Telephone Numbers & Information Emergency Medical Service (EMS): ______Fire: ______Police: ______Suicide Prevention: ______Poison Control Center:______Local800.222.1222 Poison Control: ______Health Care Providers Name Specialty Telephone Number ______Pharmacy: ______Phone Number: ______Hospital:______Phone Number: ______Employee Assistance Program (EAP): ______Health Insurance Information Company: ______Phone Number: ______Address: ______Policyholder’s Name: ______Policy Number: ______What to Tell Your Doctor or Provider (Make copies as needed.) Sample Use this summary when you call or visit a doctor or provider. See pages 13, 14, 36 and 37 for more information. Symptoms I Pain I Nausea/vomiting I Skin problems I Eye, ear, nose, throat problems I Fever/chills I Breathing problems I Stomach problems I Muscle or problems Other problems: ______Specific questions I have now: ______What I need to do: ______Medications Name/Dose Name/Dose Current medications: ______Do Not Reproduce ______Medication allergies: ______1 Acknowledgements

We are indebted to the physicians and other Gerald Freidman, M.D., Medical Director, health professionals who served on our clinical Physicians Health Plan, Kalamazoo, MI review team for this edition and past editions. Abe Gershonowicz, D.D.S., Family Dentistry, The Proven Guide to Self-Care & Being a Wise Health Consumer Sterling Heights, MI Susan Schooley, M.D., Chairperson, Department Gary P. Gross, M.D., Dermatologist, Lewis-Gale of Family Practice, Henry Ford Health Written by Clinic, Salem, VA System, Detroit, MI; Medical Director, Don R. Powell, Ph.D. Bruce Gursky, D.D.S., Complete Dental Care, American Institute for Preventive Medicine, and the Madison Heights, MI Farmington Hills, MI American Institute for Preventive Medicine J. Bruce Hagadorn, M.D., Otolarygologist, Edward Adler, M.D., S.A.C.P., Attending Lewis-Gale Clinic, Salem, VA Physician, Division of Geriatric Medicine, Donald Hayes, M.D., Former Medical Director, Note: This book is not meant to be a complete guide to health care. The information is given to help William Beaumont Hospital, Royal Oak, MI Sara Lee Corporation, Winston-Salem, NC you make informed choices about your health. You should not replace this information for expert Richard Aghababian, M.D., Past President, William Hettler, M.D., Director, University Health medical advice or treatment. Follow your doctor’s advice if it differs from what is given in this book. American College of Emergency Physicians, Service, University of Wisconsin, Stevens Also, if the problem you are reading about doesn’t go away after a reasonable amount of time, you Washington, DC Point, WI should see or call your doctor. Sara D. Atkinson, M.D., Child & Adolescent Ronald Holmes, M.D., Former Director, Division Psychiatry; General Psychiatry, Menninger of General Pediatrics, Professor, Department Clinic, Topeka, KS of Pediatrics, University of Michigan Mark H. Beers, M.D., Senior Director of Medical Center, Ann Arbor, MI This guide is one of many self-care books and programs offered by the American Institute for Geriatrics and Associate Editor, Merck William J. Kagey, M.D., Pediatrician, Lewis-Gale Preventive Medicine. The goal of all these is to help individuals reduce health care costs and improve Manual, West Point, PA Clinic, Salem, VA the quality of their lives. Joseph Berenholz, M.D., F.A.C.O.G., Diplomate, Jeanette Karwan, R.D., Director, Product HealthyLife® Self-Care Guides – Each of these booklets addresses the needs of: Families; Women; American College of Obstetrics and Development, American Institute for Men; Children; Adolescents; Pregnancy; Seniors; Alternative Medicine; and MentalSample Health. The books Gynecology, Clinical Instructor, Detroit Preventive Medicine, Farmington Hills, MI Health at Home®, Health at Home® Lifetime, and A Year of Health Hints are also available. Medical Center, Detroit, MI James Kohlenberg, M.D., Internal Medicine, John Dwight L. Blackburn, M.D., Former Medical R Medical Clinic, Madison Heights, MI Director, Anthem Blue Cross/Blue Shield, Richard S. Lang, M.D., M.P.H., Head, Section of Louisville, KY Preventive Medicine, Department of Internal For more information, call or write: For free health information: Douglas D. Blevins, M.D., Departments of Medicine, Cleveland Clinic Foundation, American Institute for Preventive Medicine Access the American Institute for Preventive Infectious Disease, Internal Medicine, Lewis- Cleveland, OH 30445 Northwestern Hwy., Suite 350 Medicine Web site, www.HealthyLife.com, and Gale Clinic, Salem, VA Martin Levinson, M.D., Chairman, Department of Farmington Hills, MI 48334-3102 click on “Online Products/365 Health Topics,” Frances B. DeHart, R.N., B.S.N., Former Health Pediatrics, Sinai Hospital, Detroit, MI 248.539.1800 / Fax 248.539.1808 then on “365 Health Topics.” Management Specialist, HealthFirst, Julie T. Lusk, M.Ed., Former Director of Health E-mail: [email protected] Greenville, SC Management, Lewis-Gale Clinic, Salem, VA Lynn DeGrande, A.C.S.C., CEAP, Herb Martin, Ph.D., CEAP, Consultant, Peak President/Senior Consultant, DeGrande & Performance Consulting Group, La Jolla, CA Associates, Grosse Pointe, MI Dan Mayer, M.D., Course Director, Evidence st Do Not Reproduce Copyright 2005, 1 edition, American Institute for Preventive Medicine Peter Fass, M.D., Former Medical Director, Based Health Care and Professor, Emergency All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, KeyCorp, Cleveland, OH Medicine, Albany Medical College; electronic or mechanical, including photocopy, recording, or any other information storage and retrieval system, Elaine Frank, M.Ed., R.D., Vice President, Attending Physician, Emergency without written permission. American Institute for Preventive Medicine, Department, Albany Medical Center, NY ISBN 0-9765048-0-4 Farmington Hills, MI 2 3 Tony Mendes, Ph.D., Former Manager, Training Lee B. Sacks, M.D., President, Advocate Health and Development, AT&T Health Promotion, Partners, Oak Brook, IL Table of Contents Basking Ridge, NJ Mark A. Schmidt, M.D., Urologist, Lewis-Gale Myron Miller, M.D., Vice Chairman and Clinic, Salem, VA Professor, Department of Geriatrics and Joel Schoolin, D.O., Medical Director, Advocate Section I Adult Development, The Mount Sinai Health Plan, Mt. Prospect, IL School of Medicine, New York, NY Michelle Schreiber, M.D., Division Head, Wise Health Care Choices Alonzo H. Myers, Jr., M.D., Orthopedic Surgeon, General Internal Medicine, Henry Ford Lewis-Gale Clinic, Salem, VA Hospital, Detroit, MI Chapter 1. Medical Care Chapter 3. Medications Joseph L. Nelson, III, M.D., Gastroenterologist, Ian Shaffer, M.D., Former Executive Vice Choosing a Doctor or Health Care Provider ....12 Safe Use of Medications...... 26 Lewis-Gale Clinic, Salem, VA President and Chief Medical Officer, Value See Your “Primary” Doctor Before You Over-the-Counter (OTC) Medications ...... 27 E. Blackford Noland, M.D., Department of Behavioral Health, Falls Church, VA Internal Medicine, Lewis-Gale Clinic, E.A. Shaptini, M.D., Former Vice President and See a Specialist ...... 13 Your Home Pharmacy...... 28 Salem, VA Medical Director, American Natural Tell & Ask the Doctor/Provider Checklists ...... 13 Medication Interactions ...... 29 Thomas C. Overhold, M.D., Department of Resources Company, Detroit, MI Choosing a Health Plan ...... 15 Overhauling Your Medicine Cabinet ...... 30 Internal Medicine and Pediatrics, Henry Steven Starr, D.P.M., Director, Birmingham Comparing Health Plans...... 15 Ford Hospital, Detroit, MI Care, Birmingham, MI Health Insurance Checklist...... 17 William A. Pankey, M.D., Senior Vice President, Bruce Stewart, M.D., Department of Internal Chapter 4. Complementary & Corporate Medical Director, D.C. Chartered Medicine, Lewis-Gale Clinic, Salem, VA Using Your Health Plan ...... 18 Health Plan, Inc., Washington, DC J. Steven Strosnider, M.D., Director of Preventing Medical Errors ...... 19 Alternative Medicine Anthony Pelonero, M.D., Medical Director, Psychological Counseling, Lewis-Gale Types...... 31 Anthem Behavioral Health; and Clinical Clinic, Salem, VA Safe Use ...... 33 Associate Professor, Virginia David J. Thaler, D.O., Internal Medicine, Lewis- Chapter 2. Medical Exams Commonwealth University - Medical Gale Clinic, Salem, VA & Tests College of Virginia, Richmond, VA Bonnie Timko, R.N., Certified Occupational Chapter 5. Medical Decisions David H. Reid, III, M.D., National Medical Health Nurse Specialist, Certified Case A Routine Checkup...... 21 Director, United States Postal Service, Manager, National OccupationalSample Health Tests & What They Are For ...... 21 Gather Facts ...... 35 Washington, DC Nurse Adm., United States Postal Service, Health Tests & When to Have Them ...... 22 Key Questions Checklist ...... 36 J. Courtland Robinson, M.D., M.P.H., Former Washington, DC Associate Professor, Dept. Gynecology and Neill D. Varner, D.O., M.P.H., Medical Director, Immunization Schedule ...... 23 Medical Decision Comparison Chart ...... 37 Obstetrics, Johns Hopkins School of Delphi Saginaw Steering Delphi Vaccines for Traveling Abroad ...... 24 Patient Rights ...... 37 Medicine, Baltimore, MD; Joint Automotive, Member of the UAW-GM Home Medical Tests ...... 24 Informed Consent ...... 38 Appointment in the Department of Health Promotion Task Force, and Medical Family Medical Record ...... 25 Advance Directives...... 38 Population Dynamics at the Johns Hopkins Director, Saginaw County Department of School of Hygiene and Public Health, Public Health, Saginaw, MI Baltimore, MD Andria Watha, Manager, Graphic Design, Edward J. Roccella, Ph.D., M.P.H., Former American Institute for Preventive Medicine, Coordinator, National High Blood Pressure Farmington Hills, MI Education Program, Office of Preventive Mark Werner, M.D., Obstetrician and Education and Control, National Heart, Lung Gynecologist,Do Laser Sur geryNot, William Reproduce and Blood Institute, Bethesda, MD Beaumont Hospital, Royal Oak, MI

4 5 Section II Chapter 8. Be Prepared for Chapter 11. Respiratory Shingles...... 132 Skin Cancer...... 134 Health & Safety Guidelines Public Health Conditions Disasters & Threats Skin Rashes...... 136 Ten Basic Tips to Stay Healthy & Safe ...... 39 Asthma ...... 95 Splinters ...... 144 Plans to Make Before a Disaster ...... 61 Avian Influenza – “Bird Flu” ...... 97 Varicose Veins...... 146 Be Prepared for Certain Disasters ...... 62 Chapter 6. Staying Well Bronchitis ...... 98 Warts ...... 148 Colds & Flu ...... 100 HealthyLife® Risk Appraisal...... 40 Section III Coughs ...... 104 Be Physically Active ...... 42 Emphysema...... 106 Chapter 13. Digestive & Urinary Common Health Problems Eat for Good Health ...... 44 Hiccups ...... 108 System Problems Nutrition for Children...... 47 Introduction...... 65 Pneumonia ...... 109 Abdominal Pain ...... 150 Control Your Weight...... 48 How to Use This Section ...... 66 SARS–Severe Acute Respiratory Syndrome ..110 Constipation ...... 153 Control Your Cholesterol and Triglycerides...... 49 Wheezing ...... 111 Diarrhea ...... 154 Be Tobacco-Free...... 50 Chapter 9. Eye Conditions Diverticulosis & Diverticulitis ...... 156 Use Alcohol Wisely ...... 51 Cataract ...... 68 Flatulence (Gas) ...... 157 Your Mind + Your Body = You ...... 52 Chapter 12. Skin Conditions Eyestrain from Computer Use ...... 70 Food Poisoning ...... 158 Manage Stress...... 53 ABC’s of Skin Care ...... 112 Floaters & Flashes ...... 71 Gallstones ...... 160 Home Safety Checklist ...... 54 Acne ...... 114 Glaucoma ...... 72 Heartburn & Indigestion...... 161 Personal Safety Checklist ...... 55 Athlete’s Foot ...... 116 Macular Degeneration ...... Sample74 Hemorrhoids ...... 163 Healthy Travel Checklist ...... 56 Blisters ...... 117 Pinkeye (Conjunctivitis) ...... 76 Hernias ...... 165 Boils ...... 118 Stye ...... 78 Hiatal Hernia...... 167 Cellulitis ...... 120 Chapter 7. Workplace Health Vision Care ...... 79 Irritable Bowel Syndrome (IBS) ...... 168 Cold Hands & Feet ...... 121 Kidney Stones...... 169 & Safety Corns & Calluses ...... 122 Lactose Intolerance...... 170 General Guidelines ...... 57 Chapter 10. Ear, Nose Dry Skin ...... 124 Peptic Ulcers...... 171 Prevent Injuries...... 57 & Throat Problems Hair Loss...... 126 Rectal Problems ...... 172 Prevent Musculoskeletal Disorders ...... 58 Ingrown Toenails ...... 127 Earaches ...... 80 Urinary Incontinence ...... 175 Workstation Exercises ...... 59 Insect Stings ...... 128 Hay Fever ...... 83 Urinary Tract Infections (UTIs) ...... 178 Manage Job Stress ...... 60 Poison Ivy (Oak, Sumac) ...... 130 Hearing Loss...... 85 Vomiting & Nausea ...... 180 Laryngitis ...... 88Do Not Reproduce Nosebleeds ...... 89 Sinus Problems ...... 90 Sore Throats ...... 92 Tinnitus (Ringing in the Ears) ...... 93 6 7 Chapter 14. Muscle & Bone High Blood Pressure...... 238 Chapter 17. Men’s Health Issues Chapter 19. Children’s Health HIV/AIDS...... 240 Problems Memory Loss ...... 242 Erectile Dysfunction (ED) ...... 291 Problems Arthritis...... 182 Multiple Sclerosis ...... 244 Jock Itch ...... 292 Bed-Wetting ...... 332 Back Pain ...... 184 Parkinson’s Disease ...... 246 Premature Ejaculation...... 293 Colic ...... 334 Fibromyalgia...... 188 Sexually Transmitted Diseases (STDs) ...... 248 Prostate Problems ...... 294 Croup ...... 336 Foot Problems...... 189 Sickle Cell Anemia ...... 254 Testicle Problems ...... 297 Lice ...... 338 Leg Pain & Pain...... 194 Sleep Disorders & Snoring...... 256 Osteoporosis ...... 199 Thyroid Problems ...... 260 Chapter 18. Women’s Health Issues Repetitive Motion Injuries ...... 202 Chapter 20. Dental & Mouth Pain & Pain ...... 205 Birth Control...... 300 Concerns Chapter 16. Mental Health Breast Lumps, Cancer & Self-Exam ...... 304 Regular Dental Care ...... 340 Conditions Cervical Cancer ...... 308 Bad Breath ...... 342 Chapter 15. General Health Endometriosis ...... 310 Mental Health ...... 262 Broken or Knocked-Out Tooth...... 343 Conditions Fibroids...... 312 Alcohol & Drug Problems ...... 263 Fractured Jaw ...... 344 Menopause ...... 314 Allergies ...... 208 Anger ...... 267 Gum (Periodontal) Disease...... 345 Menstrual Bleeding Problems ...... 316 Alzheimer’s Disease ...... 210 Anxiety & Panic Attacks ...... 269 Mouth Sores ...... 346 Menstrual Cramps...... 318 Anemia ...... 212 Codependency...... 273 Temporomandibular Joint (TMJ) Syndrome ..349 Ovarian Cysts & Cancer...... 320 Cancer ...... 214 Depression ...... 275Sample Toothaches ...... 350 Pelvic Inflammatory Disease (PID) ...... 323 Chest Pain ...... 216 Eating Disorders ...... 277 Plan for a Healthy Pregnancy...... 325 Chronic Pain ...... 218 Gambling Problems ...... 280 Premenstrual Syndrome (PMS) ...... 326 Diabetes ...... 220 Grief/Bereavement ...... 282 Toxic Shock Syndrome...... 328 Section IV Fatigue ...... 223 Stress & Posttraumatic Stress Disorder ...... 284 Vaginal Infections ...... 329 Fever ...... 226 Suicidal Thoughts ...... 287 Emergencies & First Aid Headaches ...... 228 Violence & Abuse...... 289 Introduction...... 351 Heart Disease ...... 232 Recognizing Emergencies ...... 351 Heart Palpitations ...... 235 Being Ready for Medical Emergencies ...... 352 Hepatitis ...... 236 Do Not Reproduce

8 9 Chapter 21. Emergency Procedures Fainting & Unconsciousness ...... 378 Fishhook Removal ...... 380 First Aid Precautions ...... 353 Frostbite & Hypothermia ...... 381 Rescue Breathing ...... 354 Head/Neck/Spine Injuries...... 384 CPR...... 355 Heart Attack ...... 387 First Aid for Choking ...... 356 Heat Exhaustion & Heat Stroke ...... 389 Recovery Position...... 357 Hyperventilation ...... 392 Near-Drowning ...... 393 Chapter 22. Emergency Objects in the Ear or Nose ...... 395 Poisoning ...... 397 Conditions / First Aid Seizures...... 399 Bites & Stings...... 358 Shock ...... 401 Bleeding ...... 362 Skin Injuries/Wounds ...... 402 Broken Bones/Dislocations ...... 365 , Strains & Sports Injuries ...... 404 Burns...... 368 Stroke (Brain Attack) ...... 407 Choking...... 370 Dehydration ...... 372 ...... 408 Electric Shock...... 373 Index Eye Injuries & Irritation ...... 375 Sample

