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What To Do in a Medical Emergency

MEDICAL EMERGENCIES WHAT YOU NEED TO KNOW FROM AMERICA’S EMEGENCY PHYSICIANS

www.EmergencyCareForYou.org What To Do in a Medical Emergency

At what point does a fever or stomach ache become a med- ical emergency? If you slice your finger with a knife, or you are having the worst headache you’ve ever had, should you seek emergency care? How do you know?

The following information from the nation's emergency physicians will help you identify the signs and symptoms of emergency conditions. However, emergency physicians will tell you — if you think you are having a medical emer- gency, seek emergency care right away. Better safe, than sorry. Too many people, such as men with chest pain, wait too long to seek care.

The advice in this publication is about how to handle com- mon emergency medical conditions. It does not contain all the signs or symptoms of medical emergencies, and the advice is not intended to be a substitute for consulting with a medical professional. If you think you are experiencing a medical emergency, seek immediate medical attention.

www.EmergencyCareForYou.org

2 TABLE OF CONTENTS 3 Contents PainAbdominal ...... 4 and ...... 4Asthma ...... 8 Drug ReactionsAdverse ...... 9 and StingsBites ...... 9 Bones...... 14Broken ...... 15 Choking...... 16 Colds and Flu ...... 18 Cuts and Abrasions ...... 19 Diabetic Emergencies...... 20 ...... 21 Earaches and Ear ...... 22 Electrical /Shock ...... 24 and Emergencies ...... 24 Fainting...... 25 Fever ...... 25 Poisoning...... 27 Food in Nose or Ears Bodies Foreign ...... 28 Headache ...... 28 ...... 29 Heart Attack ...... 30 Illnesses...... 31 Heat-Related / ...... 32 Neck or Back Injury ...... 32 Nosebleeds ...... 33 Poisoning...... 33 WoundsPuncture ...... 34 Rashes...... 35 Seizures...... 35 Shock...... 36 Throat...... 37Sore Sprains and Strains ...... 37 Stroke...... 38 Suicide...... 38 Sunburn...... 40 (Dental Emergencies)Teeth ...... 41 and Diarrhea...... 41 Vomiting Notes...... 42 • Symptoms of acute pancreatitis usually include Abdominal Pain pain in the middle upper abdomen that may last for a few days. The pain may become severe Abdominal or belly pain can have many causes. It may be and constant, or it may be sudden and intense. due to food poisoning, an intestinal or gall bladder It may also begin as mild pain that gets worse obstruction, an or . It could also be when food is eaten. Other symptoms include appendicitis, a kidney stone or peptic ulcer disease. In nausea, a swollen and tender abdomen, fever women abdominal pain can result from an ectopic preg- and a rapid pulse. nancy, an ovarian cyst, pelvic inflammatory disease or other female disorders. In addition, some people with pneumonia, a bladder Asthma and Allergies infection or a heart attack experience abdominal pain. Although asthma and allergies are two separate condi- Acute abdominal pain can tions — asthma is a chronic disease of the bronchial air- also be caused by chronic tubes, whereas allergies involve an overreaction of the medical conditions, such body's disease-fighting immune system — the two condi- as pancreatitis; colitis, an

ABDOMINAL / ASTHMA AND ALLERGIES PAIN tions can be intertwined and often overlap. inflammation of the large intestine (colon); or diverti- For example, because most people with asthma also culitis, an inflammation of have allergies, asthma attacks (sometimes referred to as small out-pouchings along “exacerbations”) can be triggered by exposure to aller- the colon wall. gens, such as pollen, mold or dander. This type of asthma is known as allergic asthma, and it is one of sev- For mild abdominal pain, eral types of asthma. call your doctor first. If the pain is sudden, severe or In addition, asthma and certain allergic conditions, such does not ease within 30 as hay fever and peanut , share the potential to be minutes, seek emergency life threatening. Allergies can be life-threatening when medical care. they lead to anaphylaxis. Asthma can be fatal when a severe asthma attack does not respond to inhaled bron- Sudden abdominal pain is chodilators and leads to symptoms of respiratory failure. often an indicator of serious intra-abdominal disease, such as a perforated ulcer or a ruptured abdominal Finally, since many of the symptoms of asthma are the aneurysm, although it could also result from a benign dis- same as they are for allergies, physicians may use some ease, such as gallstones. of the same medications to treat both. Continuous, severe abdominal pain or abdominal Asthma pain accompanied by continuous vomiting may Asthma is a chronic lung disease that results in 1.8 mil- indicate a serious or life-threatening condition, emergency visits and about 4,000 each year. such as one of the types described below. There are several types of asthma, and although the dis- ease can be controlled, there is not yet a cure, which • Symptoms of appendicitis may include severe means that asthma patients must manage their condi- pain (usually in the lower right abdomen, but may tion on a daily basis. Moreover, it is estimated that about start anywhere in the abdomen), loss of appetite, half of asthma sufferers do not have their condition under nausea, vomiting or fever. Treatment generally control, making it more likely that these patients will end requires urgent surgical removal of the appendix. up in an emergency department as a result of an asthma Long delays in treatment can cause serious com- attack. When poorly controlled, asthma is potentially life- plications resulting from perforation (rupture) of the appendix, which can lead to a life-threatening threatening. infection. The characteristics of asthma include inflammation • Symptoms of an ectopic pregnancy include severe (swelling and irritation) of the airways and bronchocon- abdominal pain and vaginal . In an striction (tightening of the muscles surrounding the air- ectopic pregnancy, a fertilized egg has implanted ways). Often worse at night, these problems shrink the outside of the normal site in the “womb” or uterus, such as in the fallopian tubes. airways, making it more difficult to breathe.

4 ASTHMA AND ALLERGIES 5

Asthma patients should go to the emer- the go to should patients Asthma severe departmentgency have if they if these especially symptoms, asthma severe by accompanied are symptoms panting, faintness, nausea, sweating, cold, moist and pale, rate, rapid pulse shock or a be signs of may skin. (These in blood drop life-threatening potentially be experi- patients may These pressure.) fatal asthma attack. encing a potentially

experienced even while lying in bed even experienced inhaler rescue usually effective in persons with dark complexions) breath without pausing for a sentence concentrate to breathe and neck muscles or sitting or standing to easily more • Persistent shortness• Persistent or breathlessness of breath a by • An asthma attack relieved is not that turning blue (or gray are • Lips or fingernails complete or the inability to breathe • Straining to of chest tightness • A feeling of agitation, confusion or an inability • Feelings • Hunching of shoulders, straining of abdominal Seek immediate medical attention for the following for medical attention Seek immediate with this associated signs and warning symptoms condition: life-threatening potentially These are all signs of impending fail- respiratory system all signs of impending These are also that fatal fatal condition. Be aware a potentially ure, signals, and warning asthma attacks often occur with few asphyxi- rapidly to leading can come on quickly, that they common more asthma attacks are ation and . Fatal or of allergens poor control among persons who have and an infre- in their daily environments asthma triggers history and inhalers monitors as quent of using peak flow their asthma. aids in controlling severe, that extremely it is important note to Finally, more feature not fatal asthma attacks may potentially wheezing and coughing - thus making such symptoms of asthma attacks. In in judging the severity unreliable become so have airways such cases, the breathing enough air going in and out of is not that there restricted cause wheezing or coughing. (In addition, the lungs to health conditions, wheezing also can be a sign of other and heartsuch as respiratory infection so it is failure, if these other medical attention important seek prompt to suspected.) serious conditions are Asthma is a management. chronic condition chronic

that requires daily requires that { } { to breathe properly breathe to everyday activities everyday more than twice a week than more and/or coughing • Difficulty breathing • Tightness in the chest • Coughing and wheezing • Requiring emergency or urgent care in in order care or urgent emergency • Requiring • Missing school or work • Missing school participate• Being unable to in • Requiring a quick-relief inhaler a quick-relief • Requiring • Waking at night wheezing at night wheezing • Waking The symptoms of asthma include: The symptoms The often-missed warning signs of signs often-missedThe warning are: asthma controlled poorly Asthma attacks that appear to be severe or that do not be severe Asthma attacks that appear to imme- normal medication require the patient’s to respond attacks Less serious or an medical attention. diate of asthma attacks should be evalu- frequency increasing In some cases, the patient one’s doctor. a visit to by ated - such specialist seek the advice of an asthma care may as an allergist or pulmonologist. Respiratory infections, such as the common cold or flu, such as the common infections, Respiratory (which is of asthma exacerbations, common triggers are a flu shot get to advised persons with asthma are why Other trig- becomes available). each fall when the vaccine laughing or crying cold air hard, include exercise, gers (e.g., Code Red and irritants, such as poor air quality in the summer), chemicals, smoke, ozone pollution days perfume also can Some allergens and air fresheners. include serve Common inhaled allergens triggers. as dust, pollen, mold or animal dander. Emergency department treatment of asthma typically • Abdominal pain, cramping includes , inhaled bronchodilators (such as • Panting albuterol), and systemic corticosteroids (such as pred- ALLERGIES nisone). Long-term asthma treatment includes inflamma- • Rapid or weak pulse rate tion “controllers,” such as inhaled corticosteroids, and • Pale, cold, moist skin or skin redness symptom ”relievers” such as inhaled bronchodilators. • Blueness of skin, including lips or nail beds (or grayish for darker complexions) Since the key to preventing asthma attacks is controlling them, it is important to seek out proper medical care, • Loss of consciousness take medication as directed and become educated as to To help prevent the need for emergency care how best to avoid previously described “asthma triggers.” for allergy attacks, you can take the following preventive measures: Allergies Allergies involve an overreaction of the body's immune • Visit your physician regularly. The continuing system, which is responsible for fighting infections. There advice of a doctor is crucial to the long-term treatment of allergic conditions. Your physician are many types of allergies, including seasonal allergies may refer you to a medical specialist, known as (which involve allergic reactions to pollens, grasses and an allergist/immunologist, who has received weeds), perennial allergies (which last for 9 or more special training in diagnosing and treating allergic months out of the year), chronic allergies (to allergens diseases. This type of specialist can recommend such as dust and mold), food allergies, medicine aller- certain drug therapies or desensitization treatments gies, insect allergies, and animal allergies, among (also known as “allergy shots”). others. In addition, some people develop a potentially life- • Know your allergies. If you and your physician threatening allergy to latex, which is found in rubber suspect you have allergies, you may be tested to gloves, while others can become “sensitized” to sub- determine what is triggering your symptoms. stances they have been repeatedly exposed to at work, a condition known as “occupational allergy.” • Avoid allergens. Once you know what you are allergic to, avoid the allergen. For example: Allergic responses range from mild to life threatening. — If you are allergic to , don't eat it; your first Common mildly annoying allergy symptoms include reaction may be mild but additional exposures can sneezing, congestion, runny nose, watery , headache quickly lead to life-threatening reactions. and fatigue. However, exposure to some allergens, such — If make you break out in hives, don't pet them as peanuts, shellfish, insect stings, medications, and or keep them in your home. latex can quickly progress to severe life-threatening reac- — If you are allergic to insect venom, take precautions tions or anaphylaxis. when going out of doors, particularly at certain times of year when such insects are more For that reason, seek emergency care right away if you prevalent or aggressive, or when picnicking or in wooded environments. Persons with insect-venom experience a mix of some of the following symptoms: allergies should also carry self-injectable epineph- • Difficulty breathing rine (EpiPen or TwinJect), diphenihydramine or a bee-sting kit (per a health provider's instructions); • Wheezing (along with high-pitched breathing injectable epinephrine should be used only on the sounds) person for whom it has been prescribed. • Confusion — If you are allergic to pollen or mold, avoid the outdoors on windy days or when you begin to • , fear, apprehension notice symptoms. The wind often stirs up pollen • Slurred speech and mold and carries it through the air. Also, don't hang laundry out to dry. Pollen and molds can • Swelling of the face, eyes, tongue or extremities collect on sheets and clothing And minimize activity outdoors at dawn (5 a.m. to 10 a.m.) • Trouble swallowing when pollen is usually emitted into the air. • Severe sweating — To minimize exposure to outdoor allergens, keep • Faintness, lightheadedness, dizziness car windows closed when you drive, and consider using air conditioning when your seasonal allergy • Heart palpitations (feeling one's heart beat) symptoms are at their worst, both in your car and at home (provided the system is regularly cleaned • Nausea and vomiting and maintained and filters are frequently • Diarrhea changed).

6 ALLERGIES

— If you are allergic to grass or molds, do not cut your grass and avoid the outdoors when others are mowing their lawns. — If you are allergic to mold (or have an allergic asth- matic reaction to it) and experience heightened allergic symptoms in your everyday home or work environment, consider hiring someone to investi- gate and address the problem. (Do not attempt to remove moldy insulation and other items from your home yourself; doing so can cause an intense allergic reaction.) Additional Precautions and Prevention People with allergies and asthma, which are often related, should always carry medications with them and ask their doctors about wearing medical alert bracelets or jewelry. (The MedicAlert® Foundation sells medical identification bracelets on their website at www.medicalert.org.)

More specifically, individuals with asthma should always carry a quick-relief inhaler (bronchodilator), such as albuterol, and avoid known asthma triggers when possi- ble. Individuals at risk of anaphylaxis, for whom a doctor over-the-counter medication, make sure you have has prescribed self-injectable epinephrine (such as an used it before and that it is effective. EpiPen or TwinJect), should carry it at all times and know how to use it in an emergency. Show your family and • If using a nebulizer for delivering anti-asthma friends how to use it on you as well. medication, don't forget to take it on vacation, along with an electrical current converter for it if Persons with allergic asthma and traveling abroad; portable nebulizers that are plugged into auto cigarette related allergies should avoid expo- If your doctor has lighter receptacles are also available. sure to pollution from poor air quality prescribed an epi pen, or tobacco smoke. If you live in a city • If your doctor requests that you use that measures and forecasts air qual- carry it with you at all a peak flow meter and record chart, ity, stay indoors as much as possible times and know how to be sure to take these items with you. when the forecast is poor (e.g., “Code use it in an emergency. • Bring your allergy-proof pillow or bed- Red,” Code Orange”). If you are prone { } ding to guard against dust mites. to exercise-induced asthma, be aware • If staying in a hotel or bed and breakfast, check of your limitations, especially if you do strenuous activity ahead of time to find out whether perfumed air in polluted or high-pollen areas (e.g., places that have a fresheners, deodorizers or other scented products lot of trees, grass, weeds). will be used. (Scented carpet cleaning agents also may be a problem.) Injectable epinephrine should not be used on persons • In hotels, ask for a nonsmoking room, preferably other than the person for whom it has been prescribed on a nonsmoking floor. (e.g., asthmatics or persons allergic to insect venom). Some people may have underlying health conditions that • If sensitive to mold, call ahead to determine could be adversely affected by this drug. whether this might be a problem, particularly if you are staying in a cabin or a beach bungalow. If driving, check your vehicle for mold and mildew Preventing Attacks While Traveling problems, and if camping, check tents and other • Take all necessary medications with you in their mold-prone items. original prescription bottles, in case you need to • If sensitive to sulfites, when eating out check with refill prescriptions while away. Pack extra quanti- the restaurant staff to find out whether this addi- ties of medications to make sure you don't run out. tive has been used as a food preservative. If so, Do not pack medications in checked luggage in ask if your meals can be prepared without it. case your luggage is lost; keep it in a carry-on bag. (Sulfites are commonly used as a preservative • Carry topical cream and antihista- in wine, dried fruits and dried potato products. mine medication with you - if you are using an They also occur naturally in wine.)

