Emergency Medical Safety Tips
One of the most painful injuries that one can ever experience is a burn injury. When a burn occurs to the skin, nerve endings are damaged causing intense feelings of pain. Every year, millions of people in the United States are burned in one way or another. Of those, thousands die as a result of their burns. Many require long-term hospitalization. Burns are a leading cause of unintentional death in the United States, exceeded in numbers only by automobile crashes and falls. Serious burns are complex injuries. In addition to the burn injury itself, a number of other functions may be affected. Burn injuries can affect muscles, bones, nerves, and blood vessels. The respiratory system can be damaged, with possible airway obstruction, respiratory failure and respiratory arrest. Since burns injure the skin, they impair the body's normal fluid/electrolyte balance, body temperature, body thermal regulation, joint function, manual dexterity, and physical appearance. In addition to the physical damage caused by burns, patients also may suffer emotional and psychological problems that begin at the emergency scene and could last a long time.
Classifying burns Burns are classified in two ways: Method and degree of burn.
Never assume the source of a burn. Gather information and be sure.
- Thermal - including flame, radiation, or excessive heat from fire, steam, and hot liquids and hot objects.
- Chemical - including various acids, bases, and caustics.
- Electrical - including electrical current and lightning.
- Light - burns caused by intense light sources or ultraviolet light, which includes sunlight.
- Radiation - such as from nuclear sources. Ultraviolet light is also a source of radiation burns.
Determining the severity of burns
- First degree burns are superficial injuries that involve only the epidermis or outer layer of skin. They are the most common and the most minor of all burns. The skin is reddened and extremely painful. The burn will heal on its own without scarring within two to five days. There may be peeling of the skin and some temporary discoloration.
- Second degree burns occur when the first layer of skin is burned through and the second layer, the dermal layer, is damaged but the burn does not pass through to underlying tissues. The skin appears moist and there will be deep intense pain, reddening, blisters and a mottled appearance to the skin. Second degree burns are considered minor if they involve less than 15 percent of the body surface in adults and less than 10 percent in children. When treated with reasonable care, second degree burns will heal themselves and produce very little scarring. Healing is usually complete within three weeks.
- Third degree burns involve all the layers of the skin. They are referred to as full thickness burns and are the most serious of all burns. These are usually charred black and include areas that are dry and white. While a third-degree burn may be very painful, some patients feel little or no pain because the nerve endings have been destroyed. This type of burn may require skin grafting. As third degree burns heal, dense scars form.
Treatment of burns
- Source of the burn - a minor burn caused by nuclear radiation is more severe than a burn caused by thermal sources. Chemical burns are dangerous because the chemical may still be on the skin.
- Body regions burned - burns to the face are more severe because they could affect airway management or the eyes. Burns to hands and feet are also of special concern because they could impede movement of fingers and toes.
- Degree of the burn - the degree of the burn is important because it could cause infection of exposed tissues and permit invasion of the circulatory system.
- Extent of burned surface areas - It is important to know the percentage of the amount of the skin surface involved in the burn. The adult body is divided into regions, each of which represents nine percent of the total body surface. These regions are the head and neck, each upper limb, the chest, the abdomen, the upper back, the lower back and buttocks, the front of each lower limb, and the back of each lower limb. This makes up 99 percent of the human body. The remaining one percent is the genital area. With an infant or small child, more emphasis is placed on the head and trunk.
- Age of the patient - This is important because small children and senior citizens usually have more severe reactions to burns and different healing processes.
- Pre-existing physical or mental conditions - Patients with respiratory illnesses, heart disorders, diabetes or kidney disease are in greater jeopardy than normally healthy people.
Cool a burn with water. Do what you must to get cool water on the burn as soon as you can. Go to the nearest water faucet and turn on the cold spigot and get cool water on the burn. Put cool, water-soaked cloths on the burn. If possible, avoid icy cold water and ice cubes. Such measures could cause further damage to burned skin. Never apply ointment, grease or butter to the burned area. Applying such products, actually confine the heat of the burn to the skin and do not allow the damaged area to cool. In essence, the skin continues to "simmer." After the initial trauma of the burn and after it has had sufficient time to cool, it would then be appropriate to put an ointment on the burn. Ointments help prevent infection. The one exception to the "Cool a Burn" method is when the burn is caused by lime powder. In that case, carefully brush the lime off the skin completely and then flush the area with water. In the event of any serious burns, call 9-1-1.