Do Not Reproduce

10

Section 1: Wise Health Care Choices Chapter 3

Over-the-Counter (OTC) I If you have an allergy to a medicine, check Medications the list of ingredients on OTC medicine Medications labels. Find out if what you are allergic to is in them. Some labels will warn persons with I Keep medicines in their Over-the-counter (OTC) certain allergies to avoid taking that medicine. Safe Use of Medications original containers or in medications are ones that containers with sections you can get without a I Don’t take any OTC product if you are I Things to tell your doctor: for daily doses. prescription. Often, they pregnant or nursing a baby unless your doctor are less potent than or health care provider says it is okay. • Things you have had an allergic reaction to. I Let your doctor know prescribed ones. When about your past I Before taking herbal remedies and • If you are pregnant or breast-feeding. taken in large amounts, reactions to certain supplements, check with your doctor. • If another doctor is also treating you. though, an OTC medicine medicines. Tolerance Use OTC medications might equal or exceed the • If you have diabetes or kidney or liver levels may change with as directed. Drug Facts (Sample OTC label) dose of a prescribed disease. age. As some people Active ingredient (in each tablet) Purpose medicine. Read the information on the label. To age, they may be more Containers with Chlorpheniramine maleate 2 mg ...... Antihistamine • If you use alcohol, tobacco, or drugs. learn more about OTC medicine labels, access sensitive to some sections for daily Uses temporaily relieves these symptoms due to hay fever or other upper I See that your doctor has an up-to-date list of www.fda.gov. Search for “over-the-counter medications, such as doses and times can respiratroy allergires: all the medicines you take. This includes medicine label.” An example is in the next column. painkillers or sedatives. remind you when to I sneezing I runny nose I itchy, watery eyes I itchy throat prescribed and over-the-counter (OTC) ones, take medicines. vitamins, and herbal supplements. Keep an I Ask about the possible Use OTC Medicines Wisely Warnings Ask a doctor before use if you have up-to-date list in your wallet. side effects of a medication. Find out what I Ask your doctor or health care provider what you should do if you have any. OTC products are safe for you to use. Find I glaucoma I a breathing problem such as emphysema or chronic bronchitis I trouble urinating due to an enlarged prostate gland I Ask your doctor these questions: What is the out what he or she prefers you to take for pain I Ask if you can drink alcohol while taking the medicine for? When should I take it? How Sample and fever. Ask a doctor or pharmacist before use if you are taking tranquilizers or sedatives long do I need to take it? Should I take it with medication(s). Alcohol can lessen the effects of some medicines. Other medicines, such as I Do not take more than the label states. Don’t When using this product or without food? Can I crush the medicine if I I You may get drowsy I avoid alcoholic drinks sedatives, can be deadly when used with take OTC medicines on a regular basis unless can’t swallow it whole? Write these things I alcohol, sedatives, and tranquilizers may increase drowsiness your doctor tells you to. down so you don’t forget what was said. alcohol. I be careful when driving a motor vehicle or operating machinery I excitability may occur, especially in children I I Read the package labels. Heed the warnings I Tell your local and Don’t take someone else’s medication. listed. If you are unsure whether or not an If pregnant or breast-feeding, ask a health professional before use. mail order pharmacist I Throw away medications that have expired. Keep out of reach of children. In case of overdose, get medical help or what medicines and OTC medication will help or harm you, check I Try to reduce the need for some medications, contact a Poison Control Center right away. supplements you take. with your doctor or pharmacist. such as sleeping pills or laxatives. A hot bath Directions List these on the form I Store medicines in a dry place. Keep them out and a glass of milk might help you fall asleep. adults and children 12 years take 2 tablets every 4 to 6 hours; the health plan sends of children’s reach. Having more fiber in your diet can reduce or and over not more than 12 tablets in 24 hours you. Harmful mixtures replace the need for a laxative. Check with I Don’t tell children that medicine is candy. children 6 years to under 12 years take 1 tablet every 4 to 6 hours; with other drugs and your doctor on ways other than medicines to not more than 6 tablets in 24 hours with foods can be I Before you take a medicine, check the help treat Doyour problem. Not Reproduce children under 6 years ask a doctor identified. expiration date. Discard ones that have o o Your local or mail I Even if you feel better, don’t stop taking a expired. Replace items as needed. Other information: store at 20-25 C (68-77 F). Protect from excessive moisture. order pharmacist can prescribed medicine unless your doctor tells Inactive ingredients: D&C yellow no. 10, lactose, magnesium stearate, microcrystalline cellulose, pregelatinized starch answer questions about you to. Stopping some medications can be medications. harmful. Also, don’t skip doses. 26 27 Chapter 3 - Medications Section 1: Wise Health Care Choices

Your Home Pharmacy Medicines Common Uses Side Effects/Warnings/Interactions Pain Relievers Basic Over-the-Counter (OTC) Medications that Can Help with Self-Care Acetaminophen Gives pain relief. Lowers fever. More gentle on stomach than other OTC Medicines Common Uses Side Effects/Warnings/Interactions (e.g., Tylenol, Anacin-3, Datril, Does not reduce swelling. pain relievers. Can result in liver problems Liquiprin, Panadol, Tempra). in heavy alcohol users. Large doses or Antacids (e.g., Tums, Rolaids, Stomach upset. Heartburn. Don’t use for more than 2 weeks without long-term use can cause liver or kidney Mylanta). your doctor’s advice. Don’t use high- damage. sodium ones if on a low-salt diet. Don’t use if you have chronic kidney failure. Aspirin* Gives pain relief. Lowers fever Can cause stomach upset (which is made (e.g., Bayer, Bufferin). Antidiarrheal medicine Diarrhea. Don’t give Pepto-Bismol to anyone under and swelling. worse with alcohol use). May cause (e.g., Kaopectate, Imodium 19 years of age. It contains salicylates, stomach ulcers and bleeding. Avoid if you: A-D, Pepto-Bismol). which have been linked to Reye’s Have an ulcer, have asthma, are under 19 Syndrome. Also, Pepto-Bismol can cause years of age (due to its link to Reye’s black stools. Syndrome), and/or are having surgery within 2 weeks. High doses or prolonged Antihistamines (e.g., Chlor- Allergies. Cold symptom relief. May make you drowsy or agitated. Can use can cause ringing in the ears. Trimeton, Benadryl). Relieves itching. cause dry mouth, and/or problems with urinating. Don’t use with alcohol, when Ibuprofen* (e.g., Advil, Gives pain relief. Lowers fever Can cause stomach upset and peptic ulcers. operating machines, or when driving. Motrin, Adult and Children’s and swelling. Take with milk or food. Can make you Don’t use if you have glaucoma or an Advil). more sensitive to the effects of the sun. Don’t use if you are allergic to aspirin. enlarged prostate or problems passing Ketoprofen* for adults Don’t use if you have a peptic ulcer, blood urine. (e.g., Actron, Orudis KT). clotting problems, or kidney disease. Cough suppressant Dry cough without mucus. May make you drowsy. People with Naproxen Sodium* for adults (e.g., Robitussin-DM or others glaucoma or problemsSample passing urine (e.g., Aleve). with dextromethorphan). should avoid ones with diphenhydramine. Decongestant (e.g., Sudafed, Stuffy and runny nose. Postnasal Don’t use if you have high blood pressure, * These medicines are examples of nonsteroidal anti-inflammatory drugs (NSAIDs). Dimetapp). drip. Allergies. Fluid in the ears. diabetes, glaucoma, heart disease, a history of stroke, or an enlarged prostate. Medication Interactions I Drug-condition interactions. Some medical Expectorant (e.g., Robitussin Cough with mucus. Don’t give with an antihistamine. conditions make taking certain drugs harmful. One example is taking a nasal decongestant if or others with guaifenesin). Talk to your doctor or pharmacist about all of the you have high blood pressure. Laxatives (e.g., Ex-Lax, Constipation. Long-term use of stimulant-type can lead medications you take. These include prescribed Correctol (stimulant-types), to dependence and to muscle weakness due and OTC medicines and dietary supplements I Drug and food/beverage interactions. Alcohol Metamucil (bulk-forming type). to potassium loss. (vitamins, minerals, herbal products). Heed should not be mixed with certain drugs. Throat anesthetic (e.g., Minor sore throat. Don’t give throat lozenges to children warnings on labels, too. Grapefruit juice should not be taken with certain medicines for high blood pressure and Sucrets, Chloraseptic spray). under age 5. I Drug-drug interactions. These can make a high blood cholesterol. Toothache anesthetic Toothache. Teething. Call doctor before giving to babies under 4 drug work less, increase the action of a drug, (e.g., Anbesol). monthsDo old. Not Reproduceor cause side effects, even harmful ones. For The “Side Effects/Warnings/Interactions” Chart continued on next page example, unless told to by a doctor, do not take an antihistamine if you take medicine for columns on page 28 and this page point out high blood pressure or a sedative or common medication interactions for OTC tranquilizer. medicines. 28 29 Chapter 3 - Medications

Common Drug Interactions Drug Harmful or Less Effective With* Acid reducers (for heartburn). Asthma drug – theophylline. Blood thinner – warfarin. Tricyclic antidepressants, such as Elavil and Pamelor. Antibiotics. Some birth control pills. Asthma drug – theophylline. Beta-blockers. Caffeine. Cimetidine (in acid reducers). Blood thinner – warfarin. Antacids. Aspirin. High doses (400 IU or more) of vitamin E. Vitamin K and/or foods high in it (liver, broccoli, brussels sprouts, kale, spinach, etc.). Grapefruit juice or grapefruit. Some statin drugs to lower cholesterol. Grapefruit juice or grapefruit. Nitrates to dilate blood vessels. Cialis. Levitra. Viagra. * This does not include all medicines and foods that can cause harmful reactions with these drugs. Ask your doctor or pharmacist for more information.

Overhauling Your Medicine I Activated charcoal is no longer advised for home use for some swallowed poisons. Call the Cabinet Poison Control Center at 800.222.1222 before using syrup of ipecac. {Note: The American I Take everything out of the Academy of Pediatrics advises that parents medicine cabinet. don’t give syrup of ipecac to children.} I Check expiration dates. Throw Sample out all outdated medicines. If Basic Supplies to Help with Self-Care you’re not sure about a certain item, call your pharmacist. I Adhesive bandages, sterile gauze, first aid tape, and scissors. Ask what the shelf life is. Inventory your I I Discard old tubes of cream medicine Antiseptic preparation (e.g., Betadine). cabinet at least that are hardened or cracked. I Eye dropper. Throw out any liquid once a year. I Heating pad/hot water bottle. medicines that look cloudy or filmy. I Humidifier, vaporizer (cool-mist). I If medications are not in original containers and clearly labeled, throw them away. Some I Ice pack/heat pack. medicines come in tinted glass, for example, I Rubbing alcohol. because exposure to light may cause them to deteriorate. I SunscreenDo with a sun protection Not factor Reproduce (SPF) of 15 or more. I Every medication is a potential poison. If there are children in the house, keep all I Thermometer (digital or ear). medicines and vitamins locked in a high I Tongue depressor and flashlight. cabinet, well out of their reach. 30 Section III: Common Health Problems Chapter 10 Chapter 7. Eye Conditions Earaches, Continued Ear, Nose & Throat Problems Does the earache occur with jaw pain, Does a child show the following signs, headache, and a clicking sound when especially after a respiratory tract you open or close your mouth? infection, a cold, air travel, or if the Earaches child has had ear problems before? • Constant pulling, touching, or Signs & Causes tugging at the ear(s). • No response to a whistle or a loud Symptoms The most common cause of earaches is plugged Eustachian tubes. These Self-Care / Prevention clap. go from the back of the throat to the middle ear. Fluid or pressure in a To Help Prevent Ear Pain I Mild to severe ear pain. • Fever. (See pages 226 and 227.) plugged Eustachian tube causes pain. This is caused by an infection of the I Don’t put cotton-tipped swabs, bobby pins, • Crying that won’t stop. I Feeling of fullness or middle ear, a cold or sinus infection, or allergies. Other things that can etc. in your ears. This could damage the • Ear(s) that are hot and hurt when discomfort in the ears. cause ear pain include changes in air pressure in a plane, something stuck eardrum. touched. in the ear, too much earwax, tooth problems, and ear injuries. I Tugging at the ear and • Acting cranky and restless, I Don’t blow your nose with too much force. restlessness in young especially at night or when lying I If you can, avoid places that have very loud children. Questions to Ask down. noises (construction sites, etc.). Wear earplugs when exposed to loud noises. Outer Ear Canal Did the ear pain start after a blow to the ear or recent head Does the earache persist, is it more Inner Ear trauma? I Keep the volume on low when using stereos, than mild, and does it occur after any compact discs (CDs), etc. If someone else can of the following? hear the music when you are listening to one With the earache, do any symptoms of meningitis occur? • A mild ear injury. of these devices with earphones, the volume • Blowing your nose hard or many Middle • Severe, persistent headache. Sample is too loud. Ear • Stiff neck (can’t touch the chin to the chest). times. Eardrum • Lethargy. • A small object has been stuck in the To Avoid Getting “Swimmer’s Ear” Eustachian Tube • Seizure. ear that cannot easily be removed. I Wear wax or silicone earplugs. • Red or purple rash that doesn’t fade when pressure is Or, an insect has gotten in the ear Diagram of Ear I Wear a bathing cap. applied to the skin. that cannot safely be removed. • In an infant, bulging of the fontanelle (soft spot of the skull). • A cold, sinus, or upper respiratory I Don’t swim in dirty water. Swim on the Ruptured Eardrum Signs infection. surface not underneath the water. I Ear pain. • Exposure to extremely loud noises, I Use an over-the-counter product, such as With ear pain, do any of these problems occur? such as rock concerts, heavy I Some hearing loss. Swim-Ear, as directed. • Vomiting. machinery, etc. • Fever. (See pages 226 and 227.) I Blood or other To Reduce Ear Pain • Sticky, green, or bloody discharge from the ear. discharge from the ear I Place a warm washcloth next to the ear. Some • The ear pain is severe or worsens when wiggling the ear lobe. With the earache, do you also have (especially after health professionals recommend putting an sticking an object in the • Sensitivity to the light. Do Not Reproducehearing loss, ringing in the ears, ice bag or ice in a wet washcloth over the dizziness, or nausea? ear or exposure to painful ear for 20 minutes. extremely loud noise). Flowchart continued on next page I Take an over-the-counter medicine for pain as Flowchart continued in next column directed on the label. 80 81 To Learn More, See Back Cover Chapter 10: Ear, Nose & Throat Problems Section III: Common Health Problems

Earaches, Continued I A corticosteroid To Open Up the Eustachian Tubes and Help Them Drain Hay Fever nasal spray and Treatment eye drops, I Sit up. Prop your head up when you sleep. The medical term for hay fever is allergic Treatment includes pain cromolyn I Yawn. This helps move the muscles that open the Eustachian tubes. rhinitis. Hay fever is most common in spring and relievers and methods to sodium, and fall when a lot of ragweed is in the air. Some dry up or clear the I Chew gum or suck on hard candy. (Do not give to children under age oral people have hay fever all year, though. blocked ear canal. Self- 5.) This tip is especially helpful during pressure changes that take corticosteroids. care can be used to treat place during air travel, but can also help if you wake up with ear pain. Signs & Symptoms I Skin tests to many earaches. Severe I When traveling by air, stay awake when the plane takes off and find out what and/or constant ear pain things you are lands. Wear ear plugs. I Itchy, watery eyes. needs a medical diagnosis. allergic to. I Often, antibiotics are not Take a steamy shower. I Runny, itchy nose. I Allergy shots. needed for middle ear I Your doctor may advise a nasal Use a cool-mist vaporizer, especially at night. I Congestion. infections in children. spray for hay fever symptoms. I Drink plenty of cool water. It is best to take About 8 in 10 children I Sneezing. what your doctor advises instead of testing over- with ear infections get I Gently, but firmly, blow through your nose while holding both nostrils the-counter products on your own. better without antibiotics. closed until you hear a pop. This can be done several times a day. Causes Let your child’s doctor I If okay with your doctor, take a decongestant to help relieve the decide if and when an Hay fever is a reaction of the Questions to Ask swelling that causes the pain. (Don’t use a nasal spray decongestant Hay fever has antibiotic should be upper respiratory tract to for more than 3 days unless directed by your doctor.) nothing to do with Do you have severe breathing prescribed. allergens. I When you give a baby a bottle, hold the baby in an upright position. hay or fever. problems or severe wheezing? SampleTreatment To Treat a Mild Case of “Swimmer’s Ear” Do you have any of these symptoms of The goal is to clean and dry the outer ear canal without doing further Talk to your doctor if self-care measures do not an infection? damage to the top layer of skin. help. He or she may prescribe: • Fever. (See pages 226 and 227.) I Antihistamines. For best results, take the • Green, yellow, or bloody-colored I Shake the head to expel trapped water. antihistamine 30 minutes before going nasal discharge or mucus. I Dry the ear canal. Get a clean facial tissue. Twist each corner into a outside. {Note: Some over-the-counter • Throbbing facial pain. tip and gently place each tip into the ear canal for 10 seconds. antihistamines can make you more drowsy For more Repeat with the other ear using a new tissue. than prescribed ones. Also, be careful when information, Do you still have hay fever symptoms driving and operating machinery since some contact: I Use an over-the-counter product, such as Swim-Ear. Drop it into the when you avoid hay fever triggers or antihistamines can make you drowsy.} ears to fight infection. Follow package directions. do hay fever symptoms interfere with National Institute on I A decongestant. daily activities? Deafness and Other I Do not remove earwax. This protects the ear canal. Communication Disorders (NIDCD) For an Insect in the Ear Do Not Reproduce 800.241.1044 I Shine a flashlight into the ear. Doing this may cause the insect to www.nidcd.nih.gov come out. See, also, To Remove an Insect from an Ear on page 396. See Self-Care / Prevention on next page

82 83 To Learn More, See Back Cover Chapter 10: Ear, Nose & Throat Problems Section III: Common Health Problems