7 • If food allergies are a significant problem, pack • Difficulty swallowing snacks at home you can eat while traveling - in case • Swelling of the tongue, throat and nasal you find yourself without access to “safe” foods. passages (nasal and throat congestion) • If allergic to pollens (e.g., trees, grass, weeds),

ANAPHYLAXIS • Localized edema (or swelling), especially check the pollen counts in the area you are involving the face traveling to by calling the local Chamber of Commerce or the National Allergy Bureau at • Itchiness and redness on the skin, lips, 1-800-9-POLLEN. Also, call 1-800-7-ASTHMA for eyelids or other areas of the body local support group contacts who may be able • Skin eruptions and large welts or hives to offer useful local information. • Skin redness • Check with your insurer on coverage limitations and policies regarding out-of-state or out-of-net- • Bluish skin color, especially the lips or nail work coverage. beds (or grayish in darker complexions) • Nausea, stomach cramping, vomiting/diarrhea Anaphylaxis • Heart palpitations (feeling the heart beating) • Weak and rapid pulse Anaphylaxis is a severe, life-threatening, multisystemic • Drop in blood pressure allergic reaction that is triggered by common substances, • Dizziness, fainting or loss of consciousness, such as foods, insect stings, medications and latex. which can lead to shock and heart failure.

About half of all anaphylaxis episodes are caused by such foods as peanuts, tree nuts (e.g., walnuts, pecans, What To Do: almonds and cashews), , shellfish, cow's milk and • If the person is having anaphylaxis, call 911 eggs. Bees, wasps, hornets, yellow jackets and fire ants immediately. are the cause of about 500,000 allergy-related emer- • If the person is unconscious, lay him or her gency visits and at least 50 deaths each year. flat and elevate the feet. Medications can cause anaphylaxis, particularly drugs in the penicillin family. Other commonly used medications • If available, administer self-injectable epinephrine and pain relievers that can trigger anaphylaxis include (e.g., EpiPen, TwinJect), which should be carried by aspirin, ibuprofen, anesthetics and . People all persons who know they are at risk for anaphy- laxis. (Under new American Heart Association and who have had one or more previously mild episodes of American Red Cross first-aid guidelines, first-aid anaphylaxis may be at risk for more severe future providers may help victims who are experiencing episodes. Repeat exposure to allergens, such as latex, a bad anaphylactic reaction use a prescribed may also increase the risk of developing anaphylaxis. epinephrine auto-injector - as long as the first-aid provider is trained to do so, the state law allows it Anaphylaxis symptoms can develop quickly, in some and the victim is unable to self-administer the epi- cases within minutes or hours after exposure to an aller- nephrine.) Also, check for a medical tag, bracelet gen. In some cases, the symptoms can abate and then or necklace that may identify anaphylactic triggers. return hours later. The most dangerous symptoms of ana- • Friends, family and caregivers of children with phylaxis affect the respiratory system (breathing) and/or allergies should be given a list of the child's cardiovascular system (heart and blood pressure). emergency contacts and allergy triggers, and a plan for dealing with an allergic emergency. • Persons who have experienced anaphylaxis Specific symptoms may include: should consider seeing an allergist (especially • Difficulty breathing due to narrowing of if they are not sure what caused it). An allergist airways and swelling of the throat consultation will help identify potential causes and develop a plan of action for safeguarding • Wheezing or coughing individuals against possible future episodes. Family • Unusual (high-pitched) breathing sounds members and friends should also be educated. • Confusion • If the cause of the anaphylaxis - such as a particular medication - has been identified, • Anxiety that substance should be avoided in the future. • Slurred speech

8 ADVERSE DRUG REACTIONS / BITES AND STINGS Adverse Drug Reactions Bites and Stings

Many drugs cause side effects, and certain medicines can Most bites and stings are easily treatable and non-threat- trigger life-threatening reactions - allergic and non-allergic ening. However, some insects, , - and even - in some people. Some medicines also interact with other humans - can bite or break the skin and potentially intro- medications and cause adverse drug reactions. People duce disease into your body. who take three or four medications each day are more like- ly to have reactions to drugs. In addition, the use of herbal Animal Bites supplements and alternative medicines, such as St. Animal bites can be frightening, and in some cases, are John's Wort, can interact with certain drugs and cause medical emergencies. The most common in health problems. the is from household pets, with and cats causing the most . bites and scratches Adverse drug reactions are especially prone to infection. Human or animal bites can occur within min- can become infected or transmit illnesses such as . utes or within hours of A tetanus shot may be required if you have not had one exposure. They are a within 10 years; if you are not sure when you had your last leading cause of death tetanus shot, and you’ve been bitten, you should get one in the United States, within 72 hours after your injury. resulting in more than 100,000 deaths each If bitten, but the bleeding is minor, cleanse and treat the year. as you would a minor wound. Wash the area thor- oughly with soap and water, apply an ointment The most common symptoms of allergic (unless the person has allergies or sensitivities to antibi- reactions to drugs are: otics) and cover with a clean bandage. • Skin rash or hives If the bite creates a deep puncture or the skin is badly • Itchy skin torn and bleeding, apply direct pressure to stop the bleed- • Wheezing or other breathing problems ing and get medical attention right away. If you develop a fever or other signs of infection - swelling, redness, pain, • Swelling a bad smell or fluid draining from the area - see a physi- • Diarrhea or constipation cian immediately. The most common drug that can cause problems is peni- cillin. Antibiotics, sulfa drugs, barbiturates, and insulin If an animal acts strangely and bites you, go to an emer- also can cause adverse drug reactions. Some medicines gency department or see your doctor immediately, trigger a response from the immune system in people because the animal may have rabies. This is especially with drug . The body's immune system true for , , and foxes. If possible, cap- perceives the substance as attacking the body, so it ture the animal, if it is safe to do so, so it can be checked attacks the system. for rabies, which is fatal in humans if left untreated. If the animal is dead, wear gloves or use a shovel More than 90 percent of adverse drug reactions do not to move it into a plastic involve an allergic immune system response. Instead, bag. Do not damage these reactions may produce a range of symptoms involv- the animal's head, ing virtually any system or part of the body - which often since rabies testing is makes them difficult to recognize. done on the brain, and do not freeze the animal. Reactions to drugs may range from mild, such as upset Clean the area and any stomach or drowsiness, to severe, life-threatening condi- tools used to remove the tions, such as anaphylaxis. These reactions can occur animal with a bleach solu- with prescription medications, over-the-counter medica- tion. Some people avoid seek- tions and supplements or herbal remedies. ing treatment, because they fear it will involve a series of Always tell your doctor if you have adverse reactions to painful shots to the abdomen. medications and wear an identifying bracelet or jewelry This used to be true, but a sim- such as a MedicAlert® bracelet. pler, less painful treatment is now involved.

9 Strange animal behavior may be a sign of rabies and typ- If a bite or sting wound remains or worsens over several ically includes an unprovoked attack. For example, if nor- days, seek medical treatment for possible infection. Get mally shy nocturnal (night) bite during the day, immediate medical attention if you have been bitten or they may be infected. Rabies is rare in dogs, cats, rodents stung and you exhibit signs of an extreme allergic reac- and plant-eating animals. Other signs of rabies in animals tion or anaphylaxis. include drooling, running in circles, appearing paralyzed BITES AND STINGS or exhibiting unusual or aggressive behaviors. Symptoms of an allergic reaction include: • Hives, itching or rash at the site or even away To prevent children from getting animal bites, from the bite area including from those that may have rabies: • Swollen lips or eyelids • Teach children to avoid unfamiliar animals, particularly wild animals, and to understand that • Swelling of the throat any animal may bite when it is frightened, ill or • Difficult or noisy breathing (wheezing) injured. Even pets that are normally friendly may bite when startled by sudden noises or motions, • Loss of consciousness or disturbed when sleeping or eating. While it's nearly impossible to prevent all insect • Never leave young children unattended with animals. bites and stings, these are steps you can take to minimize the risks: • Make sure your child has had a tetanus shot. • Use insect repellent. Repellents with DEET are effective in preventing bites by mosquitoes, ticks, Insect Stings fleas, chiggers, and flies. Repellents for Most people have mild reactions to insect bites, but some children should contain no more than 10 percent have severe allergic reasons that require emergency DEET. Do not use DEET on babies. treatment. In addition, some insects carry disease, such • Don't use scented soaps, perfumes, hair sprays, as West Nile Virus or encephalitis, although this is rare. or sunscreens, which can attract bugs. Insect bites or stings that cause severe pain and swelling • Avoid going outdoors during peak hours when at the site of the bite, a generalized rash or any swelling insects are out - dusk and dawn. of the face or difficulty breathing, require immediate med- • Avoid areas where insects nest or gather, such ical evaluation. as stagnant pools of water, garbage cans, and orchards and gardens where flowers are in bloom. If you are stung by an insect, such as a bee, • Don't leave food, drinks, or garbage out and treat the area by: uncovered. • Removing the . Scrape or flick it out with • When outdoors in wooded, floral or grassy areas, something stiff like a credit card, or even grasp or in areas infested with ticks or mosquitoes, it with tweezers and pull it straight out, to avoid wear long-sleeved shirts and pants and protective squeezing more venom into the wound. shoes. Dress in light colors, if possible (so insects • Washing the wound with soap and water. will be easier to detect) and avoid dressing in bright colors or flowery prints, which attract some • Using cold compresses or ice to help reduce insects. Don't wear baggy clothing, which can trap any swelling and relieve pain. bugs. • Monitoring for signs of severe allergic reaction. • Check yourself and your children for ticks after leaving infested areas. If you find one, and you know how to remove it, do so. If not, see “How to Remove a Tick.” • If you have removed a tick, keep an eye on the area and check for signs of or Rocky Mountain Spotted Fever, and call your physician if symptoms are present. • Children and adults who are highly allergic should wear medical identification bracelets, and adrenaline auto-injectors (epi pens) should be available at all times.

10 BITES AND STINGS

Spider Bites and Scorpion Stings Jellyfish and Stingray Stings Most are not dangerous. For most bites, wash the Most jellyfish stings are harmless and occur by accident wound with soap and water and apply an antibiotic ointment. when people come in contact with the . Some The bite may cause some irritation or itching, but should heal varieties of jellyfish are more poisonous than others, such in five to seven days. Some bites can lead to local skin infec- as the from Australia. Most stingray injuries tions, which are easily treated with antibiotics. require emergency care. To prevent injury, avoid swim- ming in areas where there are sightings of jellyfish or stingrays. Two of the most poisonous spiders in the The tentacles of a jellyfish release a poison that results in a skin eruption, in the form of a painful red rash that - United States are the es. The sting usually causes a sting mark, pain and black widow and the swelling, which may last several days to several weeks. Both jellyfish and stingray stings also can cause life- { brown recluse. } threatening shock and allergic reactions. The sting of a stingray causes a bleeding wound that may Two of the most poisonous spiders in become swollen and turn blue or red. It causes excruciat- the United States (more common in ing pain and can result in death. Severe symptoms may southern states) are the black widow include nausea, fever, muscle cramps, paralysis, elevated (which is shiny with a red hourglass marking on belly) and heart rate and seizures. the brown recluse (has a violin-shaped marking on top, and is about one-inch long). Always seek emergency care if you are bitten by one of these types of spiders.

Black widows release a when they bite that can damage the human . Reactions to a black widow bite can include pain at the bite site, nausea, severe abdominal pain or muscle cramping.

Venom from a brown recluse can cause tissue damage. Reactions from its bite may include fever, nausea, headache, burning, pain or itching, or a deep blue or pur- ple area around the bite, surrounded by a whitish ring and then a red ring (similar to a bull’s eye).

If you are bitten by either one of these poisonous spiders: If stung by a jellyfish or stingray: • Call 911 and explain what has happened. • Carefully remove any tentacles or still on the body. Make sure to cover your hand - do not • Wash the area with soap and water and cover directly touch the tentacles or you will be injured. with gauze and a cold pack. • Soak jellyfish stings in water or Scorpions in the United States typically are found in ( will increase pain and may release Arizona, New Mexico and in California. Scorpion stings more of the toxin). are most dangerous to the very young and the very old. If you are stung by a scorpion, you will feel immediate pain • Soak stingray stings in hot (but not scalding) water or burning. until the pain diminishes. • Wash and bandage. Scorpion stings usually occur at night. Stings may cause • For stingray stings, apply pressure to stop the bite marks, swelling and pain, which can be treated with bleeding. If necessary, and you are trained to medication. You also might apply ice to help with pain. do so, perform CPR. Seek immediate medical care for more serious symp- toms, such as nausea, vomiting, rise in blood pressure, • If an allergic or life-threatening reaction is observed, call 911 or your local emergency diarrhea, or allergic reactions. number immediately.

