證明最為有效的。事 實上，我們難以完全避免跌倒。對於病人而言，再次跌倒所帶來之風險 遠較單次跌倒的高。 如要有效進行「二級預防」 ，須向病者和護理人員灌輸相關知識。年齡超 過70歲及存有跌倒誘發因素之長者，日常應得到知識傳授，多作演習， 跌倒的風險得以降低。 評估各項因素，並針對危險因素作出合適預防措施，相信這為最佳的預 防方法。通常包括以下數方面： － 藥物：重新評估和減少份量（如精神藥品） － 平衡和步行姿勢訓練 － 鍛煉及強化肌肉 － 監測血壓與姿勢 － 修正家居危機

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1 4 2

6 5

3 7

15 8

9

12 10

11

家居危機修正 臥室 1. 保持照明 － 在睡床附近置一 盞電燈（設有電燈開關或夜燈 功能） 2. 坐下來穿衣 3. 清理地面上的雜物 浴室 4. 在廁所及浴室安裝扶手桿 5. 在坐廁上放置加高坐廁器 6. 在沐浴時使用沐浴椅或手持式 花灑頭 樓梯及走廊 7. 在樓梯的兩旁加添扶手 8. 在每一樓梯級安裝防滑條板 9. 確保通道有足夠的照明，並沒 有物件阻礙

13 14

起居室 10. 移除所有在通道上的電線和 物件 11. 移除地毯或以膠帶黏緊地毯 的邊緣 12. 如座椅太低，可使用軟墊或 加高器以助站立 廚房 13. 使用有扶手及無輪的餐椅 14. 不要使用高光滑度的地蠟 15. 將東西置於伸手可及的地方

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須注意以下事項，並應盡快改善： － 穿着不合適的鞋類會導致滑倒和失去平衡等問題 － 使用不當助行器 － 沒有改善視力障礙問題 對於有病患的獨居人士，安裝緊急召喚系統是非常有幫助的。另一 方面，有證據顯示，維生素D的補充可預防長者跌倒和骨折。如有需 要，可向醫生諮詢。 多做運動可對抗老化帶來的影響、降低跌倒的風險，並提高生活質 量；無論曾否跌倒，運動都可帶來很多益處，例如︰ － 減緩骨骼和肌肉流失 － 減少認知障礙和改善身體機能 － 減少便秘及失禁次數 － 改善血糖控制情況 － 提高睡眠質量 各人的運動量隨身體狀況而有所不同。對於健康的長者，每星期5至7 天進行30至60分鐘中等強度的運動（如快步行走、慢踏單車或打羽毛 球等）是適切的。對於身體狀況較弱之長者，進行中等強度的運動少 於10分鐘是可以的， 並應該慢慢延長運動時間。 有不少醫學證據指出，進行平衡訓練，如跳舞或太極，能顯著防止跌 倒，有着一定的重要性。亦可考慮進行其他簡單的平衡練習，詳情可 向醫生或物理治療師諮詢。

跌倒後起立步驟 1

跌倒後，嘗試找一張椅子，以協助傷者爬起來。 如情況允許，嘗試爬近那椅子。

2

以單手按住椅子作為支撐，以助提升身體。

3

以雙手抓緊椅子，嘗試提起一隻腳踏在地面，另一 隻腳則跪在地上。

4

嘗試用雙腳站立。

5

坐在椅上稍作休息。

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創傷性脊髓損傷

背景

－ 身體任何部位感覺麻木 － 創傷後肌肉力量變弱 － 大小便失禁及肛門位置喪失感覺 － 觸摸頸部會感到痛楚

! 觸摸傷者的背部時 要格外留神及溫柔

!

應該 儘快尋求醫護人員幫忙

急救員目標

避免 移動病人，除非病人身處危險的地方

肌肉骨骼 疼痛

肌肉骨骼疼痛

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痛風

背景

痛風是最為劇烈的一種關節炎，由尿酸結晶引起，患者關節出現多種症 狀，如發紅、痛楚、發熱和腫脹。全港約有5%人口受痛風症影響，而長 者因此症入院留醫的比率非常高。 痛風的主要成因是血液中出現過多尿酸晶體，並在關節中成形，這可能 由於因進食過多高嘌呤食物，如肉類和魚類、飲酒或藥物如利尿藥，而 產生過多尿酸；又或是因腎功能衰竭而使尿酸不能排走。 90%高尿酸症 個案是由於腎臟無法去除尿酸而造成的，只有不足10％之個案是由於尿 酸生產過多而引發的。然而只有10％之個案會發展痛風性關節炎。 超重、高血壓、食用含過多嘌呤的食物、飲酒及服用藥物如利尿藥等 都是患上痛風的風險因素。

症狀

在痛風發作時： － 關節突然劇痛和僵硬（50％的病例病發位置在大腳趾，也可能發 生在踝關節和膝關節） － 關節發紅 病發前期最壞的情況是出現疼痛和腫脹，大多在夜間發病。

! 受影響的關節非痛風 通常涉及的關節 ! 高燒及身體顫抖 ! 患有糖尿病或任何缺 乏免疫力的患者

! ! !