Hay Fever, Continued Hearing Loss Causes Self-Care / Prevention I Presbycusis (prez-bee-KU-sis). This is a People over age 50 are likely to lose some hearing Avoid Hay Fever Triggers gradual type of hearing loss. It is common each year. The decline is usually gradual. About with aging. With this, you can have a hard I If you are allergic to pollen and molds, let someone else do outside 30% of adults age 65 through 74 and about 50% of time understanding speech. You may not chores. Mowing the lawn or raking leaves can make you very sick. those age 85 and older have hearing problems. tolerate loud sounds. You may not hear high I Keep windows and doors shut and stay inside when the pollen count Hearing problems can get worse if they are pitched sounds. Hearing loss from presbycusis or humidity is high. Early morning is sometimes the worst. ignored and not treated. People with hearing does not cause deafness. problems may withdraw from others because they I Avoid tobacco smoke and other air pollutants. I Ear wax that blocks the ear canal. may not be able to understand what others say. I To limit dust, mold, and pollen: Hearing loss can cause an older person to be I A chronic middle ear • Use rugs that can be washed often. Don’t use carpeting. labeled “confused” or “senile.” infection or an infection of the inner ear. • Dust and vacuum often. Wear a dust filter mask when you do. I Medicines (e.g., aspirin). • Use drapes and curtains that can be washed often. Signs & Symptoms I Blood vessel disorders, • Put an electronic air filter on your furnace or use portable air I Words are hard such as high blood purifiers. to understand. pressure. • Put a plastic cover on your mattress or cover it completely with This worsens I Acoustic trauma, such as an allergen-free mattress cover. when there is background from a blow to the ear or • Sleep with no pillow or with the kind your doctor or health care noise. from excessive noise. provider recommends. If you use a pillow, cover it with an Noise-Induced Hearing SampleI allergen-free cover. Certain sounds Loss (NIHL) can be are overly loud Exposure to loud • Try not to have stuffed animals kept in the from a one-time exposure or annoying. noises increases the bedroom. If you must, have only one that to an extremely loud I Hearing a sound or to repeated risk for hearing can be washed. Wash it in hot water loss. once a week. hissing or exposure to loud level ringing sounds. (See Decibels of Sound on page 86.) • Don’t dry sheets and blankets background For more I Ménière’s disease. This is a problem of the outside. Another person’s speech may noise. This can inner ear. The hearing loss comes and goes. information, sound slurred or mumbled. contact: • Shower or bathe and wash your hair after be constant or it Dizziness is also a symptom. heavy exposure to pollen, dust, etc. can come and go. Asthma and Allergy I Small tumors on the auditory nerve. Brain I I Concerts, TV shows, etc. are less enjoyable Foundation of America Don’t have pets. If you have a pet, keep it out of the bedroom. tumor (rarely). because much goes unheard. 800.7.ASTHMA When you can, keep the pet outdoors. (727.8462) I Use an air conditioner or air cleanerDo in your house, Not especially in the Reproduce www.aafa.org bedroom. Electronic air filters are better than mechanical ones. Clean the filter often. Or, try a doctor-approved air purifier, especially in the bedroom. Devices with HEPA filters can be very effective in cleaning indoor air. 84 85 To Learn More, See Back Cover Chapter 10: Ear, Nose & Throat Problems Section III: Common Health Problems

Hearing Loss, Continued Hearing Loss, Continued To Clear Earwax Decibels (dB) of Sound Treatment Self-Care / Prevention (Use only if the eardrum is not ruptured. (See Sound levels are measured Ruptured Eardrum Signs on page 80. Check with your doctor if you are not sure.) in decibels (dB). In I Earwax is removed by a health care provider. For Gradual, Age-Related Hearing Loss general, the louder the I Ask people to speak clearly, distinctly, and in I Hearing aid(s). These make sounds louder. I Lie on your side. Using a syringe or medicine sound, the higher the dB. a normal tone. dropper, carefully squeeze a few drops of I Speech reading. This is learning to read lips and facial expressions. I Look at people when they are talking to you. lukewarm water into your ear (or have Type of Sound ...... dB I Auditory training. This helps with specific hearing problems. Watch their expressions. someone else do this). Let the water remain Weakest sound heard ...... 0 I Surgery. This can be done if the problem requires it. I Try to limit background noise when speaking there for 10 to 15 minutes and then shake it Whisper ...... 30 with someone. out. Now, squeeze a few drops of hydrogen Normal talking ...... 60–70 peroxide, mineral oil, or an over-the-counter I In a church or theater, sit in the 3rd or 4th row Questions to Ask cleaner, such as Debrox into the ear. Let the Average radio ...... 75 with people sitting around you. excess fluid flow out of the ear. Busy street ...... 80 When your child is awake, does he or she not respond to any I Install a flasher or amplifier on your phone, sound, even a whistle or a loud clap? I After several minutes, put warm water in the door chime, and alarm clock. Repeated Exposures > 85 ear again. Let it stay there for 10 to 15 can lead to hearing loss With hearing loss, do any of these problems occur? To Hear Sounds Better minutes. Tilt the head to allow it to drain out of the ear. Hair dryer ...... 90 • A discharge from the ear. I Use a hearing aid. • Ear pain doesn’t go away. There are many kinds. Lawnmower ...... 90 Repeat this entire procedure again in 3 hours if • You feel dizzy or it feels like things are spinning around Examples are ones Subway train...... 95 the earwax has not cleared. you. worn: Rock concert...... 110–120 • A recent ear or respiratory infection. • In-the-Ear (ITE). Chain saw ...... 120 • It feels like your ears are blocked. Sample • Behind-the-Ear For more information, Ear pain begins at 125 dB (BTE). contact: Is a nondigital watch not heard when held next to the ear? Jet take-off ...... 135 • In-the-Canal (ITC). American Speech-Language Hearing Association I To find the hearing aid 800.638.8255 One time exposure >140 Do you hear a ringing sound in one or both ears all of the time? that works best for you, www.asha.org dB can cause permanent see an audiologist. Ask Hearing aids help to hearing loss him or her about a trial hear sounds better. Better Hearing Institute Siren (at 100 feet) ...... 140 Did you lose your hearing after exposure to loud noises, period with different hearing aids to find one Hearing Help-on-Line Firearms ...... 140–170 (e.g., rock concerts, power tools, firearms, etc.) and has this you are comfortable with. www.betterhearing.org not improved? Loudest tone the ear I Use devices and listening systems that help National Institute on Deafness and Other can hear...... 197 you hear better when you use your telephone, Communication Disorders (NIDCD) Do Not Reproducemobile phone, TV, stereo, etc. 800.241.1041 www.nidcd.nih.gov See Self-Care / Prevention on next page

86 87 To Learn More, See Back Cover Chapter 10: Ear, Nose & Throat Problems Section III: Common Health Problems

Did the nosebleed follow a blow to the Laryngitis Nosebleeds head or nose or a severe headache? Or, Laryngitis is when your Causes does the nosebleed occur in a person larynx (voice box) is Signs & Symptoms taking blood-thinning medicine? irritated or swollen. Common causes are allergies and irritants like smoke; bacterial or viral I Bleeding from a nostril. infections; and strained vocal cords. Smoking, drinking alcohol, In the past 48 hours, did 3 or more breathing cold air, and using already distressed vocal cords can make I Bleeding from the nose and down the back of nosebleeds occur and did each one Signs & the problem worse. Growths on the vocal cords or nerve damage to the the throat. take longer than 10 minutes to stop? Symptoms vocal cords can also cause hoarseness. Causes Did the nosebleed start after taking I Hoarse, husky, and weak Questions to Ask Nosebleeds are often caused by broken blood newly prescribed medicine? Or, do voice or loss of voice. Do you have a high fever or are you coughing up yellow, vessels just inside the nose. Risk factors include: nosebleeds occur often? I Cough. green, or bloody-colored mucus? I A cold or allergies.

I Sore throat, fever, I Frequent nose blowing and picking. and/or trouble Do you have hard, swollen lymph glands in your neck or do you I Dry environment. swallowing. feel like you have a “lump” in your throat that doesn’t go away? I Using too much nasal spray. Self-Care / Prevention I A punch or other blow to the nose. Treatment Has hoarseness lasted more than a week in a child, more than I Sit with your a month in an adult, or does it become chronic in a smoker? head leaning Self-care treats most cases A nosebleed is serious when heavy bleeding from forward. Pinch of laryngitis. If needed, deep within the nose is hard to stop. This type the nostrils shut. Sampleoccurs most often in the elderly. It can be caused your doctor may prescribe Use your thumb an antibiotic for a bacterial by: Hardening of nasal blood vessels; high blood and forefinger to infection. pressure; and medicines that treat blood clots. Self-Care / Prevention gently squeeze the nose’s I Don’t smoke. Avoid secondhand smoke. Treatment midsection. Pinching the Nostrils Shut I Don’t talk if you don’t need to. Write notes, instead. Self-care treats most nosebleeds. If needed, a I Hold for up to 20 minutes without stopping. I Use a cool-mist humidifier in your bedroom. doctor can pack the nostril to stop the bleeding or Use a clock to time this. Breathe through For more I Drink a lot of fluids. Drink warm drinks, such as weak tea, with do a treatment that seals the blood vessel that your mouth while you do this. Repeat a information, honey and/or lemon juice. bleeds. second time, if needed. If a second attempt contact: fails, go to an urgent care center or hospital 1 I Gargle every few hours with warm salt water ( /4 teaspoon of salt in American Academy of Questions to Ask emergency department. 1 cup of warm water). Otolaryngology - Is blood from a nosebleed going down I Don’t take aspirin or other nonsteroidal anti- Head and Neck Surgery I Run hot water in the shower to makeDo steam. Sit inNot the bathroom and Reproduce inflammatory drugs. the back of the throat or backward into www.entnet.org breathe the moist air. the mouth? I For the next 24 hours, elevate your head I Suck on cough drops, throat lozenges, or hard candy. (Don’t give to above the level of your heart. Also, wait 24 children under age 5.) Take an over-the-counter medicine for pain as Flowchart continued in next column hours before you blow your nose, lift heavy directed on the label. objects, or exercise hard. 88 89 To Learn More, See Back Cover Chapter 10: Ear, Nose & Throat Problems Section III: Common Health Problems

Sinus Problems, Continued Sinus Problems Have you been treated for a sinus An antifungal medicine helps treat a fungal infection and do symptoms not improve Your sinuses are behind Signs & Symptoms infection in the sinuses. Surgery may be needed after taking the prescribed medicine for your cheekbones and to drain the sinuses. Surgery can be done to 48 hours? Or, do symptoms return after For a Sinus Infection forehead and around your enlarge a sinus passage that is too narrow to you are done with prescribed treatment? I Fever. eyes. allow proper drainage. I Green, yellow, or bloody-colored nasal discharge.

I Foul-smelling or tasting postnasal drip. Questions to Ask I Severe headache that doesn’t get better when you take an over-the- With a recent headache, fever, sinus Self-Care / Prevention counter pain reliever. The headache is worse in the morning or when pressure and pain, and yellow, green, or bending forward. bloody nasal discharge, are all of the I Use a cool-mist humidifier especially in the bedroom. Put a humidifier on the furnace. I Pain between the nose and lower eyelid. Cheek or upper jaw pain. following symptoms now present, especially in a child? I Put a warm washcloth, warm or cold I A feeling of pressure inside the head. Stuffy nose. • Sudden onset of a fever. compress over the sinus area of your face. I Swelling around the eyes, nose, cheeks, and forehead. • Redness and swelling of the eyelid(s) Use the one that helps most for the pain. or area around the eye(s). I Cough that worsens at night. I Drink plenty of liquids. • Protruding eye(s) and pain behind Nasal Sinuses I Fatigue. the eye(s). I Take an over-the-counter (OTC) medicine for Healthy sinuses drain • Problems moving the eye(s). pain as directed on the label. For sinus congestion without an infection, drainage is clear and there is almost a quart of mucus • Eye pain and redness. I no fever. Take an OTC decongestant or an OTC pain every day. They keep the reliever with a decongestant (e.g., Tylenol air you breathe wet. Your Sample Do you have 2 or more of the following Sinus). {Note: Persons with high blood sinuses can’t drain right if Causes symptoms? pressure and older men should check with they are blocked, infected, I Bacterial, viral, or fungal infection. Sneezing hard with your mouth • Fever. their doctors before taking decongestants. or swollen. Sinus problems closed or blowing your nose too much with a cold. • Green, yellow, or bloody-colored Decongestants with an antihistamine can give include: nasal discharge for more than 3 older men urinary problems.} I Irritants like tobacco smoke, air pollutants, etc. Hay fever or other days. This may occur with a foul- I A sinus infection. This allergies. I Use nose drops only for the number of days smelling or bad-tasting drainage into can be acute or chronic. prescribed. Repeated use of them creates a I A nasal deformity. Sinuses that don’t drain well. the back of the throat. dependency. Don’t share nose drops with I Sinus congestion • Headache that gets worse when you others. Throw the drops away after treatment. without an infection. Treatment bend forward and that may not be relieved with over-the-counter pain For more information, Sinus congestion without an infection does not need an antibiotic and relievers. contact: can be treated with self-care. A decongestant helps break up the • Pain (usually throbbing) around the congestion. eye(s), cheek(s), upper jaw(s), Do Not Reproduce National Jewish Medical and Research Center and/or between the nose and eye An acute sinus infection usually clears up in 2 weeks with an antibiotic, 800.222.LUNG (222.5864) socket(s). a decongestant, and nose drops or a nasal spray. When this is not the www.njc.org case, the problem may be a chronic sinus infection which takes longer to treat and/or may need further investigation to diagnose the cause. Flowchart continued in next column 90 91 To Learn More, See Back Cover Chapter 10: Ear, Nose & Throat Problems Section III: Common Health Problems

Sore Throats I Persistent allergies. Tinnitus I High blood pressure. Signs & Causes (Ringing in the Ears) I Reactions to drugs. These include: Aspirin; levodopa (for Parkinson’s disease); quinidine I Smoking. Dry air. Postnasal drip. Cough. Allergies. Symptoms Tinnitus is hearing ringing or other noises in the (for irregular heartbeats); propranolol (for I Dry, irritated throat. I Viruses, such as with a cold or the flu. (See Colds & Flu on page 100.) ears when no outside source makes the sounds. high blood pressure, etc.); quinine (for leg Almost everyone gets “ringing in the ears” at one cramps); and caffeine. I Soreness or pain in the I Infection from bacteria, such as strep throat. time or another. This may last a minute or so, but throat, especially when I Ménières disease. With this, dizziness, then goes away. When hearing these sounds you talk or swallow. ringing sounds, and hearing loss occur Questions to Ask persists, suspect tinnitus. The noises can range in Swollen neck glands. together. Symptoms come and go. Do you have severe shortness of breath? Or, can you not volume from a ring to a roar. Tinnitus affects nearly I The back of the throat swallow your own saliva? 36 million Americans, most of them older adults. In some cases, no cause is found. and/or the tonsils look bright red or have pus With sore throat, do you have a fever higher than 102oF, Signs & Symptoms deposits or white spots. Treatment swollen neck glands, ear pain, bad breath, a skin rash, and/or I Ringing, buzzing, I Enlarged tonsils that dark urine? Or, does the back of your throat or tonsils look Treatment is aimed at finding and treating the hissing, humming, feel tender (tonsillitis). bright red or have pus? cause of tinnitus. Treatment includes: roaring, or whistling I A hearing aid that plays a soothing sound to noises in the ears. Fatigue, fever, postnasal drown out the tinnitus. Have you been in contact with someone who had strep throat drip, bad breath, headache, These problems can in the last 2 weeks, do you get strep throat often, or has a I A tinnitus masker. This is worn behind the and/or earache can also persist or come and go. mild sore throat lasted longer than 3 weeks? ear. It makes a subtle noise to distract the occur. I Problems sleeping. Sample person from tinnitus. The masker does not I Emotional distress. interfere with hearing and speech. Treatment I Hearing loss. I Sleeping pills, if needed. Self-care treats most sore throats. Your doctor may Self-Care / Prevention Tinnitus can be quite Also, most major cities have support groups and disturbing. It can interfere take a throat culture to see I Don’t smoke. Avoid secondhand smoke. clinics for tinnitus. with normal activities. if strep or another type of 1 Most often, tinnitus I Gargle every few hours with a solution of /4 teaspoon of salt bacteria is the cause. If so, affects older adults. dissolved in 1 cup of warm water. Don’t eat spicy foods. Questions to Ask an antibiotic may be Causes Did the tinnitus start after taking too prescribed. Strep throat I Drink plenty of fluids like warm tea. For strep throat, have cold needs medical care to foods and liquids. Exposure to loud noise which damages nerves in much aspirin or other medicines with prevent other health the inner ear is the most common cause. This can salicylates, and do you have any of I Sit in the bathroom while hot water runs in the shower. Use a cool- be from prolonged exposure or from one extreme these problems? problems. Sore throats mist vaporizer in the room where you spend most of your time. caused by viruses do not Do Not Reproduceincident. • Nausea and/or vomiting. I Suck on a piece of hard candy or throat lozenge every so often. • Confusion. need an antibiotic. Other Causes (Don’t give to children under age 5.) Rest your voice, if this helps. • Rapid breathing. I Ear disorders, such as labyrinthitis. This is I Take an over-the-counter (OTC) medicine for pain as directed on the swelling of canals in the ear that help label. Take an OTC decongestant for postnasal drip, if okay with maintain balance. Flowchart continued on next page your doctor. 92 93 To Learn More, See Back Cover Chapter 10: Ear, Nose & Throat Problems

Tinnitus, Continued

With ringing in the ears, do you have any of these problems? • Severe pain in the ear(s). • A foreign object is in the ear that cannot be removed. • A recent ear or head injury. • You can’t hear.

With ringing in the ears, do you have any of these problems? • Feeling dizzy or like you are spinning. • Loss of balance or your walking is unsteady. • Vomiting or nausea. • Drainage from the ear(s). • Sleep habits and/or daily activities are disrupted.

Self-Care / Prevention

I Wear earplugs or earmuffs when exposed to loud noises. This can prevent noise-induced tinnitus. Sample I Treat an ear infection right away.

I For mild cases of tinnitus, play the radio or a white noise tape. White noise is a low, constant sound.

I Use biofeedback or other relaxation techniques.

For more I Limit your intake of caffeine, Get regular exercise. This information, alcohol, nicotine, and aspirin. promotes good blood circulation. contact: I Talk to your doctor if you use the drugs listed in Causes on page 93. The American Tinnitus I If the noises started during or after traveling in an airplane, pinch Association your nostrils and blow through your nose. When you fly, chew gum 800.634.8978 Do Not Reproduce or suck on hard candy to prevent ear popping and ringing sounds in www.ata.org the ear. If possible, avoid flying when you have an upper respiratory or ear infection.

