Lacerations

Lacerations It could happen when chopping a tomato too quickly, stepping on a sharp object such as a nail or being careless when trimming that board for your weekend project. We have all experienced cuts, scrapes or punctures at some point. Most often these can be treated at home. Wash the cut with soap and water Apply direct pressure to the cut to stop the bleeding Use an antibacterial ointment to help prevent infection Protect the cut from dirt by covering it with a clean bandage

Seek emergency care if:

Bleeding is severe, spurting or does not stop after 15 minutes of pressure The wound is large or deep The cut is more than a quarter inch deep The injury is caused by a rusty object, fishhook, animal bite or nail There is debris in the wound There are signs of infection – warmth and redness, a painful or throbbing sensation, fever, swelling or a pus-like discharge You have not had a tetanus shot within the last 10 years

Broken Bones From church softball leagues and bicycle rides to car accidents and falls from tree houses, the potential for broken bones is all around us. If you do break a bone, you’ll need to seek immediate medical attention.

Signs of a break: • • • • •

Misshapen limb or joint Swelling, bruising or bleeding Severe pain Numbness and tingling Limited mobility or cannot move the limb

Fracture first aid:

• Apply pressure to the wound with a clean cloth or sterile bandage to stop any bleeding. • Do not try to realign the bone. Keep the injured area immobilized. • Apply ice packs to the injured area to reduce swelling and relieve pain. Do not apply ice directly to the skin – wrap ice in a towel or cloth. • Feeling faint or being short of breath could be signs of shock. Lay the person down with their feet elevated if possible.

Burns

Burns are categorized by their severity, ranging from first or second degree to third degree. A first degree burn is the least serious of the three and only involves the outer layer of skin. First degree burns cause the skin to appear red and may involve swelling and pain. An example would be a sun burn. Second degree burns occur when the first layer of skin has been burned through, causing the second layer of skin to be burned. In this case, blisters will develop and the skin will appear very red and splotchy, accompanied by severe pain and swelling. These burns can occur from sun exposure or contact with ovens, irons, BBQ grills or fireworks. A third degree burn is the most serious category, involving all layers of the skin and possibly muscle and bone. A third degree burn causes the skin to appear charred black or dry and white and results in permanent tissue damage.

Treating minor burns:

• Cool the burn by holding it under cold running water, submerging it in cold water or applying cold compresses. • Keep the burn covered with loosely tied soft gauze. • Use an over-the-counter pain reliever to alleviate pain. Do not apply ice directly to the burned area as this could further damage the skin.

Treating major burns: • Seek emergency medical care • Do not remove burned clothing

• Do not submerge large, severe burns in cold water • Ensure that the person is breathing and that circulation is flowing • If possible, elevate the burned portion of the body above the level of the heart • Cover the burned area with a cool, moist bandage Chemical Burns Chemical burns can occur when strong acids or alkalies come in contact with the skin and/or the eyes. Caring for chemical burns: 1. Rinse exposed area with running water for 20 minutes; a hose is preferable but you may use a shower or faucet. 2. Carefully remove the contaminated clothing, making sure not to touch the unaffected skin with the contaminated clothing. Cut clothing away, if necessary. 3. If the chemical has splashed into your child's eyes, begin rinsing his/her eyes immediately and continue doing so until medical help has arrived. If your child wears contact lenses, try to remove them. 4. Cover the burned area loosely with a dry, clean cloth. 5. If the chemical your child has been exposed to is a dry or powdered chemical, it may not be necessary to rinse the area with water. Instead of rinsing, gingerly wipe the powder from the skin and check the package enclosure for emergency advice. 6. Seek medical attention or dial 911 for emergency medical attention. Heat or Thermal Burns A heat-induced or thermal burn can occur when the skin comes in contact with any heat source, such as a cooking pan, an iron, a fire, a hot surface or a hot, scalding liquid. Caring for a heat-induced or thermal burn: 1. Remove the child from the heat source. 2. Cool the affected area with cold water or cold compresses until pain is reduced or alleviated. 3. If a blister has formed, do not break it. 4. Protect the burn with a dry, sterile, gauze bandage or with a clean bed sheet or cloth. 5. If your child's clothing is stuck to the burned area, do not attempt to remove it. Instead, cut around the clothing leaving the burn intact. 6. Do not apply any ointments, oils, or sprays to the burned area. 7. If the burn is serious, seek medical attention or dial 911 for emergency medical attention.