有關症狀可能意味着關 節發炎，而非單純痛風

－ 通過藥物治療和物理治療，舒緩病人的症狀 － 諮詢家庭醫生及尋求合適治療

急救員目標

應該 1. 病情消退後緊接的24小時，盡量讓受影響的關節休息 2. 抬高受影響關節 3. 用冰減輕腫脹 4. 如首次病發，應盡快尋求藥物治療 5. 如為復發性病患者，應尋求醫生處方藥物治療 6. 服用非類固醇抗炎藥NSAIDs秋水仙鹼和類固​​醇。應盡快開始進 行治療，令症狀迅速及徹底消退 避免 1. 使用暖墊（並不適用於受影響關節） 2. 服用別嘌醇

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備註

控制飲食 多吃蔬菜、水果和低脂乳製品及每天最少喝8杯水。魚類、家禽和瘦 肉，建議每天食用份量為4至6盎司。 避免進食的高嘌呤食物如下： 肉－ 特別是含高脂肪紅肉，如鵝和動 物內臟

魚－ 沙丁魚、鯖魚、鮭魚

貝殼類 － 貽貝、蛤蜊、扇貝、蝦

蘑菇、蘆筍、花椰菜、菠菜

酒精

酵母

含高果糖玉米糖漿成分的蘇打水、 飲料或食物

可以安全進食的低嘌呤食物如下： 綠色蔬菜、蕃茄 水果

非全麥麵包和穀類食品

牛油、脫脂牛奶、奶酪和雞蛋

朱古力和可可

花生醬和堅果

咖啡、茶、碳酸飲料

乳製品可降低患上痛風風險： － 低脂或脫脂牛奶 － 低脂肪酸奶

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肌肉骨骼疼痛

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骨關節炎 它是由關節退化而形成，通常受影響位置如膝蓋、臀部、腰部、後 頸、手指和腳趾關節。

背景

在早期階段，負責減少骨骼之間摩擦的軟骨開始分解，引起疼痛和 關節腫脹。在後期階段，骨刺在關節之間形成，並引發炎症和損害 關節。 流行病學 骨關節炎（OA）是長者一種普遍 疾病，亦是引致長者行動不便的 主要原因之一。 在70歲或以上的 長者群組中，每3位長者便有1位 因骨關節炎而不便行動，情況非 常普遍。

症狀

風險因素 － 年老 － 超重 － 重複性動作會使關節受傷，特 別蹲坐及跪，是引發膝骨節發 炎的常見危險因素

－ 關節愈趨疼痛和僵硬，致使活動能力下降 － 關節活動時發出咔嗒聲 / 斷裂聲音 － 受影響的關節附近範圍出現輕微腫脹

! 受影響的範圍關節非 痛風通常涉及的關節 ! 高燒及身體寒顫 ! 有糖尿病或任何缺乏 免疫力的患者

! ! !

－ 通過藥物治療和物理治療減輕患者症狀 － 諮詢家庭醫生

急救員目標

應該 1. 如關節腫脹： a / 讓關節充分休息 b / 每數小時利用冷墊冰敷患處約20分鐘 c / 利用彈性繃帶包紮受影響關節 d / 抬高肢體 2. 如關節僵硬： a / 每隔數小時，利用熱墊敷患處約20分鐘 3. 改變生活模式，如輕度運動（如太極、伸展運動等） ，減輕體重亦 有助對抗關節炎。 4. 物理治療 — 持之以恆的運動鍛煉 5. 職業治療 — 利用輔助設備，以幫助改善活動能力 6. 服用由醫生處方的止痛藥和消炎藥 避免 1. 症狀沒有得到適當治療而延遲醫療諮詢

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腰痛 如果有下列任何警示訊號，應立即尋求醫療救助。

症狀

腰痛的嚴重原因

警示訊號

癌症

－ 有癌症病史 － 體重無故下降

波特氏病 （脊柱結核）

－ 發低燒 － 慢性咳嗽，痰帶有血絲 － 流夜汗

馬尾症候群 （脊髓壓迫神經）

－ 大小便失禁 － 肌肉虛弱，出現有異常感覺 － 大腿、臀部內側逐喪失感覺

壓縮神經

－ 肌肉乏力/消瘦 － 失去肌腱反射 － 呈陽性的巴賓斯基反射

骨折

－ 嚴重創傷，如曾從高處墮下 － 需要服用糖皮質激素 － 骨質疏鬆症 （特別針對更年期的女性） － 放鬆躺著時，脊柱出現疼痛

感染

－ 手術後，於傷口附近位置 出現劇痛 － 發燒 － 尿道感染 － 免疫抑制 － 靜脈吸毒者 － 曾有患癌歷史

應該

急救員目標

－ 服用撲熱息痛和非類固醇抗發炎藥NSAIDs，可能有助改善病情 － 慎遵醫生的指示 避免 有一種誤解是，持續腰痛患者經常需要臥床休息。但是，如果疼痛 不是由於外傷造成，積極生活方式實際是對病人有好處的。進行瑜 伽、伸展和核心力量建設活動也可能是非常有用的。