Insect bites and stings are common, and most are considered minor. It is only when the insect is poisonous or when the patient has an allergic reaction and runs the risk of developing anaphylactic shock that the situation becomes an emergency. Even under those conditions, accurate diagnosis and prompt treatment can save lives and prevent permanent tissue damage.
The normal reaction to an insect sting is a sharp, stinging pain followed by an itchy, swollen, painful raised area. The swelling may be there for several days but usually goes away within 24 hours. Local reactions are rarely serious or life-threatening and can be treated with cold compresses.
However, there are some people who have allergic reactions to "normal" insect stings. Approximately 50 people die each year in the United States from insect stings. This is more than all other bites combined including snakebites. Thousands of people are allergic to bee, wasp, and hornet stings. Insect stings can be deadly for those people, on the average, within 10 minutes of the sting but almost always within the first hour.
The stinging insects that most commonly cause allergic reactions belong to a group of the hymenoptera, the insects with membranous wings. These include bees, wasps, hornets, and yellow jackets. Stings from wasps and bees are the most common.
Black Widow Spider
The black widow is a spider with a shiny black body, thin legs and an hourglass shaped red/white mark on its abdomen. The female is much larger than the male and is one of the largest spiders in the United States. Males generally do not bite. Females bite only when hungry, agitated or protecting the egg sac. The black widow is not aggressive. They are usually found in dry, secluded, dimly lit areas. More than 80 percent of all bite victims are adult men.
Black widow spider bites are the leading cause of death from spider bites in the United States. The venom is 14 times more toxic than rattlesnake venom. It is a neurotoxin that causes little local reaction but does cause pain and spasms in the larger muscle groups of the body within 30 minutes to three hours. Severe bites can cause respiratory failure, coma and death.
Those at the highest risk are children under age 16, the elderly, people with chronic illness and people with high blood pressure. Signs and symptoms of a black widow spider bite:
- A pinprick sensation at the bite site, becoming a dull ache within 30 to 40 minutes
- Pain and spasms in the shoulders, back, chest, and abdominal muscles within 30 minutes to three hours
- Rigid, boardlike abdomen
- Restlessness and anxiety
- Vomiting and nausea
The symptoms usually last 24 to 48 hours. Treatment:
- Treat for shock
- Apply a cold compress but do not apply ice
- Transport to hospital as quickly as possible
There are two types of brown spiders or brown recluse spiders in Arizona. They often are called violin spiders because of the characteristic "violin-shaped" marking on the upper back. They are generally brown but can range in color from yellow to dark brown. They are timid with webs in dry undisturbed areas. The Arizona species is not the same as the brown recluse spider in the Midwest.
The bite of the brown spider is a serious medical condition. The bite is nonhealing and causes tissue death. Sometimes surgery is necessary. The bite causes only a mild stinging sensation if any at all. Victims often are unaware they have been bitten. Several hours after the bite, the following signs and symptoms begin to result:
- A small white area appears surrounded by a margin of redness which may produce a mild itching pain.
- A blister appears surrounded by mild swelling and redness.
- A "bulls-eye" or "target" lesion develops
- There may be fever, chills, rash, hives, nausea and pain in the joints over the next few days.
The target lesion will enlarge over the next few days and produce extensive tissue death. There is no antivenom. The lesion will have to be soaked in antispetic and possibly antibiotics. Surgery may be necessary to cut out the dead tissue.
Burns and Scalds
It only takes one second to get a serious third degree burn from water that is 156 degrees Fahrenheit. If instant coffee granules melt in your tap water, it's set too hot and could cause serious burns to you or someone in your family.
Safe Water Temperatures
Water at temperatures between 124 and 130 degrees Fahrenheit is hot enough to do laundry, dishes and other household cleaning tasks without causing a major threat to you and your family. However, water heaters often are installed at somewhere between 140 and 150 degrees.
A word of caution - water heater thermostats are not very reliable. Many are marked "low-medium-high" and who knows what that is? Those that have numbers shouldn't be relied upon either.
Turn on just the hot water at your sink or bathtub. Let the water run for three to five minutes. Then check the water temperature with a meat or candy thermometer. If the water is 130 degrees or higher, the thermostat on the water heater should be turned down. Wait one day for the water to reach the new temperature and then check the temperature at the same faucet again. Repeat the process until your water temperature is between 124 and 130 degrees Fahrenheit.