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Section IV: Emergencies & First Aid Chapter 22 ChapterEmerg 7. Eyeency Conditions Conditions / Bites & Stings, Continued First Aid For Stings Signs & Symptoms Treatment Self-care treats mild reactions to stings. A Bites & Stings I Quick, sharp pain. severe allergic reaction needs immediate care. I Swelling, itching, and redness at the sting Symptoms of a severe allergic reaction usually For Bites site. These can occur beyond the sting site. happen soon after or within an hour of the sting. Signs & Symptoms I Less common, but more dangerous, are bites I Raised bump (with or without pus). Persons with a severe allergic reaction to a sting from skunks, raccoons, bats, and other I Signs of a severe allergic reaction. (See I Swelling. Redness. Pain. Itching. animals that live in the wild. These animals page 208.) in the past should carry an emergency kit, prescribed by a doctor. A medical alert tag I Bleeding. can have rabies. This is a serious viral should be worn to let others know of the allergy. infection. It can be fatal. Most house pets are Causes I Tissue loss, if the wound is severe. vaccinated for rabies. It’s unlikely they carry Persons who have had severe reactions to bee or wasp stings should ask their doctors about I Skin rash. With Lyme disease, a red bull’s the virus. I Insect stings. (See page 128 and 129.) eye rash with a white center around the bite allergy shots. I Mosquito bites can cause West Nile virus if I Marine animals that sting include jellyfish, occurs. Fatigue, fever, and joint pain may the mosquito is infected with it. Portuguese Man-of-War, and sea nettles. also occur. I Snake bites can be fatal if the bite is from a I Lockjaw. This is a painful, persistent poisonous snake (e.g., rattlesnakes, cotton Questions to Ask stiffness of the jaw due to a toxin. Tetanus mouths, copperheads, and coral snakes). Was the bite or sting from a poisonous shots can prevent this. (See Immunization Are any of these problems present? snake, spider, etc. or do any of these I Shark bites are a potential problem when Schedule on page 23.) Sample• Signs of a severe allergic reaction problems occur? swimming in shark-infested waters. I Allergic reaction, such as with insect bites. listed on page 208. {Note: Before • Fainting. Feeling lightheaded. (See Signs & Symptoms of Allergies on emergency care, use emergency kit • Confusion. page 208.) Treatment as directed.} • Seizures. Self-care can be used for dog and cat bites that • Signs of shock. (See page 401.) • Feeling restless or dizzy. cause scratches on the skin and for insect bites • The bite severely mangled the skin • Breathing problems. Causes • Painful cramps and muscle stiffness {Note: that do not cause a severe allergic reaction. All and/or causes severe bleeding. Give first in the abdomen, , chest, I Dog, cat, and human bites are the most human bites that break the skin should be checked {Note: See First Aid For Severe aid as common animal bites in the U.S. by a doctor due to the high risk for infection. Bleeding on pages 363 and 364.} and/or back. needed. • Fever. Chills. Heavy sweating. See page I Black widow and A series of rabies shots can prevent the spread • Nausea. Vomiting. 360.} brown recluse spider of rabies to humans. The shots should begin Was the bite from an animal that lives bites can cause severe soon after a bite from an infected animal. in the wild or a pet that has not been reactions. immunized against rabies? Was the bite over a joint and does it Antivenom canDo be given for poisonousNot snake Reproduce cause painful movement? I Deer tick bites can Enlarged deer tick bites at emergency medical facilities. It should cause Lyme disease, a on left. Actual size at Flowchart continued in next column be given within 4 hours of the bite. Flowchart continued on next page bacterial infection. right.

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Bites & Stings, Continued Bites & Stings, Continued For a Stingray Bite I Remove the For Non-Poisonous Snake Do you have a fever, pus, or increased swelling and/or For Deer Tick Bites person from the Bites redness 24 or more hours after the animal bite? I Remove any ticks found on the skin. Use water. I Gently wash the site tweezers to grasp the tick(s) as close to the with soap and water. skin as you can. Pull gently and carefully in a I Apply a local steady upward motion at the point where the pressure bandage I Treat the bite as a minor wound. (See For Minor tick’s mouthpart enters the skin. Try not to for a wound that Stingray. Cuts and Scrapes on crush the tick. The secretions released may bleeds a lot. Self-Care / First Aid spread disease. page 403.) I Immerse the wound area in hot water for 30 For Poisonous Snake Bites Before Medical Care I After you remove the ticks, wash the wound to 90 minutes. Make sure the water is not hot I If you notice signs of an I Carefully move the person away from the snake. Calm the person. area and your hands with soap and water. enough to burn the skin. infection, call your Have him or her rest. Moving about can help spread the venom. doctor. I Save one tick in a closed jar with rubbing I Scrub the wound area well with soap and water. I Gently wash the bite area with soap and water. Keep the limb of the alcohol to show the doctor. bite site level with the heart (or just below this). Apply a splint to the I Unless the wound is a slight one in only one For Poisonous Spider limb of the bite site to keep it from moving. limb, get medical help right away. Bites Until Emergency For Dog and Cat Bites I Being careful, note, if you can, the shape of the snakes eyes, pupils, I Wash the bite area right away with soap and Care Arrives For Stings from Jellyfish or Sea Nettles, etc. I Perform rescue and head, the colors it is, and if it has rattles. warm water for 5 minutes. If the bite is deep, I Remove the person from the water. Don’t breathing, if needed. flush the wound with water for 10 minutes. I Don’t try to kill the snake, cut the fang mark, or suck out the venom. touch the sting area with bare hands. (See Rescue Breathing Dry the wound with a clean towel. Then get on page 354.) I Don’t apply a tourniquet, a bandage, or ice to the bite. medical care. I Rinse the sting area with salt (not fresh) water right away. Don’t put ice on the skin. If you I If you can, keep the For Poisonous Spider and Scorpion Bites Before Medical Care I If the wound is swollen, apply ice wrapped in a towel for 10 minutes. can, put vinegar or rubbing alcohol on the area bitten area lower than I Sample Do rescue breathing, if needed. several times for 30 or more minutes until the the level of the heart. I A tetanus shot is needed if tetanus I If you can, keep the bitten area lower than the level of the heart. pain is relieved. I Calm the person and immunizations are not up-to-date. I Calm the victim and keep him or her warm. I Apply dry or moist heat to the sting area until keep him or her warm. I If the bite hurts, take an over-the-counter the pain subsides. You can mix one part I Gently clean the site of the bite with soap and water or rubbing I Gently clean the site of (OTC) medicine for pain. ammonia with 3 parts salt water and apply alcohol. the bite with soap and I Report the incident to the animal control this to the sting area. water or rubbing I Put an ice pack over the bite site to relieve pain. department. I Wear gloves when you remove stingers. Use a alcohol. I If you can, catch the spider in a closed container to show the doctor. I If a pet’s immunizations are not current, towel to wipe the stingers or the tentacles off. I Put an ice pack over the I Get emergency care! arrange with the animal control department Use tweezers to lift large tentacles. Don’t bite site for pain relief. for the pet to be observed for the next 10 days scrape or rub them. I If you can, catch the For Human Bites Before Medical Care to be sure it does not develop rabies. I To relieve itching, apply OTC calamine lotion I spider in a closed Wash the wound area with soap and water for at least 5 minutes. I Observe the wound for a few days. Look for or 1% hydrocortisone cream to the affected Don’t scrub hard. Rinse with runningDo water or withNot an antiseptic Reproduce container to show what signs of infection. Often, cat bite wounds area as directed on the label. kind it is. solution, such as Betadine. need an antibiotic. I Contact your doctor for any signs of I Cover the wound area with sterile gauze. Tape only the ends of the infection. (See page 120.) gauze in place. Then get medical care. 360 361 Chapter 22: Emergency Conditions / First Aid Section IV: Emergencies & First Aid

Bleeding, Continued Bleeding Does a person with a bleeding disorder For Internal Bleeding or who takes blood-thinning medicine Most adults can donate a Signs & Symptoms I A bruise. This is bleeding from and damage to have a hard time controlling bleeding? pint of blood without tissues beneath the skin. harmful side effects. For External Bleeding I Damage to blood vessels and/or internal Does a person with a bleeding disorder Losing a quart of blood, I A skin wound. structures. This includes a blunt injury that or who takes blood-thinning medicine quickly, though, can lead to I Dark red blood gushes or flows from veins. does not break the skin, a bleeding ulcer, and have a minor wound? shock and even death. In a an aneurysm. child, losing a pint (or less I Bright red blood spurts from arteries. I Bleeding disorders. Are any of these problems present? depending on the child’s I Blood oozes from capillaries. The bleeding • Frequent nosebleeds. size) can put the child in usually clots off by itself. Skin wounds are common Taking blood-thinning drugs can result in both • Small red dots or clusters of small, extreme danger. causes of bleeding. internal and external bleeding. pinpoint-sized red specks under the For Internal Bleeding skin. Treatment I Vomiting or coughing up true, red blood. This includes blood-tinged Questions to Ask • Easy bruising. sputum. • Excessive bleeding from cuts. When bleeding occurs, the Are any of these problems present? I A bruise on the skin of the chest or abdomen, especially if it is in a • In females, excessive or prolonged goal is to find the source, • A body part has been amputated. place where no blow was struck. menstrual bleeding or vaginal stop or lessen the bleeding, • Bleeding from a wound is severe. bleeding after menopause. and help the body cope I Fractured ribs. • Blood spurts from the wound and it with the loss of blood. • Blood in the urine or stools. I Dizziness. Fainting. Weakness. is not controlled with direct pressure. {Note: Give I For severe bleeding, • Signs of shock. See page 401. first aid as treatment includes first I Lethargy. Excessive sleepiness. Mental status changes. These can needed. See aid measures and occur with trauma to the head, even if it is mild.Sample this page and Are any of these problems present? page 364.} emergency medical I Fast pulse. Cold, moist skin. care. • Bleeding comes from a deep wound Self-Care / First Aid I Stools contain bright red blood or are black (not due to taking iron). (it appears to go down to the muscle I For minor bleeding, or bone) and/or a bone is exposed. For Severe Bleeding treatment depends on • The skin on or around the wound site Stay calm. Call 9-1-1 or take the cause and other Causes hangs open. the person to nearest hospital medical conditions For External Bleeding emergency department. In the • A deformity is at the injury site. {Note: Give present. I Abrasions (scraped skin). Lacerations (cut skin with jagged edges). • Bleeding from what appears to be a first aid as meantime, I Bleeding disorders need Punctures. (See Skin Injuries / Wounds on page 402.) minor wound continues after 20 needed. See I Monitor for signs of this page and to be treated by a I Knife, gunshot, or other wounds can graze or penetrate the skin. minutes of applied pressure. shock. (See page 401.) page 364.} doctor. These can damage internal blood vessels and body organs. I Control bleeding.

I Injury wounds. Are any signs of internal bleeding I Apply direct pressure to Do Not Reproducelisted on page 362 present? (Note: Wear waterproof the wound using a clean These may take days after an injury to gloves or use cloth or sterile bandage. occur.) another waterproof material when you give first aid for Flowchart continued in next column bleeding. 362 363 Chapter 22: Emergency Conditions / First Aid Section IV: Emergencies & First Aid

Bleeding, Continued Broken Bones / Dislocations Pressure Points I Put pressure on the wound for at least 10 minutes. {Note: If the cut is large and the edges of it gape open, pinch the edges of the wound For Broken Bones while you apply pressure.} Signs & Symptoms Below the injured site, numbness and tingling I If bleeding continues before medical help arrives, put extra cloths or can occur. The skin can be pale, blue, purple, or bandages on top of existing ones and reapply pressure. gray. It feels colder than the skin on the I Elevate the wounded area higher than heart level while applying uninjured limb. pressure. Do this if no bone is broken. With a Causes I Do not remove an object that is stuck in a wound. Pack it in place compound or with padding. Put tape around the padding so it doesn’t move. I Injuries from falls and accidents. With a simple open fracture, or closed I If bleeding still continues after 15 to 20 minutes of direct pressure, the broken I Osteoporosis. (See page 199). apply pressure to a “pressure point.” Use the pressure point closest fracture, the bone breaks broken bone I Too much or repeated stress on a bone. to the bleeding site that is between the wound and the heart. (See through the does not Pressure Points at left.) skin and a break the skin. A skin wound is present. This Treatment wound is not present. I Keep applying pressure to the bleeding site. Use flat fingers to put can cause bleeding. The bone may need to be reset. A splint or cast pressure on the pressure point until the bleeding stops. Don’t apply a Symptoms of broken bones are pain, swelling, may need to be worn. {Note: Broken fingers, tourniquet except to save a life. bruising, and loss of function or feeling. The toes, and ribs don’t need a cast.} Muscles and 1. Wrists: palm surface, I Keep looking for signs of shock. (See page 401.) injured area looks crooked, misshaped, or near the fracture site need to be exercised. thumb side. deformed. 2. Wrists: palm surface, For Amputation For Dislocations pinky side. I Sample Control bleeding. See First Aid for Severe Bleeding on page 363 3. Under armpits. and on this page. Signs & Symptoms Causes

4. Inside of , halfway I Wrap the severed part in a clean, dry (not wet) cloth or sterile gauze. A dislocation is a separation of the end of a bone I Injuries from contact sports or falls. Over between the Place the wrapped part in a plastic bag or other waterproof container. and the joint it meets. The bone is displaced from stretching bones that touch in joints. and armpits. Put these on a bed of ice. Do not submerge the severed part in cold its proper position. A dislocated joint is swollen, I Joints weakened by previous injury. water or ice. misshaped, very painful, and discolored. 5. Groin, about halfway I Suddenly jerking a toddler’s hand or . Dislocations can cause damage to the between and Force applied in the wrong direction can For Bleeding from the Scalp membrane lining the joint, tears to nearby genitals. snap the ball of the upper arm bone out of I Use a ring pad to apply pressure around the edges of the wound, not muscles and , and nerve damage. 6. Temples. on the wound. Make a ring pad (shaped like a doughnut) with a the shoulder socket. The shoulders are especially prone to 7. Behind . bandage of narrow, long strips of cloth. Start with one end of the narrow bandage and wrap it around all four fingers on one hand until dislocation injuries. The is a common Treatment you form a loop. Leave a long stripDo of the bandage Not material to weave Reproducesite in toddlers. Fingers, hips, , elbows, Medical care is needed to put a dislocated bone in and around the loop so it doesn’t unravel. jaws, and even the spine can be dislocated. A back into its socket. With this, the dislocated dislocated vertebrae in the spine often damages joint should function within 24 to 48 hours. {See also Self-Care / First Aid in Skin Injuries / Wounds on the spinal cord and can paralyze body parts Limited activity for 4 to 6 weeks allows enough page 403.} lower than the injury site. time for the injury to heal.

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Broken Bones / Dislocations, Continued Broken Bones / Dislocations, Continued For Fractures to Limbs I To make an arm splint, put padding between Questions to Ask Are any of these problems present? the arm and the body. If an elbow is not • An injury to the face does not allow involved, place the arm across the chest and Do any of these problems occur? the jaw to open and close. • A severe injury to the head, neck, and/or back. wrap a cloth around the entire body. If the • A lot of bruising appears around the elbow is involved, place the arm straight or • Severe bleeding and a bone pushes through the skin. injury. Or, the area around an eye is • A very hard time breathing. slightly bent against the body. Wrap the cloth swollen and discolored. around the body and arm. • An elderly person has fallen and can’t move or get up. {Note: • It is hard to move the joint closest to Give first • Severe abdominal pain after trauma to the abdomen or back. I Make a sling with a triangular piece of cloth. aid for the the injury. problem Place the largest part under the arm and tie as needed. the ends at the neck. See page Does the area discolor more in the first I Make a splint for a leg or tie the injured leg to 367.} 24 hours after the injury? Or, do pain Are any of these problems present? the other leg. Place padding in between the • Bleeding cannot be controlled with 10 minutes of direct and swelling not improve or respond to Self-Care/First Aid? legs. Do not tie the splint too tightly. This pressure. could interfere with blood flow. • Sweating. Dizziness. Thirst or an ashen skin color. • Sudden shortness of breath follows an injury. I Use cold packs on the injured site. Do not use • A bone is broken in the , pelvis, or and the person ice next to the skin. This can cause can’t move or get up. frostbite. • The skin under the fracture is cold and blue. Or, a pulse Self-Care / First Aid I For pain, take an over-the-counter pain can’t be felt below the fracture site. For Broken Bones Before Getting Medical Care reliever as directed. Don’t use aspirin if you • Numbness or severe pain occurs below any other injured {Note: Give first {Note: If a head, neck, or spine injury is have bleeding. area. Sampleaid for the suspected, see Head / Neck / Spine Injuries on • After an injury to the neck or back, a limb feels numb, weak problem page 384.) For Dislocations or tingles. as needed. Dislocations need medical care. The longer they • A bone breaks through the skin or bulges just under the skin. See page 367.} For an Open Fracture are out, the harder it is to get them back in. • A limb or fracture site looks deformed. I Monitor for signs of shock. (See page 401.) I If a head, neck, or back injury is suspected, see I Control bleeding with direct pressure. Do not Head / Neck / Spine Injuries on page 384. Are any of these problems present? press on or move a bone that sticks out. Do not I Immobilize the injured area above and below • The person can’t move the limb, bear weight on it, or extend reset the bone. and flex it. the injured joint. I Immobilize the wound with a splint. Use a • Pain is severe. I Don’t try to straighten a bone or joint that is firm material, such as a folded newspaper or • Pain, swelling, and discolored skin occur within 30 minutes misshaped. Don’t try to put a joint back in its broom handle. Secure the splint above and of the injury. socket. • Pain and swelling get worse after 2 hours of using cold below the injury or tie the injured part to an I Apply cold packs to relieve pain and swelling. packs on the injured site and elevatingDo it. Not Reproduceuninjured part. Use shoe laces, belts, etc. to hold the splint in place. Do not tie too tightly. I Follow your doctor’s instructions. Check the area below the splint to make sure Flowchart continued on next page I that the skin is warm and pink in color. If not, Take an over-the-counter medicine for pain as loosen the ties. directed. 366 367 Chapter 22: Emergency Conditions / First Aid Section IV: Emergencies & First Aid

