Alphabetic Guide to Medical Emergencies - Abrasions

Emergency Treatment

Wash the area in which the skin is scraped or rubbed off with soap and water, using clean gauze or cotton. Allow the abrasion to air-dry, and then cover it with a loose sterile dressing held in place with a bandage. If a sterile dressing is not available, use a clean handkerchief.

Change the dressing after the first 24 hours, using household hydrogen peroxide to ease its removal if it sticks to the abrasion because of clotted blood. If the skinned area appears to be accompanied by swelling, or is painful or tender to the touch, consult a physician.

Acid Burns

Among acids likely to be encountered at work and around the home are sulphuric, nitric, and hydrochloric acids. Wet-cell batteries, such as automobile batteries, contain acid powerful enough to cause chemical destruction of body tissues, and some metal cleaners contain powerful acids.

Emergency Treatment

Wash off the acid immediately, using large amounts of clean, fresh, cool water. Strip off or cut off any clothing that may have absorbed any of the acid. If possible, put the victim in a shower bath; if a shower is not available, flood the affected skin areas with as much water as possible. However, do not apply water forcefully since this could aggravate damage already done to skin or other tissues.

After as much of the acid as possible has been eliminated by flooding with water, apply a mild solution of sodium bicarbonate or another mild alkali such as lime water. Caution should be exercised, however, in neutralizing an acid burn because the chemical reaction between an acid and an alkali can produce intense heat that would aggravate the injury; also, not all acids are effectively neutralized by alkalis—carbolic acid burns, for example, should be neutralized with alcohol.

Wash the affected areas once more with fresh water, then dry gently with sterile gauze; be careful not to break the skin or to open blisters. Extensive acid burns will cause extreme pain and shock; have the victim lie down with the head and chest a little lower than the rest of the body. As soon as possible, summon a physician or rush the victim to the emergency room of a hospital.

Aerosol Sprays

Although aerosol sprays generally are regarded as safe when handled according to directions, they can be directed accidentally toward the face with resulting contamination of the eyes or inhalation of the fumes. The pressurized containers may also contain products or propellants that are highly flammable, producing burns when used near an open flame. When stored near heat, in direct sunlight, or in a closed auto, the containers may explode violently.

Emergency Treatment

If eyes are contaminated by spray particles, flush the eye surfaces with water to remove any particles of the powder mist. Then carefully examine eye surfaces to determine if chemicals appear to be imbedded in the surface of the cornea. If aerosol spray is inhaled, move the patient to a well-ventilated area; keep him lying down, warm, and quiet. If breathing fails, administer artificial respiration. Victims of exploding containers or burning contents of aerosol containers should be given appropriate emergency treatment for bleeding, burns, and shock.

The redness and irritation of eye injuries should subside within a short time. If they do not, or if particles of spray seem to be imbedded in the surface of the eyes, take the victim to an ophthalmologist. A physician should also be summoned if a victim fails to recover quickly from the effects of inhaling an aerosol spray, particularly if the victim suffers from asthma or a similar lung disorder or from an abnormal heart condition.

Alkali Burns

Alkalis are used in the manufacture of soap and cleaners and in certain household cleaning products. They combine with fats to form soaps and may produce a painful injury when in contact with body surfaces.

Emergency Treatment

Flood the burned area with copious amounts of clean, cool, fresh water. Put the victim under a shower if possible, or otherwise pour running water over the area for as long as is necessary to dilute and weaken the corrosive chemical. Do not apply the water with such force that skin or other tissues are damaged. Remove clothing contaminated by the chemical.

Neutralize the remaining alkali with diluted vinegar, lemon juice, or a similar mild acid. Then wash the affected areas again with fresh water. Dry carefully with sterile gauze, being careful not to open blisters or otherwise cause skin breaks that could result in infection. Summon professional medical care as soon as possible. Meanwhile, treat the victim for shock.

Angina Pectoris

Angina pectoris is a condition that causes acute chest pain because of interference with the supply of oxygen to the heart. Although the pain is sometimes confused with ulcer or acute indigestion symptoms, it has a distinct characteristic of its own, producing a feeling of heaviness, strangling, tightness, or suffocation. Angina is a symptom rather than a disease, and may be a chronic condition with those over 50. It is usually treated by placing a nitroglycerine tablet under the tongue.

An attack of acute angina can be brought on by emotional stress, overeating, strenuous exercise, or by any activity that makes excessive demands on heart function.

Emergency Treatment

An attack usually subsides in about ten minutes, during which the patient appears to be gasping for breath. He should be kept in a semireclining position rather than made to lie flat, and should be moved carefully only in order to place pillows under his head and chest so that he can breathe more easily. A physician should be called promptly after the onset of an attack.

Animal Bites/Rabies

Wild animals, particularly bats, serve as a natural reservoir of rabies, a disease that is almost always fatal unless promptly and properly treated. But the virus may be present in the saliva of any warm-blooded animal. Domestic animals should be immunized against rabies by vaccines injected by a veterinarian.

Rabies is transmitted to humans by an animal bite or through a cut or scratch already in the skin. The infected saliva may enter through any opening, including the membranes lining the nose or mouth. After an incubation period of about ten days, a person infected by a rabid animal experiences pain at the site of infection, extreme sensitivity of the skin to temperature changes, and painful spasms of the larynx that make it almost impossible to drink. Saliva thickens and the patient becomes restless and easily excitable. By the time symptoms develop, death may be imminent. Obviously, professional medical attention should begin promptly after having been exposed to the possibility of infection.

Emergency Treatment

The area around the wound should be washed thoroughly and repeatedly with soap and water, using a sterile gauze dressing to wipe fluid away from—not toward—the wound. Another sterile dressing is used to dry the wound and a third to cover it while the patient is taken to a hospital or physician's office. A tetanus injection is also indicated, and police and health authorities should be promptly notified of the biting incident.

If at all possible the biting animal should be identified—if a wild animal, captured alive—and held for observation for a period of 10 to 15 days. If it can be determined during that period that the animal is not rabid, further treatment may not be required. If the animal is rabid, however, or if it cannot be located and impounded, the patient may have to undergo a series of daily rabies vaccine injections lasting from 14 days for a case of mild exposure to 21 days for severe exposure (a bite near the head, for example), plus several booster shots. Because of the sensitivity of some individuals to the rabies vaccines used, the treatment itself can be quite dangerous.

Recent research, however, has established that a new vaccine called HDCV (human diploid cell vaccine), which requires only six or fewer injections, is immunologically effective and is not usually accompanied by any side effects. The new vaccine has been used successfully on people of all ages who had been bitten by animals known to be rabid.

Appendicitis

The common signal for approaching appendicitis is a period of several days of indigestion and constipation, culminating in pain and tenderness on the lower right side of the abdomen. Besides these symptoms, appendicitis may be accompanied by nausea and a slight fever. Call a physician immediately and describe the symptoms in detail; delay may result in a ruptured appendix.

Emergency Treatment

While awaiting medical care, the victim may find some relief from the pain and discomfort by having an ice bag placed over the abdomen. Do not apply heat and give nothing by mouth. A laxative should not be offered.

Asphyxiation

See GAS POISONING.

Asthma Attack

Emergency Treatment

Make the patient comfortable and offer reassurance. If he has been examined by a physician and properly diagnosed, the patient probably has an inhalant device or other forms of medication on his person or nearby.

The coughing and wheezing spell may have been triggered by the presence of an allergenic substance such as animal hair, feathers, or kapok in pillows or cushions. Such items should be removed from the presence of the patient. In addition, placing the patient in a room with high humidity, such as a bathroom with the shower turned on, may be helpful.

Asthma attacks are rarely fatal in young people, but elderly persons should be watched carefully because of possible heart strain. In a severe attack, professional medical care including oxygen equipment may be required.

Back Injuries

In the event of any serious back injury, call a physician or arrange for immediate professional transfer of the victim to a hospital.

Emergency Treatment

Until determined otherwise by a physician, treat the injured person as a victim of a fractured spine. If he complains that he cannot move his head, feet, or toes, the chances are that the back is fractured. But even if he can move his feet or legs, it does not necessarily mean that he can be moved safely, since the back can be fractured without immediate injury to the spinal cord.

If the victim shows symptoms of shock, do not attempt to lower his head or move his body into the usual position for shock control. If it is absolutely essential to move the victim because of immediate danger to his life, make a rigid stretcher from a wide piece of solid lumber such as a door and cover the stretcher with a blanket for padding. Then carefully slide or pull the victim onto the stretcher, using his clothing to hold him. Tie the body onto the stretcher with strips of cloth.