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頸部疼痛和肩部疼痛 背景

若肌肉曾經拉傷、出現退化、或長期姿勢不正確，甚至癌症均可以 導致頸部和肩部疼痛。在嚴重的情況下，頸部和肩部疼痛可擴散至 頭部，引起頭痛。

！麻木和刺痛感覺 ！跌倒損傷 ！四肢無力 ！沒原因地消瘦 ！曾患癌症 ！吞嚥困難

! ! ! ! ! !

應該

急救員目標

－ 應用熱墊和冷墊以舒緩疼痛 － 多做運動及糾正姿勢，或可治療肩頸痛 － 諮詢醫生或物理治療師，進一步進行X光檢查 避免 － 過度扭動脖子，以防止進一步的傷害 － 過度拉緊頸部和肩部

膝關節疼痛 膝關節疼痛在長者群中極為常見。然而，引起膝關節疼痛的原因眾多。

背景

原因 － 滑囊炎 － 韌帶或肌腱撕裂 － 血液流入關節 － 痛風 － 膿毒性關節炎（感染膝關節） － 軟組織損傷/發炎

！如膝蓋感到極痛且灼 熱，病者可能已患上 膿毒性關節炎，必須 立即求醫，因為膝關 節可能已被細菌破壞 ！不能如常行走，這 已表示情況嚴重和緊 急，病者也必須立即 求醫

備註

治療 － 止痛藥可能會有助舒緩病情 － 讓受影響之膝蓋部分多加休息

!

!

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敏感症與 系統性過敏症

背景

敏感症是免疫系統對某種無害的 外來物質（如抗原）出現過敏反 應。患有敏感症的人士會對特定 的抗原有敏感反應。 系統性過敏症是一種嚴重的過敏 反應。如果得不到及時治療，便 會危及生命；若能提早辨識患者 的情況，對其多加照顧，可有效 避免死亡的風險。

進食含有敏感成份的食物，亦會 引起敏感性反應的。 花生是常引起過敏反應並威脅生 命的食物。其他例子有海產、牛 奶、雞蛋、大豆和小麥。 有些人對某種特殊化學品和藥物 亦會出現過敏反應，最常見的是 抗生素、磺胺類藥物和乳膠。

原因 誘發過敏性反應的常見原因包括 蜂螫或昆蟲毒液等、服用某類藥 物、接觸花粉和灰塵。 過敏反應可以很輕微，亦可以很 嚴重。

症狀

敏感症的症狀和徵兆由輕度至中 度不等，較系統性過敏症輕微 － 嘴唇、臉、眼睛腫脹 － 身上出現蕁麻疹（即風疹） 、 皮疹， 感導搔癢 － 虛弱 － 噁心 － 胃部抽筋 － 嘔吐 － 頭暈

系統性過敏症通常是突然發生， 在接觸過敏原後數秒或數分鐘後 便會病發。 以下症狀可能會出現： － 蕁麻疹（風疹） 、風塊和身體 發紅 － 面部和舌頭腫脹 － 咽喉閉塞、聲音嘶啞 － 呼吸短促而嘈雜，出現喘鳴情 況，並持續咳嗽 － 休克 － 失去知覺

敏感症常見的致敏原：

藥物

螫傷

食物

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! 蕁麻疹（風疹） ， 風塊和 身體發紅 ! 舌頭腫脹 ! 咽喉閉塞，聲音嘶啞 ! 呼吸短促而嘈雜、喘鳴， 持續咳嗽 ! 休克 ! 失去知覺

! ! ! ! ! !

－ 確認是系統性過敏症的症狀和徵兆 － 尋求緊急醫療救助

急救員目標

應該 1. 如果懷疑是系統性過敏症，立即撥打999，尋求緊急醫療救助 2. 如果病者失去意識： 檢查氣道，呼吸和循環功能，並施行心肺復甦術 3. 如果病者意識清醒： a / 協助患者到一個舒適的位置，讓其安坐 b / 保持冷靜並安撫患者 c / 檢查患者是否備有治療藥物，並協助患者服藥 d / 立即用抗組胺劑 e / 如果患者備有腎上腺素自動注射器，應立即協助使用 4. 如五分鐘過後沒有改善，可再次使用 5. 在等待救援時，保持監測患者反應、呼吸和脈搏 避免 1. 單獨留下長者， 因為情況可能會在短時間內轉差 2. 耽擱腎上腺素的注射，因這是緊急治療過敏反應的主要方法