Burns, Continued Burns Self-Care / First Aid Does the burn appear red with For Severe Burns Before Emergency Care Signs & Symptoms swelling, blisters, and pain at the time I Remove the person from the source of heat. Causes of the burn? If so, do any of these For electrical burns, see Electric Shock on Burns can result from dry First-degree burns affect only the outer skin layer. problems occur? page 373. Call 9-1-1! Keep the person’s heat (fire), moist heat (steam, The skin area appears dry, red, and mildly swollen. • The burn is on an infant or child and airway open. Treat for Shock. (See page 401.) hot liquids), electricity, First-degree burns are painful and sensitive to touch. it covers more than an area the size I Remove hot or burned clothes that come off chemicals, or from radiation, They should feel better in 1 to 2 days. They heal in of the palm of the child’s hand. about a week. 1st degree burn easily, not if they are stuck to the skin. including sunlight. The • The burn is on an adult and the area {Note: I Cover the burns loosely with clean cloths. Use longer the skin is exposed to Second-degree burns affect the skin’s outer and lower affected is larger than 10 square Give first direct pressure to control bleeding. Don’t rub. the burn source, the worse layers. The skin is painful, swollen, red, and has inches or is more than two times the aid for burns as the burn can be. blisters. The skin also has a weepy, watery surface. size of an adult’s palm. I Stay with the person until medical care arrives. • The burn is on the face, hands, feet, needed. Third-degree burns affect the outer and deeper skin See next I If lye or a dry chemical gets on the skin, Treatment genital area, or on any joint. column.} layers and organs below the skin. The skin appears brush off the powder. Then flush with clean Third-degree burns always black-and-white and charred. It swells. Tissue under 2nd degree burn water for at least 20 minutes or until EMS need emergency care. A the skin is often exposed. Third-degree burns may Does a chemical burn affect a large arrives. Remove glasses, but not contacts, second-degree burn needs have less pain than first-degree or second-degree area of the body? Or, does it affect the before treating the eyes. immediate care if it is on burns. Why? No pain is felt where nerve endings are hands, feet, face, eyes, or genital area? {Note: the face, hands, feet, destroyed. Pain may be felt around the margin of the Give first For First-Degree and Second-Degree Burns genitals, a joint, or if the burn, though. aid for (that are less than 3'' in diameter) burn affects a large area. burns as I Use cold water or cloths soaked in cold water 3rd degree burn Self-Care/First Aid treats Questions to Ask Sample Do any of these problems occur? needed. on burned areas for 15 minutes or until the • A sunburn affects a large area of the See next pain subsides. Do not use ice at all. Doing most first-degree burns and column.} second-degree burns. With or following a burn, do any of these problems exist? body. It is very painful. The skin this could result in frostbite. • Loss of or decreasing level of consciousness. (See Fainting appears red, dry, and shiny. I Cover the area loosely with a dry cloth, such as & Unconsciousness on page 378.) Shivering or chills also occur. sterile gauze. Hold it in place by taping only • Breathing problems, chest pain, fast or irregular pulse. • A burn affects a person who is the edges of the gauze. Change the dressing the • The person was in an enclosed room with exposure to a diabetic, elderly, or who has a next day and every 2 days after that. large amount of smoke from a fire. lowered immune status from illness, taking medicine, etc. I Don’t use ointments. Aloe vera can be applied For more • A burn causes uncontrolled pain over closed skin 3 to 4 times a day. For a Does the burn affect outer and deeper skin layers and do any information, despite using Self-Care/First Aid. more severe burn less than 3'' x 2'', use of these signs occur? contact: • The burn has not improved in 48 Second Skin Moisture Pads, etc. • The skin looks charred or black and white and dry. hours. I Safe USA™ • Skin layers separate. This may look like burned pages of a {Note: See Don’t break blisters. If they break on their 888.252.7751 English / paper book. Do Not“First Aid Reproduce own, apply an antibacterial spray or ointment Spanish • The burned area covers more than the size of the person’s palm. For Severe or treatment prescribed by your doctor. Keep www.cdc.gov/safeusa Burns the area loosely covered with a sterile dressing. • Pain is not felt. Before I Prop the burned area higher than the rest of Emergency See Self-Care / First Aid in next column Care” on the body, if you can. Flowchart continued on next page page 369.} 368 369 Chapter 22: Emergency Conditions / First Aid Section IV: Emergencies & First Aid

Choking, Continued I Try not to laugh and eat at the same time. Choking Laughing can draw food into the windpipe. After a choking incident, does the I If you wear dentures, make sure they fit well. With choking, the airway person have wheezing, a cough that Causes Since your mouth sensation is lessened, you is partly or completely doesn’t go away, chest pain when are at a higher risk of choking. Eat slower. blocked. When it is I Food goes down the windpipe. Small objects get stuck in the throat breathing in, and/or a fever? Chew food more thoroughly. completely blocked, the and airway. I Don’t run or play sports with objects in the brain doesn’t get oxygen. I Fluids, such as mucus or liquids, are swallowed the wrong way and Without oxygen, the brain block the airway. mouth. can begin to die in 4 to 6 I Don’t give beads; nuts; popcorn; foods with I Snoring. Choking can occur when the tongue blocks the airway. minutes. Self-Care / First Aid pits, (e.g., grapes, cherries); chewing gum For first aid for choking for a conscious and an (especially bubble gum); hard candy, throat Signs & Treatment unconscious person, see page 356. lozenges, and cough drops, etc. to children Emergency action is needed for a person who cannot breathe, speak, or under age 5. Symptoms First Aid for Choking When Able to Breathe cough forcefully. The Heimlich maneuver can expel an object that I Cut hot dogs, sausages, seedless grapes, and When a person’s airway is blocks the airway. It is used for a person who is conscious. Emergency and Speak (or an infant or child can cry) caramels into small pieces before you give completely blocked, he or medical care is needed for a person who loses consciousness. Rescue I Cough to clear the airway. them to children under age 5. she: breathing and chest compressions are needed before medical help I Take a slow, deep breath to get a lot of air I Don’t let your child chew or suck on rubber I Can’t talk. arrives. Even if the object is expelled, the person should see a doctor or into the lungs. balloons or pieces of them. I go to a hospital emergency department. Can’t breathe. I Give a deep, forceful cough. Breathe in I Keep small, solid objects, such as paper clips, I Can’t cough. deeply enough to be able to cough out 2 or 3 away from children 3 years old and younger. Questions to Ask times in a row before taking a second breath. I May turn blue. Sample Make sure, too, that they don’t get toys that Is the person unconscious? Or, is the person choking and not I Don’t slap a person on the back. Doing this have small parts, such as eyes on stuffed When a person’s airway is breathing? {Note: While waiting for emergency medical care, can drive the object down deeper. animals, game pieces, dice, etc. A young child give or have someone give First Aid for Choking on page should not play with any object smaller than partly blocked, he or she: I Have the person sit or stand. Bending forward I Wheezes. 356.} may cause the object to fall against the vocal his or her closed fist. I Coughs. cords. Get emergency care right away! I Put childproof latches on cupboards that have Does the person have any of these problems? harmful items. I Has fast and/or labored • A hard time swallowing. Fast and/or labored breathing. Prevention I Store all medicines and vitamins in containers breathing. • Persistent cough with a hard time breathing. I Chew all foods well before swallowing. Eat at with childproof lids. Keep them out of I • Severe wheezing that doesn’t go away. Has chest pain when a slow pace. children’s reach. Put them in locked cabinets, breathing in. • Drooling a lot. The person can’t swallow saliva. I if needed. • Constant or unrelieved gagging. Limit alcoholic drinks before you eat. This lessens the chance of swallowing large pieces • The feeling that something is stuck in the esophagus or throat. I Remove plastic labels and decals from baby Do Not Reproduceof food. walkers and other kiddy furniture before Flowchart continued on next page children can peel them off.

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Dehydration Electric Shock Causes I Touching a high-voltage (more than 1,000 Dehydration is when the Causes Electric shock occurs when an electric current volts) source, such as high-tension wires that body loses too much water flows through the body. The human body is made fall during a storm. Touching someone who is and needed minerals I The body does not get enough fluids for it’s needs. up of 60% to 70% water. This makes it a good still touching a live current. Touching a low- conductor of electricity. Burns, damage to (electrolytes). I Too much water or other body fluids and electrolytes, such as voltage (less than 1,000 volts) current source, internal organs, heart rhythm problems, and death sodium and potassium are lost. This can result from: Repeated such as an electric socket or worn cord. Signs & can result from electric shock. episodes of diarrhea and/or vomiting; heavy sweating; heat I Mixing water and electricity. Symptoms exhaustion; or heat stroke. Signs & Symptoms I Being struck by lightning. A bolt of lightning For Severe Dehydration carries as many as 30 million volts. I Severe thirst Treatment I Shocking (sometimes). Fluids and electrolytes must be replaced. If this can’t be done by mouth, sensations. Questions to Ask they are given through an IV solution. Numbness or I Sunken and dry eyes. Tearless eyes. (Infants tingling. A change Do any of these problems occur? may not show this Questions to Ask in vision, speech, • The person is still in contact with the sign.) or in any electric source or was in contact with Do any of these problems occur? sensation. a high-voltage wire. I Dry mouth, tongue, and • Signs of severe dehydration listed at left. • The person was struck by lightning. {Note: I Burns or open lips. • A child or person has been left in a hot car or other hot, • The person is not breathing. Give first wounds. These aid for the enclosed place and has any of the signs listed at left. I No urine or a low occur where the problem • After being in hot conditions, 2 or more signs of heat amount of urine that is electricity enters as needed. exhaustion listed on page 389 occur. Sample See page dark yellow. and exits the body. 374.} Electric Shock can cause Has an electric shock gone through the I Sunken fontanelle (the I Muscle spasms or tissue damage under the body in such a way that it might have soft spot on an infant’s skin’s surface. contractions. passed through the center of the head). I Sudden immobility or fractures. A body part chest? Or, are any signs and I Headache. Feeling Self-Care / First Aid may looked deformed. symptoms of electric shock listed in lightheaded, especially the left column present? when getting up I If vomiting isn’t present, adults and children over age 12 should I Interrupted breathing. Irregular heartbeats or quickly. drink about 2 cups of fluid per hour. Fluids of choice are: Sports chest pain. drinks; flat cola; clear sodas; broths; popsicles; and gelatin. I Seizures. After having an electric shock, are any I Dry skin that doesn’t I of these problems present? spring back when If you have high blood pressure, heart disease, kidney disease, I Unconsciousness. diabetes, or a history of stroke, you should find out what fluids your • Cough with phlegm. Fever. Headache. pinched. • Wounds are not healing. doctor prefers you take when you need to replace lost fluids. A small child who bites or sucks on an electric I Feeling dizzy. Do Not Reproduce • Tetanus shots are not up-to-date. Confusion. Severe I For children under 2 years old, consult your child’s doctor about the cord can have a facial injury or distinct burn weakness. amount and type of fluid to give. Ask your child’s doctor about using around the rim of the mouth. over-the-counter products that give fluid and electrolytes. Examples I Increase in breathing are Pedialyte and Infalyte. and heart rate. 1 I For children over 2 years old, give up to 1 /2 quarts of fluid per day. See Self-Care / First Aid on next page 372 373 Chapter 22: Emergency Conditions / First Aid Section IV: Emergencies & First Aid

Electric Shock, Continued Eye Injuries & Irritation Questions to Ask Treatment Self-Care / First Aid Do any of these problems occur? Contact with electricity Beware! Do not put yourself in danger to give first aid. Do not touch the Signs & Symptoms • A foreign body is stuck in the eye. • One or both eyes were exposed to from a high-voltage wire person until power is shut off. Signs and symptoms depend on the cause. acid, alkali, or any harmful or being struck by I If the source is a high-voltage wire or lightning, call 9-1-1! Common symptoms are: chemicals. {Note: Give lightning needs emergency I first aid for I It is safe to touch a person struck by lightning. Pain and/or swelling in or around the eye(s). medical care. Contact with the problem I The eyes burn, are dry, and/or itch. electricity from a low- I If the source is a low-voltage current, remove the fuse or switch off as needed. See page 376.} voltage current needs the circuit breaker to the electrical outlet. Did super glue get in the eye(s)? {Note: emergency medical care if I If you can’t shut off the source, with dry feet and hands, use a board, Causes any signs or symptoms Before emergency care, do not try to pry wooden stick, rope, etc. to get the person away from the source. For Eye Injuries listed on page 373 are the eye(s) open. Rinse the eyes with I Causes include: present. A person who If it is safe for you to touch the person, check for Circulation Signs. warm tap water for 20 to 30 minutes.} I A physical blow does not have any (See page 353.) Do Rescue Breathing (see page 354), CPR (see to the eye. symptoms should still see page 355), or treat for Shock (see page 401), as needed. Do any of these problems occur? a doctor to check for • Unless it is absolutely necessary, don’t move the person. He or she I Harsh chemicals. • A severe blow to the eye with or could have a traumatic injury, especially to the head or neck. without a broken bone of the face. possible internal injuries. I A foreign body is Poor vision increases the • Check for burns. Cover burned areas with dry, sterile dressings. stuck in the eye. risk for eye injuries. • Vision loss, blurred vision, double To Avoid Being Harmed vision, or blood in the pupil after an • Give first aid for Shock (see page 401), if needed. eye injury. by Lightning For Eye Irritation I Heed weather • A cut to the eye or eyelid. Prevention Causes include: {Note: Give warnings. • Signs of a severe allergic reaction I Stay clear of fallen wires. Inform the police, electricSample company, etc. I Particles in the eye. first aid for (see page 208) after a bite or sting to the problem I Take shelter in a I Install ground-fault circuit-interrupters (GFCIs) in wall outlets of I Too much sun exposure. the eye. {Note: Before immediate as needed. building, if you can. bathrooms, kitchens, etc. With GFCIs, when an electrical appliance See page I Low humidity. care, use emergency kit as directed.} I Stay in your car (if it is falls into water, the current is instantly cut off. 377.} not a convertible) I Strong wind. I Don’t turn electrical switches on or Do you have eye pain or visual rather than out in the off or touch an electric appliance I Scratches from contact lenses. changes after exposure to a welder’s open. while your hands are wet, while flame or other ultraviolet source? Other causes are allergies, infections, and I If you are caught standing in water, or when sitting in outside, avoid tall a bathtub. conditions that make the eyes dry. With aging, the trees, open water, metal eyes can get irritated more easily because they Do you have a contact lens in an eye I Replace worn cords and wiring. objects, and high make less tears. and can’t find it or remove it or does it ground. Crawl into a I Cover all electric sockets with Heed warnings to avoid cause eye pain? low-lying place or curl plastic safety caps. Doelectrical Not hazards. ReproduceTreatment up on the ground, head I Before you do electrical repairs, remove the fuse from the fuse box Mild eye irritations and injuries can be treated Flowchart continued on next page to knees with your or switch off the circuit breaker. Don’t just turn off the appliance or with self-care. More serious problems need head touching the light switch. medical care. ground.

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Eye Injuries & Irritation, Continued Eye Injuries & Irritation, Continued For Dry, Irritated Eyes With your doctor’s Is eye pain present? For a Bruise from a Minor Injury that Surrounds the Eye, But Does Not Damage the okay, use over-the- Eye Itself counter artificial tear drops, such as I Put a cold compress over the injured area right away. Do this for 15 minutes, every Ocu-Lube. hour, for 48 hours. Refrigerate the Self-Care / First Aid solution, if needed. I Take an over-the-counter medicine for the For a Foreign Body Sticking Into the Eye Wash your hands When you use eye drops, pain and swelling. before using. I Do not remove the object. follow the label’s directions. I After 48 hours, put a warm compress over the I Don’t press on, touch, or rub the eye. injured area. For an Insect Bite Without a Severe Allergic I Cover the injured eye with a clean object, such as a paper cup that Reaction I Seek medical care if these measures do not I Wash the eye(s) with warm water. will shield, but not touch the eye or the foreign object. Use tape to help. hold the cup in place without putting pressure on the eye or the I Take an antihistamine if okay with your doctor. foreign object. To Remove a Foreign Particle On the White of I Gently cover the uninjured eye with a clean bandage and tape, too. the Eye or Inside the Eyelids Prevention This helps to keep the injured eye still. Get Immediate Care! I Do not remove an object stuck in the eye, a I Wear safety glasses when your eyes are metal chip, or a foreign body over the colored exposed to sawdust, etc. Wear sunglasses that For Harmful Chemicals in the Eye(s) part of the eye. (See For Foreign Body block UV rays. I Flush the eye(s) with water immediately! Sticking Into the Eye on page 376.) I When using harsh chemicals, wear rubber I Hold the injured eye open with your thumb SampleI Wash your hands. gloves and protective glasses. Don’t rub your and forefinger. At the faucet or with a eyes if you’ve touched harsh chemicals. Turn I If the foreign object is under the upper lid, your head away from chemical vapors. pitcher or other clean container, flush the look down and pull the upper lid away from eye with a lot of water. Start at the inside the eyeball by gently grabbing the eyelashes. I To help prevent dry eyes, use a humidifier. corner and pour downward to the outside Press a cotton-tipped swab down on the skin Limit exposure to smoke, dust, and wind. corner. This lets the water drain away from surface of the upper eyelid and pull it up and Don’t drink alcohol. the body and keeps it from getting in the toward the brow. The upper lid will invert. I Use artificial tear drops with your doctor’s okay. other eye. Flush the eye(s) with I Twist a piece of tissue. Moisten the tip with I For more I water immediately! Don’t stare directly at the sun, especially Keep pouring the water for 10 to 30 or more tap water (not saliva). Gently try to touch the information, during a solar eclipse. minutes. Flush the eye with water until you get medical help. speck with the tip. Carefully pass the tissue contact: I Don’t use eye makeup when an allergy or I If both eyes are injured, pour water over both eyes at the same time. over the speck which should cling to the tip. Prevent Blindness Or, flush one eye with water at a time. Switch back and forth quickly chemical irritant bothers your eye(s). I Do not rub the eye or use tweezers or America to treat both eyes. Or, place the face in a sink or container filled with anything sharp to remove a foreign object. I Don’t allow a child to stick his or her head 800.331.2020 water. Tell the person to move hisDo or her eyelids upNot and down and Reproduce out of the window of a moving car, etc. Sand, www.preventblindness. remove the face from the water to take breaths. Use this method if I Gently wash the eye with cool water. insects, and other flying objects can strike the org chemicals get in your eyes and you are alone. eye and irritate or damage the cornea.