11 Bites Tick Bites (Lyme Disease and Snake bites can be life-threatening if the snake is poison- Rocky Mountain Spotted Fever) ous. Poisonous snakes found in the United States include Tick bites can cause Lyme disease or Rocky Mountain rattlesnakes, copperheads, cottonmouth water moc- spotted fever, which must be treated by a physician. Ticks casins and snakes. If you see a snake, do not touch cause 20,000 new cases of Lyme disease in the United it, but instead, back away from it slowly. States each year, especially in the northeast, mid-Atlantic BITES AND STINGS and north-central states. Visit the Centers for Disease If you are bitten, remember the color and shape of the Control and Prevention website and check their Lyme snake. This information will help medical providers Disease map to see how prevalent it is in your area: treat you. If you are walking in http://www.cdc.gov/ncidod/dvbid/lyme/ld_statistics.ht high water, and you are m. Several hundred to more than one thousand new not sure you have been cases of Rocky Mountain spotted fever are reported each bitten by a snake, year, although it is likely that many cases go unreported. look for a pair of puncture marks at Lyme Disease the wound and for Lyme disease is usually treated easily when caught redness and swelling, early enough. as well as severe pain. Early symptoms of Lyme disease usually appear If bitten by a pit viper (rattlesnake, copperhead, within a few weeks of infection and include: cottonmouth): • A bull's-eye-shaped rash - white in the center and • Call 911 or your local emergency number bright red on the outside; but this is not true in immediately. all cases. • Cleanse the wound, but do not try to cut around • Flu-like symptoms, such as a feeling of weakness the fang marks and suck out the venom. People or discomfort, sore throat, dry cough, stiff neck, who do this often do more damage than good. headache swollen glands and fatigue. • Immobilize the bitten area and keep it at the • Photosensitivity (light sensitivity to the eyes same level as the heart. Do not try to apply a or skin). tourniquet. Left untreated, Lyme disease • It's important for the victim to remain calm and may spread to the heart, move as little as possible. That will help prevent brain and nervous system. the spread of the poison through the body. Later-stage symptoms of • Do not apply ice or flush the wound with water. Lyme disease are more serious and can include: If bitten by an elapid snake (coral snake): • Arthritis, particularly in the knees, which can • Take an additional step of wrapping the area in an become chronic if the elastic roller bandage so that it is snug but not infection goes untreated tight; the point farthest from the heart should be wrapped first. • Severe headaches • Check the area for sensation, increased skin tem- • Abnormal heartbeats perature and redness before and after bandaging. • Bell's palsy (a condition that causes facial • Minor swelling and itching can be treated with muscles to weaken or become paralyzed) cool compresses, over-the-counter oral antihista- • Cognitive difficulties mines or hydrocortisone creams. Use only as directed. • Memory loss • Numbness and tingling or coordination problems If bitten by a snake, • Extreme fatigue do not try to suck out • Chronic or extreme muscle pain the venom or Rocky Mountain Spotted Fever apply a tourniquet. Rocky Mountain spotted fever is the most severe of the tick-borne illnesses. { Call 911 instead. } 12 BITES AND STINGS 13 bites is critical. bites mosquito Because there is no specificBecause there Virus infection, prevention of infection, prevention Virus treatment available for West Nile West for treatment available hands with soap and water. with soap hands as DEET (no more than 10 percent formula for formula percent than 10 as DEET (no more on infants under use for intended not children; months old) or natural oil of lemon eucalyptus two three) under age use on children for intended (not details on insect repel- and skin. For on clothing see www.cdc.gov/nci- guidelines lents and usage dod/dvbid/westnile/qa/insect_repellent.htm. inserting mosquito of standing water, sources larvae pellets in drains, maintaininggutters clean flowing. waters fountain and keeping shirts and pants. long-sleeve outdoors; wear active. more are mosquitoes out. mosquitoes keep to disease). prevent (precautionary to measure communities Many program. mosquito-control For management. practice integrated details, see www.beyondpesticides.org. ill - put in a sealable plastic bag in your freezer. bag in your a sealable plastic ill - put in { } { • After removal, disinfect the area and wash your wash and area the disinfect • After removal, become identification case you in the tick for • Save • When you are outside, use insect repellent such outside, use insect repellent are • When you draining by sites breeding mosquito • Eliminate are up as much as possible when you • Cover and sunrise, when sunset inside between • Stay on doors and windows screens • Install or repair hands bare with your birds handle dead • Never and support community's your • Investigate Mosquito Bites (West Nile Virus) (West Bites Mosquito Nile West in 1999, States First reported in the United appears It typically in the rapidly. Virus has since spread summer until fall. the virus infected, of those who become 20 percent For a public health illness. It is considered causes a mild, flu-like a potentially is a risk of contracting concern because there of cases. The percent in about one fatal brain infection 50 and age persons over for of the virus is greater severity compromised. are persons whose immune systems for which mosquitoes, by transmitted Nile Virus is West chance of becoming your reduce to means the best way bitten. getting avoid is to infected Here's how: tuck pants thing; and pets, and check their and do not crush the tick and do not in the skin. as possible. or bathe after potential exposure. or bathe after potential DEET (no more than a 10 percent formula for for formula percent a 10 than DEET (no more and skin. and none on babies), on clothing children, grasses, and, if hiking, stay on wide, clear trails. grasses, and, if hiking, stay into socks so that ticks will be easier to spot. that ticks will be easier to socks so into wooded areas or grasslands; wear a hat and or grasslands; wear areas wooded clo light-colored long-sleeved, detected, or if Lyme disease symptoms develop. develop. disease symptoms or if Lyme detected, with a tweezers (or between your fingertips your (or between if with a tweezers twisting the tick, Avoid available). not are tweezers cause its body parts embed- remain which may to ded underneath the skin, often causing infection. fur, ears and paws for ticks, which can drop off ticks, which can drop for ears and paws fur, upholstery. once inside and lurk in carpeting and • Pull outward with steady pressure. with steady • Pull outward twist, which can cause parts• Do not remain it to of • Use tweezers to grasp it as close to the skin grasp it as close to to • Use tweezers • Use tick repellents on your on your • Use tick repellents • Check yourself regularly for ticks, and shower ticks, and shower for regularly • Check yourself • Use insect repellents, such as those containing • Use insect repellents, • Avoid wooded areas, piles of leaves and tall piles of leaves areas, wooded • Avoid • Cover up when you are outside, especially near are up when you • Cover • Sudden onset of fever • Sudden • Headache pain • Muscle on hands and feet • Rash • Get tested for Lyme disease if a tick bite is disease if a tick bite Lyme for • Get tested • If bitten, remove the tick by pulling it straight up by the tick remove • If bitten, To remove a tick: remove To because it may contain fluids infected with disease. contain fluids infected because it may How To Remove a Tick Remove To How the size of a sesame approximately deer ticks are Adult much smaller - about the size of ticks are seed, but nymph remov- a speck of dirt difficult Avoid - and more detect. to hands, bare ing a tick with your To avoid exposure to disease-carrying to ticks, ACEP exposure avoid To preventative the following recommends taking measures: Preventing Tick Bites Preventing After an incubation period of about 5 to 10 days, days, 10 Afterto about 5 of period an incubation have fever spotted Mountain with Rocky people include: that symptoms signs and The disease can be difficultThe disease can in the early diagnose to it treatment and appropriate and without prompt stages, if it begins is effective can be fatal. treatment Antibiotic early enough. Identifying Mild and Severe Symptoms In addition: • Splint the injury in the position it was found in. • About one in five persons who become infected show any signs of illness, and usually these • Splint above and below the fracture site. Pad symptoms are mild. Most infected people will the splints to reduce discomfort. experience fever, headache, fatigue, aches and BROKEN BONES • Do not try to realign the body part. However, if pains and, in some cases, swollen lymph nodes circulation is poor and the skin is turning pale, and a skin rash on the trunk of the body. and no medical assistance is available, gently • These symptoms generally last for a few days, moving the injured part back into its normal but in some cases can linger for a few weeks. position may improve circulation. • Symptoms of serious infection include headache, • Avoid making the high fever, neck stiffness, stupor, disorientation, splint too tight, coma, tremors, , muscle weakness which can cut off and paralysis. circulation. Check for circulation, • Symptoms of the most severe infections include numbness, West Nile encephalitis (inflammation of the brain), warmth and meningitis (inflammation of the tissue surrounding skin color. the brain and spinal cord) and West Nile poliomyelitis (inflammation of the spinal cord that • If the bone is causes sudden weakness and/or paralysis in the sticking out from limbs and/or breathing muscles). the skin (open fracture), do not Because specific treatments are not available for West try to push it Nile Virus, prevention of mosquito bites is critical. back in. Use a clean, dry cloth or bandage to cover Broken Bones it until medical help arrives. Broken bones (also called fractures) are a common injury • Apply ice pack to for adults and children. They may be caused by falls, reduce swelling (except for small children and not motor vehicle crashes, direct blows and even intentional directly on the skin). injuries, such as violence and child abuse. • Stop any bleeding by gently applying pressure to the wound with a sterile bandage or Broken bones are a common injury for chil- clean cloth. dren under age 10. Children have additional risks associated with breaking bones, Unless you have • Prevent shock. because their bones are still growing; this to, never move includes damage to growth plates and growth Tips for specific body parts: at wrong angles. Women who have gone a person with through menopause also are at increased risk • If a finger appears to be broken or because they lose bone mass and their bones a broken bone. dislocated, tape the injured finger to the finger next to it. For an injured become weaker. Bones can be strengthened thumb, a splint may be used. throughout life, however, through weight-bear- { } ing exercise and calcium diet supplements. • For a broken leg, use a triangular bandage to bind the injured leg to the uninjured leg. Symptoms of a broken bone include swelling, bruising • For a broken ankle/foot, use a soft splint (a and being unable to put weight on it or use it for normal pillow or a heavy towel) to immobilize the area. movement. Do not move a person with a broken bone The person's shoe should not be removed. unless you are in a life-threatening situation involving fur- • Most rib fractures heal on their own within two ther potential harm to the injured person (such as a car months. However, in rare instances, broken accident that results in a car fire), especially someone ribs can puncture the lungs and cause internal with a head, neck or back injury or a hip or pelvis fracture. bleeding. If you suspect someone has a rib fracture, position a pillow or folded blanket If it becomes necessary to move someone with a broken between the area where pain is occurring and bone, immobilize the injured area first with a splint. If you the arm, then bind the arm to the body to don't have a splint, make one using a folded newspaper, support the injured rib area. board or rolled up piece of clothing.

14 BURNS 15 start rescue breathing if you know how. how. know start if you breathing rescue son's heart. Do home remedy. other ointments or any butter, burned skin. or remove the break not by a person wearing gloves. gloves. a person wearing by chemicals offrinse placing the the skin by 20 minutes. to 15 for person in a shower and the eyes eyes your protect to (Be careful person.) of the injured 20 minutes for with cool running water areas help arrives. or until emergency or longer substance or an object that could be harmful battery) first(e.g., watch control call poison It is helpful to (1-800-222-1222) and then 911. has been swallowed. what chemical product know the hospital. to it with you Take • Check for breathing. If the person breathing, is not breathing. • Check for burned arms and legs higher than the per- • Raise use Do not cloths. the person with cool, wet • Cover • Dry off chemicals should be brushed the skin the person's jewelry and and clothing • Remove flushed chemicals should be off• Wet affected a chemical has swallowed or someone else • If you For more serious electrical burns: For In addition, know what to do in case you or your clothing or your case you do in to what know In addition, immedi- floor, the (to run), drop (don't stop fire: catches while rolling face and hands your (cover and roll ately), the flames). smother to over been burned, else who has helping someone are If you first, danger person the so puts unless doing from remove as well. in danger you Burns Electrical Chemical and local or your electrical burns, call 911 chemical and For sure make the situation to Assess number. emergency be in contact the victim) will not (and the with you an approach electrical injuries, DO NOT For source. been has source the power know person until you injured turned off. chemical burns: For Sunburns with extensive blistering or general symptoms or general blistering Sunburns with extensive serious more or chills, are weakness of nausea, vomiting, evaluation. and need physician Minor electrical burns can be treated with cool (not cold with cool (not Minor electrical burns can be treated After oint- cleansing, a mild antibiotic or ice) compresses. is also shot be applied. A tetanus may ment and bandage especially if the person had one has not recommended, years. than 10 in more Burns people die 4,000 About in the United each year burn and fire from States of one are injuries. Burns of the leading causes They injury. childhood scald- can be caused by or liquids hot ing from cooking oils, contact with overexpo- flames, or from the sun. Burns to sure also can be electrical bites (e.g., when a child or an electrical cord) eep the burned areas ele- eep the burned areas 10 days to two weeks weeks two to days 10 burned areas, and apply a clean bandage. and apply a clean bandage. burned areas, cream. can also apply antibiotic You clean, cold compress on it until the pain subsides. clean, cold compress or other butter use not use ice. Do not Do not types of grease. remove any burned clothing, except clothing except burned clothing, any remove imbedded in the burn. • Fever drainage or foul-smelling • Puss-like swelling • Excessive of the skin • Redness fluid or brownish filled with greenish • A • A burn that doesn't heal in • Remove jewelry or tight clothing from around from jewelry or tight clothing • Remove • Run cool - not cold - water over the burn or hold a over cold - water cool - not • Run • Remove the person from the heat source and the heat source the person from • Remove chemical (e.g., resulting from swallowing or spilling swallowing from (e.g., resulting chemical skin). bleach on your Get immediate medical attention if you have any of any have if you medical attention immediate Get a burn: to related symptoms the following For minor burns: For Minor Burns vated to reduce swelling. swelling. reduce to vated Never break blisters from a burn, and remember not to not a burn, and remember from blisters break Never helping are burned skin. If you to stuck clothing remove someone with a serious burn, k Seek emergency care for more serious burns and for any burns and for serious more for care Seek emergency even areas, hands, and genital mouth, eyes, the burns to medical atten- get area, a large if mild. If the burn covers tion immediately. Prevent burns by following safety precautions: • Install smoke detectors on every floor and check to make sure they are working and/or replace batteries every six months. • Teach children to avoid hot substances and

BURNS / CHOKING chemicals. If you have young children, use safety latches in your home. • When cooking, keep pot handles turned toward the rear of the stove, and never leave pans unattended. • Do not leave hot cups of coffee on tables or counter edges. In the event of choking, the American Heart • Do not carry hot liquids or food near your child Association and ACEP offer the following guidelines: or while holding your child. • Always mix and stir then check the temperature of Conscious Adult food or beverages before serving a child, especially • In the event of choking, rescuers should take foods or liquids heated in a microwave. action if they see signs of severe airway obstruc- • Keep matches and lighters out of children’s reach tions (including poor air exchange and increased in a locked cabinet. Use only child-resistant lighters. breathing difficulty, a silent cough, cyanosis or if the person is unable to speak or breathe). • Prevent scalding by keeping your water heater set at 120º to 125º F; test bath water before putting a • To differentiate between mild airway obstruction child in the bathtub. and severe airway obstruction, the rescuer should ask, “Are you choking?” If the victim nods yes, • Cover unused electric assistance is needed. Choking also is often outlets with safety indicated by the Universal Distress Signal (hands caps, and replace clutching the throat). damaged, frayed or brittle electrical cords. • If the person can speak, cough or breathe, do not interfere. • Keep fire extinguishers on every floor of your • If the person cannot speak, cough or breathe, house, especially in give abdominal thrusts known as the Heimlich the kitchen, and know Maneuver. how to use them. • To employ the Heimlich Maneuver, reach around • Do not put water on the person's waist. Position one clenched fist a grease fire - it can above the navel and below the rib cage. Grasp spread the fire. your fist with your other hand. Pull the clenched fist sharply and directly backward and upward under the rib cage six to 10 times quickly. • In case of obesity or late pregnancy, give chest thrusts. Choking (Heimlich Maneuver) • Continue uninterrupted until the obstruction is relieved or advanced life support is available. In ACEP recommends that the Heimlich Maneuver be either case, the person should be examined by employed only when a person is choking and his or her a physician as soon as possible. life is endangered by a windpipe obstruction. Choking is signaled by an inability to speak, cough or breathe, and Unconscious Adult may result in a loss of consciousness and death. Avoid • Position the person on his or her back, arms using excessive force in employing the Heimlich by side. Maneuver to avoid injury to the ribs or internal organs. • Shout for help. Call 911 or the local emergency Given the potentially life-or-death nature of the situation, number. use your best judgment. • Perform a finger sweep to try to remove any foreign body from the mouth. Only remove an object you can see and easily extricate.