Back Pain

See SCIATICA.

Black Eye

Although a black eye is frequently regarded as a minor medical problem, it can result in serious visual problems, including cataract or glaucoma.

Emergency Treatment

Inspect the area about the eye for possible damage to the eye itself, such as hemorrhage, rupture of the eyeball, or dislocated lens. Check also for cuts around the eye that may require professional medical care. Then treat the bruised area by putting the victim to bed, covering the eye with a bandage, and applying an ice bag to the area.

If vision appears to be distorted or lacerations need stitching and antibiotic treatment, take the victim to a physician's office. A physician should also be consulted about continued pain and swelling about the eye.

Black Widow Spider Bites

Emergency Treatment

Make the victim lie still. If the bite is on the arm or leg, position the victim so that the bite is lower than the level of the heart. Apply a rubber band or similar tourniquet between the bite and the heart to retard venom flow toward the heart. The bite usually is marked by two puncture points. Apply ice packs to the bite. Summon a physician or carry the patient to the nearest hospital.

Loosen the tourniquet or constriction band for a few seconds every 15 minutes while awaiting help; you should be able to feel a pulse beyond the tourniquet if it is not too tight. Do not let the victim move about. Do not permit him to drink alcoholic beverages. He probably will feel weakness, tremor, and severe pain, but reassure him that he will recover. Medications, usually available only to a physician, should be administered promptly.

Bleeding, Internal

Internal bleeding is always a very serious condition; it requires immediate professional medical attention.

In cases of internal bleeding, blood is sometimes brought to the outside of the body by coughing from the lungs, by vomiting from the stomach, by trickling from the ear or nose, or by passing in the urine or bowel movement.

Often, however, internal bleeding is concealed, and the only symptom may be the swelling that appears around the site of broken bones. A person can lose three or four pints of blood inside the body without a trace of blood appearing outside the body.

Some Symptoms of Internal Bleeding

The victim will appear ill and pale. His skin will be colder than normal, especially the hands and feet; often the skin looks clammy because of sweating. The pulse usually will be rapid (over 90 beats a minute) and feeble.

Emergency Treatment

Serious internal bleeding is beyond the scope of first aid. If necessary treat the victim for respiratory and cardiac arrest and for shock while waiting for medical aid.

Bleeding, Minor

Bleeding from minor cuts, scrapes, and bruises usually stops by itself, but even small injuries of this kind should receive attention to prevent infection.

Emergency Treatment

The injured area should be washed thoroughly with soap and water, or if possible, held under running water. The surface should then be covered with a sterile bandage.

The type of wound known as a puncture wound may bleed very little, but is potentially extremely dangerous because of the possibility of tetanus infection. Anyone who steps on a rusty nail or thumbtack or has a similar accident involving a pointed object that penetrates deep under the skin surface should consult a physician about the need for antitetanus inoculation or a booster shot.

Blisters

Emergency Treatment

If the blister is on a hand or foot or other easily accessible part of the body, wash the area around the blister thoroughly with soap and water. After carefully drying the skin around the blister, apply an antiseptic to the same area. Then sterilize the point and a substantial part of a needle by heating it in an open flame. When the needle has been thoroughly sterilized, use the point to puncture the blister along the margin of the blister. Carefully squeeze the fluid from the blister by pressing it with a sterile gauze dressing; the dressing should soak up most of the fluid. Next, place a fresh sterile dressing over the blister and fasten it in place with a bandage. If a blister forms in a tender area or in a place that is not easily accessible, such as under the arm, do not open it yourself; consult your physician.

The danger from any break in the skin is that germs or dirt can slip through the natural barrier to produce an infection or inflammation. Continue to apply an antiseptic each day to the puncture area until it has healed. If it appears that an infection has developed or healing is unusually slow, consult a doctor. Persons with diabetes or circulatory problems may have to be more cautious about healing of skin breaks than other individuals.

Blood Blisters

Blood blisters, sometimes called hematomas, usually are caused by a sharp blow to the body surface such as hitting a finger with a hammer while pounding nails.

Emergency Treatment

Wash the area of the blood blister thoroughly with soap and water. Do not open it. If it is a small blood blister, cover it with a protective bandage; in many cases, the tiny pool of blood under the skin will be absorbed by the surrounding tissues if there is no further pressure at that point.

If the blood blister fails to heal quickly or becomes infected, consult a physician. Because the pool of blood has resulted from damage to a blood vessel, a blood blister usually is more vulnerable to infection or inflammation than an ordinary blister.

Boils

Boils frequently are an early sign of diabetes or another illness and should be watched carefully if they occur often. In general, they result from germs or dirt being rubbed into the skin by tight-fitting clothing, scratching, or through tiny cuts made during shaving.

Emergency Treatment

If the boil is above the lip, do not squeeze it or apply any pressure. The infection in that area of the face may drain into the brain because of the pattern of blood circulation on the face. Let a physician treat any boil on the face. If the boil is on the surface of another part of the body, apply moist hot packs, but do not squeeze or press on the boil because that action can force the infection into the circulatory system. A wet compress can be made by soaking a wash cloth or towel in warm water.

If the boil erupts, carefully wipe away the pus with a sterile dressing, and then cover it with another sterile dressing. If the boil is large or slow to erupt, or if it is slow to heal, consult a physician.

Bone Bruises

Emergency Treatment

Make sure the bone is not broken. If the injury is limited to the thin layer of tissue surrounding the bone, and the function of the limb is normal though painful, apply a compression dressing and an ice pack. Limit use of the injured limb for the next day or two.

As the pain and swelling recede, cover the injured area with a foam-rubber pad held in place with an elastic bandage. Because the part of the limb that is likely to receive a bone bruise lacks a layer of muscle and fat, it will be particularly sensitive to any pressure until recovery is complete.

Botulism

The bacteria that produce the lethal toxin of botulism are commonly present on unwashed farm vegetables and thrive in containers that are improperly sealed against the damaging effects of air. Home-canned vegetables, particularly string beans, are a likely source of botulism, but the toxin can be found in fruits, meats, and other foods. It can also appear in food that has been properly prepared but allowed to cool before being served. Examples are cold soups and marinated vegetables.

Emergency Treatment

As soon as acute symptoms—nausea, diarrhea, and abdominal distress—appear, try to induce vomiting. Vomiting usually can be started by touching the back of the victim's throat with a finger or the handle of a spoon, which should be smooth and blunt, or by offering him a glass of water in which two tablespoons of salt have been dissolved. Call a physician; describe all of the symptoms, which also may include, after several hours, double vision, muscular weakness, and difficulty in swallowing and breathing. Save samples of the food suspected of contamination for analysis.

Prompt hospitalization and injection of antitoxin are needed to save most cases of botulism poisoning. Additional emergency measures may include artificial respiration if regular breathing fails because of paralysis of respiratory muscles. Continue artificial respiration until professional medical care is provided. If other individuals have eaten the contaminated food, they should receive treatment for botulism even if they show no symptoms of the toxin's effects, since symptoms may be delayed by several days.

Brown House (or Recluse) Spider Bites

Emergency Treatment

Apply an ice bag or cold pack to the wound area. Aspirin and antihistamines may be offered to help relieve any pain or feeling of irritation. Keep the victim lying down and quiet. Call a physician as quickly as possible and describe the situation; the physician will advise what further action should be taken at this point.

The effects of a brown spider bite frequently last much longer than the pain of the bite, which may be comparatively mild for an insect bite or sting. But the poison from the bite can gradually destroy the surrounding tissues, leaving at first an ulcer and eventually a disfiguring scar. A physician's treatment is needed to control the loss of tissue; he probably will prescribe drugs and recommend continued use of cold compresses. The victim, meanwhile, will feel numbness and muscular weakness, requiring a prolonged period of bed rest in addition to the medical treatments.

Bruises/Contusions

Emergency Treatment

Bruises or contusions result usually from a blow to the body that is powerful enough to damage muscles, tendons, blood vessels, or other tissues without causing a break in the skin.

Because the bruised area will be tender, protect it from further injury. If possible, immobilize the injured body part with a sling, bandage, or other device that makes the victim feel more comfortable; pillows, folded blankets, or similar soft materials can be used to elevate an arm or leg. Apply an ice bag or cold water dressing to the injured area.

A simple bruise usually will heal without extensive treatment. The swelling and discoloration result from blood oozing from damaged tissues. Severe bruising can, however, be quite serious and requires medical attention. Keep the victim quiet and watch for symptoms of shock. Give aspirin for pain in adults.