I Loosely bandage the eye with sterile cloth and tape. Don’t touch the I Don’t let children play with or near sparklers, eye. Get Immediate Care! bottle rockets, and other fireworks. 376 377 Chapter 22: Emergency Conditions / First Aid Section IV: Emergencies & First Aid

Fainting & Unconsciousness, Continued For Fainting Fainting & Unconsciousness I Catch the person before he or she falls. Did fainting occur with any of these Signs & Causes conditions? I Lie the person down with the head below heart • A recent head injury. level. Raise the legs 8 to 12 inches to promote Symptoms Fainting is due to a sudden drop in blood flow or glucose supply to the • Severe bleeding. {Note: Give first aid blood flow to the brain. If the person can’t lie brain. This causes a temporary drop in blood pressure and pulse rate. down, have him or her sit down, bend forward, Fainting is a brief loss of for this. See pages 363 and 364.} Medical reasons for this include: and put the head between the knees. consciousness. It can last • Severe pain in the abdomen or pelvis. I Low blood sugar (hypoglycemia). This can occur in diabetics, in from seconds to 30 • Blood in the stools or urine. Black, I Loosen any tight clothing. early pregnancy, in persons on severe diets, etc. tarlike, or maroon colored stools. minutes. Just before I Don’t slap or shake a person. Don’t give • Being over 40 years old and this is fainting, a person may feel I Anemia. Eating disorders. anything to eat or drink. a sense of dread, feel the first time for fainting. I Conditions which cause rapid loss of blood. I Check for a medical alert tag. Respond as dizzy, see spots, and have • A known heart problem. A fast or needed. nausea. I Abnormal heart rhythm. Heart attack. Stroke. irregular heartbeat. • Diabetes and the person does not I Head injury. Heat stroke. Heat exhaustion. To Reduce the Risk of Fainting If a person falls and can’t respond to a glucagon injection or rubbing a sugar source, such as cake I Follow your doctor’s advice to treat any remember the fall itself, he Other things that can lead to feeling faint or fainting include: frosting paste inside the mouth. medical problem which may lead to fainting. or she has fainted. I A sudden change in body position like standing up too fast. This is • Being a young person and the fainting Take medicines as prescribed. Let the doctor called postural hypotension. know about any side effects. An unconscious person is took place during a sports activity. hard to rouse and can’t be I A side effect of some medicines. Drinking too much alcohol. • Slow, noisy, or unusual breathing. I Get up slowly from bed or from a chair. • Seizure symptoms, such as twitching made aware of his or her I Anxiety or sudden emotional stress or I Avoid turning your head suddenly. surroundings. The person fright. or jerking in a person not known to Sample I Wear loose-fitting clothing around the neck. is unable to move on his or have epilepsy. I Being in hot, humid weather or in a I Don’t exercise too much when it is hot and her own. stuffy room. Standing a long time in humid. Drink a lot of fluids when you exercise. one place. I Avoid stuffy rooms and hot, humid places. Treatment I Extreme pain. When you can’t do this, use a fan. Treatment depends on the Get out of bed slowly. Self-Care / First Aid cause. Questions to Ask I If you drink alcohol, do so in moderation. For Unconsciousness Do any of these problems occur? I Check for breathing and Circulation Signs For a Low Blood Sugar Reaction • The person is not breathing. {Note: Do Rescue Breathing. (see page 353). Call 9-1-1! Do Rescue I Have a sugar source, such as: One half cup of See page 354.} Breathing and CPR, (see pages 354 to 355), fruit juice or regular (not diet) soda; 6 to 7 • The person is unconscious longer than 2 minutes or is or treat for Shock (see page 401), as needed. regular (not sugar free) hard candies; 3 having a hard time breathing. glucose tablets; or 6 to 8 ounces of milk. • Any heart attack warning sign. (See page 387.) I Check for a medical alert tag or information. Do Not Reproduce I If you don’t feel better after 15 minutes, take • Signs of dehydration. (See page 372.) Call the emergency number if there is one. the same amount of sugar source again. If you • Signs of shock. (See page 401.) Follow instructions given. don’t feel better after the second dose, call • The person who fainted had sudden, severe back pain. I Don’t give the person anything to eat or your doctor. drink, not even water. Flowchart continued on next page 378 379 Chapter 22: Emergency Conditions / First Aid Section IV: Emergencies & First Aid

Hole Frostbite & Hypothermia Shank Fishhook Removal Signs & Symptoms Frostbite freezes the skin. It can damage tissue below the skin, too. Most often, frostbite affects the Barb toes, fingers, earlobes, chin, and tip of the nose. Fishhook A fishhook can nick or cut the skin, get stuck in the skin near its O surface, or get deeply embedded in the skin. Hypothermia is when body temperature drops below 96 F. The body loses more heat than it can make. This usually occurs from staying in a cold place for a long time. Treatment For Frostbite and Frostnip First aid treats most fishhook accidents. Signs & Symptoms Frostnip is a less serious problem. The skin turns Questions to Ask white or pale and feels cold, but the skin does not A Is a fishhook stuck in an eye? I Cold, numb skin swells and feels hard and feel hard and solid. solid.

I Loss of function. Absence of pain. Causes Is the fishhook still in the skin, do signs of an infection (see page 120) occur, or are tetanus shots not up-to-date? I Skin color changes from white to red to Frostbite and frostnip can occur when B purple. Blisters occur. temperatures drop below freezing. Both can set in very slowly or very quickly. This will depend on I Slurred speech. how long the skin is exposed to the cold and how I Confusion. cold and windy it is. Self-Care / First Aid C For a Fishhook Deeply Embedded in the Skin Sample For Hypothermia I Put ice or cold water on the wound area to numb it. Push on the Causes shaft of the hook until the barb protrudes. A With wire cutters, snip Signs & Symptoms the hook at either the shank or the barb. B Pull the hook out. C With mild hypothermia, symptoms include: I Exposure to cold temperatures (wet or dry). Shivering; slurred speech; memory lapses; and I Wash the wound area well with soap and water. Treat for a puncture Many factors increase the risk. Examples are: wound (see page 403). the abdomen and back feel cold. Wet clothing or lying on a cold surface; circulation problems; diabetes; and old age. With moderate hypothermia, shivering stops, D The elderly are more prone to hypothermia if For a Fishhook Stuck Near the Surface of the Skin but the skin feels ice cold and looks blue. The they live in a poorly heated home and do not person may act confused, drowsy, very cranky, I Put ice or cold water on the wound area. dress warm enough. and/or stuporous. Muscles may be rigid and I Take a piece of fishing line. Loop one end and tie it to the hook near stiff. Pulse rate and breathing slow down. I Immersion. This can be from 6 hours or less the surface of the skin. D Grasp the shaft end of the hook with one of exposure to cold water immersion. It can E 1 th With severe hypothermia, the person has dilated hand and press down about /8 inch to disengage the barb. E also be from water immersion or exposure on pupils, no response to pain, and loses I Keep pressing the hook down andDo jerk the fishing Notline in a motion Reproduce land to cold, wet weather near freezing for up consciousness. The person appears to be dead. parallel to the skin’s surface to make the shaft of the hook lead the to 24 hours. Death occurs in half or more of persons with barb out of the skin. F Treat for a puncture wound (see page 403). severe hypothermia. I Shock. (See page 401.) F {Note: For nicks or surface cuts to the skin, treat for a cut (see page 403).

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Frostbite & Hypothermia, Continued Frostbite & Hypothermia, Continued First Aid for Frostnip I Warm the affected area. This can be done a Treatment Questions to Ask Self-Care / First Aid number of ways: Self-care measures can Do any of these problems occur? First Aid for Frostbite and Hypothermia • Place cold fingers in armpits. treat frostnip. Prompt • No breathing. {Note: See Rescue Breathing on page 354.} Before Emergency Care • Place cold feet onto another person’s warm emergency medical care is • Pale or blue colored skin, lips, and/or nailbeds. I Gently move the person to a warm place and stomach. needed for frostbite to keep • Loss of or decreasing level of consciousness. Fainting. Call 9-1-1! O the area affected from • Body temperature is less than 95OF. • Put the affected area in warm water (101 F I Check for Circulation Signs. (See page 353.) to 102OF). getting infected and to • Rigid and stiff muscles. Do Rescue Breathing (see page 354) or CPR prevent the loss of a limb. • Mental confusion. Feeling drowsy. (see page 355), as needed. After warming the area, the skin may be red and Hypothermia needs • Slow pulse. Problems breathing. tingling. If it is not treated, frostnip can lead to emergency medical care. • Stumbling. Lack of coordination. I Loosen or remove wet and/or tight clothing. frostbite. • Signs and symptoms of frostbite. (See page 381.) Remove jewelry. Wind Chill Temperature I Don’t rub the area with snow or soak it in As the wind increases, the I Protect the exposed area from the cold. It is With a low body temperature, did the person have a recent cold water. body is cooled at a faster more sensitive to re-injury. infection and now has signs of sepsis (lethargy, chills, I Warm the affected area by soaking it in a tub rate. This causes the skin vomiting, looks sick, and delirium)? of warm water (101OF to 104OF) and an temperature to drop. Wind antiseptic solution, such as Betadine. Prevention chill temperature combines To Prevent Frostbite and Outdoor Have any of these persons had prolonged exposure to the cold? I Stop when the affected area becomes red, not outdoor air temperature and Hypothermia wind speed to give a • Elderly persons. when sensation returns. This should take I Stay indoors, as much as possible, when it is • Persons with a history of alcoholism or drug abuse. about 45 minutes. If done too fast, thawing temperature of what it very cold and windy. “feels like” on the skin. • Persons whose immune systems are depressed dueSample to can be painful and blisters may develop. disease and/or medication. I Wear clothing The National Weather I If warm water is not available, cover the made of wool or Service has a “Wind Chill person with blankets, coats, etc. or place the polypropylene. Chart” that shows frostbitten body part in a warm body area, After being warmed, does the person continue to shiver? Or, These fabrics temperatures, wind speeds, such as an armpit or on the abdomen (human does his or her body temperature not return to normal after 4 stay warm even and exposure times that hours of warming? heat) or use a blow dryer, if available. cause frostbite. To get this, when wet. access www.nws.noaa.gov/ I Keep exposed areas elevated, but protected. Layer clothing. om/windchill. I Don’t rub or massage a frostbitten area. Wear 2 or 3 pairs of socks I Protect the exposed area from the cold. It is Wear outerwear that is {Note: Continue to look for symptoms. The damage from exposure to instead of 1 more sensitive to re-injury. windproof and waterproof. the cold may not be noted for 72 hours.} heavy pair. I Don’t break blisters. Wear roomy shoes. Do not wear items that See Self-Care / First Aid on next pageDo Not Reproduce constrict the hands, wrists, or feet. I Wear a hat that keeps your head and ears warm. A major source of heat loss is through the head.

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Head / Neck / Spine Injuries, Continued Head / Neck / Spine Injuries Self-Care / First Aid Questions to Ask First Aid for a Severe Injury I Do not move the person unless his A Treatment Signs & Symptoms Does the person have one or more or her life is in danger. If so, log signs and symptoms for a severe If you suspect a head, For a Severe Injury roll the person, place tape across injury listed on page 384? {Note: See neck, or back injury, you I The scalp, neck, or back bleeds. the forehead, and secure the First Aid for a Severe Injury on this must keep the head, neck, person to a board to keep the head, I It looks like the head, neck, or back is in an odd position. page.} and back perfectly still neck, and back areas from moving at all. A until emergency medical I Pain is felt in the back, neck, and/or head. The pain can be severe. I Call 9-1-1! care arrives. Any I Stiff neck. Was a recent injury to the head, neck, movement of the head, and/or back not treated with I Check for Circulation B I Abdominal pain. Vomiting. neck, or back could result emergency or medical care and are any Signs. (See page 353.) If in paralysis or death. I Blood or fluid comes from the mouth, nose, or an ear. of these problems present? doing rescue breathing, do I Loss of vision. Blurred or double vision. Pupils are not the same • Severe pain. not tilt the head backward. size. • Numbness, tingling, or weakness in Pull the lower jaw open instead. B the face, arms, or legs. I Inability to move any part of the body. Weakness in an arm or leg. • Loss of bladder control. To Immobilize the Head, Neck, and/or Back Walking is difficult. • A headache has lasted longer than 2 I Tell the person to lie still and not move his or I New feelings of numbness occur in the legs, arms, shoulders, or any days and gets worse with time. her head, neck, back, etc. other part of the body. • Unusual feeling or sensations. I Log roll as listed above or place rolled towels, • Large or increased area of swelling Keep the head, neck, and I New loss of bladder or bowel control occurs. etc. on both sides of the neck and/or body. Tie back perfectly still. despite the use of ice. in place, but don’t interfere with the person’s I Confusion. Drowsiness. Personality changes. Sample breathing. If necessary, use both of your I Convulsions. After a head, neck, or back injury, do hands, one on each side of the person’s head I Loss of consciousness. any of these problems occur? to keep the head from moving. • Pain from a head, neck, or back I Monitor for Bleeding (see page 362) and Watch for signs and symptoms for the first 24 hours after the injury. injury lasts longer than 1 week or Shock (see page 401). Keep the person warm Symptoms may not occur for as long as several weeks, though. goes away and returns. with blankets, coats, etc. • Signs of infection (e.g., redness, For a Injury fever, pus, drainage, etc.) occur at Move Someone You Suspect Has Injured His or I Neck pain and stiffness. the site of the wound. Her Neck in a Diving or Other Water Accident • A whiplash injury is suspected. I Having a hard time raising the head off of a pillow. Before emergency care arrives: I Protect the neck and/or spine from bending or Causes twisting. Place your hands on both sides of Do Not Reproduce the neck. Keep it in place until help arrives. Anything that puts too much pressure or force on the head, neck, or See Self-Care / First Aid in next column I If the person is still in the water, help the back can result in injury. Common causes are falls, accidents, and hard person float until a rigid board can be slipped blows. under the head and body, at least as far down as the buttocks. 384 385 Chapter 22: Emergency Conditions / First Aid Section IV: Emergencies & First Aid

Head / Neck / Spine Injuries, Continued Heart Attack Causes First Aid For Traffic I If no board is available, get several people to take the person out of Accidents the water. Support the head and body as one unit. Make sure the head I The most common cause is one or more blood A heart attack clots that block an artery in the heart. Often, a I If the person was in a does not rotate or bend in any way. happens when the motorcycle accident, do blood clot forms in an artery already heart does not get narrowed by plaque. not remove the helmet. First Aid for Minor Head Injuries enough blood supply Neck Neck Jaw Jaw Call 9-1-1 to do this. I Put an ice pack or bag of frozen vegetables in a cloth. Apply this to for a period of time. I Having a heart attack in the past increases the I Don’t move the person. the injured area. Doing this helps reduce swelling and bruising. Part or all of the risk for another one. Change it every 15 to 20 minutes for 1 to 2 hours. Do not put ice Arm Arm He or she may have a heart muscle dies. I Spasms occur in the large coronary artery. spinal injury. Call 9-1-1 directly on the skin. Cover an open, small cut with gauze and first- This can be triggered by: Heavy physical to do this. aid tape or an adhesive bandage. Signs & exertion, such as shoveling snow; exposure to I Once you know there is no serious head injury, do normal activities cold; severe emotional stress; and having a Symptoms heavy meal. These triggers are more likely to First Aid for Bleeding again. Avoid strenuous ones. affect persons who are not active. from the Scalp I Take an over-the-counter medicine for pain as directed. A heart attack may I To control bleeding, put have warning signs. I Cocaine or amphetamine abuse can cause a I Don’t drink alcohol or take any other sedatives or sleeping pills. (See box below). It pressure around the Common places heart attack sudden heart attack. This can happen in edges of the wound. I During the next 24 hours, monitor the person. While asleep, wake the can occur without pain is felt. persons with no signs of heart disease. Make a ring pad person every 2 hours to check alertness. Ask something the person signs, too. This is (shaped like a should know, such as a pet’s name, an address, etc. If the person can’t called a “silent” heart attack. doughnut) out of long be roused or respond normally, get immediate medical care. strips of cloth to apply Heart Attack Warning Signs If You Suspect a Whiplash Injury pressure around the Sample Other Warning Signs Common Warning Signs edges of the wound. If I See your doctor as soon as you can to find out the extent of injury. If I Feeling of pain (may spread to or be felt in I Unusual chest, abdominal, or stomach pain. this doesn’t control your arm or hand is numb, let your doctor know. the arm, neck, tooth, jaw, or back), tightness, bleeding, put direct I Dizziness; nausea; trouble breathing; jaw or I For the first 24 hours, apply ice packs to the injured area for up to 20 burning, squeezing, or heaviness in the chest. pressure on the wound. arm pain without chest pain. minutes every hour. This lasts more than a few minutes or goes Don’t poke your hand away and comes back. I Fast or uneven heartbeat or pulse. into the person’s brain, I After 24 hours, use ice packs or heat, I Sweating for no reason, pale, gray, or though. whichever works best, to relieve the pain. I Chest discomfort with: clammy skin. There are many ways to apply heat. Take • Fainting I Don’t wash the wound a hot shower for 20 minutes a few times a or apply an antiseptic or day. Use a hot-water bottle, heating pad • Feeling lightheaded. Signs More Likely in Women Than Men any other fluid to it. (set on low), or heat lamp directed to the • Nausea. I An uneasy feeling in the chest with: I neck for 10 minutes, several times a day. Unexplained or extreme anxiety; unusual If blood or pink-colored • Shortness of breath. fluid is coming from the (Use caution not to burn the skin.) fatigue or weakness; fluttering heartbeats; or ear, nose, or mouth, let Do Not Reproduce• Sweating. severe indigestion that doesn’t go away with I Wrap a folded towel around the neck to Use a cervical neck pillow it drain. Do not try to help hold the head in one position during or a small rolled towel an antacid. stop its flow. the night. behind your neck instead of {Note: If any of these signs occur, call 9-1-1. Then, give “First Aid for a Heart Attack Before a regular pillow. Emergency Care” listed on page 388.}