16 CHOKING 17 (Over one year old) one year (Over (Over one year old) year one (Over thrusts as described for a conscious infant. a conscious for as described thrusts body and, if visible, the foreign for thrusts, look it. remove thrusts, and, after continue chest each sequence which should be body, the foreign check for to removed. begin CPR. breathing, not thrusts. support life or advanced is available. expelled a by should be examined In either case, you as soon as possible. physician for an adult, except: for speak); the dispatcher cannot if you (even ately is that an emergency recognize should be able to using a land-line, in some are If you occurring. then be able to or she may he all) areas, (but not personnel to trace the call and send emergency an be traceable to not (Cell phone calls may you. location.) exact expel abdomen and chest to on your hard press give fists to use your to the object or attempt abdominal thrusts (Heimlich Maneuver). yourself Maneuver) as described for adults. Avoid being adults. Avoid as described for Maneuver) injury avert ribs and to to in order forceful overly best judgment). organs (use your internal to 8 years old. Instead, perform a tongue-jaw lift perform a tongue-jaw old. Instead, 8 years to can see it. body only if you the foreign and remove the rib and below the navel clenched fist above hand. Pull the other fist with your Grasp your cage. and backward clenched fist sharply and directly times quickly. 10 six to under the rib cage upward • Perform the sequence of back blows and chest and blows of back • Perform the sequence and chest • After back blows of each sequence breathing. rescue • Resume and of back blows sequence • Continue with the is and the infant body is removed • If the foreign • In case of obesity or late pregnancy, give chest give pregnancy, • In case of obesity or late the obstruction is until • Continue uninterrupted • If the child becomes unconscious, continue as • If the child becomes unconscious, up in children perform• Do not sweep a blind finger breaths. slow panic; if possible, take • Do not number immedi- or the local emergency • Call 911 a chair and the back of lean over • If available, position one Heimlich Maneuver, the employ • To • Perform abdominal thrusts (the Heimlich Unconscious Child are choking and are alone: If you Conscious Child of a child: an object from the airway dislodge To the infant face down on the infant face down (Under one year old) (Under one year (Under one year old) (Under one year placing your thumb in the infant's mouth and placing your or gums; the jaw incisor teeth grasping the lower body, see the foreign then lifts If you upward.) it. remove number. number. your lap, head lower than torso and firmly than torso support- lap, head lower your the infant Turn back blows. five ed. Perform up to on his or her back as a unit and perform five up to thrusts. chest thrusts on infants. the foreign body is expelled or the infant becomes or the infant body is expelled the foreign unconscious. thrusts in the sternal (breastbone) region. Depress region. (breastbone) thrusts in the sternal each thrust. Avoid 1 inch for 1/2 to the sternum the tip of the sternum. up, head lower than torso. up, head lower infant face down over your forearm, head lower forearm, your over infant face down supportedthan torso, thigh. on your if necessary. removed or advanced life support life or advanced available. is removed person the examined have When successful, as soon as possible. a physician by rescue breathing, perform breathing, abdominal thrusts, until rescue successful. rise and fall. If the person is not breathing, person fall. If the and breathing, rise is not six unsuccessful, give If perform breathing. rescue Heimlich Maneuver). thrusts (the abdominal 10 to perform an unconscious thrusts on abdominal To the person the heel and place person, over kneel on the person'sof one hand slightly abdomen, hand on other place your Next, the navel. above the abdomen with of the first. into top Press thrusts. upward quick, infant's shoulder blades using the heel of your hand. of your infant's shoulder blades using the heel • If trained to do so, begin rescue breathing. do so, begin rescue • If trained to • Perform the tongue-jaw lift. by (Grip on the jaw • Perform the tongue-jaw • Shout for help. Call 911 or the local emergency help. Call 911 • Shout for • Alternative method: Lay method: Lay • Alternative • Do not perform blind finger sweeps or abdominal perform• Do not sweeps blind finger • Repeat both back blows and chest thrusts until and back blows both • Repeat • Using two or three fingers, deliver up to five up to fingers, deliver or three • Using two • While supporting the head, turn the infant face • Deliver up to five back blows, forcefully, between the between forcefully, blows, back five up to • Deliver • Support head and neck with one hand. Place the • After the obstruction is removed, begin CPR, begin CPR, • After the obstruction is removed, • Continue uninterrupted until the obstruction is until the obstruction • Continue uninterrupted • Repeat sequence: Perform finger sweep, attempt sweep, Perform finger sequence: • Repeat • Listen for breathing and watch for the chest to the chest for watch and breathing for • Listen Unconscious Infant Conscious Infant Colds and Flu

It's hard to escape the common cold or the flu, and it can be even more difficult telling them apart. Both are caused

COLDS AND FLU by viruses, and therefore do not respond to antibiotics. Flu symptoms usually are more severe than the typical sneezing, stuffiness and congestion that go along with a cold. Flu symptoms also tend to develop quickly - typically between one and four days after a person is exposed to the flu virus, and people are contagious from 24 hours before they become ill until their symptoms resolve. Colds The signs and symptoms of colds include: • An initial tickle in the throat

• A runny or stuffy nose and sneezing from person to person by direct contact or through virus- • Cough infected droplets coughed or sneezed in the air. Most people who get the flu recover completely in one to two • Sore throat weeks, but some, especially elderly people, develop seri- • Headache ous and potentially life-threatening illnesses, such as • Mild fever pneumonia.

• Mild fatigue The flu sometimes develops into bacterial pneumonia, • Mild muscle aches ear infection, sinus infection, dehydration and worsening of chronic medical conditions. Very young children and • Loss of appetite the elderly are more susceptible to complications of the • A change in nasal discharge from watery to flu than the general population. About 36,000 people die thick yellow or green each year from the flu. Colds may be treated with over-the-counter deconges- tants and cough medicines. Follow the instructions on the Signs and symptoms of the flu may include: label carefully. Note that, as of January 2008, the Food • High fever (usually 100 to 103 degrees F and Drug Administration (FDA) has stated that cough and in adults and often higher in children) cold medications not be given to children under age 2 • Chills (and they are considering expanding this restriction to children up to age 6). • Headache • Fatigue Prolonged colds (lasting longer than one week) and those associated with a high fever or a cough that produces yellow • Muscle aches mucus or phlegm may need evaluation by a physician. • Dizziness • Loss of appetite As of January 2008, the Food and Drug • Dry cough Administration (FDA) has stated that • Sore throat cough and cold medications not be given • Runny or stuffy nose to children under age 2 (and they are • Weakness considering expanding this restriction • Ear infection to children up to age 6). { } • Diarrhea Call your doctor if there are signs of dehydration, seizures, Flu earache, a cough that produces discolored mucus or diffi- Influenza, commonly known as “the flu,” is caused by a culty breathing. Children with chronic conditions, such as virus, which infects the respiratory tract. The flu is spread severe asthma or cystic fibrosis, may require hospitalization.

18 CUTS AND ABRASIONS CUTS

In the case of children who have the flu, during flu season. It isn't a guarantee against getting sick, call the doctor if the child: though mainly because there are many viruses that can cause the flu, and the vaccine only protects against a • Has symptoms that are serious or get worse —- or starts to get handful of them. However, among those better and suddenly gets worse The ideal time to get persons who do get the flu after receiving the flu shot, symptoms usually will be • Has a temperature greater than flu vaccinations is milder. (It should be noted that the season- 102 degrees F for more than a al flu shot does not offer protection against few days usually October or avian (or bird) flu, and it also would not be Keep in mind the flu usually lasts no November. effective in the event of pandemic flu, a more than a week or two and is best{ }virulent human influenza that causes a cured by getting rest, good nutrition and global outbreak of serious illness and to plenty of fluids. which there is little natural immunity.) Flu Vaccination The best way to protect against the flu is to get vaccinated Cuts and Abrasions every year. The ideal time to get vaccinated is usually October or November, before flu season begins; however Most cuts are minor, but it's still important to care for getting a flu shot later may still provide protection since them. Most can be treated by cleaning with soap and flu season typically peaks in January and lasts through water and applying a clean bandage. You also may want about March. to treat the cut with an antibiotic ointment. If you delay care for only a few hours, even a minor wound can build Emergency physicians highly recommend that persons enough to cause a serious infection and who are at high risk of having serious flu complications increase your risk of a noticeable scar. and people who live with or care for high flu-risk individu- als (including home caregivers and health care workers) Puncture wounds may get vaccinated each year. not seem very serious, but because germs and Persons in high-risk groups include: debris are carried deep • Children six months old through age five into the tissues, a physi- cian evaluation may be • Pregnant women needed. In addition, • Persons age 50 and older antibiotics or a tetanus shot may be required. • Persons with chronic medical conditions • Persons in nursing homes and long-term care Seek medical atten- facilities tion for a cut or a The flu vaccine is generally available beginning in October wound that shows any and is distributed through health care providers, in-store of the following signs: clinics, schools and many places of employment. Check • Long or deep cuts with your physician, your local government or community that need stitches services center. Getting a flu shot can reduce most • Cuts over a joint people’s chances of catching the flu by up to 80 percent • Cuts from an animal or human bite • Cuts that may impair function of a body area, such as an eyelid or lip • Cuts that remove all the layers of the skin, like slicing off the tip of a finger • Cuts caused by metal objects or puncture wound • Cuts over a possible broken bone • Cuts that are deep, jagged or “gaping” open

19 • Cuts that have damaged underling nerves, tendons or joints • Cuts that have foreign materials, such as dirt, glass, metal or chemicals embedded in them • Cuts that show signs of infection, such as fever, swelling, redness, a pungent smell, pus or fluid draining from the area

DIABETIC EMERGENCIES • Cuts that include problems with movement or sensation, or increased pain

Seek emergency care if: • The wound is still bleeding after a few minutes of steady, firm pressure with a cloth or bandage. • Signs of shock occur. • Breathing is difficult because of a cut to the • Fast breathing neck or chest. • Pale, sweaty skin • There is a cut to the eyeball. • Headache, trembling • There is a cut that amputates or partially • Odorless breath amputates an extremity. • Numbness in hands or feet • There is a deep cut to the abdomen that causes moderate to severe pain. • Hunger A tetanus shot may be required if you have not had one within 10 years or if you are unsure of when you last had Symptoms of diabetic coma include: one. Tetanus is a bacterial infection that affects the nerv- • Weak and rapid pulse ous system and is often fatal. Although most people are aware that stepping on a rusty nail or a puncture wound • Nausea can cause a tetanus infection, most people do not know • Deep, sighing breaths that tetanus bacteria can also enter the body even • Unsteady gait through a tiny pinprick, a scratch from an animal, splin- ters, bug bites and even burns that break the skin. • Confusion • Flushed, warm, dry skin Diabetic Emergencies • Odor of nail polish or sweet apple • Drowsiness, gradual loss of consciousness It is estimated that more than 20 million people in the United States have diabetes, with an estimated six million people being unaware they have it. The best way to pre- for both conditions is the same: vent diabetic emergencies is to effectively manage the • If the person is unconscious or unresponsive, call disease through making healthy food choices, exercise 911 or your local emergency number immediately. and frequently checking blood glucose levels. • If an unconscious person exhibits life-threatening conditions, place the person horizontally on a flat Diabetics may experience life-threatening emergencies surface, check breathing, pulse and circulation, from too much or too little insulin in their bodies. Too and administer CPR while waiting for professional much insulin can cause a low sugar level (hypoglycemia), medical assistance. which can lead to insulin shock. Not enough insulin can • If the person is conscious, alert and can assess cause a high level of sugar (hyperglycemia), which can the situation, assist him or her with getting sugar cause a diabetic coma. or necessary prescription medication. Symptoms of insulin shock include: • If the person appears confused or disoriented, give him or her something to eat or drink and • Weakness, drowsiness seek immediate medical assistance. • Rapid pulse

20 DROWINING Drowning

Drowning occurs most often among small children and people who can't swim, but even experienced swimmers may be susceptible, depending on weather conditions, water currents, their health and other circumstances.

Drowning is one of the leading causes of death among children ages one to four years of age. It only takes a few seconds for a child to drown, and small children can drown in just a few inches of water - in a bathtub, a toilet or a bucket.

Parents need to keep a close eye on their children when they are near any water sources, especially pools or at the beach or a lake. In addition, parents need to know the lim- its of their child's ability to swim and to set firm rules • Avoid cliff edges, stay behind fences and obey for play around the water, and to never leave kids unsuper- warning signs. vised. For every child who drowns, more than 10 children are treated in emergency departments for near drowning. • Never run and dive in the water. Even if you have previously checked current conditions, those conditions can change rapidly. Keep in mind the following safety precautions: In addition, boating accidents can also result in drowning. • Teach your children While life jacket use has increased, according to the to swim. Centers for Disease Control and Prevention, 90 percent of people who died in boating accidents were not wearing • Never swim alone. any kind of flotation device. Just because you know how • Only swim in to swim doesn't mean you should go boating without a life places that are jacket. Wearing a life jacket is important for anyone who supervised. Never goes out on water. allow children to swim without adult To avoid ending up in the emergency department as supervision. a result of your next boating trip: • Install safety • Always wear your life jacket and carry first aid fences with child- equipment in the boat. proof latches around swimming • Tell someone when you're going, who is with you pools. and how long you'll be away. • Never dive into • When changing seats, stay low and near the unfamiliar water. center line of a small boat. If you're at the beach: • On sailboats, keep alert to wind and sail activity and stay low to avoid getting hit by the sail • Always swim near a lifeguard tower and never “boom.” swim alone. • Monitor the weather carefully for signs of a storm. • Check with lifeguards about surf and beach conditions before going in the water. Obey • Take a marine radio with you to call for assistance warning signs in dangerous areas. in case there are any problems. (Cell phones frequently do not work off-shore.) • Don't overestimate your swimming ability. Never depend on flotation devices for your safety. • Never drink alcoholic beverages on a boat. Being “tipsy” can result in falling overboard. Your ability • Never drink alcohol and swim. to swim safely or call for help is greatly reduced by • Always swim or surf in designated areas. alcohol use.

21 If a person appears to be drowning (e.g., is flailing in the Earaches and Ear Infections water, yelling for help, coughing or going under, or appears to be unconscious or floating in the water), check Earaches and ear infections can have a variety of causes the area, alert a lifeguard if one is nearby, then call 911 - viral, bacterial and fungal - and can affect different parts or your local emergency number. of the ear. Common infections include outer ear infec- tions (or what is commonly known as “swimmer's ear”), In addition: middle-ear infections and inner-ear infections. • Do not attempt to rescue a drowning person while in the water yourself unless you are trained to do Ear infections also can be caused by scratching the ear so and have lifesaving equipment. People who are canal when cleaning their ear, especially if a cotton- drowning may panic and pull you underwater with tipped applicator or dangerously sharp small object, such

EARACHES AND EAR INFECTIONS EARACHES them; dangerous circumstances - such as strong as a hair clip, is used. In other cases, a middle ear infec- currents or rip - may also endanger you. tion (otitis media) can cause an external infection to • If possible, reach out with or throw an object that develop through the draining of pus into the ear canal floats to the person from a secure out-of-water through a hole in the eardrum. position, such as a boat, a swimming pool ladder or a dock. Swimmer’s Ear • For a person pulled from the water, tilt the head Swimmer's ear involves back, lift the chin and check for breathing and an infection of the ear other signs of life. Expel fluid or other objects canal (the tubular open- from the mouth. ing that carries sounds • If the person is not breathing, give two slow from the outside of the rescue breaths. If rescue breaths go in, give body to the eardrum). The CPR. If rescue breaths do not go in, reposition infection can be caused the airway and reattempt. by many different types of • If the person is still not breathing after rescue bacteria or fungi, and usu- breaths are administered, see section on ally develops in teens and unconscious choking. young adults whose ears are exposed to excessive amounts of water, such as the water in a swim- ming pool or lake. Often, people affected by swimmer’s ear have been diving or swimming for long periods of time, and usually in chlorinated or polluted waters, although even water from the shower can transport infectious bacteria directly into the ear canal. Swimmer’s ear is most common in warm climates and occurs more often during the summer months, when more people are swimming. The infection typically begins gradually and usually within a day of being immersed in water.

Symptoms of swimmer’s ear include: • Severe ear pain that gets worse when the outside part of the ear (also known as the pinna), is pulled or pressed. (Itching may also occur in the ear canal before the pain begins.) • A reddened or swollen outer ear, with enlarged and tender surrounding glands. • A greenish-yellow pus discharge along with possible difficultly in hearing (if passage of sound through the ear canal is blocked by the pus buildup). • A slight fever, in some cases.