Bullet Wounds

Bullet wounds, whether accidental or purposely inflicted, can range from those that are superficial and external to those that involve internal bleeding and extensive tissue damage.

Emergency Treatment

A surface bullet wound accompanied by bleeding should be covered promptly with sterile gauze to prevent further infection. The flow of blood should be controlled as described under “Severe Bleeding” in this chapter. Don't try to clean the wound with soap or water.

If the wound is internal, keep the patient lying down and wrap him with coats or blankets placed over and under his body. If respiration has ceased or is impaired, give mouth-to-mouth respiration and treat him for shock. Get medical aid promptly.

Burns, Thermal

Burns are generally described according to the depth or area of skin damage involved. First-degree burns are the most superficial. They are marked by reddening of the skin and swelling, increased warmth, tenderness, and pain. Second-degree burns, deeper than first-degree, are in effect open wounds, characterized by blisters and severe pain in addition to redness. Third-degree burns are deep enough to involve damage to muscles and bones. The skin is charred and there may be no pain because nerve endings have been destroyed. However, the area of the burn generally is more important than the degree of burn; a first- or second-degree burn covering a large area of the body is more likely to be fatal than a small third-degree burn.

Emergency Treatment

If burns are minor, apply ice or ice water until pain subsides. Then wash the area with soap and water. Cover with a sterile dressing. Give the victim one or two aspirin tablets or acetaminophen to help relieve discomfort. A sterile gauze pad soaked in a solution of two tablespoons of baking soda (sodium bicarbonate) per quart of lukewarm water may be applied.

For more extensive or severe burns, immediately seek professional treatment. While help is being obtained, there are a few things you can do. Get the victim away from the fire or heat. Monitor the victim's breathing and stop any bleeding. Cool the burn with cool water. Cut—never pull—clothing from burned areas. If fabric is stuck to the burn, cut around it and leave it in place. Cover the burn with a cool, moist sterile pad or clean sheet. Do not apply oils, sprays, or ointments. If fingers or toes are burned, gently separate them with dry, sterile, non-adhesive dressings.

To prevent shock, make sure the victim's head is lower than his feet. Be sure that the victim is covered sufficiently to keep him warm, but not enough to make him overheated; exposure to cold can make the effects of shock more severe. Provide the victim with plenty of nonalcoholic liquids such as sweetened water, tea, or fruit juices, so long as he is conscious and able to swallow.

To prevent infection, do not permit absorbent cotton or adhesive tape to touch the wound caused by a burn. Do not apply iodine or any other antiseptic to the burn. Do not open any blisters. Do not permit any unsterile matter to touch the burn area. Do not cough, sneeze, or even breathe toward the wound resulting from a burn. Serious infections frequently develop in burn victims from contamination by microorganisms of the mouth and nose.

Skin Grafts

In serious burn cases, it is very important to get the wounds closed as quickly as possible to protect against infection. Left to itself, the skin will contract over the wound, resulting in scarring that is disfiguring and often disabling. A graft of the patient's own healthy skin (autograft) is the best covering for a burn wound, but patients with extensive burns often do not have enough healthy skin for autografting. It is possible to grow, over the course of several weeks, grafts of skin from small samples of uninjured skin taken from the patient's body. Grafts of cadaver skin or pig skin may be used—especially as a temporary covering—but they are often rejected by patients’ immune systems.

Artificial skins can take the place of cadaver and pig skin grafts. One type of artificial skin, called INTEGRA, has an inner layer made from collagen fibers from animal tissues and an outer, protective layer of silicone. It can be left in place for up to two months and encourages the growth of the patient's own skin underneath it. TransCyte artificial skin combines a bioengineered human dermal layer with a synthetic covering.

See also CHEMICAL BURNS OF THE EYE.

Carbuncles

Carbuncles are quite similar to boils except that they usually develop around multiple hair follicles and commonly appear on the neck or face. Personal hygiene is one factor involved in the development of carbuncles; persons apparently susceptible to the pustular inflammations must exercise special care in cleansing areas in which carbuncles occur, particularly if they suffer from diabetes or circulatory ailments.

Emergency Treatment

Apply moist hot packs to the boil-like swelling. Change the moist hot packs frequently, or place a hot-water bottle on the moist dressing to maintain the moist heat application. Do not handle the carbuncle beyond whatever contact is necessary to apply or maintain the moist heat. The carbuncle should eventually rupture or reach a point where it can be opened with a sterile sharp instrument. After the carbuncle has ruptured and drained, and the fluid from the growth has been carefully cleaned away, apply a sterile dressing.

Frequently, carbuncles must be opened and drained by a physician.

Cat Scratch Fever

Although the scratch or bite of a house cat or alley cat may appear at first to be only a mild injury, the wound can become the site of entry for a disease virus transmitted by apparently healthy cats. The inflammation, accompanied by fever, generally affects the lymph nodes and produces some aches and pains as well as fatigue. Although the disease is seldom fatal, an untreated case can spread to brain tissues and lead to other complications.

Emergency Treatment

Wash the scratch thoroughly with water and either soap or a mild detergent.

Watch the area of the scratch carefully for the next week or two. If redness or swelling develop, even after the scratch appears healed, consult your physician. The inflammation of the scratch area may be accompanied by mild fever and symptoms similar to those of influenza; in small children, the symptoms may be quite serious. Bed rest and antibiotics usually are prescribed.

Charley Horse

A charley horse occurs because a small number of muscle fibers have been torn or ruptured by overstraining the muscle, or by the force of a blow to the muscle.

Emergency Treatment

Rest the injured muscle and apply an ice pack if there is swelling. A compression dressing can be applied to support the muscle. Avoid movement that stretches the muscle, and restrict other movements that make the victim uncomfortable. If pain and swelling persist, call a physician.

During the recovery period, which may not begin for a day or two, apply local heat with a hot water bottle or an electric heating pad, being careful not to burn the victim. A return to active use of the muscle can begin gradually as pain permits.

Chemical Burns of the Eye

Emergency Treatment

Flush the victim's eye immediately with large quantities of fresh, clean water; a drinking fountain can be used to provide a steady stream of water. If a drinking fountain is not available, lay the victim on the floor or ground with his head turned slightly to one side and pour water into the eye from a cup or glass. Always direct the stream of water so that it enters the eye surface at the inside corner and flows across the eye to the outside corner. If the victim is unable, because of intense pain, to open his eyes, it may be necessary to hold the lids apart while water pours across the eye. Continue flushing the eye for at least 15 minutes. (An alternate method is to immerse the victim's face in a pan or basin or bucket of water while he opens and closes his eyes repeatedly; continue the process for at least 15 minutes.)

When the chemical has been flushed from the victim's eye, the eye should be covered with a small, thick compress held in place with a bandage that covers both eyes, if possible; the bandage can be tied around the victim's head. Note: Apply nothing but water to the eye; do not attempt to neutralize a chemical burn of the eye and do not apply oil, ointment, salve, or other medications. Rush the victim to a physician as soon as possible, preferably to an ophthalmologist.

Chemicals on Skin

Many household and industrial chemicals, such as ammonia, lye, iodine, creosote, and a wide range of insecticides can cause serious injury if accidentally spilled on the skin.

Emergency Treatment

Wash the body surface that has been affected by the chemical with large amounts of water. Do not try to neutralize the chemical with another substance; the reaction may aggravate the injury. If blisters appear, apply a sterile dressing. If the chemical is a refrigerant, such as Freon, or carbon dioxide under pressure, treat for frostbite.

If the chemical has splashed into the eyes or produces serious injury to the affected body surface, call a physician. The victim should be watched closely for possible poisoning effects if the chemical is a pesticide, since such substances may be absorbed through the skin to produce internal toxic reactions. If there is any question about the toxicity of a chemical, ask your doctor or call the nearest poison control center.

Chigger Bites

Emergency Treatment

Apply ice water or rub ice over the area afflicted by bites of the tiny red insects. Bathing the area with alcohol, ammonia water or a solution of baking soda also will provide some relief from the itching.

Wash thoroughly with soap, using a scrub brush to prevent further infestation by the chiggers in other areas of the body. Apply sulfur ointment as protection against mites that may not have attached themselves to the skin. Continue applications of ice water or alcohol to skin areas invaded by the insects. Clothing that was worn should be laundered immediately.

Chilblains

Emergency Treatment

Move the victim to a moderately warm place and remove wet or tight clothing. Soak the affected body area in warm—but not hot—water for about ten minutes. Then carefully blot the skin dry, but do not rub the skin. Replace the clothing with garments that are warm, soft, and dry.