Precautions When Bathing a Child
Another way to prevent scald injuries is to change behavior when it involves children. Run cold water into a bathtub first and then add hot water to adjust the temperature. Before placing a child into the tub, measure the temperature of the water. It should not exceed 102 degrees.
Take the phone off the hook while bathing the child. This will help maintain necessary continuous supervision of the child who is in the bathtub. Clearly mark the hot water setting on single valve units and turn the valve to the cold setting after filling the tub. This will reduce the risk of unintentionally introducing hot water into the tub.
Keep toys out of the bathtub. Placing toys in the tub while bathing the child establishes the bathtub/bathroom as a "play area." Give the child a washcloth to hold and face the child away from the faucet handles. This will take their attention away from the faucets and reduce the risk of them turning on the hot water during the bathing activity. As the child matures, teach them that the bathroom is a place for specific activities and not a play area. Establish designated "play areas" in the home and teach the child that these are the places to play rather than the bathroom or other areas of risk.
Regulate the Water Temperature
Install a tempering valve (pressure/temperature regulating) in the water line, which leads to the bathroom from the water heater. Set the temperature at 120 degrees. This valve has the potential of totally eliminating the risk of tap water scald burn injuries.
If you live in an apartment, ask the building's maintenance department to lower the hot water temperature. Explain why if they don't seem to understand.
"Child-Proof" Faucet Valves
If you are building a home or remodeling a bathroom, position the faucet valves at a distance of 36-40 inches above the bathtub. This will prevent young children from gaining access to the valve handles. Where practical, install the "push and turn" type valve handles. These handles are somewhat like the "child-proof" caps on medicine bottles.
Treatment for Scalding
If anyone is burned by scalding, run cool water over the burn. Cover the burn with a clean cloth and seek medical attention. Never put ointments, butter or anything greasy on a burn.
Poisons and other Harmful Substance Exposures
Each year thousands of people become injured or ill due to the effects of an unintentional harmful substance exposure. This may occur by direct skin contact, inhalation, absorption or ingestion of the substance into the body. Although these occur in all age groups and children less than five years of age are the most common victims. There are basic principles to consider:
- There are generally no antidotes for most poisoning.
- Small children can get protective caps off bottles faster than most adults.
- Siblings share, even with pets.
- Children do not always admit the truth or truly know the amount ingested.
Harmful substances are defined as chemicals, products and plants that threaten the safety of people and pets. Harmful chemicals commonly found in homes and schools include ammonia, bleach, dish soap, antifreeze, alcohol, insecticides, paint, petroleum products (kerosene and turpentine), herbicides, pesticides, drain cleaner, pine oil cleaner, spray cleaners, certain cosmetics, swimming pool additives, prescription and non-prescription medications, recreational drugs, tobacco products, mothballs and disc batteries among others. Common harmful plant exposures include mushrooms, poinsettias and oleanders. A harmful exposure is not always identifiable unless the person involved tells someone, asks for help or behaves inappropriately. Children are more likely not to tell an adult that they have swallowed some pills because they fear punishment. Adults then must learn to recognize a harmful exposure incident by carefully watching children in their care for signs of unusual odors or unusual behavior. The most obvious sign of a harmful exposure may be open pill bottles, plants that have obviously been chewed on or eaten from, open containers or a child complaining of a "tummy ache." It is important when caring for children that an adult survey areas where the children have access, especially high-risk areas such as the garage, kitchen or bathroom. Most harmful substance exposures in the toddler and child age groups occur when a youngster ingests an over-the-counter or prescription medicine such as cough medicine and cold preparations, ibuprofen, acetaminophen, Tylenol, aspirin and multi-vitamins. Adults most often have swallowed improperly stored liquids in glasses, bottles, jars and other containers accounting for the largest number of harmful substance exposures in that age group. Poison Control Center of Montgomery County, PA, 800-722-7112 (if it is serious, call 9-1-1) provides around-the-clock advice and assistance with specially-trained registered nurses for patients experiencing serious toxic problems. They can be called anytime to answer questions or provide guidelines following a toxic exposure. More than 85 percent of these exposures can be handled in the home.
Childhood Choking Prevention Tips
Keep the following items away from infants and young children: Latex balloons, Coins, Marbles, Toys with small parts, Toys that can be compressed to fit entirely into a child's mouth, Small balls, Pen or marker caps, Small button-type batteries, Medicine syringes.
