ACCIDENTS AND EMERGENCIES
Accidents and Emergencies--Contents of the Family Medicine
Chest--Foreign Bodies in the Eye--Foreign Bodies in the Ear--Foreign
Bodies in the Nose--Foreign Bodies in the Throat--A Bruise or
Contusion--Wounds--Arrest of Hemorrhage--Removal of Foreign Bodies from
a Wound--Cleansing a Wound--Closing and Dressing Wounds--The Condition
of Shock--Dog Bites--Sprains--Dislocations--Wounds of the
Scalp--Run-around--Felon--Whitlow--Burns and Scalds
Contents of the Family Medicine Chest.--The family medicine cabinet
should contain the following articles: a graduate, medicine droppers,
hot water bags, a flat ice bag, a fountain syringe, a Davidson's
syringe, a baby syringe, sterile gauze, absorbent cotton, gauze bandages
of various widths, a yard of oiled silk, one roll of one inch "Z O"
adhesive plaster, a bottle of Pearson's creolin, hydrogen peroxide
(fresh), one ounce tincture of iodine in an air-tight bottle, a can of
Colman's mustard, two ounces of syrup of ipecac, a bottle of castor oil
(fresh), one pound of boracic acid powder, one pound of boracic acid
crystal, a bottle of glycerine, a bottle of white vaseline, a bath
thermometer, some good whisky or brandy, aromatic spirits of ammonia,
smelling salts, pure sodium bicarbonate, oil of cloves for an aching gum
or toothache, a bottle of alkolol for mouth wash and gargle, and one
ounce of the following ointment for use in the various emergencies which
occur in all homes,--
Bismuth subnitrate dram one
Zinc oxide dram one
Phenol (95%) drops twelve
Resinol ointment to make ounce one
This ointment may be applied to all cuts, bruises, skin eruptions,
chafings and sores of minor importance. It is one of the best
applications for chafing of the skin in babies.
The medicine chest should also contain a small jar of Unguentine for
burns; one-tenth grain calomel tablets for a cathartic for baby to be
used as explained in the text of the book, or as advised by the
physician. It may also contain tablets for colds and for other purposes
as suggested by the family physician. It should never contain medicines
the use of which is not thoroughly understood by the mother. It is a
wrong practice for mothers to keep medicines to use for the same ailment
at a subsequent time. The ailment may not be the same and frequently the
medicine itself deteriorates, or it may get stronger with age. Many
medicines are made with alcohol in them. If kept for some time the
alcohol evaporates and leaves a concentrated mixture which, if given in
the dose meant for the fresh preparation, may poison a child. Such cases
of poisoning are on record. The same argument applies to powders.
Certain drugs lose their strength, some absorb moisture, others change
their chemical strength if kept mixed with other chemicals. They should
be thrown away after the case is over if they have not been used. It is
a dangerous practice to keep medicines around if there are children in
the family.
Foreign Bodies in the Eye.--Particles which accidentally lodge in the
eye are usually located on the under surface of the upper lid. They are
sometimes, however, found on the ball of the eye or on the inner aspect
of the lower lid. Foreign bodies which are propelled into the eye with
great force, as iron specks which railroad men frequently get sometimes
imbed themselves into the eye-ball and have to be cut out or dug out.
The entrance of the foreign particle is always accompanied by a flow of
tears which is nature's way of removing them. The offending object may
escape through the tear duct into the nose, or it may be simply washed
out with the flow of tears. Rubbing the well eye will cause a flow of
tears in both eyes and may facilitate removal of the foreign matter.
Blowing the nose may force the particle into the tear duct. The use of
the eye cup may help in ridding the eye of the body. The same object may
be accomplished if the eyes are immersed in a basin of water and opened
wide. Then by moving the eyes around the particle may be washed out. If
the particle is located on the under surface of the upper lid it may be
promptly removed by pulling the upper lid forcibly down and over the
lower lid. The eyelashes of the lower lid act as a brush and as a rule
quickly remove the irritant if the procedure is carried out adroitly.
Everting the upper lid is a means of locating the body and in making
possible its removal by a small camel's hair brush or corner of a
handkerchief. To evert the upper lid it is necessary to employ a guide.