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Heart Attack, Continued For Heat Exhaustion Heat Exhaustion & I Normal, low, or only slightly elevated body Treatment Questions to Ask Heat Stroke temperature. A heart attack is a Do any of these problems occur? I Cool, clammy, pale skin. Sweating. medical emergency! • Any heart attack warning sign listed on page 387. Sweat evaporates I Dry mouth. Thirst. Treatment works best • For a person with angina, chest pain does not respond to from the skin to when it is given within prescribed medicine or go away in 10 to 15 minutes. I Fatigue. Weakness. Feeling dizzy. {Note: cool the body. If 1 to 2 hours after Call 9-1-1 this personal I Headache. symptoms start. Treatment without delay! cooling system includes: Then, give I Nausea. Vomiting can occur. first aid listed does not work I Medicine(s) to keep I below as right or fails to Muscle cramps. blood from clotting. needed.} work, heat I Sweat cools the body. Weak or rapid pulse. I “Clot busters” to Self-Care / First Aid exhaustion or a dissolve blood clots in heat stroke can occur. heart arteries. I Call 9-1-1 or your local rescue squad right away! Call when warning Causes signs start. Don’t wait to see if the pain goes away. I Tests to diagnose the Heat exhaustion is a warning that the body is Anything that keeps the body’s natural cooling status of the heart and getting too hot. With a heat stroke, body organs system from working right can lead to heat First Aid for a Heart Attack Before Emergency Care arteries. start to overheat. They will stop working if they exhaustion and heat stroke. This includes: I Check for breathing and Circulation Signs. (See page 353.) Do CPR get hot enough. If it is not treated, a heat stroke I Extreme heat and humidity. I Angioplasty, stents, or (see page 355), as needed. can result in death. bypass surgery, if I Being in places without fans or air I If the person uses and has nitroglycerin, place one tablet under the needed. conditioners during hot, humid weather. tongue. Give as many as 3 tablets in 10 minutes. Signs & Symptoms Sample I Not being able to get to public air-conditioned Prevention I Give the person a regular (325 mg.) aspirin or 4 children’s chewable For a Heat Stroke places. Waiting for a bus or other type of aspirins (81 mg. each) to chew on. Give the aspirin after calling These signs and symptoms can occur suddenly public transportation in hot, humid weather. 9-1-1. Ask the 9-1-1 dispatcher if aspirin should be taken. I Follow prevention with little warning: I Overdressing. measures in Heart {Note: Don’t use aspirin if the person is allergic to it or has a condition I Very high temperature (104OF or higher). I Changes in the skin due to aging. Disease on page 234. that makes using it risky.} I Hot, dry, red skin. No sweating. I Poor circulation. Heart, lung, and/or kidney I Take medications, as I If you can’t call 9-1-1, drive the person to the hospital right away. If I Deep breathing and fast pulse. Then shallow prescribed. disease. you are having heart attack signs, don’t drive yourself unless you breathing and weak pulse. I I Not being able to sweat due to medicines, Don’t shovel snow or have no other choice. I Confusion. Hallucinations. carry heavy objects, such as water pills and some used for mental I Loosen clothing around the neck, chest, and waist. Don’t let the especially if you are I Convulsions. illnesses. person lie down, especially if he or she has breathing problems. A not physically fit. I I half-sitting position is better. Put the legs up. Bend them at the knees. Loss of consciousness. Alcohol or drug use. I Don’t use Put a pillow or rolled towel underDo the knees. Support Not the back. Reproduce I Any illness that causes weakness, fever, amphetamines and/or vomiting, or diarrhea. I Reassure the person that you have called for medical help and will cocaine. stay with him or her until it arrives.

I After a heart attack, follow the doctor’s treatment plan. 388 389 Chapter 22: Emergency Conditions / First Aid Section IV: Emergencies & First Aid

Heat Exhaustion & Heat Stroke, Continued Heat Exhaustion & Heat Stroke, Continued

Treatment Questions to Ask I Once the person’s temperature gets to 101OF, Prevention place him or her in the Recovery Position. A heat stroke is a medical Is any sign of a heat stroke listed on page 389 present? (See page 357.) Do not lower the temperature I Drink lots of liquids, especially if your urine emergency. Heat {Note: Call 9-1-1 without delay. Then give first aid listed below further. is dark yellow. Drink water, sport drinks, such exhaustion may respond to and on the top of page 391 as needed.} I Don’t give fever reducing medicine. as Gatorade, etc. self-care measures. If not, I Do not stay in or leave anyone in a closed, medical care is needed. I Don’t use rubbing alcohol. Are these signs of heat exhaustion present? parked car during hot weather. • Dryness on the inside of the mouth. • Fatigue. Weakness. Listlessness. First Aid for Heat Exhaustion I Don’t have drinks with alcohol or caffeine. I • Muscle cramps. Move to a I Use caution when you are in the sun. At the • Feeling lightheaded or faint. cool place first sign of heat exhaustion, get out of the indoors or in sun. If you can, avoid midday heat. Do not do the shade. Lie vigorous activity during the hottest part of the With hot conditions, do you sweat a lot and have a headache down. and nausea? day (11:00 a.m. to 4:00 p.m.). I Loosen I Wear light, loose- clothing. fitting clothing, such I Drink fluids, as cotton, so sweat such as cool can evaporate. Wear a or cold water. wide-brimmed hat Self-Care / First Aid 1 Add /2 with vents. Use an First Aid for a Heat Stroke Sample teaspoon of umbrella for shade. I Call 9-1-1! salt to 1 quart I If you feel very hot, of water. Sip try to cool off. Open a Before Emergency Care Arrives this. Or, drink window. Use a fan. I Move the person to a cool place indoors or under a shady tree. Place sport drinks, Move to a cool place indoors Go to an air- or in the shade. the feet higher than the head to avoid shock. such as conditioned place. Gatorade, etc. I Remove clothing. Either wrap the I Check with your When outdoors in the person in a cold, wet sheet; sponge I Have salty foods, such as saltine crackers, if doctor about sun sun, drink fluids and the person with towels or sheets that you tolerate them. exposure if you take: wear a hat. are soaked in cold water; or spray I Massage and stretch cramped muscles. • Water pills. the person with cool water. Fan the person. • Mood-altering medicines.

I Put ice packs or cold compresses on • Some antibiotics, such as tetracycline. the neck, under the armpits, and Doon If using an electricNot fan, keep the Reproduce the groin area. person with wet items away from the fan to avoid electric shock.

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Hyperventilation Near-Drowning Treatment Immediate medical care is needed for near- Hyperventilation is Causes Near-drowning is when a person is in danger of drowning. breathing too deeply and drowning. faster than normal. This I Anxiety is the most common cause. (See Anxiety on page 269.) Each year, almost 8,000 people die from Questions to Ask causes too much carbon I Panic attacks. (See page 269.) drowning. Seventy percent of all near-drowning dioxide to be exhaled. As a Is the person unconscious and not victims recover; 25% die, and 5% have brain result, levels of carbon I Central nervous system problems. breathing? Or, does the person have damage. dioxide in the blood and blue lips and ears and is the skin cold brain tissue drop. Treatment A toddler can drown in as little as 2 inches of water and pale? {Note: Call 9-1-1. Then, give in a bathtub, sink, etc. Toilet bowls are unsafe, too, “First Aid for Near-Drowning” below.} Self-care may be enough to treat hyperventilation. If it persists or occurs Signs & if a small child falls into one head-first. with other symptoms, seek medical care. Does the person in the water show any Symptoms Questions to Ask Signs & Symptoms of these signs? • Waves or shouts for help. I Your heart pounds. Do you breathe rapidly and have any of these problems? I A person is in the water with signs of distress. • Swims in uneven motions. I It feels like you can’t • Any heart attack warning sign. (See page 387.) He or she can’t stay above water, swims • Can’t stay above water. get enough air. • Bluish or purple color around your lips, fingernails, or skin. unevenly, signals for help, etc. {Note: Call 9-1-1. Then, give “First Aid • Asthma, emphysema, or a serious lung or heart problem. for Near-Drowning” below.} I You feel tingling and I Blue lips or ears. The skin is cold and pale. • A seizure. (See Seizures on page 399.) numbness in the arms, I Bloated abdomen. Vomiting. Choking. legs, and around the After a near-drowning incident, does mouth. Do you hyperventilate often? Or, have you had 4 or moreSample panic I Confusion. Lethargy. the person have a fever, a cough, or attacks over a 4-week span? muscle pain? I You feel a sense of I The person does not respond or can’t breathe. doom.

I You may pass out. Causes

I Not being able to swim. Being in water too Symptoms usually last 20 Self-Care / First Aid deep and too rough for one’s ability to swim. Self-Care / First Aid to 30 minutes, but seem to last hours. Though scary, I Open up a small paper bag. Loosely cover your nose and mouth with I Water sport and other accidents. Not First Aid for Near-Drowning hyperventilation is not it. Breathe slowly into the bag. Rebreathe the air in the bag. Do this following water safety rules. Not wearing a I Call 9-1-1! about 10 times. Set the bag aside. Breathe normally for a couple of life preserver, etc. Unsupervised swimming. usually dangerous. I If it is safe and possible, try to reach the minutes. I Falling through ice while fishing, skating, etc. person. Use a long pole, rope, life preserver, I Repeat the steps above for up to 15 minutes. I Injury or problems that occur while etc. Then pull him or her to safety. swimming, boating, etc. Examples are leg or I Try to breathe slowly. Focus on takingDo one breath everyNot 5 seconds. Reproduce I Did the person fall through ice? Try a human stomach cramps, fatigue, and alcohol or drug chain rescue to safely reach the person, but See also Self-Care / Prevention for Anxiety on pages 271 and 272. use. A heart attack, stroke, seizure, and a stay as far away from cracked ice as you can. {Note: If you still hyperventilate after using Self-Care / First Aid, call marine animal bite or sting may have your doctor.} occurred. 392 393 Chapter 22: Emergency Conditions / First Aid Section IV: Emergencies & First Aid

Near-Drowning, Continued Objects in the Causes Prevention I If you must swim to the person, be sure you are strong and capable enough. Take a flotation device with you. Approach the person from Ear or Nose I An object or substance is placed in the ear or For Children behind in a calm manner. Grab a piece of the person’s clothing. Or, nose on purpose and won’t come out. I Never leave an infant or cup one hand under the person’s chin. A foreign object stuck in an ear or the nose needs I Objects get stuck in the nose or ear by injury child alone in any type I Check for Circulation Signs. (See page 353.) Do Rescue Breathing to be removed. If not, an infection could result. or by accident. of bathtub. Supervise (see page 354) and CPR (see page 355) as needed. If you suspect a Damage to structures in the nose or ear could also I young children in the An insect flies or crawls into an ear. spinal injury, use jaw thrust instead of chin-lift for rescue breathing. occur. bathroom. I When getting the person out of the water, support the head and neck. I Never leave a child Questions to Ask (Suspect a neck injury, especially with diving or water sports.) Signs & Symptoms alone near water, Do any of these problems occur? A child may be swimming pools, etc. I Once out of the water, keep checking the person’s breathing and • A sharp object is stuck in a nostril or able to tell if an Lock gates to keep Circulation Signs. Respond as needed. ear. object was put in children from getting I Recovery Position • An object stuck in a nostril or ear Put the person in the . (See page 357.) Immobilize a nostril or an near swimming pools. causes severe pain or a lot of the person as much as possible. If the person is vomiting, clear his or ear and didn’t bleeding. I Have a phone near her mouth of it. come out. If not, outdoor pools, etc. • Removing an object from a nostril I Remove cold, wet clothes. Cover the person with a blanket, etc. signs and caused a severe nosebleed. I Teach children to swim. symptoms can Young children like to put things • A button-size battery is stuck in a Tell them not to swim help identify this in their mouths, ears, and nose. nostril or ear. alone and not to swim Prevention problem. too far from shore For Adults without a lifeguard or I Learn to swim. Never swim alone at the SampleFor an Object Stuck in an Ear Do any of these problems occur? other adult swimmer. beach or in a swimming pool. A lifeguard I Feeling of fullness in the ear. • Hearing loss or feeling dizzy. or other adult swimmer should be nearby • Signs of an infection, such as fever, I Put a personal floatation I Ear pain or discomfort. pain, swelling, foul odor, pus device on each child in case you suffer a leg cramp or other I Hearing loss and/or feeling dizzy. drainage, etc. when near the water or problem. I • An insect cannot safely be removed on a boat. I Wear a personal floatation device when Foul odor from the ear and/or drainage from from an ear. you are on a boat, when you fish, etc. the ear. I Tell children to check • After several tries, an object cannot I Bleeding from an ear. the depth of water I Check the depth of the water before be removed from a nostril or an ear. before diving in. It diving in. It should be at least 9 feet should be at least 9 feet deep. Never dive into an above-ground For an Object Stuck in the Nose deep. pool. I Constant nasal discharge from one nostril.

I Do not allow children I Do not use a hot tub or jacuzzi if you’ve I Foul odor. Pus or blood drains from a nostril. to go on untested ice. had any alcoholic drinks. You couldDo fall Not ReproduceI Pain, swelling, and/or tenderness. See Self-Care / First Aid on next page asleep, slip under the surface, and drown. I Take CPR and water Children should wear a safety courses. I Take CPR and water safety courses. personal floatation device.

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Objects in the Ear or Nose, Continued Poisoning Questions to Ask Treatment Self-Care / First Aid Is the person unconscious, having Poisons are harmful substances that are swallowed, convulsions, or not breathing? {Note: Medical care is needed for To Remove an Insect from an Ear inhaled, or that come in contact with the skin. Each See “First Aid For Unconsciousness” on foreign objects that can’t I Kill the insect before you try to remove it. To do this, tilt the year about 10 million poisonings occur; 80% of page 379; “First Aid For Seizures with be removed with self-care. person’s head to put the ear with the insect in an upward position. them are in children under five years old. Convulsion” on page 400; and Rescue After an object is Pour warm (not hot) mineral, olive, or baby oil into the ear. As you Breathing on page 354.} removed, an antibiotic pour the oil, straighten the ear canal. In a child, pull the earlobe may be needed if an gently backward and downward; backward and upward in an adult. Signs & Symptoms infection is present. Small, Signs and symptoms depend on the substance. After being in a closed space with a I The goal is to suffocate the insect and cause it to float out. button-sized batteries need They include a skin rash, upset stomach, and more heater or furnace on, are signs of to be removed to prevent severe problems. Some poisons can cause death. carbon monoxide poisoning present? To Remove Objects Other Than Insects burns. • Lethargy. Confusion. Agitation. I Don’t use oil. Causes • Sudden shortness of breath. I Tilt the head toward the side with the foreign object. Gently shake • Severe headache. Abdominal pain. the head toward the floor to try to get the object out. Do not shake a Things Not Meant to Be Swallowed or Inhaled • Seizure. baby. Gently pull the ear up and back. I Household cleaners, such as bleach, drain • Chest pain or irregular heartbeat. cleaners, ammonia, and lye. I Don’t use a sharp tool, cotton swab, etc. to try to locate and remove • Signs of shock. (See page 401.) the object. This risks pushing the object farther into the ear. Doing I Insecticides. Rat poison. this could damage the middle ear. I Gasoline. Antifreeze. Oil. Lighter fluid. Paint Do any of these problems occur? I Remove the object with blunt tweezers if it is easily seen and can be thinner. • Pulse rate is 140 or more beats per minute or 40 or fewer beats per grasped and pulled out. SampleI Lead. minute. I Airplane glue. Formaldehyde. To Remove Objects in the Nose • Shortness of breath. Breathing 10 or I Don’t use a sharp tool, cotton swab, I Rubbing alcohol. Iodine. Hair dye. fewer breaths per minute. Time etc. to try to locate and remove the Mouthwash. Mothballs. lapses of more than 8 seconds {Note: First, between breaths. call Poison object. I Some indoor and outdoor plants. • Any change in mental status. Control Center I Breathe through the mouth until the I Carbon monoxide. This has no color, odor, or • Hallucinations. at object is removed. taste. 800.222.1222.} I Apply gentle pressure to close the Has any substance been swallowed, other nostril and gently try to blow Things That Are Poisonous in Harmful Amounts To reduce swelling, spray a inhaled, or absorbed by the skin that the object out. I Alcohol. Drugs. Over-the-counter and nasal decongestant in the has “Harmful or fatal if swallowed” or nostril with the foreign object. prescribed medicines. I Remove the object with blunt a skull-and-crossbones sign on the I Medicinal herbs. tweezers, if it is easily seen and canDo be grasped andNot pulled out. Reproduce label? Or, did the person take a {Note: First, I Vitamins and minerals. Iron in these can be substance that could be poisonous. call Poison deadly to a small child. Control Center at See also Food Poisoning on page 158 and Bites 800.222.1222.} & Stings on page 358. See Self-Care / First Aid on next page 396 397 Chapter 22: Emergency Conditions / First Aid Section IV: Emergencies & First Aid