燒傷

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背景

燒傷和燙傷指皮膚和組織因高熱而遭受破壞。而嚴重程度往往取決於 傷者受傷的深淺程度、燒傷類型和受傷位置。而結果則與年齡、燒傷 程度和有否出現濃煙吸入導致的損傷有關。 不同類型的燒傷及原因 燒傷類型

燒傷原因

乾燒傷

火、熱的物體

燙傷

蒸汽、熱水

化學品燒傷

在家庭和工業環境中使用的各種化學品

電燒傷

高電壓和低電壓的電流

輻射燒傷

猛烈日光、太陽燈

燒傷的嚴重程度可根據受傷面積和深度進行分類。

症狀

表皮

真皮

皮下

肌肉

評估嚴重燒傷 表面燒傷 （第一度燒傷） 深度 燒傷皮膚表皮 症狀

發紅 腫脹 感到輕度疼痛

中層燒傷 （第二度燒傷） 深度 燒傷真皮 症狀

發紅 腫脹 感到極度痛楚 出水泡

深層燒傷 （第三度燒傷） 深度 燒傷皮膚全層，脂肪、 肌肉和血管都可能受損 症狀

皮膚呈現蠟質或燒焦 無痛

燒傷

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燒傷

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受傷面積分法 九分法 成人全身可分為九區，而各區面 積佔不同比例。頭部及每一上肢 各佔9%，上身、下身的每部分及 每一下肢各佔18%。

手掌法 傷者的一隻手掌位約佔身體面 積1%

！任何深層燒傷 ！口腔和咽喉燒傷 ！所有涉及臉、手、腳或 生殖器等部位燒傷 ！中層燒傷的面積大於手 部面積 ！由化學品，電力或爆炸 造成的燒傷

急救員目標

！ ！ ！ ！ ！

－ 確保病人和自己的安全 － 辨識危險訊號並尋求緊急醫療救助 － 舒緩病人的症狀 應該 1. 如果燒傷部位涉及以下器官，立即撥打999，尋求緊急醫療救助 a / 涉及氣道 b / 涉及手、臉、腳或生殖器 c / 傷口深，範圍廣，全身超過20%面積燒傷 d / 深層燒傷 e / 由化學品、電力或爆炸造成的燒傷 2. 將傷者移走，遠離火源 3. 用清水沖洗傷口，讓傷口降溫最少10分鐘，直至疼痛緩解為止 4. 如果傷處腫脹，應除去任何衣物或飾物以防壓緊傷口 5. 利用膠質薄膜，輕輕覆蓋傷處（例如保鮮紙） 避免 1. 利用護膚液、軟膏劑、油醬、醬油或牙膏塗抹傷口 2. 觸摸傷口或弄破水泡 3. 移除任何傷口的黏物 4. 過分冷凍病人 5. 用冰或冰水敷蓋傷口 6. 直接用毛巾、藥棉、毛毯或黏合劑敷料，清理傷口 7. 試圖清潔嚴重燒傷的傷口

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燒傷

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特別例子

衣物著火 － 傷者應停止跑動，以免因氣流令火勢增加 － 讓傷者伏在地上，如可以即時利用滅火毯，緊緊包住傷者身體 － 使傷者在地上滾動，弄熄身上的火焰 － 治療傷口 化學燒傷 － 施援者在施救時必須穿戴塑膠手套 － 可以的話，穿上手套，刷走任何殘留的化學物質，並為傷者除掉 任何受污染的衣物 － 用大量的水沖洗 － 保持小心，不要讓化學品四周散播 － 安排傷者送到醫院 電燒傷 － 關閉電源 － 確保傷者不再與電源接觸 － 如感到懷疑，暫時不要接近或接觸傷者 － 留意有否出現任何危及生命的情況和處理傷口 輻射燒傷 － 安排傷者到陰涼處 － 治療傷口

帶狀皰疹 （生蛇）

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帶狀皰疹（生蛇）

背景

這情況是由一種名叫帶狀皰疹的病毒所引致。當發水痘的階段過後， 其病毒會隱藏在神經細胞內。但當免疫系統轉弱時，病毒便會變得再 次活躍起來，並在皮節上引發出皮疹。

－ 皮膚變紅並有小水皰 － 在免疫力差的長者身上較為普遍

症狀

皰

小水

應該

急救員目標

－ 儘快尋求醫護人員幫忙，以進行抗病毒藥物治療 － 市面上出售的藥物，如必理痛，或能幫助舒緩輕微的痛楚 － 發病過後，受影響的位置可能會仍然感到痛楚，應盡快尋求醫 護人員意見以減輕病毒所引致的神經性痛楚 避免 － 接觸小水皰，以防感染 － 讓病人觸摸患處及接觸孕婦和小孩

中毒

中毒

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服藥過量

背景

症狀

基於多項高風險因素，長者較易出現藥物中毒的情況。由於大多長者 患有多種長期疾病，如高血壓和糖尿病，他們可能需要長期服用多種 處方藥物。隨着年紀增長，他們的新陳代謝及排出藥物的能力下降， 引致藥物副作用的機會大增。「多重用藥」是指在同一時間處方五種 或以上的藥物，這在香港的長者甚為普遍，高達42.5%的長者長期服 用多種處方藥物，亦增加了有害藥物的反應和藥物間不良的相互作用 的風險。此外，健忘和認知障礙症也會為長者服藥過量埋下伏線。

－ 昏昏欲睡，噁心和/或嘔吐 － 食道灼痛 － 呼吸有臭味 － 局部疼痛/發炎(如皮膚、眼睛等) － 特殊的中毒綜合症

! 呼吸困難 ! 突然虛脫 ! 失去知覺

! ! !