A match stem may be used in an emergency. This is laid across the middle
of the upper lid, the eye lashes are grasped with the fingers of the
other hand and the lid is bent over the match stem and turned up thus
everting or turning inside out the entire upper lid. The procedure may
be facilitated if the patient is instructed to look down while the
operator is drawing the eye-lid upward.
If the particle cannot be easily removed by any of the above methods it
is not safe for an uninstructed individual to go any further. The eye is
an exceedingly delicate organ and may be permanently injured by
unnecessary irritation. It is always safer and it may be cheaper in the
long run to consult a competent oculist in such cases.
After the removal of any object from the eye, it is desirable to
frequently wash it out with a saturated solution of boracic acid. This
mixture will allay any inflammation and will tend to restore the normal
condition more quickly and more satisfactorily than if the eye were left
to heal itself.
Foreign Bodies in the Ear.--When a foreign body gets into the ear
mothers are unnecessarily alarmed because of a failure to appreciate
that the ear is a closed passage. It is impossible for any object to get
into the ear itself; the depth of the external passage is only about one
inch in an adult. At this point the passage is completely closed by the
drum membrane. Most of the harm is done by ignorant meddling, not by the
object itself.
Children frequently put foreign bodies in the ear, as, buttons, pebbles,
beans, cherry stones, coffee, etc. The very first thing for the mother
to do when she learns that her child has put "something" in its ear is
to keep cool, and try to find out what the something is. It is
essential to know what the article is because different articles are
treated differently. For example if we try to remove a bean or pea with
a syringe, the liquid will cause the pea or bean to swell and result in
wedging it in so firmly that it will be impossible to dislodge it in
this way.
If the object is hard, as a marble, button, pebble, bead, the greatest
care must be exercised. Try to make the object fall out. To effect this,
turn the child's head downward with the injured ear toward the floor.
Then pull the lobe of the ear outward and backward so as to straighten
the canal. A teaspoonful of olive oil poured into the ear will aid in
its expulsion. If after the oil is poured in, the head is suddenly
turned as above described the object will fall out. A very effective way
to remove a hard object is to take a small camel's hair brush and coat
the end with glue, or any other adhesive substance, then place it in
contact with the object and permit it to remain long enough to become
firmly attached after which it may be gently pulled out with the object
attached. Never employ an instrument in the ear to remove a foreign
body.
When a live insect or fly enters the ear a number of safe methods may be
developed. If the ear is immediately turned to a bright light the insect
may come out of its own accord. It may be floated out with salt water,
or it may be smothered with sweet oil or castor oil after which it may
be floated or syringed out. If it is necessary to employ a syringe this
should be used gently. A foreign body may remain in the ear for days or
weeks without doing any harm. This suggests that any unnecessary poking
or prying should not be undertaken, because this may wedge it in tighter
and to injure the drum membrane.
Foreign Bodies in the Nose.--Children may put any of these articles
into the nose. Very often they do, and do not know enough to tell. If
such is the case the first symptom calling attention to the fact that
something is wrong is the appearance of a thick foul discharge from one
nostril or some obstruction to breathing on the same side.
When the foreign body may be seen the child should be made to blow the
nose, first closing the well side with the finger. If this does not
expel the object the child should be made to sneeze by tickling the free
nostril with a feather or by taking snuff. The mother should never
permit the use of instruments by one unskilled in an effort to rid the
nose of an obstruction. There is great danger of seriously injuring the
delicate structure of the nose in this way or of pushing the object so
far in that it may necessitate an operation to extract it. It is much
safer to seek medical aid before any damage is effected. It seldom does
harm to wait until the right assistance is at hand; it often does
serious harm to be too smart in these little matters.
Foreign Bodies in the Throat.--If the foreign body is in the upper
part of the throat and can be seen it may be removed with any instrument
that can grasp it. The child may be immediately held up by its feet when
the article may be shaken out. If it is further back or in the air
passages the child should be made to vomit by tickling the throat with a
feather or with the finger held in the throat till it does vomit.
When the object interferes with breathing a physician should be sent for
in a hurry. In the meantime the family may try to dislodge it by having
the child bend forward or by holding it with the head downward and,
while in this position, sharply striking the back with each cough.
Striking the chest when in this position may effect the same purpose. If
no success follows this procedure try the reverse position. Have the
child bend backward over the arm of a sofa, for example, or put him in
bed with the body hanging out of the bed face upward. If none of these
effect relief you must depend upon the skill of the physician.