Poisoning, Continued I A Fever (Febrile) Seizure. This type is Seizures brought on by a high fever in infants and Treatment Self-Care / First Aid small children. High fevers cause most A seizure is a sudden “episode” caused by an Treatment depends on the For Swallowed Poisons seizures in children aged 6 months to 5 years. electrical problem in the brain. With a seizure, a poison and its effects. 1. If the person is unconscious, shout for help. Call 9-1-1! Signs are ones of a convulsion listed in the person has change in awareness, body 2. For a conscious person, call the Poison Control Center left column. Most febrile seizures last 1 to 2 movements, or sensation. minutes, but can last longer. Seeing a child Information to give the (800.222.1222). Follow instructions. Do not give Syrup of Ipecac to have a febrile seizure causes alarm. In Poison Control Center, induce vomiting unless the Poison Control Center tells you to. general, these seizures are harmless. emergency department, {Note: The American Academy of Pediatrics recommends that Signs & Symptoms etc.: parents don’t give Syrup of Ipecac to children.} There are many types of seizures. Common types I The name of the 3. Lay the person on his or her left side to keep the windpipe clear, are: Causes substance taken. especially if the person vomited. Keep a sample of the vomit and the I A Generalized Tonic Clonic Seizure. This is Causes include epilepsy (a brain disorder), I The amount and when poison container. also called a grand mal seizure. A infections that cause a high fever, heat stroke, and it was taken. convulsion occurs with this type. Signs of a electric shock. Head injury, stroke, and toxic For Inhaled Poisons convulsion include: substances can also cause a seizure. Sometimes I A list of ingredients on 1. Protect yourself. Move the person to fresh air (outdoors if you can). • Brief loss of consciousness. Falling down. the cause of a seizure is not known. the label. Try not to breathe the fumes yourself. • The arms and legs stiffen, jerk, and twitch. I Age, gender, and 2. Follow steps 1 and 2 above for Swallowed Poisons. Get medical care. Treatment weight of the person • This type usually lasts 1 to 2 minutes. When it ends, the person’s muscles relax. Seizure disorders are treated with medication. who took the poison. For Chemical Poisons on Skin He or she may lose bladder control, be Other medical treatments may be needed. How the person is 1. Protect yourself. Flood the skin with water for 5 or more minutes. confused, have a headache, and fall asleep. feeling and reacting. Remove clothing that was in contact with the person. Any medical problems Sample This is the type most people think of with Questions to Ask the person has. 2. Gently wash the skin with soap and water. Rinse well. Get medical the word “seizure.” care. Did the seizure occur with or after any I An Absence Seizure. This is also called a of the following? petit mal seizure. A convulsion does not • The person stopped breathing. {Note: For more Prevention occur with this type. Signs of an absence Do Rescue Breathing. See page 354.} information, seizure include: • A head or other serious injury. {Note: I Buy household products, vitamins, and medicines in child-resistant contact: packaging. Keep these and all poisons out of children’s reach. • Blank stares. It looks like the person is See Head / Neck / Spine Injuries on daydreaming or not paying attention. page 385.} Federal Safety Hotline I Put child-resistant latches on cabinet doors. Follow instructions for • Signs and symptoms of a heat 888.252.7551 use and storage of pesticides, household cleaners, and other poisons. • Lip smacking. Repeated blinking, chewing or hand movements. stroke. (See page 389.) National Poison Control I Keep products in original containers. Don’t transfer them to soft • Electric shock. (See page 373.) Center drink bottles, plastic jugs, etc. • This type of seizure usually lasts only a • Poisoning. (See page 397.) 800.222.1222 few seconds, but can occur many times a • Symptoms of meningitis. (See I Teach children not to take medicine and vitamins unless an adult www.poisonprevention.org Do Not Reproduceday. When the seizure ends, the person is page 101.) gives it to them. Don’t call these “candy” in front of a child. not confused, but is not aware that the • An illness with symptoms of lethargy SafetyUSA™ I Wear protective clothing, masks, etc. when using chemicals that seizure occurred. and confusion, flu, or chicken pox. www.cdc.gov/safeusa could cause harm if inhaled or absorbed by the skin. • Absence seizures are common in children I Install carbon monoxide detectors in your home and garage. and can result in learning problems. Flowchart continued on next page 398 399 Chapter 22: Emergency Conditions / First Aid Section IV: Emergencies & First Aid

Seizures, Continued Shock Treatment Febrile Seizure Prevention Are any of these conditions present? Shock requires emergency medical care. For a child who has had a • This is the first time the person had a seizure or the seizure Shock occurs febrile seizure in the past, lasts longer than 5 minutes. when the Questions to Ask give acetaminophen or • The person has a second seizure soon after the first one or circulation ibuprofen at the first sign of has multiple seizures. system fails to Are signs and symptoms of shock a fever. Give the right kind • The person has a hard time breathing. send blood to all listed on this page present? {Note: Call and dose for his or her • The person who had the seizure is pregnant or has diabetes. parts of the body. 9-1-1! Then, give first aid listed below.} weight. Insert suppositories • The seizure is different from the typical seizure the person With shock, that lower fevers, instead, if has. (It may take longer to wake up after the seizure ends.) blood flow or Loss of blood from any injury prescribed by the child’s blood volume is doctor. can cause shock. Has the person stopped taking medicines for seizures? Or, do too low to meet {Note: Don’t give aspirin seizures occur more often or are they more severe? the body’s needs. Areas of the body are deprived to anyone less than 19 of oxygen. The result is damage to the limbs, Self-Care / First Aid years old.} lungs, heart, and brain. First Aid for Shock Before Emergency Care I Check for breathing and Circulation Signs. I Dress the child in light, Signs & Symptoms (See page 353.) Do Rescue Breathing or loose clothes. CPR as needed. (See pages 354 to 355.) Self-Care / First Aid I I Weakness. Trembling. Apply washcloths rinsed I Lay the person flat, face-up, but do not move For Seizures with Convulsions in lukewarm (not cold) I Feeling restless. Confusion. him or her if you suspect a head, back, or water to your child’s I Stay calm. Protect the person from injury. Cushion the head with a I Pale or blue-colored lips, skin, and/or neck injury. forehead and neck. pillow, a coat, etc. Move sharp objects out of the way. Sample fingernails. Cool and moist skin. I Raise the person’s feet about 12 inches. Use a Sponge the child’s arms, I Loosen tight clothes, especially around the neck. legs, and trunk with I Rapid, shallow breathing. Weak, but fast box, etc. Do not raise the feet or move the lukewarm water. Don’t I If the person vomits, clear the mouth of it. pulse. legs if hip or leg bones are broken. Keep the person lying flat. use cold water, ice, or I Do not hold the person down or throw water on the face. Don’t put I Nausea. Vomiting. Extreme thirst. rubbing alcohol. anything into the mouth. (A spoon in the mouth does not prevent I If the person vomits or has trouble breathing, tongue biting.) I Enlarged pupils. raise him or her to a half-sitting position (if I Keep trying to bring the I Loss of consciousness. no head, back, or neck injury). Or, turn the fever down until it is I If the seizure in a child is due to a fever, start bringing the child’s 101OF or less. temperature down as soon as the seizure stops. Sponge the child’s person on his or her side to prevent choking. body with room temperature water. Do not put the child in a bathtub. Causes I Loosen tight clothing. Keep the person warm. For more Do not use ice. Do not use rubbing alcohol. Cover the person with a coat, blanket, etc. information, I A heart attack. I Report how long the seizure lasts and the symptoms that occur. I Monitor for Circulation Signs. (See page contact: I Severe or sudden blood loss from an injury or 353.) Repeat as needed. I After the seizure, lay the person on his or her side. Let the person National Institute of Do Not Reproduceserious illness. Bleeding can occur inside or sleep. Check for a medical alert tag. Respond as needed. Do not I outside the body. Do not give any food or liquids. If the person Neurological Disorders embarrass the person. wants water, moisten the lips. and Stroke (NINDS) I A large drop in body fluids, such as following I Call 9-1-1 (except for a febrile seizure or a seizure in a person you I www.ninds.nih.gov a severe burn. Reassure the person. Make him or her as know has a seizure disorder). comfortable as you can. 400 401 Chapter 22: Emergency Conditions / First Aid Section IV: Emergencies & First Aid

Skin Injuries / Wounds, Continued I After the bleeding has stopped and when it is Skin Injuries / Wounds clean and dry, apply a first-aid cream. Does any sign of infection occur? Signs & Causes • Fever and/or general ill feeling. I Put one or more bandages on the cut. The edges • Redness. Or, red streaks extend from of the cut skin should touch, but not overlap. Symptoms For Cuts, Scrapes & Punctures the wound site. Use a butterfly bandage if you have one. The cause can be any object that penetrates the skin. This includes cut Cuts slice • Increased swelling, pain, or I Keep a scrape clean and dry. Dress it with gauze the skin glass, a splinter, stepping on a nail or tack, falling on pavement, etc. tenderness at or around the wound. and first-aid tape. Change this every 24 hours. open. This causes For Bruises For Punctures that Cause Minor Bleeding Common causes are falls or being hit by some force. Bruises result Was the cut or puncture from dirty bleeding and objects, rusty nails, or objects in the I Let the wound bleed to cleanse itself. pain. when broken blood vessels bleed into the tissue under the skin. Persons Cut who take blood-thinners bruise easily. soil? Or, did a puncture go through a I Remove the object (e.g., splinter). Use clean shoe, especially a rubber-soled one? tweezers. Hold a lit match or flame to the ends Scrapes are For information on Burns, see pages 368 and 369. of the tweezers to sterilize them. Let them cool less serious and wipe the ends with sterile gauze. than cuts, Treatment Do you have any of these problems? but more • Bruises appear often and easily, take I Two to 4 times a day, clean the wound area painful Treatment depends on the cause and how severe the skin injury is. longer than 2 weeks to heal, or occur with soapy water. Dry it well and apply an because Simple wounds can be treated with self-care. An antibiotic treats a more than 3 times a year for no antibacterial cream. Do this for several days. more nerve bacterial infection. Medical care, such as stitches, may be needed for known reason. endings are Scrape deep cuts or ones longer than an inch. • Vision problems occur with a bruise For Bruises affected. near the eye. I Apply a cold pack to the bruised area as soon as Questions to Ask Sample possible (within 15 minutes of the injury). Keep Punctures the cold pack on for 10 minutes at a time. Apply are stab With an injury, do any of the following occur? pressure to the cold pack. Take it off for 30 to wounds. • Loss of consciousness. {Note: See “First Aid For 60 minutes. Repeat several times for 2 days. Unconsciousness” on page 389.} This causes Self-Care / First Aid I Rest the bruised area and raise it above the pain, but • Signs of shock. (See page 401.) {Note: For severe bleeding, see Self-Care/First level of the heart, if practical. may not • Severe bleeding or blood spurts from the wound. (Apply direct pressure on the wound site while seeking care.) Aid – For Severe Bleeding on page 363.} I Two days after the injury, use warm result in Puncture bleeding. • Bleeding continues after pressure has been applied for more For Minor Cuts and Scrapes compresses for 20 minutes at a time. {Note: than 10 minutes (or after 20 minutes for a minor cut). I Clean in and around the wound thoroughly I Do not bandage a bruise. Try to avoid hitting • A deep cut or puncture appears to go down to the muscle or Give first Bruises cause black and aid as with soap and water. the bruised area again. blue or red skin. As they bone and/or is located on the scalp or face. needed. I Press on the cut for up to 10 minutes to stop heal, the skin turns • A cut is longer than an inch and is located on an area of the See First the bleeding. Use sterile, wet gauze or a clean For more information, yellowish-green. Pain, body that bends, (e.g., the elbow, knees, etc.). Aid sections in cloth. Dry gauze can stick to the wound. contact: tenderness, and swelling • The skin on the edges of the cut hangsDo open. Not Reproduce Bleeding Don’t use a bandage to apply pressure. also occur. on page 364 and Safe USA™ Flowchart continued on next page in Skin Injuries/ I If still bleeding, lift the part of the body with 888.252.7751 English / Spanish Wounds on the cut higher than the heart, if practical. page 403.} www.cdc.gov/safeusa 402 403 Chapter 22: Emergency Conditions / First Aid Section IV: Emergencies & First Aid

Sprains, Strains & Sports Injuries, Continued Sprains, Strains & Sports Injuries For Sports Injuries Are any of these signs present? Sports injury symptoms depend on the injury. • A bone sticks out or bones in the Common Sports Injuries They include pain, tenderness, swelling, and injured part make a grating sound. bruising. Bones may be broken or dislocated. • An injured body part looks bent, separation (See Common Sports Injuries on page 404.) shortened, or misshaped. or Fractured collar bone • You can’t move the injured body part {Note: See tendinitis (back side of Causes or put weight on it. First Aid shoulder) • The injured area is blue, pale, or feels section in Sprains occur cool, but the same limb on the other Broken Side stitch (sharp pain from an Bones/ Tennis elbow (pain on side of the body does not. the outside of ) felt underneath rib cage) accident, injury, Dislocations fall, etc. A on page Strained finger 367.} Low back strain occurs when you Are any of these signs present? (lower back) injury (to overstretch or • You can’t bend or straighten an or overexert a injured limb. cartilage) muscle or An ankle can cause • Bad pain and swelling occur or the Pulled (not a strain on the achilles tendon. pain gets worse. Shinsplint ligament). This • Pain is felt when you press along the bone near the injury. Muscle cramp is usually due to overuse and injuries, such as sports injuries. Stress fracture (microfracture, usually Does the sprain or strain not improve Achilles tendon pain (stretch, in the bones in the feet or legs, caused SampleQuestions to Ask after using self-care for 2 days? tear, or irritation to the tendon by sudden increase in the amount of that connects the calf muscle to weight bearing exercise) Do you suspect a head, neck, or spinal the back of the heel) Plantar fasciitis (irritation of ligaments injury by any of these symptoms? Blisters (sores from friction) and tissues in the foot arch) • Paralysis. The head, neck, or back can’t move. • Inability to open and close the Self-Care / First Aid Signs & Symptoms fingers or move the toes or any part of the arms and legs. I If the injury is not serious, stop what you are For Sprains • Feelings of numbness in the legs, doing and use R.I.C.E. (See page 197.) A sprain happens when you overstretch or tear a ligament. (This is arms, shoulders, or any body part. {Note: See I If you sprained a finger or hand, remove fibrous tissue that connects bones.) A joint is affected, but there is no • It looks like the head, neck, or back First Aid rings. (If you don’t and your fingers swell up, dislocation or fracture. Symptoms are rapid pain, swelling, bruising, and section in is in an odd position. the rings may have to be cut off.) a warm feeling at the injured site. Head/ • Neck pain is felt right away. Neck/ I Take an over-the-counter medicine for pain, if Do Not Reproduce Spine For Strains Injuries on needed. {Note: Many sports medicine A strain is an injury to the muscles or . (These are tissues that Flowchart continued in next column page 385.} providers do not recommend aspirin-like connect muscles to bones.) Symptoms are pain, tenderness, swelling, and medicine at first, because it can make bruising. bleeding and bruising worse.} 404 405 Chapter 22: Emergency Conditions / First Aid Section IV: Emergencies & First Aid

Sprains, Strains & Sports Injuries, Continued Stroke (Brain Attack) Questions to Ask I Try liniments and balms. These provide a cooling or warming Treatment Does any stroke warning sign occur? sensation by masking the pain. They do not promote healing. A stroke is also called a “brain attack.” With a Treatment for sprains, {Note: Call 9-1-1 without delay! Then, I Once the injury begins to heal, use M.S.A.: stroke, brain cells die due to a blood clot or strains, and sports injuries follow first aid listed below.} • Movement. Work toward a full range of motion as soon as rupture of a blood vessel in the brain. The end depends on the injury and result is brain damage (and possible death). on the extent of damage. possible. This will help maintain flexibility during healing and In the past, have stroke warning signs Self-care may be all that is prevent any scar tissue from limiting future performance. In the U.S., strokes are the 3rd leading cause of occurred briefly and then gone away? needed for mild injuries. • Strength. Gradually strengthen the injured area once the swelling death. They are the leading cause of adult disability. Sports injuries and sprains is controlled and a range of motion is back. may need medical • Alternative Activities. Do regular exercises that do not strain the Stroke Warning Signs treatment. Some sprains injured part. Start this a few days after the injury, even though the need a cast. Others may Sudden numbness or weakness of the face, arm, injured part is still healing. Self-Care / First Aid need surgery if the tissue or leg, especially on one side of the body. affected is torn. First Aid Before Emergency Care Sudden confusion, trouble speaking or Prevention I Note the time when the first sign(s) of stroke understanding. Broken bones (other than To Prevent Serious Injuries (especially during contact sports) occurred. Report this time to emergency broken toes) need I Wear the right protective gear and clothing for the sport (e.g., a Sudden trouble seeing in one or both eyes. personnel. For the most common type of immediate medical care. helmet; shoulder, knee, and wrist pads; a mouth guard, etc.). strokes, a clot-busting drug should to be given Sudden trouble walking, dizziness, loss of within 3 hours of the start of symptoms. I Train in the sport so you learn how to avoid injury. “Weekend balance or coordination. athletes” are prone to injury. Follow the rules that apply to the sport. I Do not give the person anything to eat or Sudden severe headache with no known cause. drink. Do not give aspirin. General Prevention Sample I Ease into any exercise program. Build up gradually. Causes Prevention I Avoid running on hard surfaces like asphalt and Most strokes are caused by a blood clot in an I Take medicine(s) as prescribed (e.g., ones to concrete. Run on flat surfaces. Running uphill artery in the neck or brain. Some are caused by control blood pressure, blood cholesterol, puts added stress on the achilles tendon. bleeding into or around the brain. diabetes, and atrial fibrillation). I Don’t lock your knees. When you jump, land with Risk Factors for a Stroke I Get to and stay at a healthy weight. Get your knees bent. regular exercise. For more I Transient ischemic attack (TIA). This is a I Wear shoes and socks that fit well. The widest area information, temporary lack of blood supply to the brain. I Don’t smoke. If you smoke, quit. Use alcohol contact: of your foot should match the widest area of the With a TIA, stroke symptoms can appear for a in moderation. Manage stress. shoe. You should be able to wiggle your toes with short term and then go away. A TIA is a National Institute of the shoe on in both a sitting and standing position. Do warm-up warning that a stroke may follow. For more information, Arthritis and Wear shoes that provide shock absorption and exercises before contact: Musculoskeletal and Skin stability. Do Notthe activity. ReproduceI Atrial fibrillation. This is an irregular Diseases (NIAMS) beating of the heart. I Stop if you feel pain. Don’t do the activity until you can do it National Stroke Association www.nih.gov/niams without pain. I High blood pressure. Cigarette smoking. 800.787.6537 or www.stroke.org Diabetes. I Cool down after exercise. Do the activity at a slower pace for 5 minutes. American Heart Association 800.553.6321 or www.americanheart.org 406 407

The Proven Guide to Self-Care & Being a Wise Health Consumer About 25% of all doctor visits and 55% of all emergency room visits are not needed. Healthier at Home® teaches you:

I When you need emergency medical care.

I When to call or see your doctor.

I When and how to treat a problem at home.

Topics Include:

I Skin Conditions I Eyes, Ears, Nose & Throat Problems

I Digestive Problems I Sexually Transmitted Diseases (STDs)

I Dental Health Problems I Emergency Procedures & Conditions

I Muscle & Bone Problems I Men’s, Women’s & Children’s Health SampleI Wise Consumerism & Wellness I Other Health Problems and Concerns I Chronic Illnesses

I Respiratory Problems

I Mental Health Conditions

I Places to Get Information & Help

Learn More Online: For reliable health information in English and Spanish, access: Dowww .medlineplus.govNot. Get Reproduce information by clicking on: • Health Topics • Drug Information • Health News • Dictionary • Directories • Medical Encyclopedia