Head Injuries More than half a million people are hospitalized each year as a result of severe head injuries. These can be caused by anything from slipping on ice (and hitting your head) to car or sporting accidents.

Seek emergency care if:

• There is loss of consciousness • The person is confused, drowsy or lethargic or becomes restless, clumsy or loses coordination • There is severe head or facial bleeding • The person is on blood thinning medications, such as Plavix or Coumadin/Warfarin • The person stops breathing • The person experiences convulsions • The person’s pupil’s change in size or there is blurred vision • There are personality changes or unusual behavior

Choking

Choking is an emergency. Call 911 emergency medical services. Do not attempt to drive a choking person to a hospital emergency department. What to do if a person starts to choke: •

It is best not to do anything if the person is coughing forcefully and not turning a bluish color. Ask, "Are you choking?" If the person is able to answer you by speaking, it is a partial airway obstruction. Stay with the person and encourage him or her to cough until the obstruction is cleared.

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Do not give the person anything to drink because fluids may take up space needed for the passage of air. • Someone who cannot answer by speaking and can only nod the head has a complete airway obstruction and needs emergency help. The American Heart Association recommends the following: • The treatment for a choking person who begins to turn blue or stops breathing varies with the person's age. In adults and children older than one year of age, abdominal thrusts (formerly referred to as the "Heimlich maneuver") should be attempted. This is a thrust that creates an artificial cough. It may be forceful enough to clear the airway. • The quick, upward abdominal thrusts force the diaphragm upward very suddenly, making the chest cavity smaller. This has the effect of rapidly compressing the lungs and forcing air out. The rush of air out will force out whatever is causing the person to choke. • How to perform abdominal thrusts Lean the person forward slightly and stand behind him or her. Make a fist with one hand. Put your arms around the person and grasp your fist with your other hand in the midline just below the ribs. Make a quick, hard movement inward and upward in an attempt to assist the person in coughing up the object. This maneuver should be repeated until the person is able to breathe or loses consciousness. (See diagram below.)

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If the person loses consciousness gently lay him or her flat on their back on the floor. To clear the airway, kneel next to the person and put the heel of your hand against the middle of the abdomen, just below the ribs. Place your other hand on top and press inward

and upward five times with both hands. If the airway clears and the person is still unresponsive, begin CPR. • For babies (younger than one year of age), the child will be too small for abdominal thrusts to be successful. Instead, the infant should be picked up and five back blows should be administered, followed by five chest thrusts. Be careful to hold the infant with the head angled down to let gravity assist with clearing the airway. Also be careful to support the infant's head. If the infant turns blue or becomes unresponsive, CPR should be administered. • If you are in doubt about what to do, and you are witnessing someone choking, call for emergency help immediately, do not delay. You may be able to successfully stop the choking before help arrives using techniques discussed here, but it is best for the choking person to be evaluated by the emergency medical team when they arrive. If something is still in the person's throat, the emergency medical team can begin care immediately and take the person to the hospital for further treatment. • Variations of abdominal thrusts for special circumstances: • The victim is seated: The maneuver may be performed with the victim seated. In this instance, the back of the chair acts as a support for the victim. The rescuer still wraps his or her arms around the victim and proceeds as described above. The rescuer will often have to kneel down. In the event that the back of the chair the victim is sitting in is too high, either stand the victim up or rotate the victim 90 degrees, so that the back of the chair is now to one side of the victim. • For small rescuers and large victims, particularly children rescuing an adult: Instead of standing behind the victim, have the victim lie down on his or her back. Straddle the victim's waist. Place one hand on the belly, halfway between the belly button and the edge of the breastbone. Thrust inward and upward. This is the same technique used in unconscious people. You are choking and you are alone: You may deliver an abdominal thrust on yourself. This can be done in one of two ways. •