－ 識別藥物過量的病症 － 尋找懷疑服藥過量的環境線索 － 立即尋求醫護人員幫忙

急救員目標

應該 1. 如果長者沒有知覺： a / 立即撥打999，告知當值人員發生了懷疑中毒事件 b / 保持呼吸氣道通暢 c / 監察生命特徵（如指脈搏、呼吸率、知覺） d / 施行心肺復甦術 2. 如果長者有知覺和情況穩定： a / 立即撥打999，告知當值人員發生了懷疑中毒事件 b / 協助長者到一個舒適的位置 （應讓長者的身軀朝向左方，這樣可減少毒素被小腸吸收） c / 評估中毒性質： － 企圖自殺或不慎中毒？ － 服用的藥物/毒藥種類和數量？ － 服用時間？ d / 尋找環境線索（如已開啟的藥物容器） e / 繼續監察長者的生命特徵（如指脈搏、呼吸率、知覺等） f / 保留嘔吐物和其他線索（如藥物容器）的樣本 避免 嘗試引起嘔吐

中毒

65

中毒

66

備註

必理痛，為市面上最為常見的藥物，若攝入劑量 過多，會有潛在中毒的風險。若攝取過量必理痛 （劑量高達7.5至10克），毒性將會十分強烈。 按不同的病症，必理痛中毒可分為四階段： 階段

階段 1 （服用後半小時至一天）

病症

階段2 （服用後18小時至3天）

－ 腹部右上方感疼痛 － 厭食 － 噁心 － 嘔吐 － 小便量減少

階段3對肝有影響的階段 （服用後3至4天）

－ 噁心 － 嘔吐 － 腹痛 － 黃疸、凝血病、低血糖及肝性腦病可 能暗示肝臟壞死 － 急性腎衰竭

階段4復原階段 （服用後4天至3週）

－ 病症和對器官的影響消散

－ 可以沒有任何症狀 － 厭食 － 噁心 － 嘔吐 － 全身無力

中毒

67

中毒

68

普遍及有害的服藥 過量：攝入的毒物 攝入的毒物包括中草藥、野生植物、菇類和魚類（雪卡魚毒） 。 中草藥 文獻早已有記載，有些中草藥含有劇毒，因此必須遵照中醫師的建 議使用。

背景

中草藥中毒通常由以下其中一種原因導致，誤服品質差劣、欠缺監 控的中藥或錯誤服用類似中藥的替代品。 誤用 － 這通常是由於服藥過量，煎煮時間過度及不適當的烹調方法所引 起。煎煮烏頭鹼類草藥，如草烏、川烏等是必須的，皆因過程中能 去除大量的毒素。 品質監控差劣 － 中草藥中含有雜質，能導致意外中毒。在某些情況下，西藥更被非 法加進中藥裡，以提升其功效。 錯誤替代類似中藥 － 有些草藥之名稱或外貌容易混淆，故此，有些有毒的草藥被用以替 代一些無毒的草藥並非不常見。