A Bruise or Contusion.--A bruise or contusion is an injury to the
tissues underneath the skin, but this does not imply that the skin
itself is opened or damaged. In every bruise the small blood vessels are
ruptured, and the blood collects in the tissues causing distention,
swelling and pain. The blood is held in the tissues, it is stagnant,
becomes dark in color and so produces the bluish discoloration that we
see in all bruises. The color varies according to the extent of the
collected blood. At first it is red and inflamed looking, then purple,
then black, then greenish and finally citron. The so-called "black-eye"
is a typical example of this degree of bruise. After a bruise the parts
swell from the collection of blood and from the accompanying
inflammation. This causes pain which persists for a day although the
spot may be sore and tender for a week or more.
In all mild varieties home remedies may suffice, but in the more serious
and extensive bruises it is advisable to seek medical assistance. It is
essential to completely put the part to rest and to elevate it. This
will relieve the pain and favor the absorption of the exuded blood. If
the bruise is on the foot, the leg should be elevated until the foot is
higher than the hip. If, on the hand, it should be so held that it will
be higher than the elbow and it may frequently be held higher than the
shoulder to relieve the throbbing and the pain.
As a rule, cold should be applied as soon after the injury as possible,
cloths wrung out of ice water, or a piece of ice may be bound on the
part for a short time. The object of the cold is to stop the internal
bleeding. If the injury is slight, as are most of the injuries of the
household, the mother may apply repeated cloths wrung out of very hot
water. This procedure tends to aid the immediate absorption of the blood
and prevents a discoloration of the part. If there is great pain relief
may be afforded by applying a firm bandage saturated in the lead-water
and laudanum mixture which may be obtained in the drug store under the
name of lead and opium wash. The bruised part should be massaged every
day and a simple ointment may be applied to soften the inflamed area.
If any complication arises in the treatment of a bruise, it will be
necessary to consult a physician.
Wounds.--A wound implies an injury to the skin in addition to injury
to the underlying parts to a lesser or greater extent. The skin may be
opened by cutting, or stabbing wounds; or it may be punctured, torn,
contused, or bruised open. These injuries are effected in various ways.
We speak of machinery or mechanical wounds, or gunshot wounds, bites,
cuts, stabs and other varieties of wounds.
It is very important to know exactly how a wound is produced and the
nature of the instrument which opened the skin. We try to obtain this
information in order to estimate the probable degree of poison that may
or may not have entered into the wound.
The first thing to do in treating wounds is to stop the bleeding. If the
patient is suffering from shock he should be given active treatment for
this condition as described elsewhere. If the wound contains any foreign
bodies these should be removed. The wound should then be cleansed,
closed and dressed and kept at rest. If the wound is poisoned, or if
there is any fear that lockjaw may arise, or if the wound has been
caused by a mad dog it will require special treatment.
It is far better not to interfere if you do not know what to do than to
do harm. One should offer no advice if they are not qualified to give
advice. Much harm has resulted from doing the wrong thing in these
cases. The instruction in the following pages is given so that the
average mother may know what to do in emergency but not with the
intention that she may regard her knowledge as sufficient to dispense
with the aid of the physician.
Arrest of Hemorrhage.--When there is a wound there is always bleeding;
this means that some blood vessels have been cut or torn open allowing
blood to escape. The character of the hemorrhage will determine the
nature of the treatment to be employed. On general principles, the first
thing to do in the presence of bleeding is to elevate the part, if that
is possible. If there is simply a general oozing of blood, it may be
controlled and arrested by pressure. This pressure should be steady and
prolonged. It is best accomplished by wetting a clean handkerchief or a
pad of gauze in ice cold water, placing this on the part and binding it
on firmly with a bandage.
If the discharge of blood flows in a steady stream and is rather dark
the hemorrhage is coming from a vein. We know that veins carry blood
toward the heart so that any pressure or constriction employed to stop a
venous hemorrhage should be tied on the side of the wound further
removed from the heart. Inasmuch as veins have soft walls the right kind
of pressure will in most instances stop the bleeding. The part should be
elevated after the pad is adjusted in place. Any tight band on the limb
as a garter or sleeve band should be removed as they tend to interrupt
the return circulation.
If the hemorrhage is from an artery the blood is bright red. It spurts
out forcibly, is difficult to control and demands immediate attention.