You can deliver a true "self"-abdominal thrust with your own hands. This is done by positioning your hands in the same fashion as if you were performing the maneuver on another person and delivering an inward and upward thrust. Another option is to bend your belly over a firm object, such as the back of a chair, and thrust yourself into the object. You may pass out before you expel the object and before help arrives. In most communities, the 911 emergency system has what is known as enhanced 911. Whenever a call is placed through 911 to the dispatch center, the dispatcher has the phone number, address of the telephone, and owner of the line of the incoming call. This allows for rapid location of an incident and allows interrupted calls to be investigated. By dialing 911 and leaving the phone line open in communities where this protocol is followed, you could be ensuring the arrival of rescue personnel in the event your "self"abdominal thrust fails to clear the foreign body and you do pass out. If the dispatcher has no response on an open line, the call must be investigated. Check with your local police department and find out if your 911 dispatch center follows these procedures. If you live in a community that does not have a 911 system, check with your local police department both for the emergency number, and to find out if they follow these procedures. Pregnant/obese people: Abdominal thrusts may not be effective in people who are in the later stages of pregnancy or who are obese. In these instances, chest thrusts can be administered. For the conscious person sitting or standing, take the following steps: 1. Place your hands under the victim's armpits. 2. Wrap your arms around the victim's chest. 3. Place the thumb side of your fist on the middle of the breastbone.

4. Grab your fist with your other hand and thrust backward. Continue this until the object is expelled or until the person becomes unconscious. For the unconscious pregnant or obese person: The sequence of events is the same as those for an unconscious adult. Chest thrusts, rather than abdominal thrusts, are delivered. To position yourself for chest thrusts, take the following steps: 1. Kneel on one side of the victim. 2. Slide two fingers up the bottom edge of the rib cage until you reach the bottom edge of the breastbone called the xiphoid process. 3. With your two fingers on the xiphoid, place your other hand on the breastbone, just above your fingers. The thrusts should be quick and forceful to remove the object. 4. Care should be taken because complications such as rib fractures and heart muscle damage have been known to occur with chest thrusts. 5. If at all possible, subdiaphragmatic (below the ribcage) abdominal thrusts should be used in the pregnant woman, especially if there is still room between the enlarging uterus and baby, and the rib cage to perform the maneuver. The American Red Cross recommends the following first aid for the conscious choking adult: Have someone call 9-1-1. 1. Obtain consent from the victim. 2. Lean the person forward and give 5 black blows with the heel of your hand. 3. Give 5 quick, upward abdominal thrusts. (NOTE: You can give yourself abdominal thrusts by using your hands, just as you would do to another person, or lean over and press your abdomen against any firm object such as the back of a chair.) 4. Continue alternating back blows and abdominal thrusts until: 5. The obstructing object is forced out. 6. The person can breathe or cough forcefully. 7. The person becomes unconscious. What to do next: If the victim becomes unconscious, call 9-1-1, if not already done, and follow the steps for an unconscious choking adult below. The American Red Cross recommends the following for the unconscious choking adult: Try 2 rescue breaths. (If available, use protective barrier airway, resuscitation mask or face shield. The American Red Cross recommends that rescue breaths should not be delayed because you do not have a barrier or do not know how to use one). To give a rescue breath: 1. Tilt the head and lift the chin, then pinch the nose shut. 2. Take a breath and make a complete seal over the person's mouth. 3. Blow in to make the chest clearly rise. (TIP: Each rescue breath should last about 1 second.) 4. If breaths do not go in, tilt the head farther back. Try 2 rescue breaths again. 5. If the chest does not rise - give 30 chest compressions. (TIP: Remove breathing barrier when giving chest compressions.) To give a chest compression: 1. Place two hands in center of the chest (on lower half of sternum). 2. Compress 1-1/2 to 2 inches. 3. Compress 30 times in about 18 seconds (100 compressions per minute). 4. Look for an object in the airway. 5. Remove if one is seen. 6. Try 2 rescue breaths. 7. Repeat until EMS responders arrive or the obstruction is removed and the patient begins to breathe on his or her own.

POISONING Poisoning can be caused by swallowing, injecting, breathing in, or being exposed to a poisonous substance.