以下是其他常見的例子： 類似的中草藥不可互相替代

馬兜鈴科 — 廣防己* （已於2004年6月1日在 香港禁止銷售）

VS 防已科 — 防已* （《中醫藥條例清單第四冊》列出 的中草藥）

應小心區分外觀近似的草藥

茄科 — 洋金花* （《中醫藥條例清單第八冊》列出 的中草藥）

VS 紫葳科 — 凌霄花 * （《中醫藥條例清單第八冊》列出 的中草藥）

* 圖片來源：香港特別行政區衛生署中醫藥事務部

中毒

69

中毒

70

中草藥 有些草藥含有劇毒： 未經處理的草烏

未經處理的川烏

鬧羊花 *

未經處理的馬錢子 *

砒霜 *

斑蝥屬

朱砂 * （塊狀朱砂）

洋金花 *

* 圖片來源： 香港特別行政區衛生署中醫藥事務部

症狀

－ 噁心、嘔吐、腹瀉及腹痛 － 胸腔不適，快速或不規則的心跳 － 氣促/氣喘 － 頭痛、頭暈、麻木及視力模糊 － 取決於藥物毒性 草藥

有效成份

病徵

烏頭鹼生物鹼

製附子

－ 麻木 － 口腔及腸道有灼熱的 感覺 － 血壓下降，胸腔疼痛 － 噁心、嘔吐、腹瀉 － 氣促/氣喘，頭痛， 出汗

廣防己

－ 腎臟受損

製川烏 製草烏

馬兜鈴酸 尋骨風 蒼術

莨菪胺及 顛茄鹼阿托品雜質

－ 皮膚乾燥，口腔乾燥 － 視力模糊 － 幻覺 － 心跳快速

馬錢子

馬錢子鹼及 二甲馬錢子鹼

－ 抽搐、搐搦 － 噁心、嘔吐 － 沒有知覺

番瀉葉

安特拉歸農綜合體

－ 腹痛 － 噁心、嘔吐、腹瀉 － 腸道流血，腎臟受損

各種弄成粉未 的草藥

氫化潑尼松

－ 庫興樣特徵

中毒

71

中毒

72

蘑菇 有些蘑菇含有劇毒，可以分類如下：

背景

蘑菇類型： 疝疼乳菇

毒紅菇

雞腿菇

黃粉牛肝菌 ／粉末牛肝菌

涉及的身體系統： 腸胃系統 其毒性所引發的症狀： 噁心、嘔吐、腹瀉、腹部痙攣

蘑菇類型： 鹿花菌 涉及的身體系統： 血液系統 其毒性所引發的症狀： 黃疸、血尿、溶血

蘑菇類型： 豹斑鵝膏菌

鬆果鵝膏菌

涉及的身體系統： 神經系統 其毒性所引發的症狀： 紊亂

蘑菇類型： 白毒鵝膏菌

涉及的身體系統： 肝臟 其毒性所引發的症狀： 黃疸

圖片來源：維基百科

鱗柄白毒傘

中毒

73

中毒

74

雪卡中毒 在香港，雪卡毒是其中一種最常引發食物中毒的神經毒素

背景

一般與雪卡毒魚類中毒相關的珊瑚魚包括: 紅鰽 *

老虎斑 *

燕尾星斑 *

西星斑 *

油𩺬 *

東星斑 *

* 香港特別行政區食物安全中心圖片

症狀

雪卡毒的症狀很快浮現，快則可在進食後30分鐘內發病︰ － 嘔吐 － 腹瀉 － 噁心 － 腹痛 － 手、腳和嘴唇刺痛 － 皮膚痕癢 － 對溫度的知覺改變 － 疲勞 － 肌肉和關節疼痛

－ 識別食物中毒的病症 － 立即尋求醫護人員幫忙

急救員目標

應該 1. 如果長者沒有知覺： a / 立即撥打999，告知當值人員發生了懷疑中毒事件 b / 保持呼吸氣道通暢 c / 監察生命特徵（如指脈搏、呼吸率、知覺等） d / 如有需要，施行心肺復甦術 2. 如果長者有知覺和情況穩定： a / 立即撥打999，告知當值人員發生了懷疑中毒事件 b / 協助長者處於舒適的位置 （應讓長者的身軀朝向左方，這樣可減少毒素被小腸吸收） c / 評估中毒性質 d / 食物種類和數量 e / 進食時間 f / 繼續監察長者的生命特徵（如指脈搏、呼吸率、知覺等） 避免 1. 嘗試引起嘔吐 2. 進食在野外採摘的野菜或菌類

中毒

75

中毒

76

普遍及有害的服藥 過量：化學品中毒 家居清潔劑和腐蝕劑 在香港，每年約有100宗家居產品中毒的個案，普遍是因意外地吞下 或吸入家居清潔劑，如漂白劑和不銹鋼清潔劑所引致的。

背景

症狀

急救員目標

－ 口腔灼痛的感覺 － 咽喉和胃部疼痛 － 咽喉腫脹 － 嘔吐 － 大便帶血 － 識別可能中毒的病症 － 立即撥打999，尋求醫護人員協助 － 辨別可能中毒的原因 應該 1. 立即撥打999，尋求醫護人員協助 2. 如果長者仍然清醒： a / 讓長者保持鎮定 b / 協助他/她處於舒適的位置 避免 1. 嘗試引發長者嘔吐 2. 給予飲料或食物予長者

吸入中毒 普遍的吸入中毒包括吸入有毒煙霧（如氯氣） 、氣罐（如滅蟲劑）和 一氧化碳。

背景 － 咳嗽 － 胸悶

症狀

急救員目標

－ 呼吸感到吃力 － 呼吸困難

如果是一氧化碳中毒，則會有以下情況： － 頭痛 － 頭暈 － 疲倦 － 噁心 － 視力模糊 － 協調障礙 － 失去知覺 － 評估環境的潛在危險並採取保護措施，以保障自身安全 － 識別吸入中毒的症狀 － 立即撥打999，尋求醫護人員協助 － 通知其他人發生事故 應該 1. 尋求協助 2. 在試圖處理長者的不適情況前，先保障自身安全 3. 保持環境空氣流通 4. 在安全情況下，提供生命支援措施 避免 1. 在沒有評估風險前，進入受影響的建築物範圍 2. 施以人工呼吸