Give the victim a stimulant such as tea or coffee, or an alcoholic beverage, and put him to bed with only light blankets; avoid the pressure of heavy blankets or heavy, tight garments on the sensitive skin areas. The victim should move the affected body areas gently to help restore normal circulation. If complications develop, such as marked discoloration of the skin, pain, or blistering and splitting of the skin, call a physician.

Cold Sores/Fever Blisters

Emergency Treatment

Apply a soothing ointment or a medication such as camphor ice. Avoid squeezing or otherwise handling the blisters; moisture can aggravate the sores and hinder their healing. Repeated appearances of cold sores or fever blisters, which are caused by the herpes simplex virus, may require treatment by a physician.

Concussion

See HEAD INJURIES.

Contusions

See BRUISES.

Convulsions

Emergency Treatment

Protect the victim from injury by moving him to a safe place; loosen any constricting clothing such as a tie or belt; put a pillow or coat under his head; if his mouth is open, place a folded cloth between his teeth to keep him from biting his tongue. Do not force anything into his mouth. Keep the patient warm but do not disturb him; do not try to restrain his convulsive movements.

Send for a physician as quickly as possible. Watch the patient's breathing and begin artificial respiration if breathing stops for more than one minute. Be sure that breathing actually has stopped; the patient may be sleeping or unconscious after an attack but breathing normally.

Convulsions in a small child may signal the onset of an infectious disease and may be accompanied by a high fever. The same general precautions should be taken to prevent self-injury on the part of the child. If placed in a bed, the child should be protected against falling onto the floor. Place him on his side—not on his back or stomach—if he vomits. Cold compresses or ice packs on the back of the neck and the head may help relieve symptoms. Immediate professional medical care is vital because brain damage can result if treatment is delayed.

See also EPILEPTIC SEIZURES.

Cramps

See MUSCLE CRAMPS.

Croup

Croup is a breathing disorder usually caused by a virus infection and less often by bacteria or allergy. It is a common condition during childhood, and in some cases, may require brief hospitalization for proper treatment.

The onset of a croup attack is likely to occur during the night with a sudden hoarse or barking cough accompanied by difficulty in breathing. The coughing is usually followed by choking spasms that sound as though the child is strangling. There may also be a mild fever. A physician should be called immediately when these symptoms appear.

Emergency Treatment

The most effective treatment for croup is cool moist air. Cool water vaporizers are available as well as warm steam vaporizers. Another alternative is to take the child into the bathroom, close the door and windows, and let the hot water run from the shower and sink taps until the room is filled with steam.

It is also possible to improvise a croup tent by boiling water in a kettle on a portable hot plate and arranging a blanket over the back of a chair so that it encloses the child and an adult as well as the steaming kettle. A child should never be left alone even for an instant in such a makeshift arrangement.

If the symptoms do not subside in about 20 minutes with any of the above procedures, or if there is mounting fever, and if the physician is not on his way, the child should be rushed to the closest hospital. Cold moist night air, rather than being a danger, may actually make the symptoms subside temporarily.

Diabetic Coma and Insulin Shock

Diabetics should always carry an identification tag or card to alert others of their condition in the event of a diabetic coma—which is due to a lack of insulin. They also should advise friends or family members of their diabetic condition and the proper emergency measures that can be taken in the event of an onset of diabetic coma. A bottle of rapid-acting insulin should be kept on hand for such an emergency.

Emergency Treatment

If the victim is being treated for diabetes, he probably will have nearby a supply of insulin and a hypodermic apparatus for injecting it. Find the insulin, hypodermic syringe, and needle; clean a spot on the upper arm or thigh, and inject about 50 units of insulin. Call a physician without delay, and describe the patient's symptoms and your treatment. The patient usually will respond without ill effects, but may be quite thirsty. Give him plenty of fluids, as needed.

If the victim does not respond to the insulin, or if you cannot find the insulin and hypodermic syringe, rush the victim to the nearest physician's office.

Insulin shock—which is due to a reaction to too much insulin and not enough sugar in the blood—can be treated in an emergency by offering a sugar-rich fluid such as a cola beverage or orange juice. Diabetics frequently carry a lump of sugar or candy that can be placed in their mouth in case of an insulin shock reaction. It should be tucked between the teeth and cheek so the victim will not choke on it.

If you find a diabetic in a coma and do not know the cause, assume the cause is an insulin reaction and treat him with sugar. This will give immediate relief to an insulin reaction but will not affect diabetic coma.

Diarrhea

Emergency Treatment

Give the victim an antidiarrheal agent; all drugstores carry medications composed of kaolin and pectin that are useful for this purpose. Certain bismuth compounds also are recommended for diarrhea control.

Put the victim in bed for a period of at least 12 hours. Do not let the victim become dehydrated; if he is thirsty, let him suck on pieces of ice. If the diarrhea appears to be subsiding, let him sip a mild beverage like tea or ginger ale; cola syrup is also recommended.

Later on the patient can try eating bland foods such as dry toast, crackers, gelatin desserts, or jellied consomme. Avoid feeding the patient rich, fatty, or spicy foods. If the diarrhea fails to subside or is complicated by colic or vomiting, call a physician.

Dizziness/Vertigo

Emotional upsets, allergies, and improper eating and drinking habits—too much food, too little food, or foods that are too rich—can precipitate symptoms of dizziness. The cause also can be a physical disorder such as abnormal functioning of the inner ear or a circulatory problem. Smoking tobacco, certain drugs such as quinine, and fumes of some chemicals also can produce dizziness.

Emergency Treatment

Have the victim lie down with the eyes closed. In many cases, a period of simple bed rest will alleviate the symptoms. Keep the victim quiet and comfortable. If the feeling of dizziness continues, becomes worse, or is accompanied by nausea and vomiting, call a physician.

Severe or persistent dizziness or vertigo requires a longer period of bed rest and the use of medicines prescribed by a physician. While recovering, the victim should avoid sudden changes in body position or turning the head rapidly. In some types of vertigo, surgery is required to cure the disorder.

Drowning

Victims of drowning seldom die because of water in the lungs or stomach. They die because of lack of air.

Emergency Treatment

If the victim's breathing has been impaired, start artificial respiration immediately. If there is evidence of cardiac arrest, administer cardiac massage. When the victim is able to breathe for himself, treat him for shock and get medical help.

Drug Overdose (Barbiturates)

Barbiturates are used in a number of drugs prescribed as sedatives, although many are also available through illegal channels. Because the drugs can affect the judgment of the user, he may not remember having taken a dose and so may take additional pills, thus producing overdose effects.

Emergency Treatment

If the drug was taken orally, try to induce vomiting in the victim. Have him drink a glass of water containing two tablespoons of salt. Or touch the back of his throat gently with a finger or a smooth blunt object like the handle of a spoon. Then give the victim plenty of warm water to drink. It is important to rid the stomach of as much of the drug as possible and to dilute the substance remaining in the gastrointestinal tract.

As soon as possible, call a physician or get the victim to the nearest hospital or physician's office. If breathing fails, administer artificial respiration.

Drug Overdose (Stimulants)

Although most of the powerful stimulant drugs, or pep pills, are available only through a physician's prescription, the same medications are available through illicit sources. When taken without direction of a supervising physician, the stimulants can produce a variety of adverse side effects, and when used frequently over a period of time can result in physical and psychological problems that require hospital treatment.

Emergency Treatment

Give the victim a solution of one tablespoon of activated charcoal mixed with a small amount of water, or give him a glass of milk, to dilute the effects of the medication in the stomach. Then induce vomiting by pressing gently on the back of the throat with a finger or the smooth blunt edge of a spoon handle. Vomiting also may be induced with a solution made of one teaspoonful of mustard in a half glass of water. Do not give syrup of ipecac to a victim who has been taking stimulants.

As soon as possible call a physician or get the victim to the nearest hospital or physician's office. If breathing fails, administer artificial respiration.

Earaches

An earache may be associated with a wide variety of ailments ranging from the common cold or influenza to impacted molars or tonsillitis. An earache also may be involved in certain infectious diseases such as measles or scarlet fever. Because of the relationship of ear structures to other parts of the head and throat, an infection involving the symptoms of earache can easily spread to the brain tissues or the spongy mastoid bone behind the ear. Call a physician and describe all of the symptoms, including temperature, any discharge, pain, ringing in the ear, or deafness. Delay in reporting an earache to a doctor can result in complications that require hospital treatment.

Emergency Treatment

This may include a few drops of warm olive oil or sweet oil held in the ear by a small wad of cotton. Aspirin can be given to adults to help relieve pain. Professional medical treatment may include the use of antibiotics.