22 EARACHES AND EAR INFECTIONS

Prevent swimmer's ear by avoiding swimming in polluted waters, using ear plugs for swimmers, as directed, and administering over-the-counter drops after swimming if you think you might be at risk. (Do not use these drops if you have ear tubes or a hole in your eardrum.) In addition, dry your ears thoroughly with a clean towel after swim- ming and keep objects out of your ear canals, especially small or sharp objects such s cotton-tipped applicators or bobby pins.

Seek emergency care for any of the following symptoms: • Pain in an ear with or without fever • Itching of the ear or ear canal • Loss of hearing or difficulty hearing in one or both ears • Thick, yellow discharge (when the infection has • Pus or discharge from an ear, especially if it’s caused the eardrum to burst, fluid to flow out and thick, yellow, bloody, or foul-smelling pain to subside; this is not a serious condition and the eardrum usually heals on its own) Medical treatment of swimmer's ear will depend on the severity of the pain and the extent of infection. Mild infec- Many ear infections go away without treatment; however, tions may require your doctor to prescribe eardrops with eardrops or antibiotics may be prescribed, depending on antibiotics or corticosteroids. If treated with medication, the severity of the infection and the age of the child. Over- swimmer's ear is usually cured within seven to 10 days, the-counter pain relievers containing acetaminophen although you may need to avoid the water for a longer (such as Tylenol or Tempra) may help, as does applying a time. In addition, ear pain may increase for 12 to 24 warm (not hot) washcloth or heating pad on the ear, and hours following treatment, after which it should subside. rest. Do not give aspirin to persons under age 19. In more severe cases of swimmer's ear, the opening into the ear may be narrowed by swelling, in which case the Ear infections may cause temporary difficulty with hearing. ear may need to be cleaned and a cotton wick inserted Seek medical attention especially for hearing in young before the eardrops can be applied. In addition, a culture children, since the ability to learn to talk is affected by of the ear may be taken to help identify the cause of the hearing. infection, and oral antibiotics may be prescribed. Inner Ear Infections Middle Ear Infections (Otitis Media) Infections of the inner ear (labyrinthitis) usually result The middle ear is the small part of the ear just inside the from viral illnesses, such as influenza, and can cause eardrum; it is connected to the throat through a small vertigo (a feeling that things are moving when they are tube. This part of the ear can get infected when germs not), dizziness, nausea, imbalance, difficulty concen- from the nose and throat are trapped following the block- trating, tinnitus (ringing in the ears), reduced hearing age of the connecting tube, usually during a cold. A physi- and other symptoms. These symptoms also may be cian evaluation is required to make the diagnosis and to caused by head injuries, drug reactions, allergies, begin appropriate treatment. Middle ear infections are underlying medical disorders or aging. A physician eval- more common in young children and usually show up as uation is required to make the diagnosis and to begin ear pain and fever, which can sometimes be high. appropriate treatment.

Symptoms of middle ear infections include: If the symptoms are caused by a virus, the infection usually improves on its own. However, a doctor may rec- • Earache (ranging from mild to severe). Babies ommend taking prescription or over-the-counter anti- with middle ear infections may cry, fuss and tug at their ears nausea medications, or receiving an injection to control the symptoms. Recurrent symptoms may indicate • Fever Meniere's disease, a disorder in which fluid builds up in • A plugged feeling in the ears accompanied by the inner ear and causes vertigo and balance problems. trouble hearing

23 Whether a person survives an electric shock depends on the type of circuit (AC or DC current), level of the , level of amperage, the way in which the current entered the body, the duration of exposure, the victim's general health, and the timing and adequacy of treatment. Seeking immediate emergency assistance is vital in such situations.

To assist someone with an electrical injury: Check to see if the person is still in contact with the . If so, don't touch the person, and find another way Electrical Injury/Shock to shut off the power, such as at the circuit or breaker box. A victim in contact with an AC current (household cur- Causes of electrical injury and shock include accidental expo- rent) may not be able to let go of the point of contact sure to household or appliance wiring, arcs from power because their muscles contract strongly in response to lines, the severing of an electrical cord or sticking of foreign the . objects into an outlet (typically in the case of a young child), faulty machinery and occupational accidents. (Lightning is • Check breathing and pulse. a separate topic with a unique set of injuries.) • Call 911 or emergency number. An electrical injury to the skin or internal organ can occur • For lightning injuries, see the summer safety sec- by accidental exposure to an electrical current. Although tion in “How To Prevent Medical Emergencies.” the external burn may appear minor, severe or fatal inter- • For shock related to electrical burns, see nal damage still may have occurred, especially to the “How To Prevent Medical Emergencies.”

ELECTRICAL INJURY / SHOCK / EYE EMERGENCIES AND WOUNDS / SHOCK / EYE EMERGENCIES ELECTRICAL INJURY heart, muscles or brain. Electrical injury can cause (from the electrical impact to the heart), muscle and nerve destruction and thermal burns. Eye Emergencies and Wounds

Approximately 3 percent to 4 percent of patients admit- Eye wounds and emergencies can include cuts and ted to burn centers in the United States are victims of scratches, traumatic injuries from foreign objects, burns electrical injuries; serious electrical burns carry a 40 per- and chemical exposure (e.g., cleaning solutions, garden cent chance of death. The two most common age groups chemicals). Any of these conditions can potentially lead to for electrical injury are children under six (e.g., exploring vision loss if left untreated. Always wear eye protection for toddlers) and young adults (electrical workers and con- hazardous activities and impact sports. struction workers in particular). Electrical injury is the fifth leading cause of occupational death in the United States. Eye pain does not necessarily indicate a medical emer- gency; it can be caused by such problems as migraine Symptoms of electrical injury or resulting headaches, sinus infections or contact complications. shock may include: “Pinkeye,” or inflammation of the upper and lower eyelids, • Skin burns is caused by a viral infection and will usually run its • Numbness, tingling course over time. If it leads to more serious infections, physician evaluation will be needed. • Weakness • Muscle contraction or pain • Bone fractures • Headache • Hearing impairment • Seizures • Irregular heart rhythms • Cardiac arrest • Respiratory failure • Unconsciousness

24 FAINTING / FEVER 25 • Irregular heartbeat• Irregular • Chest pain • Shortness of breath vision • Blurred • Confusion talking • Trouble upon turning the head • Fainting in a month than once more • Fainting Fever a range for an illness, but a symptom itself is not by Fever a side effectof medical conditions. It also can be of some is one of the most common reasons medications. Fever department visit an emergency that parents with a child. an important in also plays role body temperature Elevated Most fightinginfection. to the body's normal response degrees (F) (37 Fahrenheit people consider 98.6 degrees person's but a body temperature, Celsius [C]) a healthy and vary or more, may a degree normal body temperature in the morning, higher (lower during the day it fluctuates at night). unless it dangerous in an adult usually isn't usually Fever If it is C) or higher. F (39.4 degrees degrees 103 registers it may symptoms, of the following any by accompanied illness. a serious or life-threatening indicate Consult your doctor if fainting is associated with: associated is if fainting doctor your Consult If you feel faint, either lie down or sit down immediately. If immediately. or sit down either lie down faint, feel If you your head between with your bend forward down, sit you until brain. Wait your to the blood flowing help get knees, to trying stand up. If someone else before to better feel you faints, position the person on his or her back and elevate the heart, signs of possible. Check for if the legs above If the person clothing. or restrictive Loosen belts breathing. call 911. consciousness within a minute, doesn't regain a foot offa foot the ground. ground or other flat surface, or other ground while facing up in a horizontal position. call 911 or your local emergency number. local emergency or your call 911 contact lens, do not try to remove it. Do not rub it. Do not contact try lens, do not remove to covering by the eye Protect pressure. or apply any patch. it loosely with gauze or a cloth water or other liquid. Do not apply any pressure. apply any Do not liquid. or other water compress without putting pressure on the eye. putting pressure without compress the tapedCrushed ice in a plastic bag can be to eye. on the injured gently rest to forehead immediately flush the eye with water for at least for with water flush the eye immediately from eye the uninjured protecting minutes, 15 under a faucet or Hold water. contaminated open as wide as possible. the eye and keep shower it. or bandage or rub the eye touch Do not not visible not • Loosen any restrictive clothing. restrictive • Loosen any eat or drink. to the person anything give • Do not • Check for breathing and injuries. breathing • Check for shock and stroke. out seizure, • Rule the legs up to no injuries, elevate are • If there • Assist the person by lowering him or her to the him or her to lowering • Assist the person by • If someone faints or appears to be fainting, • If someone faints or appears to • If there is an object stuck in the eye, including a is an object stuck in the eye, • If there • If there is a cut to the eye, do not wash with wash not do the eye, is a cut to • If there • If there has been a blow to the eye, apply a cold the eye, to has been a blow • If there • If eye has been in contact a chemical, with • If eye • Loss of vision (partial• Loss of or total) eye the injured of blood or clear fluid from • Leakage contact fumes with chemicals, including eye • Any • A visible wound • A visible is if a wound appearance, even eye • A bloodshot Fainting is a loss of consciousness caused when the is a loss of consciousness Fainting the brain is momentarily interrupted. blood supply to it usually is not While typically sudden and alarming, harmful (unless the personsuffers fainting-related quickly. injuries), and consciousness is typically regained of underlying health condi- be indicative it may However, abnormal heart blood pressure, tions, such as low so the person should or stress, hypoglycemia rhythm, medical attention. seek follow-up Fainting If someone is having an eye emergency, seek emergency, an eye If someone is having In addition: attention. medical immediate The signs and symptoms of eye emergencies include: emergencies of eye symptoms signs and The Seek immediate medical attention if your Contact a physician for any child with a fever who: FEVER symptoms include: • Is under three months of age and whose • Pain or tenderness in the abdomen temperature is greater than 100.4 degrees F (38 degrees C), because infants don't have • Nausea or vomiting well-developed immune systems and could have • Severe headache serious infections • Stiff neck that resists movement • Has a body temperature higher than 102 degrees F (38.8 degrees C) • Light hurts eyes • Looks very sick, is unresponsive and uninterested • Convulsions or seizures in the surroundings, is sluggish and won't suck • Difficulty breathing on breast or bottle • Strange behavior, altered speech • Cries constantly, continuously or without relief • Mental status changes, confusion, difficulty • Is difficult to waken waking, extreme sleepiness • Has a stiff neck • Rash (particularly if it looks like small • Has purple spots on the skin bleeding spots under the skin) • Has difficulty breathing Drink plenty of fluids to avoid dehydration. For children • Is drooling excessively or having great difficulty under age one, the best liquid is an oral rehydration solu- swallowing tion, such as Pedialyte.® • Has symptoms of earache or sore throat • Has a limp or will not use an arm or leg For children, fever is considered a rectal temperature of above 100.4 degrees F (38 degrees C) or an oral temper- • Has significant abdominal pain ature above 99.5 degrees F (37.5 degrees C). (Rectal • Has painful urination or difficulty urinating temperature readings are usually about 1 degree F higher than oral readings.) • Has any amount of redness or swelling on his or her body Although rare, some children under age five can experience • Has a seizure (fit or ) seizures, especially if the child's temperature rises or falls • Becomes dehydrated rapidly. Seizures can be very alarming to parents, but they do not cause any permanent harm in most children. Most illnesses associated with fever run their course over Call your pediatrician or seek a period of time and can be treated with acetaminophen emergency care if your child or ibuprofen (unless the person is allergic or has been Don’t use has a fever of 104 degrees F advised by a physician not to take these medications). alcohol or ice (40 degrees C) or higher. Until you get help, remove any Aspirin should not be given to children or teenagers under water on a child unnecessary clothing and try to age 19 because of the possibility of developing Reye's with a fever. cool the child down. If at home, Syndrome, a rare but potentially fatal medical disorder. In { } you can the child with addition, ibuprofen is not recommended for infants lukewarm water, place the child younger than six months of age. in a tub of cool water or let the child rest under a single layer of thin towels which have been dipped into cool water and wrung out. Don't let the child get chilled. Don't use alcohol or ice water. Take steps to ensure that the Aspirin should not be given to children child remains as cool and comfortable as possible while enroute to the emergency department. or teenagers under age 19 because of the possibility of developing Reye’s Syndrome, a rare but potentially { fatal medical disorder. }

26 FOOD POISONING Food Poisoning Preventive Measures • Keep a clean kitchen. Regularly wash or sanitize Even the healthiest foods can become unhealthy if improp- counters, cutting boards and utensils. erly handled, cooked or stored. In the United States approx- • Wash your hands before preparing foods and imately 10,000 people die each year from food poisoning, before eating. and many more become ill and require medical attention. • Check dates on food labels and throw out expired food. Food poisoning can be caused by several different bacte- ria, such as salmonella or botulism. Although certain • Use special care when preparing or storing meat, types of food poisoning can be fatal, most cases run their poultry and shellfish. Separate raw foods from course in a couple of days. other foods. For example, if you cut raw chicken on a cutting board, make sure you wash the cut- ting board and your hands before you slice raw vegetables on it. And don't use the same knife without washing it. • After handling raw foods, immediately and thoroughly wash hands, utensils and preparation surfaces. • Follow any recommended precautions on food labels. • Rinse foods that are not cooked before they are eaten, such as fresh fruits and vegetables. • Cook foods thoroughly. Never partially cook meat or poultry and then finish cooking it later. Use a food thermometer in cooking. • Refrigerate leftover meat, , dairy products, eggs, or poultry as soon as possible. Do not let these foods sit out of the refrigerator longer than Symptoms of food poisoning are similar to those of the two hours. Make sure your refrigerator maintains flu, except for fever, which is more likely to occur with the a temperature of 40 degrees F (4 degrees C) or below and your freezer is 0 degrees F or below. flu, and should be treated the same. Refrigerate or freeze perishable or prepared foods within two hours of purchase or preparation. They usually begin from two hours to two days after Marinate foods in the refrigerator. eating the tainted food and include: • Don't eat raw shellfish. Don't eat or drink • Headache unpasteurized dairy products. • Nausea • Eat foods soon after they have been cooked. • Diarrhea and/or vomiting • Do not keep leftovers long. If you have any doubts, • Stomach cramps or pain throw them out. More serious symptoms can include blurred vision, • Never give honey to infants, even in small fatigue and a dry mouth. amounts, because of the risk of botulism. For more information about food safety, Actions visit www.foodsafety.gov. Sip water or diluted juice as soon as vomiting has decreased. If symptoms continue for more than 24 hours, or if you are unable to tolerate any fluids, contact your pri- mary care doctor or visit the emergency department. Also seek emergency care if you become dehydrated. Most adults can handle one day without nutrition, but contin- ued vomiting to the point of dehydration requires medical attention. Finally, be aware that adults can handle dehy- dration better than small children and that high fever also can indicate a more serious illness.

27 Foreign Bodies in Nose or Ears

As many parents know, young children, especially those under age five, sometimes put items, such as marbles, beads, dried beans, tiny button-shaped batteries or small toys in their ears, noses and mouths. These items can be harmful, so it's important to seek immediate medical attention to remove them, if they are not easily removable. It's also important recognize the symptoms of foreign bodies, in case you did not know they were inserted.