備註

在企圖燒炭的自殺個案中，大多會出現一氧化碳中毒的情況。一氧化 碳是一種無色、無味、無嗅的氣體。中毒的症狀包括睏倦、身體狀況 虛弱、頭痛及皮膚泛紅，帶櫻桃色。這是可以致命的，受害者必須儘 快送往醫院。

中毒

77

中毒

78

蛇咬與蟲螫 蛇咬

背景

症狀

在香港的蛇咬個案中，大多患者皆被青竹蛇咬至中毒的。被其他毒蛇 咬傷亦被界定為緊急醫療情況。被非毒蛇咬傷有時也會出現嚴重敏感 反應。

－ 有兩孔刺痕 － 被咬部位可能沒有痛楚 － 被咬部位發紅、腫脹、發熱和痛楚 － 噁心和嘔吐 － 視力受損 － 唾液分泌和出汗增加 － 呼吸困難

急救員目標

－ 施以急救，並儘快尋求醫護人員協助 － 毒蛇是很難識別的 — 有些無毒的蛇之特徵與毒蛇很相似 － 遠離蛇類並假設蛇是有毒的 應該 1. 立即撥打999。儘管該蛇被認定是沒帶有毒性，蛇咬須由醫生妥 善處理。 2. 如果長者是清醒的： a / 告訴長者不要移動和保持鎮定 b / 讓長者躺下，把頭和肩膀升起 固定被咬的部位並保持在心臟以下位置 c / 儘快以肥皂和清水清洗傷口 d / 如果沒有痛楚的話，以壓迫繃帶包紮傷口。 不要脫去覆蓋傷口衣服，因這樣會加速毒液的吸收 e / 標示被咬的地方。用繃帶包紮雙腿，以固定受傷的肢體 f / 包紮完成後檢查血液循環情況。要預留有少許空間（約莫一隻 手指之空間），讓手指插入繃帶 g / 在待救援人員前來之際，觀察和記錄生命跡象 3. 如果長者已不省人事： a / 打開氣道並檢查呼吸 b / 如有需要，施行心肺復甦術

避免 1. 使用止血帶或將繃帶綁得太緊，若繃帶綁得太緊，會完全停止 血液的供應，導致永久傷殘 2. 利用小刀割開傷口或以口啜出毒液。這樣會導致細菌感染 3. 嘗試捕捉該蛇，以茲識別

中毒

79

中毒

80

蟲螫 蟲螫通常不會即時帶來危險，但當昆蟲的毒液引起過敏反應時，這便 需要進行緊急治理。

背景 － 被咬部位發紅、腫脹、發熱和感到痛楚

症狀

! 蕁麻疹（風疹） ， 風塊和 身體發紅 ! 面部和舌頭腫脹 ! 咽喉閉塞、聲音嘶啞 ! 氣促/氣喘、喘鳴、喘息， 持續性的咳嗽 ! 休克 ! 失去知覺

! ! ! ! ! !

應該

急救員目標

1. 如出現以上症狀，尋求緊急醫療救助 2. 提高蟲螫部位 3. 用冰袋敷10分鐘，以減輕腫脹 4. 監察生命特徵，並觀察過敏性反應的病症 避免 1. 切開或吸啜被蟲螫的傷口

中毒

81

痛楚管理

常見的止痛方法 服藥

普通止痛藥可以舒緩疼痛。 a / 在開始服用撲熱息痛時，劑量宜為500至1000微克 （mg） （約1至2片） 。如果經由醫生指示，則可服用更 高劑量。 b / 另外，非類固醇抗發炎藥NSAIDs，如布洛芬，是 可以使用的。然而，一些非類固醇抗發炎藥NSAIDs 可能引起胃出血，部份人服食後會出現血障礙或胃 腸道症狀，故此該類人士應盡量避免服食。