Ear, Foreign Body in

Emergency Treatment

Do not insert a hairpin, stick, or other object in the ear in an effort to remove a foreign object; you are likely to force the object farther into the ear canal. Instead, have the victim tilt his head to one side, with the ear containing the foreign object facing upward. While pulling gently on the lobe of the ear to straighten the canal, pour a little warmed olive oil or mineral oil into the ear. Then have the victim tilt that ear downward so the oil will run out quickly; it should dislodge the foreign object.

Wipe the ear canal gently with a cotton-tipped matchstick, or a similar device that will not irritate the lining of the ear canal, after the foreign body has been removed. If the emergency treatment is not successful, call a physician.

Electric Shocks

An electric shock from the usual 110-volt current in most homes can be a serious emergency, especially if the person's skin or clothing is wet. Under these circumstances, the shock may paralyze the part of the brain that controls breathing and stop the heart completely or disorder its pumping action.

Emergency Treatment

It is of the utmost importance to break the electrical contact immediately by unplugging the wire of the appliance involved or by shutting off the house current switch. Do not touch the victim of the shock while he is still acting as an electrical conductor.

If the shock has come from a faulty wire out of doors and the source of the electrical current can't be reached easily, make a lasso of dry rope on a long sturdy dry stick. Catch the victim's hand or foot in the loop and drag him away from the wire. Another way to break the contact is to cut the wire with a dry axe.

If the victim of the shock is unconscious, or if his pulse is very weak, administer mouth-to-mouth respiration and cardiac massage until he can get to a hospital.

Epileptic Seizures

Epilepsy is a disorder of the nervous system that produces convulsive seizures. In a major seizure or grand mal , the epileptic usually falls to the ground. Indeed, falling is in most cases one of the principal dangers of the disease. Then the epileptic's body begins to twitch or jerk spasmodically. His breathing may be labored, and saliva may appear on his lips. His face may become pale or bluish. Although the scene can be frightening, it may not truly be a medical emergency; but may become so if prolonged.

Emergency Treatment

Make the person suffering the seizure as comfortable as possible. If he is on a hard surface, put something soft under his head, and move any hard or dangerous objects away from him. Make no attempt to restrain his movements, and do not force anything into his mouth. Just leave him alone until the attack is over, as it should be in a few minutes. If his mouth is already open, you might put something soft, such as a folded handkerchief, between his side teeth. This will help to prevent him from biting his tongue or lips. If possible, turn the person's head so if he vomits, the matter will be expelled, and he won't choke. If another seizure begins, or if the seizure lasts more than ten minutes, call a physician. If his lower jaw sags and begins to obstruct his breathing, support of the lower jaw may be helpful in improving his breathing. After a seizure has stopped, turn the person's head to the side so he can breathe normally.

When the seizure is over, the patient should be allowed to rest quietly. Some people sleep heavily after a seizure. Others awake at once but are disoriented or confused for a while. If it is the first seizure the person is aware of having had, or if it does not resolve, see a physician promptly.

Eye, Foreign Body in

Emergency Treatment

Do not rub the eye or touch it with unwashed hands. The foreign body usually becomes lodged on the inner surface of the upper eyelid. Pull the upper eyelid down over the lower lid to help work the object loose. Tears or clean water can help wash out the dirt or other object. If the bit of irritating material can be seen on the surface of the eyeball, try very carefully to flick it out with the tip of a clean, moistened handkerchief or a piece of moistened cotton. Never touch the surface of the eye with dry materials. Sometimes a foreign body can be removed by carefully rolling the upper lid over a pencil or wooden matchstick to expose the object.

After the foreign object has been removed, the eye should be washed with clean water or with a solution made from one teaspoon of salt dissolved in a pint of water. This will help remove any remaining particles of the foreign body as well as any traces of irritating chemicals that might have been a part of it. Iron particles, for example, may leave traces of rust on the eye's surface unless washed away.

If the object cannot be located and removed without difficulty, a small patch of gauze or a folded handkerchief should be taped over the eye and the victim taken to a physician's office—preferably the office of an ophthalmologist. A physician also should be consulted if a feeling of irritation in the eye continues after the foreign body has been removed.

Fever

Emergency Treatment

If the fever is mild, around 100°F. by mouth, have the victim rest in bed and provide him with a light diet. Watch closely for other symptoms, such as a rash, and any further increase in body temperature. Aspirin usually can be given in adults.

If the temperature rises to 101°F. or higher, is accompanied by pain, headache, delirium, confused behavior, coughing, vomiting, or other indications of a severe illness, call a physician. Describe all of the symptoms in detail, including the appearance of any rash and when it began.

Fever blisters

See COLD SORES.

Finger Dislocation

Emergency Treatment

Call a physician and arrange for inspection and treatment of the injury. If a physician is not immediately available, the finger dislocation may be reduced (put back in proper alignment) by grasping it firmly and carefully pulling it into normal position. Pull very slowly and avoid rough handling that might complicate the injury by damaging a tendon. If the dislocation cannot be reduced after the first try, go through the procedure once more. But do not try it more than twice.

Whether or not you are successful in reducing the finger dislocation, the finger should be immobilized after your efforts until a physician can examine it. A clean flat wooden stick can be strapped along the palm side of the finger with adhesive tape or strips of bandage to hold it in place.

Fingernail Injuries

Emergency Treatment

Wash the injured nail area thoroughly with warm water and soap. Trim off any torn bits of nail. Cover with a small adhesive dressing or bandage.

Apply petroleum jelly or cold cream to the injured nail area twice a day, morning and night, until it is healed. If redness or irritation develops in the adjoining skin area, indicating an infection, consult a physician.

Fish Poisoning

Emergency Treatment

Induce vomiting in the victim to remove the bits of poisonous fish from the stomach. Vomiting usually can be started by pressing on the back of the throat with a finger or a spoon handle that is blunt and smooth, or by having the victim drink a solution of two tablespoons of salt in a glass of water.

Call a physician as soon as possible. Describe the type of fish eaten and the symptoms, which may include nausea, diarrhea, abdominal pain, muscular weakness, and a numbness or tingling sensation that begins about the face and spreads to the extremities.

If breathing fails, administer mouth-to-mouth artificial respiration; a substance commonly found in poisonous fish causes respiratory failure. Also, be prepared to provide emergency treatment for convulsions.

Food Poisoning

Emergency Treatment

If the victim is not already vomiting, try to induce it to clear the stomach. Vomiting can be started in most cases by pressing gently on the back of the throat with a finger or a blunt smooth spoon handle, or by having the patient drink a glass of water containing two tablespoons of salt. If the victim has vomited, put him to bed.

Call a physician and describe the food ingested and the symptoms that developed. If symptoms are severe, professional medical treatment with antibiotics and medications for cramps may be required. Special medications also may be needed for diarrhea caused by bacterial food poisoning.

Fractures

Any break in a bone is called a fracture. The break is called an open or compound fracture if one or both ends of the broken bone pierce the skin. A closed or simple fracture is one in which the broken bone doesn't come through the skin.

It is sometimes difficult to distinguish a strained muscle or a sprained ligament from a broken bone, since sprains and strains can be extremely painful even though they are less serious than breaks. However, when there is any doubt, the injury should be treated as though it were a simple fracture.

Emergency Treatment

Don't try to help the injured person move around or get up unless he has slowly tested out the injured part of his body and is sure that nothing has been broken. If he is in extreme pain, or if the injured part has begun to swell, or if by running the finger lightly along the affected bone a break can be felt, do not move him. Under no circumstances should he be crowded into a car if his legs, hip, ribs, or back are involved in the accident. Call for an ambulance immediately, and until it arrives, treat the person for shock.

Splinting

In a situation where it is imperative to move someone who may have a fracture, the first step is to apply a splint so that the broken bone ends are immobilized.

Splints can be improvised from anything rigid enough and of the right length to support the fractured part of the body: a metal rod, board, long cardboard tube, tightly rolled newspaper or blanket. If the object being used has to be padded for softness, use a small blanket or any other soft material, such as a jacket.

The splint should be long enough so that it can be tied with a bandage, torn sheet, or neckties beyond the joint above and below the fracture as well as at the site of the break. If a leg is involved, it should be elevated with pillows or any other firm support after the splint has been applied. If the victim has to wait a considerable length of time before receiving professional attention, the splint bandaging should be checked from time to time to make sure it isn't too tight.

In the case of an open or compound fracture, additional steps must be taken. Remove that part of the victim's clothing that is covering the wound. Do not wash or probe into the wound, but control bleeding by applying pressure over the wound through a sterile or clean dressing.