In other cases, insects may crawl or fly into the nose or ear canal, causing discomfort or pain and potential harm. Or small pieces of hair may become imbedded in the ear canal (especially within a day or two after a haircut). Headache FOREIGN BODIES IN NOSE OR EARS / HEADACHE FOREIGN Symptoms caused by such objects may include discom- Headaches have a variety of causes. Some are caused by fort and pain, difficulty hearing, rattling sensations in the stress and muscle tension, while others may be caused ear, rasping noises in breathing, problems with swallow- by lack of sleep, a delayed meal, an injury or even foods ing or choking, a bloody nose or ear or nose drainage (e.g., lack of caffeine, alcohol, chocolate, cheeses, nuts, sometimes accompanied by a bad odor. Drainage from food preservatives). People also may get headaches from only one nostril also may be an indicator of a foreign chemical irritants and odors, such as perfumes, smoke object in the nose. and fresh paint. Unless the object is visible and easily removed, physician Nearly 30 million Americans experience migraine evaluation and treatment are recommended. If the for- headaches, which usually are accompanied by vision eign body is visible and the child is cooperative, you can changes (or auras) and sensitivity to light and/or sound. ask the child to sneeze (or blow hard through his or her Pain from a migraine usually occurs as throbbing on one nose) to remove it. side of a person's head and nausea or vomiting might occur. In some cases, a person might experience a com- If the object is not visible or easily removed, do not bined tension and migraine headache. Migraine attempt to remove it yourself, and do not ask the child headaches can occur from changes in estrogen levels in to blow hard through the nose. Do not use Q-tips, hair- women. pins or other small, insertable objects to attempt to remove the stuck item, particularly in the ears. (Foreign A less common form of headache comes in the form of a objects inserted in the ears can rupture or damage the “clustering” of several painful daily attacks over a period eardrum.) of weeks or months. Known as a “cluster headache,” this ailment is five to eight times more common in men than Seek immediate emergency care if the person has dif- in women and may be either episodic or chronic. The clus- ficulty breathing. Foreign items in the nose and ears ter headache usually peaks within five minutes and lasts should be removed promptly by a physician. If the for an hour or so. The pain is almost always one-sided and object is in the ear, a physician may use special instru- localized behind the eye. Pain with this type of headache ments or magnets (if the object is metal) to remove it. may originate as a stabbing sensation behind one eye The doctor also may clean the ear canal with water or and may be severe. The affected eye may also become fill the ear with mineral oil to suffocate an insect or teary. use a suction machine to help pull the object out. In the case of foreign bodies in the nose, sedation may Most headaches can be relieved with over-the-counter be necessary, and instruments, such as forceps or pain relievers, sleep, ice packs or even massage. suction machines, may be used. The doctor also may Chronic or worsening headaches should be evaluated by prescribe nose drops or antibiotic ointments to treat or a physician. A physician also should evaluate changes in prevent infection. the frequency, length or severity of your headaches or any over-use of pain relievers.

28 HEAD INJURY 29 from sleeping. with a head injurywith It is not necessary to prevent a person prevent to { } the front of the head the front such as bruising on the scalp mality of the skull, injury at the location of the area or a depressed pain medications than more ness for one minute scious or cannot be awakened other than the is larger in the middle of the eye) • Exhibits any of the danger signs listed for adults for signs listed of the danger • Exhibits any crying stop • Won't • Can't be consoled eat or nurse to • Refuses bulging in the soft• In infants, exhibits on spot abnor- trauma or obvious sign of skull any • Shows • Headaches that worsen, despite over-the-counter despite worsen, • Headaches that coordination numbness or decreased • Weakness, vomiting • Repeated • Loss of conscious- is uncon- • Person • Sleepiness pupil sizes - one pupil (the black part • Unequal or seizures • Convulsions speech • Slurred confusion or agitation • Increased consciousness, and brain injuries can occur without a occur without can injuries and brain consciousness, of consciousness. loss Danger Signs - Children Danger medical assistance if the child: Seek emergency Danger Signs - Adults Signs Danger bruising, fracture, can involve head injuries Severe clot. bleeding or a blood internal swelling, of these signs any notice care if you Seek emergency head injury:of severe You do not need to prevent a person with a head injury prevent to need do not You a coma; against going into as a safeguard sleeping from If the person has neck pain, trythis concept is a myth. to of the neck. movement any prevent common in is more that vomiting should note Parents should only seek medical atten- and they children, young head injury repeat- a suspected if a child vomits tion for than once or twice edly in a brief period of time (e.g., more within an hour) after a head injury. no known cause, which may indicate stroke (a stroke indicate cause, which may no known non-traditional symptom). changes, or the pain feels different from pain from different or the pain feels changes, headaches. with previous associated such as severe drowsiness, sedation or nausea drowsiness, such as severe and vomiting. one susceptible to dehydration or malnutrition. dehydration one susceptible to or excruciating pain. or excruciating confusion, stiff neck, prolonged vomiting, slurred stiffconfusion, vomiting, neck, prolonged especially numbness or weakness, speech or of the body. on one side • You experience a sudden, severe headache with a sudden, severe experience • You • The nature, frequency or severity of the headache or severity frequency • The nature, • You experience major side effects to medication, side effects to major experience • You • Head pain prevents eating or drinking, making eating or drinking, • Head pain prevents • Headache medication does not relieve chronic chronic relieve not medication does • Headache • The headache is accompanied by high fever, fever, high by is accompanied headache • The If a person consciousness after then loses a head injury, be serious which may the person has had a “concussion,” has been a temporary loss in because it means there lose brain function. Some people with concussions do not Head injuries can be caused by falls, motor vehicle crash- vehicle falls, motor Head injuries can be caused by injuries by violence. It's important prevent to es and even safety car and wearing seat belt in your buckling your sports such as helmets, while biking or playing equipment, Protect construction work. heavy or construction hats for safe. yourself make to steps and take children your Head Injury Seek emergency care if: care emergency Seek Children also get headaches, but they usually are not seri- not usually are headaches, but they also get Children or serious symp- headaches with frequent ous. Children a medical professional. by should be evaluated toms Heart Attack • Nausea or dizziness • Unexplained anxiety, weakness, or fatigue Heart attack (myocardial infarction) remains the leading • Palpitations, cold sweat or paleness killer of both men and women in the United States. More HEART ATTACK than 400,000 Americans die from heart attacks each year. Getting emergency medical help immediately can dramati- The most common heart attack symptom for both women cally increase your chances of survival and recovery. and men is chest pain or discomfort. Women are more likely than men to experience shortness of breath, nausea/ A heart attack is not always a sudden, deadly event. Often vomiting and back or jaw pain. it is an evolving process during which a clot forms in an artery of the heart, depriving the heart of blood and oxy- If you suspect someone is having a heart attack: gen. The longer the heart attack process continues, the • Call 911 or your emergency services number more permanent damage is done to otherwise healthy immediately. Stay with the person until the heart muscle. ambulance arrives. Do not attempt to drive the person to the hospital; if his or her condition Many people ignore the warning signs of a heart attack or should worsen, there is nothing you can do to help wait until their symptoms become unbearable before while driving. seeking medical help. Others wait until they are absolutely • After 911 is called, the EMS dispatcher will likely sure it's a heart attack because they worry they will look give pre-arrival instructions (when appropriate) for foolish if it is a false alarm. These reactions can result in the administration of aspirin (not acetaminophen, dangerous delays. ibuprofen or naproxen) and nitroglycerin (if pre- scribed) while emergency-response units are Only skilled medical professionals can determine if some- enroute to the scene The ideal aspirin dose in one is having a heart attack. Your responsibility is to recog- such instances is two to four baby aspirin or one full or extra strength tablet (325 or 500mg), and nize the warning signs and act quickly. If you are having a chewing helps get the aspirin into the bloodstream heart attack, you may be moved from the emergency faster than swallowing it whole. (The patient department to a catheterization lab to receive angioplasty or should not be given aspirin if his or her physician a stent, or possibly heart bypass surgery. In addition, hospi- has advised otherwise, e.g., because of allergies or tals have lifesaving medications that are designed to stop a possible harmful interactions with other medica- heart attack by dissolving the clot and restoring blood flow tions or known disease complications). to the heart, although these medications work best when • If the person is conscious, keep the person calm given within the first one or two hours after the onset of and help him or her into a comfortable position. heart attack symptoms, when the damage is still limited. The victim should stop all physical activity, lie down, loosen clothing around the chest area, People often will experience some, but not all, of the and remain calm until the ambulance arrives. following symptoms, which may come and go: • If the person becomes unconscious, make sure • Uncomfortable pressure, fullness, squeezing the person is lying on his or her back. Clear the sensation or pain in the center of the chest, airway and loosen clothing at the neck, chest and lasting more than a few minutes, or it goes away waist. Check for breathing and pulse; if absent, and comes back and if trained to do so, begin cardiopulmonary • Pain that spreads to the shoulders, neck, jaw, (CPR). arms or back • Chest discomfort accompanied by lightheaded- ness, fainting, sweating, nausea or shortness of breath Some less common warning signs of heart attack that should be taken seriously - especially if they accompany any of the above symptoms - include: • Shortness of breath and difficulty breathing • Abnormal chest pain (angina), stomach, or abdominal pain (Symptoms may feel like indigestion or heartburn.)

30 HEAT-RELATED ILLNESSES 31 with heart disease are more likely to develop it develop to heartwith likely more are disease severe more have African Americans themselves. are and consequently, than whites hypertension risk. at greater that of non-smokers. than twice rise. levels cholesterol disease rises as blood in preventing a significant role plays exercise heart disease. and blood vessel heart and stroke, disease develop to likely more risk factors. no other have they if even disease. cardiovascular of developing risk the legs and stomach area. the legs and stomach juice or cool water, small amounts of and give liquids sportsa commercial give (Do not liquid. if the person is unconscious.) • Heredity (including race). Children of parents of parents race). Children (including • Heredity risk of heart A smoker's • Smoking. attack is more The risk of coronary heart• High cholesterol. moderate-to-vigorous Regular, inactivity. • Physical body fat are excess with People • Body weight. the This condition seriously increases • Diabetes. • Symptoms include muscle spasms, usually in • Symptoms in a cool place the person rest have treat, • To area. the affected and massage • Gently stretch salt tablets. administer • Do not or exhaustion. signs of heat stroke • Check for Heat-Related Illnesses Heat-Related the to overexposure illness can be caused by Heat-related heat.Young extreme situation that involves sun or any can most at risk, but anyone and the elderly are children be affected. Heat Cramps You can reduce your chances of having a heart chances of having attack your by can reduce You start. not should smoking, and nonsmokers quitting eat regularly, exercise weight, can also lose excess People reduce medications to diet, and take cholesterol a low It's also important if prescribed. maintain a to cholesterol exces- and avoid diabetes, control blood pressure, healthy about physician your to Talk alcohol consumption. sive heart for risk factors dis- major have taking aspirin if you a family his- have if you and checkups, ease. Get regular tory of heart disease, it's especially important that you can be information More lifestyle. maintain a healthy on the American Heartfound Association's website www.americanheart.org. cardiac arrest and the arrest cardiac with an electric treatment the abnor- stop shock to mal heart If an rhythm. where AED is available rec- ACEP or live, work you ommends taking a train- use learn to ing course to 2004, it. In September and Drug Food the U.S. approved Administration sales of over-the-counter use in for AEDs, available the home and without a prescription. than women, and they have attacks earlier in life. have and they than women, heart attacks who have are women older ages, At them within a die from as men to twice as likely weeks. few who die of coronary heart 65 ages disease are or older. instructed to chew and swallow an aspirin unless and swallow chew to instructed otherwise (e.g., has advised you physician your because including of allergies or contraindications, medications with other possible harmful interactions in mind Keep complications). disease or known the blood- the aspirin into helps get that chewing it whole. than swallowing faster stream services number immediately. Do not drive drive Do not services number immediately. the hospital. to yourself be having a heart attack and want to get to the to a heart get be having to attack and want the personcall 911 Have hospital immediately. servicesor the emergency number. • Gender. Men have a greater risk of heart a greater attack Men have • Gender. • Increasing age. About four out of five people out of five four About age. • Increasing • Once you have called 911, you likely will be will likely you called 911, have • Once you • If you are alone, call 911 or the emergency the emergency or alone, call 911 are • If you • If you are with someone, tell that person you may that person you tell with someone, are • If you The major risk factors for coronary for The major risk factors heart disease are: Heart Prevention Attack Automated External Defibrillators (AEDs) Defibrillators External Automated portable, operate can be trained to rescuers computer- Lay apply defibrillators (AEDs) used to external ized, automated restartelectric shock to a a heart that has developed , the most com- called ventricular rhythm chaotic Survival arrest. is directly mon cause of sudden cardiac the onset of sudden the amount of time between to linked If you think you may be having a heartbe having attack: may you think If you Heat Stroke and Other signs may include a lack of sensation in the affected Exhaustion area; and skin that appears waxy, cold to the touch or dis- • Symptoms of early heat colored (flushed, white, gray, yellow, blue or purple). exhaustion symptoms include cool, moist, pale or flushed To prevent hypothermia, avoid prolonged exposure to the skin; headache; dizziness; cold, ensure adequate heating, and dress appropriately weakness; feeling exhausted; for the environment and circumstances. In addition, avoid heavy sweating; nausea; and excessive alcohol consumption and the use of illegal sub- giddiness. stances, which can increase the risk of hypothermia. • Symptoms of heat stroke (late stage of heat illness) include flushed, hot, dry skin; fainting; If you suspect hypothermia, call 911 or your local a rapid, weak pulse; rapid, shallow breathing; emergency number. In addition: vomiting; and increased body temperature of • Remove any jewelry and wet clothing, if possible. more than 104 degrees. • Frostbitten skin should be handled with great • People with these symptoms should immediately care. Do not rub. rest in a cool, shaded place and (if conscious) drink plenty of non-alcoholic, non-caffeinated • Gently treat the affected area by soaking it in fluids. warm water (100 degrees F to 105 degrees F) until normal skin color appears and the area • Apply cool, wet cloths or water mist while fanning feels warm again. HYPOTHERMIA/FROSTBITE / NECK OR BACK INJURY / NECK OR BACK HYPOTHERMIA/FROSTBITE the person. • Cases of severe frostbite may require medical • Seek immediate medical attention by calling 911 follow-up. or your local emergency number for symptoms that include cool, moist, pale skin, rapid pulse, elevated or lowered blood pressure, nausea, Neck or Back Injury loss of consciousness, vomiting or a high body temperature. Suspected neck or back (spinal cord) injuries should be • For late stage heat stroke symptoms, cool the taken seriously because of the risk of paralysis and even person further by positioning ice or cold packs on death. When someone has a head or neck injury, he or wrists, ankles, groin and neck and in armpits. she should not be moved because movement may cause • Administer CPR if the person becomes further damage to spinal cord nerves (which carry mes- unconscious. sages between the brain and body), resulting in possible paralysis below the site of the injury.