冷墊

冷墊多用於紓緩炎症。受傷時宜第 一時間使用，但要避免直接利用冰 塊接觸患處，以防凍傷。

熱墊

可增加患處之血液循環，從而使組 織修復和癒合過程可以更有效進 行，並應以熱毛巾敷蓋受影響的患 處表面。在處理外傷時，宜待炎症 消退後才使用。

痛楚管理

83

痛楚管理

84

拉伸

利用彈性帶子，固定在左膝及左腿之中間膝脛，繼而用力分開兩腿， 訓練小腿肌肉力量。 1

2

如下圖所示，平躺身體，臉朝下方，慢慢提起腿。經過5至10次練習 後，再轉另外的腿重覆練習。 1

2

如下圖所示，平躺身體而臉朝上，慢慢屈曲大腿至胸部。然後慢慢地 把大腿放回原來的位置。重複5至10次，據個人體質而定。 1

2

有關方法可減輕肌肉骨骼疼痛，亦可配合熱墊一起使用。

痛楚管理

85

有氧運動

例子包括游泳和快步行。有氧運動是緩解慢性疼痛的最佳方法。

抗阻練習

抗阻運動可增加肌肉的強度，加強關節穩定性，對於舒緩關節 痛楚是非常有效（按照物理治療師的建議練習，可以防止關節 進一步受損傷）

經皮電刺激神經 治療法（TENS）

通過使用電流刺激神經，大腦的疼痛訊號可以被調節或抑制，從 而減輕疼痛。

99 99 150 bps

繃帶包紮法及 傷口敷料

繃帶包扎法及傷口敷料

87

頭部包紮 物料 三⻆繃帶 X 1 敷料 X 1 步驟 1

2

前面 在傷口上鋪蓋敷料

前面 將帶底向內摺至傷病者的眉毛上方

3

前面

側面

背面

慢慢地將帶底向後收緊，於後枕骨下面將繃帶交叉 4

5

前面 將繃帶沿底繞至前面眉心中間打平結

背面 收好帶尖，完成頭部包紮

繃帶包扎法及傷口敷料

88

臂懸帶 物料 三角繃帶 X 1

步驟 1

2 帶尖

請求傷者支撐受傷的手臂。帶尖指向傷肢手肘，帶角由健側 肩膊，繞過頭後到傷側肩膊

將下半幅繃帶覆上

3

4

5

於傷側鎖骨凹位打平結， 將繃帶拉直，用手指放在 手肘外側

將帶尖扭緊，然後放入手 肘內作固定

完成圖

肩懸帶 物料 三角繃帶 X 1

步驟 1

2

將傷肢斜放胸前，手指指 向健側鎖骨

4

3

帶尖指向傷肢手肘，帶角 指向手指

5

背面

於健側鎖骨位打平結

將繃帶的下半幅摺入

6

背面

將帶尖扭緊，然後放入手 肘內作固定

繃帶包扎法及傷口敷料

89

繃帶包扎法及傷口敷料

90

手肘包紮 物料 2 英寸紗布卷 X 1 敷料 x 1

步驟 1

2

將傷口提高至心臟以上位置。用敷料蓋 住它

於鋪蓋敷料的位置，使用 2 英寸的紗布 卷繃帶，在關節中央開始重複繞一圈以 作固定

3

4

然後繞一圈向下，一圈向上，收帶尾時， 在關節對上重複繞一圈以作固定

在帶尾繫上扣針或膠布

繃帶包扎法及傷口敷料

91

前臂包紮 物料 2 英寸紗布卷 X 1 敷料 x 1

步驟 1

2

x2

將傷口提高至心臟以上位置。用敷料蓋 住它

使用 2 英寸的紗布卷繃帶，由受傷部位之 下開始，由內而外紮穩前後兩次

3

4

以簡單螺旋包紮法進行包紮，每繞一圈 時，繃帶應覆蓋前1圈繃帶三分之二範圍

直至繃帶將敷料完全覆蓋後，於繃帶末端 繫上扣針或膠布

繃帶包扎法及傷口敷料

92

腕部包紮 物料 2 英寸紗布卷 X 1 敷料 x 1

步驟 1

將傷口提高至心臟以上位 置，用敷料蓋住它

4

將繃帶圍繞手背，使繃帶 的下邊恰好貼住手指繞 一圈，然後再將其斜繞回 手腕

2

使用 2 英寸紗布卷繃帶， 在手腕位置上，重複繞兩 圈作固定

5

重複以上步驟，以八字形 包紮法包紮手背，覆蓋前1 圈繃帶三分之二範圍

3

將繃帶斜繞過手背至尾 指旁

6

直至繃帶將整隻手及敷料 完全覆蓋後，環繞手腕兩 次， 在繃帶末端繫上扣針 或膠布

繃帶包扎法及傷口敷料

93

手掌包紮 物料 三角繃帶X 1 敷料X 1

步驟 1

a

3

b

c 如手掌嚴重出血，將傷口提高至心臟以上位置，並以敷 料蓋住傷口，並請求長者以拳頭握緊。將半摺疊的三角 繃帶中央置於拳頂

4

5

交叉繃帶的兩端至手腕處

6

手腕後 以繃帶兩端包紮手背，在 其繞回手腕前，於每一末 端覆蓋三根手指

重複以上步驟

包紮手腕，於手背位置 打結

鳴謝

94

在「We Are With You」項目撥款資助下，《銀齡急救基本法》、《長 者急症ABC》二書順利出版，並成功從深入淺出的角度，向市民灌 輸專業急救知識，服務長者及弱勢社群的熹願得以實踐。一系列以 「基本生命救援」為主題之工作坊、展覽及座談會亦順利舉辦，讓大 眾受惠，實在感激萬分。 另外，二書之所以成功面世，急症醫學小組的同學功不可沒，在此 感謝他們一直以來的努力付出。

樊潔玲醫生 梁令邦醫生

筆記

95

筆記

96

97