Frostbite

Emergency Treatment

Begin rapid rewarming of the affected tissues as soon as possible. If possible, immerse the victim in a warm bath, but avoid scalding. (The temperature should be between 102° F. and 105° F.) Warm wet towels also will help if changed frequently and applied gently. Do not massage, rub, or even touch the frostbitten flesh. If warm water or a warming fire is not available, place the patient in a sleeping bag or cover him with coats and blankets. Hot liquids can be offered if available to help raise the body temperature.

For any true frostbite case, prompt medical attention is important. The depth and degree of the frozen tissue cannot be determined without a careful examination by a physician.

Gallbladder Attacks

Although gallstones can affect a wide variety of individuals, the most common victims are overweight persons who enjoy rich foods. The actual attack of spasms caused by gallstones passing through the duct leading from the gallbladder to the digestive tract usually is preceded by periods of stomach distress including belching.

X rays usually will reveal the presence of gallstones when the early warning signs are noted, and measures can be taken to reduce the threat of a gallbladder attack.

Emergency Treatment

Call a physician and describe in detail the symptoms, which may include colic high in the abdomen and pain extending to the right shoulder; the pain may be accompanied by nausea, vomiting, and sweating. Hot water bottles may be applied to the abdomen to help relieve distress while waiting for professional medical care. If the physician permits, the victim may be allowed to sip certain fluids such as fruit juices, but do not offer him solid food.

Gas Poisoning

Before attempting to revive someone overcome by toxic gas poisoning, the most important thing to do is to remove him to the fresh air. If this isn't feasible, all windows and doors should be opened to let in as much fresh air as possible.

Any interior with a dangerous concentration of carbon monoxide or other toxic gases is apt to be highly explosive. Therefore, gas and electricity should be shut off as quickly as possible. Under no circumstances should any matches be lighted in an interior where there are noxious fumes.

The rescuer needn't waste time covering his face with a handkerchief or other cloth. He should hold his breath instead, or take only a few quick, shallow breaths while bringing the victim to the out-of-doors or to an open window.

Emergency Treatment

Administer artificial respiration if the victim is suffering respiratory arrest. Arrange for medical help as soon as possible, requesting that oxygen be brought to the scene.

Head Injuries

Accidents involving the head can result in concussion, skull fracture, or brain injury. Symptoms of head injury include loss of consciousness, discharge of a watery or blood-tinged fluid from the ears, nose, or mouth, and a difference in size of the pupils of the eyes. Head injuries must be thought of as serious; they demand immediate medical assistance.

Emergency Treatment

Place the victim in a supine position, and, if there is no evidence of injury to his neck, arrange for a slight elevation of his head and shoulders. Make certain that he has a clear airway and administer artificial respiration if necessary. If vomitus, blood, or other fluids appear to flow from the victim's mouth, turn his head gently to one side. Control bleeding and treat for shock. Do not administer stimulants or fluids of any kind.

Heart Attack

A heart attack is caused by interference with the blood supply to the heart muscle. When the attack is brought on because of a blood clot in the coronary artery, it is known as coronary occlusion or coronary thrombosis .

The most dramatic symptom of a serious heart attack is a crushing chest pain that usually travels down the left arm into the hand or into the neck and back. The pain may bring on dizziness, cold sweat, complete collapse, and loss of consciousness. The face has an ashen pallor, and there may be vomiting.

Emergency Treatment

The victim must not be moved unless he has fallen in a dangerous place. If no physician is immediately available, an ambulance should be called at once. No attempt should be made to get the victim of a heart attack into an automobile.

Until help arrives, give the victim every reassurance that he will get prompt treatment, and keep him as calm and quiet as possible. Don't give him any medicine or stimulants. If oxygen is available, start administering it to the victim immediately, either by mask or nasal catheter, depending on which is available.

If the victim is suffering from respiratory arrest, begin artificial respiration. If he is suffering from cardiac arrest, begin cardiac massage.

Heat Exhaustion

Heat exhaustion occurs when the body is exposed to high temperatures and large amounts of blood accumulate in the skin as a way of cooling it. As a result, there is a marked decrease in the amount of blood that circulates through the heart and to the brain. The victim becomes markedly pale and is covered with cold perspiration. Breathing is increasingly shallow and the pulse weakens. In acute cases, fainting occurs. Medical aid should be summoned for anyone suffering from heat exhaustion.

Emergency Treatment

Place the victim in a reclining position with his feet raised about ten inches above his body. Loosen or remove his clothing, and apply cold, wet cloths to his wrists and forehead. If he has fainted and doesn't recover promptly, smelling salts or spirits of ammonia should be placed under his nose. When the victim is conscious, give him sips of salt water (approximately one teaspoon of salt per glass of water), the total intake to be about two glasses in an hour's time. If the victim vomits, discontinue the salt solution.

Heatstroke/Sunstroke

Heatstroke is characterized by an acutely high body temperature caused by the cessation of perspiration. The victim's skin becomes hot, dry, and flushed, and he may suffer collapse. Should the skin turn ashen gray, a physician must be called immediately. Prompt hospital treatment is recommended for anyone showing signs of sunstroke who has previously had any kind of heart damage.

Emergency Treatment

The following measures are designed to reduce the victim's body temperature as quickly as possible and prevent damage to the internal organs:

Place him in a tub of very cold water, or, if this is not possible, spray or sponge his body repeatedly with cold water or rubbing alcohol. Take his temperature by mouth, and when it has dropped to about 100°R, remove him to a bed and wrap him in cold, wet sheets. If possible, expose him to an electric fan or an air conditioner. Then call for medical aid.

Hiccups

Emergency Treatment

Have the victim slowly drink a large glass of water. If cold water is not effective, have him drink warm water containing a teaspoonful of baking soda. Milk also can be employed. For babies and small children, offer sips of warm water. Do not offer carbonated beverages.

Another helpful measure is breathing into a large paper bag a number of times to raise the carbon dioxide level in the lungs. Rest and relaxation are recommended; have the victim lie down to read or watch television.

If the hiccups fail to go away, and continued spastic contractions of the diaphragm interfere with eating and sleeping, call a physician.

Insect Stings

Honeybees, wasps, hornets, and yellow jackets are the most common stinging insects and most likely to attack on a hot summer day. Strongly scented perfumes or cosmetics and brightly colored, rough-finished clothing attract bees and should be avoided by persons working or playing in garden areas. It should also be noted that many commercial repellents do not protect against stinging insects.

Emergency Treatment

If one is stung, the insect's stinger should be tweezed or scraped gently from the skin as soon as possible; don't squeeze it. Apply Epsom salt solution to the sting area. Anu'hista-mines are often helpful in reducing the patient*s discomfort. If a severe reaction develops, call a physician.

There are a few people who are critically allergic to the sting of wasps, bees, yellow jackets, or fire ants. This sensitivity causes the vocal cord tissue to swell to the point where breathing may become impossible. A single sting to a sensitive person may result in a dangerous drop in blood pressure, thus producing shock. Anyone with such a severe allergy who is stung should be rushed to a hospital immediately.

Allergic persons should always have on hand an insect-sting emergency kit, which can be obtained through a prescription.

Insulin Shock

See DIABETIC COMA AND INSULIN SHOCK.

Jaw Dislocation

The jaw can be dislocated during a physical attack or fight; from a blow on the jaw during sports activities; or from overextension of the joint during yawning, laughing, or attempting to eat a large mouthful of food. The jaw becomes literally locked open so the victim cannot explain his predicament.

Emergency Treatment

Reducing a dislocated jaw will require that you insert your thumbs between the teeth of the victim. The jaw can be expected to snap into place quickly, and there is a danger that the teeth will clamp down on the thumbs when this happens, so the thumbs should be adequately padded with handkerchiefs or bandages. Once the thumbs are protected, insert them in the mouth and over the lower molars, as far back on the lower jaw as possible. While pressing down with the thumbs, lift the chin with the fingers outside the mouth. As the jaw begins to slip into normal position when it is pushed downward and backward with the chin lifted upward, quickly remove the thumbs from between the jaws.

Once the jaw is back in normal position, the mouth should remain closed for several hours while the ligaments recover from their displaced condition. If necessary, put a cravat bandage over the head to hold the mouth closed. If difficulty is experienced in reducing a jaw dislocation, the victim should be taken to a hospital where an anesthetic can be applied. A dislocated jaw can be extremely painful.