Hypothermia/Frostbite The causes of neck or back injury include: • Accidents or falls that cause direct trauma to Hypothermia is a potentially life-threatening condition the face, neck, head or back (e.g., car or bike caused by overexposure to cold air or cold water. Although accidents, diving) most people typically are not at risk of developing hypothermia, the condition can strike anyone, depending • Any activities that result in landing on one’s head on their individual circumstances, weather conditions • Extreme or abnormal twisting of the body trunk and level of exposure in a cold or wet environment. • Sports activities (such as football) Therefore, it is important to know the risks involved and to take precautions against them. • A major blow to the head, neck or chest

The symptoms include: The symptoms of serious neck or back injury include: • Slurred speech • Head or body contorted in an unnatural or • Sluggishness unusual position • Confusion • Numbness or tingling sensations that radiate through an arm or a leg • Shallow, slow breathing • Weakness in back, neck or limbs • Unusual behavior • Difficulty standing or walking • Slow, irregular heartbeat • Inability to move arms or legs

32 NOSEBLEEDS / POISONING 33 mine whether the person has a together continuously for at least 5 minutes, or if at least 5 minutes, continuously for together tilt head not Do minutes. 10 bleeding persists, for which may blood, swallowing avoid back (so as to and diarrhea). cause nausea, vomiting uncomfortable, easily or the bleeding is not this technique. by controlled or ice pack the nose, placing a cold compress to help alleviate of the nose may the bridge across and discomfort.some swelling • Sit with head forward while pinching the nostrils while pinching • Sit with head forward nose if it becomes particularly pinching the • Stop of an injury• If the nosebleed is the result or blow Poisoning each care than 500,000 people seek emergency More - either because of poisoning States in the United year - and nearly 30,000 people die. accidental or deliberate poisoning is the second leading cause of Unintentional injuryunintentional death in America. be may home. They every in nearly found are Poisons or injected. touched breathed, accidentally swallowed, such as cleaners, antifreeze form, be in liquid may They such as pills or plants; they or solid form, or bug spray, such as carbon monoxide. be in a gas form, also may Nosebleeds that arises spontaneously especially one A nosebleed, in not are but most nosebleeds be alarming, a child, can are. really oftenserious and than they worse look much dry caused by oftenNosebleeds most are mucous or thin indoor to be linked nose (which may membranes in the Less often sinusitis, and nose picking. heat in the winter), sticking colds, allergies, injuries, from nosebleeds result per- the nose or cocaine use. In older small objects up of (“hardening atherosclerosis to be linked may sons, they disor- blood-clotting the arteries”), high blood pressure, caused by are they or sometimes ders or infections, with blood clotting. interfere drugs that aspirin and other a to be linked nosebleeds may instances, frequent In rare serious illness or disease. a nosebleed: stop To If a nosebleed occurs after a fall or car crash, seek imme- this could be a sign of internal medical attention; diate minutes, than 15 more bleeding. If bleeding persists for seek a medical assistance. If bleeding persists and is eval- or nose, physician the face, head to a blow to related deter uation is needed to nose or a facial or head fracture. broken is vomiting or choking on blood, or because you is vomiting must check that the person is still breathing. person along stationed at the head and the other the victim's side. The person's head, neck and occurs. in line while rolling back should be kept compressions. compressions. so, begin rescue breathing (CPR). (Do not move or move (CPR). (Do not breathing so, begin rescue open the to tilt the head back when attempting fingers on each jaw position your airway; instead, along the side of the head and lift open the jaw or forward.) remove it. remove neck or body; and do not move or roll the person or roll neck or body; move and do not (e.g., he or she is unless he or she is in danger in a burning vehicle). prevent movement. movement. prevent go away fingernails; dazed or semi-conscious appearance) dazed or semi-conscious fingernails; – Rolling a person requires two people, with one two a person requires Rolling – – If you must roll the person, do so only if he or she must roll If you – • If the person has no pulse, begin chest • If the person is not breathing, and if trained to do and if trained to • If the person breathing, is not • If the person is wearing a helmet, do not a helmet, do not • If the person is wearing • Do not attempt to reposition, bend or twist the bend or twist reposition, to attempt • Do not • Call 911 or the local emergency number. number. or the local emergency • Call 911 to area • Immobilize the head, neck and shoulder • Unconsciousness stiff• Neck pain, that won't neck or headache • Loss of bladder or bowel control or bowel of bladder • Loss lips, or gray blue skin; clammy (pale, • Shock If any of the above causes or symptoms are involved, causes or symptoms of the above If any and assume that the person has a spinal cord injury, steps: the follow take Some materials are not poisonous on their own, but Chemicals in the Eye become poisonous when combined with certain other • Rinse with running water for 15 to 20 minutes. substances. Make sure the water is flowing away from the uncontaminated eye. Prevent poisoning by making sure your home is as safe • If you cannot hold the eyelid open during the rins- as possible, wearing protective clothing and equipment ing, do not force it. Instead, have the person blink when using chemicals and following the directions on PUNCTURE WOUNDS as much as possible while flooding the eye. warning labels found on medicines and household chemicals. • For information regarding chemical injuries to the eye related to terrorist attacks. • Keep in mind that using proper eye protection, If you or someone else has come in such as goggles, when working with hazardous contact with poison, call the National chemicals can prevent eye injuries. Poison Control Center at 800-222-1222. { } Puncture Wounds If you or someone else has come in contact with poison, Most cuts are minor, but it is still important to properly call the National Poison Control Center at 800-222-1222. care for them. Sometimes it's hard to determine what The National Poison Control Center answers this number wounds can be treated at home and which require a trip 24 hours a day, 7 days a week. If there is a life-threaten- to the emergency department. ing emergency, call 911 (or local emergency number). Wounds that need emergency medical care are: In addition, if a person swallows a poison: • Those that will not stop bleeding after a few • Read the label on the product for safety minutes of applying direct pressure instructions. Follow the instructions. • Deep, gaping, jagged or potentially disfiguring • Be ready to describe the poison to the poison cuts, to avoid the formation of scar tissue control experts - what it was, how much was • Long or deep cuts that need stitches ingested and how long ago it was taken. Also be ready to describe the person's age and weight. • Cuts over a joint • If it's safe to do so, take the poison with you to • Cuts that may impair function of a body area the emergency department. such as an eyelid or lip • Make sure the person is breathing. If not, and if • Cuts that remove all of the layers of the skin you are trained to do so, start rescue breathing. like those from slicing off the tip of a finger • Cuts from an animal or human bite Smoke or Chemical Inhalation • Cuts that have damaged underlying nerves, • Immediately get the person to a place where he or tendons, or joints she can breathe fresh air. Avoid breathing fumes • Cuts over a possible broken bone yourself. • Cuts caused by a crushing injury • Seek prompt medical attention if you suspect carbon monoxide poisoning. (See the CDC Web • Cuts with an object embedded in them site at http://www.cdc.gov/co/guidelines.htm • Cuts caused by a metal object or a puncture for details.) wound • If the person is not breathing, and if you are Also call 911 or emergency services immediately if: trained to do so, start rescue breathing. • Bleeding from the cut does not slow during the Chemical Contamination (Skin) first few minutes of steady direct pressure. • Remove contaminated clothing and rinse • Signs of shock occur. the skin with water for 15 to 20 minutes. • Breathing is difficult because the cut is in the • Wash the skin gently with water, then rinse. neck or chest. • If there is continued irritation, seek medical • The wound is a deep cut to the abdomen that evaluation. causes moderate to severe pain.

34 RASHES / SEIZURES 35 eactions and fungal infections such as such and fungal infections eactions involving rhythmic jerking rhythmic involving open remaining generally eyes skin; these types of rashes are typically associated skin; these types of rashes are or unusual sleepiness with high fevers possible sign of a serious illness or a drug reaction) possible sign of a serious illness or a • A preceding warning or aura (in some cases) warning • A preceding partial or a convulsion • A complex seizure or alertness,• A loss of responsiveness with the • That look like small bleeding spots under the under small bleeding spots • That look like (a or inside the mouth • That appear in the eye(s) and materials; and poison ivy, oak or sumac. These types or sumac. oak ivy, and poison materials; and with fever. associated not are of rashes allergic include without fever of rashes Other causes reactions, drug r necessary is generally for evaluation Physician ringworm. types of rashes. of these and treatment diagnosis fever in association with moderate that occur Rashes infec- viral due to usually F) are degrees (less than 102 runs its course which without tions, such as roseola, appears The rash typically aftertreatment. the resolution of the fever. The symptoms of a seizure includes: The symptoms Seizures in behav- alterations sudden involuntary involve Seizures electrical excessive from ior or consciousness resulting common in persons who are activity in the brain. Seizures In minutes. three to normally last two epilepsy and have head injuries, by be caused may cases, seizures other brain develop- brain tumors, lead poisoning, inadequate disease and fevers. deficiencies, infectious ment, genetic alcohol abuse and alco- also be caused by may Seizures stroke failure, kidney holism, Alzheimer's Disease, lupus, of 50 percent illnesses. In approximately and other no cause can be identified. seizures, types of seizures: two are there In persons with epilepsy, seizures which include tonic-clonic seizures, generalized and partial as grand mal seizures); (also known seizures, which affect only part medica- of the brain. Anti-seizure person'sepilepsy. diagnosed with for available tions are nec- it is usually not In the case of most epileptic seizures, number. or the local emergency essary call 911 to from the person it is important away keep to However, his or her airway sure make harmful objects and to clear. remains Seek immediate medical evaluation for rashes: for evaluation medical Seek immediate especially if the person had one in more has not years. than 10 or other similar object), do not pull the offending similar object), do not or other cause (Doing so may object out of the wound. bleeding or organ damage.) uncontrolled life is in danger, wrap a 3" wide tourniquet above wrap a 3" wide tourniquet is in danger, life and pull tightly. area the wound steady, firm pressure for more than five minutes, than five more for firm pressure steady, Continue applying firm, immediately. call 911 with a clean cloth the wound over pressure direct until trained Maintain pressure bandage. or sterile medical help arrives. antiseptic, as it could damage healthy tissue. If healthy damage antiseptic, as it could (as bandages remove not do blood soaks through, apply instead with clotting); interfere may removal on top. directly bandages more pressure and elevate the limb above the heart, the the limb above and elevate pressure suspect the limb is broken. unless you with clean cloth or sterile bandage. (Don't use (Don't bandage. or sterile cloth with clean person's is on the if the wound pressure heavy until bleeding subsides, head.) Maintain pressure has been called) until trained or (if an ambulance medical help arrives. extremity. extremity. • A tetanus shot may be recommended as follow-up, be recommended • may shot A tetanus • If the person has been impaled (by a knife, pole a knife, (by • If the person has been impaled • If bleeding is severe, and you think the person’s and you • If bleeding is severe, • For wounds that are still bleeding after applying that are wounds • For • Deep cuts should not be cleansed. Do not apply be cleansed. Do not not • Deep cuts should • If bleeding is occurring in a limb, keep applying limb, keep in a • If bleeding is occurring • Apply firm, direct pressure over a bleeding wound a bleeding over pressure • Apply firm, direct • The wound is a cut to the eyeball. the eyeball. to is a cut wound • The partially or an cut amputates • The amputates The most common type of simple rash is inflammation of The most common type of simple as dermatitis. Contact dermatitis is the skin known substances that come in contact with the skin, caused by and such as chemicals, particularly in latex those found dyes clothing detergents; cosmetics, soaps and rubber; Rashes a variety (also called skin lesions or erythema)Rashes have skin color and texture, in changes of causes and involve In most common, especially in children. and can be quite deter- help to and characteristics cases, rash symptoms cases, medical mine what is causing the rash; in other is needed. testing To help stop the bleeding: the bleeding: stop help To Be aware that injuries that cause bleeding may also injuries that cause bleeding may that Be aware cause shock. • Barely detectable breathing during the seizure Shock SHOCK followed by deep breathing during recovery • Incontinence or loss of (in some cases) Shock is a serious, often life-threatening medical condi- • A transition back to the person's normal state tion and a leading cause of death for critically ill or injured known as the “post-ictal period”; this is a recovery people. Shock results when the body is not getting period for the brain, which may last anywhere enough blood flow and may lead to (a lack of oxy- from a few seconds to several hours and may gen in the body tissues) or cardiac arrest, in which the involve combativeness heart stops. In some cases, seizures may also involve isolated abnormal movements of a limb, periods of staring or abnormal stiff- Shock may result from allergic reactions, poisoning, trau- ening without rhythmic jerking. ma or serious injury (including spinal injuries), heavy bleeding, dehydration or heatstroke. It may also be asso- Take the following actions if someone is ciated with heart problems, infections or damage to the having a seizure: nervous system. • Move harmful objects out of the way, cushion Depending on the cause and type of shock, the head and protect the person from falling. symptoms may include: • Loosen ties, scarves or other neckware. • Pale, cool, clammy skin • Do not put anything in the person’s mouth. • Restlessness, anxiety or agitation • Do not attempt to restrain the convulsions. • Drowsiness or fatigue • After the convulsion ceases or if the person is • Dizziness, light-headedness or faintness vomiting, roll the person onto his or her left side to protect the airway and to help drain away any • Profuse sweating, moist skin mouth secretions. • Irritability • Make sure the airway is clear and the person is • Thirst breathing. If not, start rescue breathing and seek immediate medical attention. • Rapid pulse • Observe the length of the seizure, the movements • Rapid, weak breathing involved, direction of head and eye movements • Enlarged pupils and the time it takes to return to full consciousness and alertness, so you can report this information • Nausea or vomiting to a medical professional. • Blue tinge to lips or fingernails (or gray in the case of dark-complexions) Call 911 or the local emergency number immediately if: If the person is having or is suspected of having an allergic • The seizure lasts five minutes or longer, reaction, he or she may also be experiencing symptoms of or is repeated anaphylaxis, which may lead to or overlap with shock symptoms. • Injuries have resulted from the seizure • The person experiences persistent breathing To help someone in shock, first call for help difficulty (911 or your local emergency number) and then: • The person having the seizure also has a fever • Lay the person down, with his or her feet elevated • The person experiences persistent confusion about 12 inches (unless there is a head, neck or or remains unconscious back injury or if you suspect broken bones in the hips or legs); do not elevate the head. • The person is pregnant, is a diabetic, is injured or appears to have life-threatening conditions • Keep the person warm and comfortable, and loosen restrictive clothing. • This is the first time the person has had a seizure, or, in the case of an established epileptic, the • Do not give the person anything by mouth, seizure represents a marked change from the type including anything to eat or drink. or duration of seizure typically experienced • Do not move the person unless he or she is in danger.

36 SORE THROAT / SPRAINS AND STRAINS

• Make sure the person is breathing and has a pulse. If the person is not breathing, and you are trained to do so, do rescue breathing. • Continue to check breathing every five minutes until help arrives. • Take measures to control any bleeding. • Provide appropriate first aid for any injuries or illnesses. • If the person vomits or bleeds from the mouth, turn the person on his or her side to prevent choking (provided there is no suspicion of spinal injury). • Do not wait for mild shock symptoms to get worse before seeking emergency help.