CONSIDERATION It is important to note that the absence of a warning on a package label does not necessarily mean that the product is safe. Suspect poisoning if someone suddenly becomes sick for no apparent reason. Symptoms of poisoning can take time to develop. However, do not wait until symptoms develop. Get medical help immediately. Suspect inhalation poisoning if the victim is found near a furnace, a car, a fire, or in an area that is not well ventilated.

CAUSES • • • • • • • • • • • • •

medicines household detergents insecticides paints (swallowing) cosmetics gaseous poisoning food poisoning exposure to the toxic substances produced by some animals, e.g: spiders and starfish. drug overdose (accidental or intentional)

SYMPTOMS Symptoms vary according to the poison but may include • #"bluish lips • #"abdominal pain • #"chest pain • #"chills • #"cough • #"depression • #"diarrhea • #"dizziness • #"double vision • #"drowsiness • #"fever • #"headache • #"heart palpitations • #"irritability • #"loss of appetite • #"loss of bladder control • #"muscle twitching

• • • • • • • • •

#"nausea and vomiting #"seizures #"shortness of breath #"skin rash or burns #"stupor #"unconsciousness #"unusual breath odor #"weakness #"numbness and dryness of nose or mouth

DO NOT give an unconscious victim anything by mouth. DO NOT induce vomiting unless you are told to do so by the Pusat Racun Negara (PRN)/ National Poison Center (Tel : 04 – 6570099) or a doctor. A strong poison that burns on the way down the throat will also do damage on the way back up. DO NOT try to neutralize the poison with lemon juice or vinegar, or any other substance unless you are told to do so by the Poison Control Center or a doctor. [ EMERGENCY MEDICAL CARE ] 3 DO NOT use inappropriate type of antidote. DO NOT wait for symptoms to develop if you suspect that someone has been poisoned.

FIRST AID FOR SWALLOWED POISONS: 1. Check the victim's airway, breathing, and circulation. If necessary, begin rescue breathing and CPR. Try to make sure that the victim has indeed been poisoned. It is not always obvious. Some signs include chemical-smelling breath, burns around the mouth, difficulty in breathing, vomiting or unusual odors on the victim. If possible, identify the poison. 2. Call your local poison control center. 3. Only induce vomiting if the poison control center tells you to do so. 4. To induce vomiting give the victim 1 tablespoon of ipecac syrup followed 2 glasses of water. Another technique is to use a glass of warm water containing 3 teaspoons of salt or 1 spoonful of dried mustard. 5. If the victim vomits, protect the airway. If you must clear the victim's airway, wrap a cloth around your fingers before cleaning out his or her mouth and throat. 6. Monitor the victim's vital signs (temperature, pulse, rate of breathing, blood pressure). If the victim starts having convulsions, protect him or her from injury and give first aid. 7. Reassure the victim and keep him or her comfortable while getting or awaiting medical help. If the poison has spilled on the victim's clothes, remove the clothing and flush the skin with water. FOR INHALED POISONS: 1. Call for emergency help. Never attempt to rescue without notifying others first. 2. Rescue the victim from the danger of the gas, fumes, or smoke. Hold a wet cloth over your nose and mouth. Open windows and doors to remove the

fumes. 3. Avoid lighting a match as some gases may ignite. 4. Take several deep breaths of fresh air, then hold your breath as you go in. 5. After rescuing the victim from danger, check his or her airway, breathing, and circulation. If necessary, perform rescue breathing and CPR. 6. As necessary, perform first aid for skin burns, eye injuries (eye emergencies), or convulsions (convulsion, first aid). 7. If the victim vomits, protect his or her airway. 8. Even if the victim seems perfectly fine, get medical help.

PREVENTION • • • • • • • • • •

Be aware of poisons in and around your home. Take steps to protect young children from toxic substances. Be familiar with plants in your home, yard, and vicinity. Keep your children informed too. Remove any noxious plants. If you are concerned that industrial poisons might be polluting nearby land or water, report your concerns to the local health department. Most any non-food substance is poisonous if taken in large doses. Teach children about the dangers of substances that contain poison. Label all poisons. Keep all your prescription and non-prescription drugs stored out of the reach of children. Don't store household chemicals in food containers, even if they are labelled.