Jellyfish Stings

Emergency Treatment

Wash the area of the sting thoroughly with alcohol or fresh water. Be sure that any pieces of jellyfish tentacles have been removed from the skin. Aspirin or antihistamines can be administered to relieve pain and itching, but curtail the use of antihistamines if the victim has consumed alcoholic beverages. The leg or arm that received the sting can be soaked in hot water if the pain continues. Otherwise, apply calamine lotion.

If the victim appears to suffer a severe reaction from the sting, summon a doctor. The victim may experience shock, muscle cramps, convulsions, or loss of consciousness. Artificial respiration may be required while awaiting arrival of a doctor. The physician can administer drugs to relieve muscle cramps and provide sedatives or analgesics.

Kidney Stones

Emergency Treatment

Call a physician if the victim experiences the agonizing cramps or colic associated with kidney stones. Discuss the symptoms in detail with the doctor to make sure the pain is caused by kidney stones rather than appendicitis.

Comforting heat may be applied to the back and the abdomen of the side affected by the spasms. Paregoric can be administered, if available, while waiting for medical care; about two teaspoonsful of paregoric in a half glass of water may help relieve symptoms.

Knee Injuries

Emergency Treatment

If the injury appears to be severe, including possible fracture of the kneecap, immobilize the knee. To immobilize the knee, place the injured leg on a board that is about four inches wide and three to four feet in length. Place padding between the board and the knee and between the board and the back of the ankle. Then use four strips of bandage to fasten the leg to the padded board—one at the ankle, one at the thigh, and one each above and below the knee.

Summon a physician or move the patient to a physician's office. Keep the knee protected against cold or exposure to the elements, but otherwise do not apply a bandage or any type of pressure to the knee itself; any rapid swelling would be aggravated by unnecessary pressure in that area. Be prepared to treat the patient for shock.

Laryngitis

Laryngitis is associated with colds and influenza and may be accompanied by a fever. The ailment can be aggravated by smoking, and it is possible that the vocal cords can be damaged if the victim tries to force the use of his voice while the larynx is swollen by the infection.

Emergency Treatment

Have the victim inhale the warm moist air of a steam kettle or vaporizer. A vaporizer can be improvised in an emergency by pouring boiling water into a bowl and forming a “tent” over the steaming bowl with a large towel or sheet, or by placing a large paper bag over the bowl and cutting an opening at the closed end of the bag so the face can be exposed to the steam. The hot water can contain a bit of camphor or menthol, if available, to make the warm moist air more soothing to the throat, but this is not necessary.

Continue the use of the vaporizer for several days, as needed. The victim should not use the vocal cords any more than absolutely necessary. If the infection does not subside within the first few days, a physician should be consulted.

Leeches

Emergency Treatment

Do not try to pull leeches off the skin. They will usually drop away from the skin if a heated object such as a lighted cigarette is held close to them. Leeches also are likely to let go if iodine is applied to their bodies. The wound caused by a leech should be washed carefully with soap and water and an antiseptic applied.

Lightning Shock

Emergency Treatment

If the victim is not breathing, apply artificial respiration. If a second person is available to help, have him summon a physician while artificial respiration is administered. Continue artificial respiration until breathing resumes or the physician arrives.

When the victim is breathing regularly, treat him for shock. Keep him lying down with his feet higher than his head, his clothing loosened around the neck, and his body covered with a blanket or coat for warmth. If the victim shows signs of vomiting, turn his head to one side so he will not swallow the vomitus.

If the victim is breathing regularly and does not show signs of shock, he may be given a few sips of a stimulating beverage such as coffee, tea, or brandy.

Motion Sickness

Emergency Treatment

Have the victim lie down in a position that is most comfortable to him. The head should be fixed so that any view of motion is avoided. Reading or other use of the eyes should be prohibited. Food or fluids should be restricted to very small amounts. If traveling by car, stop at a rest area; in an airplane or ship, place the victim in an area where motion is least noticeable.

Drugs, such as Dramamine, are helpful for control of the symptoms of motion sickness; they are most effective when started about 90 minutes before travel begins and repeated at regular intervals thereafter.

Muscle Cramps

Emergency Treatment

Gently massage the affected muscle, sometimes stretching it to help relieve the painful contraction. Then relax the muscle by using a hot water bottle or an electric heating pad, or by soaking the affected area in a warm bath.

A repetition of cramps may require medical attention.

Nosebleeds

Emergency Treatment

Have the victim sit erect but with the head tilted slightly forward to prevent blood from running down the throat. Apply pressure by pinching the nostrils; if bleeding is from just one nostril, use pressure on that side. A small wedge of absorbent cotton or gauze can be inserted into the bleeding nostril. Make sure that the cotton or gauze extends out of the nostril to aid in its removal when the bleeding has stopped. Encourage the victim to breathe through the mouth while the nose is bleeding. After five minutes, release pressure on the nose to see if the bleeding has stopped. If the bleeding continues, repeat pressure on the nostril for an additional five minutes. Cold compresses applied to the nose can help stop the bleeding.

If bleeding continues after the second five-minute period of pressure treatment, get the victim to a physician's office or a hospital emergency room.

Poison Ivy/Poison Oak/Poison Sumac

Emergency Treatment

The poison of these three plants is the same and the treatment is identical. Bathe the skin area exposed to poison ivy, poison oak, or poison sumac with soap and water within 15 minutes after first contact. If exposure is not discovered until a rash appears, apply cool wet dressings. Dressings can be made of old bed sheets or soft linens soaked in a solution of one teaspoon of salt per pint of water. Dressings should be applied four times a day for periods of 15 to 60 minutes each time; during these periods, dressings can be removed and reapplied every few minutes. The itching that often accompanies the rash can be relieved by taking antihistamine tablets.

Creams or lotions may be prescribed by a physician or supplied by a pharmacist. Do not use such folk remedies as ammonia or turpentine; do not use skin lotions not approved by a physician or druggist. Haphazard application of medications on poison ivy blisters and rashes can result in complications including skin irritation, infection, or pigmented lesions of the skin.

Rabies

See ANIMAL BITES.

Rape

Rape has been defined as any unlawful sexual intercourse or sexual contact by force or threat. Most commonly, men commit rape against women; but homosexual rape involving men only may occur, for example, in a prison.

Of the million or more Americans who are raped each year, one in five is under the age of 12. Boys are the victims of sexual assault as often as girls. In seven to ten percent of all reported adult cases, men are the victims.

Emergency Response

The victim of rape may not always be able to help him- or herself. Because violence may accompany the rape, the victim may find it impossible to seek help at once. But where possible, the recommended course of action is to go to a hospital for physical examination. Reporting to a hospital in itself may reduce the feelings of shock, depression, anxiety, and revulsion that generally follow a sexual assault. The physical examination that takes place at the hospital may produce evidence that could be important in a court trial if the rapist is later apprehended. Victims are also advised to report the rape to the police as soon as possible.

For additional information on ways to avoid rape and what to do if it occurs, see “The Rape Victim” in Ch. 25, .

Sciatica/Lower Back Pain

Although lower back pain is frequently triggered by fatigue, anxiety, or by strained muscles or tendons, it may be a symptom of a slipped or ruptured disk between the vertebrae or of a similar disorder requiring extensive medical attention.

Emergency Treatment

Reduce the pressure on the lower back by having the victim lie down on a hard flat surface; if a bed is used there should be a board or sheet of plywood between the springs and mattress. Pillows should be placed under the knees instead of under the head, to help keep the back flat. Give aspirin to relieve the pain, and apply heat to the back. Call a physician if the symptoms do not subside overnight.

Scorpion Stings

Emergency Treatment

Apply ice to the region of the sting, except in the case of an arm or leg, in which event the limb may be immersed in ice water. Continue the ice or ice-water treatment for at least one hour. Try to keep the area of the sting at a position lower than the heart. No tourniquet is required. Should the breathing of a scorpion sting victim become depressed, administer artificial respiration. If symptoms fail to subside within a couple of hours, notify a physician, or transfer the victim to a doctor's office or hospital.

For children under six, call a physician in the event of any scorpion sting. Children stung by scorpions may become convulsive, and this condition can result in fatal exhaustion unless it receives prompt medical treatment.

Snakebites

Of the many varieties of snakes found in the United States, only four kinds are poisonous: copperheads, rattlesnakes, moccasins, and coral snakes. The first three belong to the category of pit vipers and are known as hemotoxic because their poison enters the bloodstream. The coral snake, which is comparatively rare, is related to the cobra and is the most dangerous of all because its venom is neurotoxic . This means that the poison transmitted by its bite goes directly to the nervous system and the brain.