Before a child begins to crawl, get down on his level and look for dangerous items. If you have older children, pay extra attention to their toys and be sure your younger child can't get into them.
Be aware that balloons pose a choking risk to children of any age.
Keep the following foods from children until 4 years of age: Hot dogs, Nuts and seeds, Chunks of meat or cheese, Whole grapes, (Hard, gooey, or sticky) candy, Popcorn, Chunks of peanut butter, Raw vegetables, Raisins, Chewing gum.
Insist that children eat at the table, or at least while sitting down. They should never run, walk, play or lie down with food in their mouths.
Heimlich Meneuver for Choking
Courtesy: The Heimlich Institute
A choking victim can't speak or breathe and needs your help immediately. Follow these steps to help a choking victim:
UNCONSCIOUS VICTIM, OR WHEN RESCUER CAN'T REACH AROUND VICTIM:
- From behind, wrap your arms around the victim's waist.
- Make a fist and place the thumb side of your fist against the victim's upper abdomen, below the ribcage and above the navel.
- Grasp your fist with your other hand and press into their upper abdomen with a quick upward thrust. Do not squeeze the ribcage; confine the force of the thrust to your hands. Repeat until object is expelled.
- Place the victim on back.
- Facing the victim, kneel astride the victim's hips.
- With one of your hands on top of the other, place the heel of your bottom hand on the upper abdomen below the rib cage and above the navel.
- Use your body weight to press into the victim's upper abdomen with a quick upward thrust. Repeat until object is expelled.
- If the Victim has not recovered, proceed with CPR.
The Victim should see a physician immediately after rescue.
Don't slap the victim's back. (This could make matters worse.)
Heimlich Meneuver on Yourself
When you choke, you can't speak or breathe and you need help immediately. Follow these steps to save yourself from choking:
- Make a fist and place the thumb side of your fist against your upper abdomen, below the ribcage and above the navel.
- Grasp your fist with your other hand and press into your upper abdomen with a quick upward thrust.
- Repeat until object is expelled.
- Alternatively, you can lean over a fixed horizontal object (table edge, chair, railing) and press your upper abdomen against the edge to produce a quick upward thrust. Repeat until object is expelled.
See a physician immediately after rescue.
Heimlich Meneuver on Infants
A choking victim can't speak or breathe and needs your help immediately. Follow these steps to help a choking infant:
Don't slap the victim's back. (This could make matters worse.)
- Lay the child down, face up, on a firm surface and kneel or stand at the victim's feet, or hold infant on your lap facing away from you.
- Place the middle and index fingers of both your hands below his rib cage and above his navel.
- Press into the victim's upper abdomen with a quick upward thrust; do not squeeze the rib cage. Be very gentle. Repeat until object is expelled.
- If the Victim has not recovered, proceed with CPR. The Victim should see a physician immediately after rescue.
Heat Stress Prevention
Hot weather triggers a variety of medical emergencies. Even healthy people should take it easy during extremely high temperatures and those with respiratory or other health problems, children and the elderly must be especially careful. Stay out of the sun as much as possible. Drink extra fluids, but avoid alcoholic and caffeinated beverages. Alcohol and caffeine can cause dehydration.
The best ways to prevent a heat stress emergency are:
- Drink before you're thirsty and drink often.
- Wear loose fitting clothing made of a breathable material.
- If you can, work and exercise in the cooler hours of the morning or evening.
Heat-related injuries fall into three major categories:
- Heat cramps are muscular pains and spasms that occur when the bodies electrolytes and salt are lost through the sweating process. Drink fluids that replaces body electrolytes and salt, and spend time in cooler areas to reduce sweating.
- Heat exhaustion is a medical emergency that will include heat cramps, nausea, possible vomiting, and possible confusion. When a person is suffering from heat exhaustion, they will perspire profusely and most likely will be pale. It is best treated by taking the patient to a cool place, applying cool compresses, elevating the feet and giving the patient fluids. The patient may need hospitalization and IV fluids to properly recover.
- Heat stroke is the worst heat-related injury and is a life threatening medical emergency, Dial 9-1-1. The brain has lost its ability to regulate body temperature. The patient will be hot, reddish and warm to the touch. Their temperature will be markedly high and there will be no perspiration. The patient will also be confused, or (in worst case scenarios) unconscious. Death will occur if not corrected in the hospital.