Sore Throat The symptoms of a serious sprain or a strain include: • Pain, swelling and bruising Sore throats and their hallmark signs - including dry scratchiness, redness, swelling and painful swallowing - • Inability to move a joint that go with them are typically a symptom of a common • Feeling a pop or a tear when the injury occurs underlying illness such as colds or the flu. A physician should evaluate finger injuries to check for The good news is that most sore throats last only a few fracture, dislocation or unstable ligaments. days and can be relieved by over-the-counter pain relievers such as aspirin, acetaminophen or ibuprofen. (Do not give Other minor injuries are initially treated following the children under the age of 19 aspirin; doing so can cause RICE (rest, ice, compression, elevation) principle: Reye's Syndrome, a potentially fatal illness.) Gargling sev- eral times a day with warm salt water may also give some • Rest the injured area for 24 to 48 hours. relief. Some sore throat causes, such as strep, tonsillitis • Apply ice for 10 to 15 minutes, four times a day, and abscesses, are tied to a bacterial infection. These for the first 48 hours after the injury. infections must be treated with antibiotics. • Gently wrap and compress the area with an elastic bandage gently. Wrap loosely to avoid When to seek medical for a sore throat: cutting circulation. • If the pain is severe or lasts more than a • Elevate the injury for first 24 hours; keep the few days injured area above the heart. Use a sling or a • If the sore throat is accompanied by swollen soft splint (such as a pillow) to keep the injured glands that cause difficulty breathing or area from moving. If the pain does not improve or prevent the person from swallowing fluids other signs of a fracture develop, seek medical attention. • In children in particular, if there is presence of excessive salivation, inability to swallow liquids, difficulty speaking, irritability or the inability Seek emergency care if: to move the neck. In these instances, seek immediate medical attention • You experience a popping sound or feeling in the joint upon injuring it, or if you are unable to use the joint. Apply ice or a cold pack on the way to Sprains and Strains the doctor. • The area is hot and inflamed and you have a fever A ligament is the tissue that connects a bone to a joint, (indicating a possible infection). and a sprain is a stretched or torn ligament. A sprain is an injury to ligaments, while strains are stretch injury to the • The sprain is severe, in which case a delay in muscle. Sprains and strains are typically caused by treatment might result in chronic pain or long-term joint problems. falling, twisting or getting hit. Sprains and strains are common in fingers, wrists, ankles, knees and foot arches. • Joint pain doesn't diminish after two or three days.

37 Stroke • Control diabetes. • Manage heart disease. Be aware of your family's Stroke is a life-threatening condition that constitutes a medical history of stroke. medical emergency. It is the third leading cause of death • Promptly report warning signs to your doctor. in the nation. Stroke occurs when blood flow to the brain

STROKE / SUICIDE STROKE is interrupted by a clogged or burst artery. The interrup- tion deprives the brain of blood and oxygen, and causes brain cells to die. Seek emergency care immediately if a stroke is suspected.

Stroke symptoms in general include: • Sudden numbness, weakness or paralysis and drooping of the face, arm or leg, especially on one side of the body • Suddenly blurred or decreased vision in one or both eyes • Slurred speech, difficulty speaking or inability to understand or be understood • Loss of balance or coordination Some people may have additional, nontraditional (some- times non-neurological) symptoms, including severe Suicide headache, especially if the onset is abrupt or if accompa- nied by other symptoms (such as a change in conscious- Occasional passing thoughts about death or suicide usu- ness), in which case a brain hemorrhage may be a cause ally are harmless, particularly in people who otherwise for concern. seem healthy and happy, with no signs of , mental illness, drug or alcohol abuse or crises in their Stroke symptoms that last for only a few minutes and lives. However, any persistent thoughts of or conversa- then subside may indicate a “mini-stroke,” or a transient tions about wanting to die or committing suicide should ischemic attack (TIA). TIAs are serious medical events be taken seriously. While predicting whether someone is and require treatment; they are also a warning sign that a serious about committing suicide is often difficult, certain more dangerous stroke may occur in the future. groups are more vulnerable. For example, white men have the highest rates of suicide, although women and It is important to know that stroke often goes unrecog- teens attempt suicide more often. nized; people often wait to see if their symptoms improve and unknowingly put themselves in greater danger. Risk factors for suicide include: However, because stroke can incapacitate or kill within • A prior suicide attempt minutes, doctors recommend treating a suspected stroke as a medical emergency and seeking immediate medical • Alcohol or drug abuse problems care. • Mental illness (such as depression or bi-polar disorder) If stroke is suspected, it should be communicated directly • A family history of substance abuse or immediately. Call 911 and tell the dispatcher or the triage nurse or doctor, “I think this is a stroke.” • Family violence, including physical or How to Reduce Your Risk of Stroke • Control your blood pressure. • Firearms in the home • Don't smoke. • Arrest or incarceration • Eat a healthful diet that is low in sodium and fat. • Recent release from a psychiatric hospital (an often overwhelming time of transition) • Have your cholesterol checked; if it is high follow your doctor's instructions on how to control it. • The recent suicide of a relative, friend, co-worker or classmate • Exercise regularly.

38 SUICIDE 39 If you are in crisis and in crisis and are If you alone and there is help: and there is alone access to firearms, knives, medications or any medications or knives, firearms, access to try the person use to could commit tool other to suicide. risk to don't want people. You other alone. Involve health and safety. own your the Contact the person'sif necessary. doctor, or others who team, police, a crisis intervention help. trained to are listening are the person. you Let the person know the close to contact, moving maintaining eye by person or holding his or her hand, if appropriate. determine to suicide. Try has a specific plan for what method of suicide the person is considering. standing, judgmental not or argumentative. that Stress better. and things will get is inevitable a temporary suicide is a permanent solution to problem. his or her suicidal thoughts will keep that you a physi- speak to need to may confidential. You to in order cian or mental health professional injury. the person from protect feeling suicidal, you are not are not you suicidal, feeling the Suicide Prevention Hotline toll-free at toll-free Hotline the Suicide Prevention 1-800-SUICIDE (1-800-784-2433), Deaf persons (1-800-273-8255). 1-800-273-TALK in assistance for should call 1-800-799-4889; call 1-888-628-9454.Spanish (en Español), and suicide prevention nearest available learn more, (To mental health service provider. see www.suicidepreventionlifeline.org.) • Do not leave the person alone, and eliminate leave • Do not • Don't try or attempt handle a suicide threat to number, response or the local emergency • Call 911 closely to listen arrive, help to for • While waiting Find out if the person• Ask the person questions. Be under- the person's feelings. • Acknowledge change the person that help is available, • Remind suicide the person threatening • Don't promise • Immediate assistance is available by calling by assistance is available • Immediate the to will be connected call, you • When you If someone you know is threatening to commit suicide, to is threatening know If someone you the following calm and take Remain it seriously. take the crisis: help manage to steps away belongings, visiting family members and away up a will or writing a suicide note friends, drawing difficulties or in relationships; at school, work one; financial death of a loved job loss; divorce; difficulties; illness) terminal diagnosis of a made the decision to end his or her life) made the decision to taking illegal drugs or driving recklessly including withdrawing from family members and from including withdrawing when friends or suddenly becoming outgoing the person is typically shy (including sleeping too much or too little) much or too (including sleeping too anger, or wanting to get revenge get to wanting or anger, one day and terribly “down” the next) “down” and terribly one day other means of killing oneself other or talking about wanting to die to or talking wanting about having no purpose in life having or high burnout rates, such as law enforcement enforcement as law such rates, or high burnout care or hospice terminal illness terminal • Putting one's affairs - including giving in order • Life crises, traumas or setbacks (including crises, traumas or setbacks • Life • Sudden calmness (when the person had • Risky or self-destructive behavior, such as behavior, • Risky or self-destructive • Changes in appearance, behavior or personality, in appearance, behavior • Changes • Changes in eating and sleeping habits • Changes • Feelings of great agitation, rage or uncontrolled agitation, rage of great • Feelings • Wide mood swings (feeling extremely “up” extremely mood swings (feeling • Wide • Seeking access to weapons, medications or weapons, to • Seeking access • A preoccupation with death, dying or violence, with death, • A preoccupation • Feeling depressed, or excessively sad or excessively depressed, • Feeling worthlessness of hopelessness, or • Feelings • People in occupations involving high stress high stress involving in occupations • People • Unrelenting long-term pain, or a disabling or a disabling pain, or long-term • Unrelenting Warning signs of suicide include: signs of suicide Warning The good news is that medications and therapy usually is that medications and therapy The good news In addition, treating can help people with suicidal impulses. underlying causes such as mental illness and substance oftentimes the risk of suicide. Finally, abuse can reduce just talking with a friend or a counselor can bring some hope. and can help the suicidal person regain relief In any event, if you have suicidal thoughts or you suspect suicidal thoughts or you have if you event, In any has them, it's important ignore know to someone you not in mind that most people who keep the situation. However, and kill themselves, to intend really not suicide do attempt is a cry help. cases the attempt for that in many In some cases, the person will not reveal any suicidal behav- any In some cases, the person reveal will not suicide at iors; in others, the person will consider or attempt better. a point in which it is assumed he or she is feeling • Stay with the suicidal person until you are sure • If you become overheated or uncomfortable, they are in the hands of competent professionals. go indoors or sit in the shade.

SUNBURN If you have to leave, make sure another friend or • Check with your doctor before going out into the family member can stay with the person until they sun if you take any prescription drugs. Some can receive professional help. medicines can increase your risk of sunburn or • If a person attempts suicide, immediately call for interact with the sun to cause rashes or other side emergency medical assistance. Administer first effects. Remember, once skin is sunburned aid, if necessary. If you know the person has it is more sensitive to further exposure. swallowed poison or drugs, call the Poison Control • Persons with fair skin, moles or a family history Center at 1-800-222-1222. Be prepared with the of skin cancer are especially at risk of sunburns, name of the poison or drug used. damaged skin and skin cancer and should avoid overexposure. Sunburn • Even darker-skinned people need protection from the sun's damaging rays. Although sunlight in small doses (15 to 20 minutes per day) is vital to a person's health, damage caused by • For symptoms of sunburn: spending too much time in the sun can be dangerous, as – Take a cool (not cold) bath, or apply cool, well as irreversible and can result in a medical emer- wet compresses. gency. Overexposure to the sun's ultraviolet (UV) rays, – Apply topical moisturizing creams to soothe even for short periods, can damage skin and eyes. Long- discomfort and rehydrate the skin. Avoid term effects of the sun's damage include wrinkles, leath- petroleum-based products because they ery skin, , moles, “age spots” and skin cancer. prevent heat and sweat from escaping. – Take a pain reliever with acetaminophen or ibuprofen according to product label directions, if needed. Take precautions before venturing into the sun: – Resist the urge to scratch and peel loose skin. • Wear sunscreen with the maximum level of sun – Stay in the shade until the sunburn heals and limit protection when outside (usually SPF 15, or SPF sun exposure in the future, keeping in mind that 30 if in a tropical environment or when engaging previously sunburned skin burns much easier. in prolonged outdoor activities such as sports). • Seek immediate medical care for: • Check the label to make sure it protects against – A severe sunburn with blisters both UVA and UVB rays. – Fever or chills • Use sunscreen even on cloudy, cool or overcast days, because UV rays are not filtered by clouds or – Nausea or vomiting pollution. In fact, a cloudy day may be more dan- – Confusion gerous than a sunny day, because it is cooler and people may spend more time outdoors. • Apply sunscreen at least 30 minutes before going outside. Use it liberally and reapply every two hours, after swimming or perspiring heavily. Be sure to follow the directions on the product label. Do not use sunscreen on babies younger than six months - they should be kept out of the sun as much as possible. • Avoid activities between 10:00 a.m. and 3:00 p.m. in the summer (in the Northern Hemisphere), when the sun is at its highest, and, therefore, strongest level. • Keep in mind that harmful UV rays are more intense in the summer and at higher altitudes but also can be damaging in the winter, especially where there is snow, which reflects sunlight. • Protect yourself further by wearing a hat and loose fitting, light-colored clothing.

40 TEETH / VOMITING AND DIARRHEA 41 cannot be controlled by simple pressure, go to a go to pressure, simple by be controlled cannot department.hospital emergency symptoms subside symptoms and gelatin, broth tea, ale, cola, water, ginger subside hours or until symptoms the firstfor 24 applesauce potatoes, pasta, eggs, baked bread, one day) (for cereals or cooked dairy and alcoholic beverages products candy, days three to two for dehydration) avoid (to better feel until you anyone aspirin to give muscle aches (Do not 19.) under age hours avoid (12 hours in an infant) to than 24 of dehydration. the danger no urination, or thirst, crinkled skin, little to experienced. dizziness or lightheadedness are • If bleeding does not stop after 15 minutes or it minutes after 15 stop does not • If bleeding • Getting rest and restricting activities until and restricting • Getting rest including • Drinking plenty of clear liquids, rice, soup, such as crackers, • Eating bland foods fried or spicy foods, fruits, vegetables, • Avoiding per day 12 glasses of liquids • Drinking 8 to and fever or acetaminophen for ibuprofen • Taking more continue for and/or diarrhea • Vomiting pain. or rectum stomach is severe • There is a high fever. • There in the stool. found are • Blood, mucus or worms loss, such as dry• Signs of water mouth, excessive • Fever. nausea. and cramps • Stomach and muscle aches. • Headache, tiredness Seek emergency care if: Seek emergency Vomiting and Diarrhea and Vomiting may of gastroenteritis) (symptoms and diarrhea Vomiting poisoning also can Food a virus or bacteria. be caused by illnesses usually run their Viral cause these symptoms. if poisoning, while food course without medical treatment medical attention. require may severe, vomiting with associated Other symptoms include: and diarrhea respond include: to ways Effective If repeat vomiting follows a head injury, seek a head injury, follows vomiting If repeat care. emergency clean cloth. Apply cold compresses to reduce to Apply cold compresses clean cloth. and bleeding. If bleeding does not swelling medical attention. seek immediate stop, food that may be trapped. that may food the aching tooth or gum. the aching tooth headaches, fever and sleeplessness. headaches, fever broken teeth. broken warm water and place cold compresses over the over cold compresses and place water warm of the injury. face in the area hours, the tooth usually cannot be saved.) usually cannot hours, the tooth socket because this could cause furthersocket damage. should be rinsed gently to remove dirt and debris (do remove to should be rinsed gently will saliva in the mouth, where scrub) and stored not the tooth. swallow to not care it; take help preserve child mouth of a young in the the tooth store (Do not become unconscious.) or someone who may oral surgeon. see a dentist or an and immediately firm but gentle pressure with a clean gauze or cloth. with a clean gauze or cloth. pressure firm but gentle gently use light pressure with your finger to reposi- to finger with your use light pressure gently try normal alignment. Do not its to to tion the tooth in Hold the tooth its socket. back into the tooth force place with a moist tissue or gauze. Seek medical if possible. of the injury, within 30 minutes attention • Apply ice to bruised areas. If there is bleeding, apply If there bruised areas. • Apply ice to • These wounds should be cleaned gently with a gently should be cleaned • These wounds • Rinse the mouth with warm water. Floss to remove Floss to water. • Rinse the mouth with warm • If you have a toothache, do not place aspirin on do not a toothache, have • If you • Toothaches can be extremely painful and cause can be extremely • Toothaches • If a tooth is moved slightly forwards or backwards, slightly forwards is moved • If a tooth • Locate and save any broken tooth fragments. tooth broken any and save • Locate medical attention. • Seek immediate from can result dental problems • Long-term • If the tooth is broken, rinse the mouth out with rinse the mouth out is broken, • If the tooth • Seek immediate medical attention. (After two medical attention. • Seek immediate • out that has been knocked Atooth permanent in a cup of milk or teeth place the tooth • Alternately, back in its place the tooth to attempt • Do not Cut or Bitten Tongue, Lip or Cheek Lining Tongue, Cut or Bitten Toothache Loose Tooth Broken Tooth Broken Knocked-Out Tooth Knocked-Out Dental emergencies typically involve pain or injury the to involve typically Dental emergencies an Sometimes and tongue. lips or cheek gums, teeth, significant pain or any case, any In is involved. infection be ignored. injury not should the teeth the mouth or to Teeth (Dental Emergencies) (Dental Teeth 42 NOTES NOTES 43 2121 K Street, NW, Suite 325 Washington, DC 20037 800.320.0610 www.EmergencyCareForYou.org