How to Differentiate among Snakebites

Snakes of the pit viper family have a fang on each side of the head. These fangs leave characteristic puncture wounds on the skin in addition to two rows of tiny bites or scratches left by the teeth. A bite from a nonpoisonous snake leaves six rows—four upper and two lower—of very small bite marks or scratches and no puncture wounds.

The marks left by the bite of a coral snake do not leave any puncture wounds either, but this snake bites with a chewing motion, hanging on to the victim rather than attacking quickly. The coral snake is very easy to recognize because of its distinctive markings: wide horizontal bands of red and black separated by narrow bands of yellow.

Symptoms

A bite from any of the pit vipers produces immediate and severe pain and darkening of the skin, followed by weakness, blurred vision, quickened pulse, nausea, and vomiting. The bite of a coral snake produces somewhat the same symptoms, although there is less local pain and considerable drowsiness leading to unconsciousness.

If a physician or a hospital is a short distance away, the patient should receive professional help immediately . He should be transported lying down, either on an improvised stretcher or carried by his companions—with the wounded part lower than his heart. He should be advised to move as little as possible.

Emergency Treatment

If several hours must elapse before a physician or a hospital can be reached, the following procedures should be applied promptly:

1. Keep the victim lying down and as still as possible.

2. Tie a constricting band above the wound between it and the heart and tight enough to slow but not stop blood circulation. A handkerchief, necktie, sock, or piece of torn shirt will serve.

3. If a snakebite kit is available, use the knife it contains; otherwise, sterilize a knife or razor blade in a flame. Carefully make small cuts in the skin where the swelling has developed. Make the cuts along the length of the limb, not across or at right angles to it. The incisions should be shallow because of the danger of severing nerves, blood vessels, or muscles.

4. Use the suction cups in the snakebite kit, if available, to draw out as much of the venom as possible. If suction cups are not available, the venom can be removed by sucking it out with the mouth. Although snake venom is not a stomach poison, it should not be swallowed but should be rinsed from the mouth.

5. This procedure should be continued for from 30 to 60 minutes or until the swelling subsides and the other symptoms decrease.

6. You may apply cold compresses to the bite area while waiting for professional assistance.

7. Treat the victim for shock.

8. Give artificial respiration if necessary.

Splinters

Emergency Treatment

Clean the area about the splinter with soap and water or an antiseptic. Next, sterilize a needle by holding it over an open flame. After it cools, insert the needle above the splinter so it will tear a line in the skin, making the splinter lie loose in the wound. Then, gently lift the splinter out, using a pair of tweezers or the point of the needle. If tweezers are used, they should be sterilized first.

Wash the wound area again with soap and water, or apply an antiseptic. It is best to cover the wound with an adhesive bandage. If redness or irritation develops around the splinter wound, consult a physician.

Sprains

A sprain occurs when a joint is wrenched or twisted in such a way that the ligaments holding it in position are ruptured, possibly damaging the surrounding blood vessels, tendons, nerves, and muscles. This type of injury is more serious than a strain and is usually accompanied by pain, sometimes severe, soreness, swelling, and discoloration of the affected area. Most sprains occur as a result of falls, athletic accidents, or improper handling of heavy weights.

Emergency Treatment

This consists of prompt rest, the application of cold compresses to relieve swelling and any internal bleeding in the joint, and elevation of the affected area. Aspirin is recommended to reduce discomfort in adults. If the swelling and soreness increase after such treatment, a physician should be consulted to make sure that there is not a fracture or a bone dislocation.

Sting Ray

Emergency Treatment

If an arm or leg is the target of a sting ray, wash the area thoroughly with salt water. Quickly remove any pieces of the stinger imbedded in the skin or flesh; poison can still be discharged into the victim from the sting-ray sheath. After initial cleansing of an arm or leg sting, soak the wound with hot water for up to an hour. Apply antiseptic or a sterile dressing after the soak.

Consult a physician after a sting-ray attack. The physician will make a thorough examination of the wound to determine whether stitches or antibiotics are required. Fever, vomiting, or muscular twitching also may result from an apparently simple leg or arm wound by a sting ray.

If the sting occurs in the chest or abdomen, the victim should be rushed to a hospital as soon as possible because such a wound can produce convulsions or loss of consciousness.

Strains

When a muscle is stretched because of misuse or overuse, the interior bundles of tissue may tear, or the tendon that connects it to the bone may be stretched. This condition is known as strain. It occurs most commonly to the muscles of the lower back when heavy weights are improperly lifted, or in the area of the calf or ankle as the result of a sudden, violent twist or undue pressure.

Emergency Treatment

Bed rest, the application of heat, and gentle massage are recommended for back strain. If the strain is in the leg, elevate it to help reduce pain and swelling, and apply cold compresses or an ice bag to the area. Aspirin may be taken to reduce discomfort.

In severe cases of strained back muscles, a physician may have to be consulted for strapping. For a strained ankle, a flexible elastic bandage can be helpful in providing the necessary support until the injured muscle heals.

Stroke

Stroke, or apoplexy, is caused by a disruption of normal blood flow to the brain, either by rupture of a blood vessel within the brain or by blockage of an artery supplying the brain. The condition is enhanced by hardening of the arteries and high blood pressure, and is most likely to occur in older persons. A stroke usually occurs with little or no warning and the onset may be marked by a variety of manifestations ranging from headache, slurred speech, or blurred vision, to sudden collapse and unconsciousness.

Emergency Treatment

Try to place the victim in a semire-clining position, or, if he is lying down, be sure there is a pillow under his head. Avoid conditions that might increase the flow of blood toward the head. Summon a physician immediately. Loosen any clothing that may be tight. If the patient wears dentures, remove them.

Before professional medical assistance is available, the victim may vomit or go into shock or convulsions. If he vomits, try to prevent a backflow of vomitus into the breathing passages. If shock occurs, do not place the victim in the shock position but do keep him warm and comfortable. If convulsions develop, place a handkerchief or similar soft object between the jaws to prevent tongue biting.

Sty on Eyelid

Sties usually develop around hair follicles because of a bacterial infection. They are most likely to develop in association with poor health and lowered resistance to infection.

Emergency Treatment

Apply warm, moist packs or compresses to the sty for periods of 15 to 20 minutes at intervals of three or four hours. Moist heat generally is more penetrating than dry heat.

The sty should eventually rupture and the pus should then be washed carefully away from the eye area. If the sty does not rupture or is very painful, consult a physician. Do not squeeze or otherwise handle the sty except to apply the warm moist compresses.

Sunburn

Emergency Treatment

Apply cold wet compresses to help relieve the pain. Compresses can be soaked in whole milk, salt water, or a solution of cornstarch mixed with water. The victim also may get some relief by soaking in a bathtub filled with plain water. Soothing lotions, such as baby oil or a bland cold cream, can be applied after carefully drying the skin. Don't rub the burn area while drying. Avoid the use of “shake” lotions, like calamine, which may aggravate the burn by a drying action. The victim should, of course, avoid further exposure to sunlight.

If pain is excessive, or extensive blistering is present, consult a physician. Avoid application of over-the-counter topical anesthetics that may cause allergic skin reactions.

A severe or extensive sunburn is comparable to a second-degree thermal burn and may be accompanied by symptoms of shock; if such symptoms are present the victim should be treated for shock. See also BURNS, THERMAL.

Sunstroke

See HEATSTROKE.

Tick Bites

The most common tick-borne illness is Lyme disease which is carried by a bacterium that infects mice, ticks, deer and humans. It is distinguished by a red bull's eye rash, fatigue, chills headaches and fever within three to 30 days after infection and has been fatal in some rare cases. Lyme disease can be treated with antibiotics which should be administered in the condition's early stages.

Emergency Treatment

Do not try to scrape or rub the insect off the skin with your fingers; scraping, rubbing, or pulling may break off only part of the insect body, leaving the head firmly attached to the skin. Rubbing also can smear disease organisms from the tick into the bite. To make the tick drop away from the skin, cover it with a heavy oil, such as salad, mineral, or lubricating oil. Oil usually will block the insect's breathing pores, suffocating it. If oil is not readily available, carefully place a heated object against the tick's body; a lighted cigarette or a match that has been ignited and snuffed out can serve as a hot object.

Carefully inspect the bite area to be sure that all parts of the tick have been removed. Use a pair of tweezers to remove any tick parts found. Then carefully wash the bite and surrounding area with soap and water and apply an antiseptic. Also, wash your hands and any equipment that may have come in contact with the tick. Consult a physician if symptoms of tick fever or tularemia, such as unexplained muscular weakness, occur following a bite.