Arteries carry the blood from the heart to the extremities. They beat
with every pulsation of the heart so that blood coming from an artery
spurts with every pulse beat. Even a small artery may be responsible for
a very considerable hemorrhage in a very short time. Whatever is done
must be done quickly. The parts should be freed from all clothing and if
possible elevated. Pressure may be tried, if it succeeds it must be
strong and steady pressure. The point to press must be on the heart side
of the bleeding artery since the blood stream is coming that way--this
the mother will note is the reverse from treating bleeding from a vein
as previously explained. The artery at this point may be felt beating.
It is frequently necessary to clamp the whole limb to stop an arterial
hemorrhage. This may be done in the following manner. Take a strong
piece of cloth or bandage and tie above the bleeding point. Insert a
short piece of stick between the bandage and the limb and twist around
until the bleeding stops. This should not be kept on longer than one
hour. A tourniquet of this character shuts off all the blood in the limb
and if kept on too long the parts may mortify. The best means to stop a
hemorrhage of this character is by means of a rubber bandage sold for
the purpose. It is applied by stretching at every turn. It exerts
uniform pressure and in this way does no injury to the parts. All these
measures are, of course, only temporary expedients as the artery will
finally have to be caught and tied by a physician.
Removal of Foreign Bodies From a Wound.--When the foreign bodies are
large enough to be seen they may be picked out with the fingers after
the hands have been rendered sterile. Smaller bodies may be picked up
with forceps, or they may be washed out with water that has been boiled
and cooled slightly, or a bichloride of mercury solution in the strength
of 1 to 2000 may be used; or a normal salt solution may be used. As a
general rule the physician should be allowed to undertake this procedure
so that you may not be blamed for something that may come up later.
Cleansing a Wound.--The simplest way, and the most effective, to
cleanse a wound, no matter how caused, is to procure a brush and paint
it thoroughly with tincture of iodine. The iodine should be painted
right into the raw wound, it is then bound up and left if it is small
and does not need any stitching. When the physician comes he can attend
to any further procedure that may be necessary.
Closing and Dressing Wounds.--If the wound is small, its edges may be
drawn together with narrow strips of adhesive bandage after it has been
painted with iodine. It is then bound up and kept at rest. It should be
inspected the following day to see if it is healing properly.
If the wound is large or torn, it should be seen by a physician and
dressed and closed by him. All wounds do better if they are kept at
rest.
The Condition of Shock.--When a person suffers a serious injury, loses
a large quantity of blood, or is subjected to a profound emotion, it
affects the vital powers to such an extent that the individual is said
to be suffering from shock. Shock expresses itself in varying degrees of
apathy. The patient may or may not be conscious. If conscious he gives
no evidence of feeling, he is silent and motionless although he will
respond to directions and may answer questions. The eyes are dull and
listless, the face pale and pinched, and the general expression is
apathetic. The skin is cold and there may be perspiration; the pulse is
feeble and irregular, and the breathing is shallow. The whole attitude
of the victim is one of indifference and apparent inability to
appreciate the seriousness of the situation and a seeming immunity to
pain or discomfort.
When this condition exists it must always be regarded as serious because
the patient may die as a direct result of the condition of shock. The
various symptoms depend upon a temporary paralysis of the blood vessels
which deprives the brain of blood. There is always a certain degree of
shock with all injuries. Mothers should know what to do in these cases
before the physician comes. The general treatment in all cases is to
keep the patient warm and quiet, and to use stimulants carefully.
The patient should be put in bed or on a flat surface with the feet
higher than the head. If raising the feet should cause the face to
become blue it will be advisable to restore the patient to the
horizontal posture. Artificial heat must be applied to the patient's
body and extremities by means of hot water bags, bottles, bricks,
plates, or any other handy device. Blankets should be put around the
patient and every possible means resorted to, to maintain body heat.
Mustard plasters may be put to the heart, spine and shins. Stimulants
are necessary, such as hot black coffee if possible or hot water, in
which a small portion of brandy may be put. If brandy is not obtainable
the patient may take aromatic spirits of ammonia in hot water every
twenty minutes for a number of doses. In every case of shock a physician
should be sent for immediately.
Dog Bites.--When a child is bit by a dog every effort should be made
to get the dog. It should be kept in a safe place for a week so that it
may be definitely known whether it is sick or not. If the dog dies
within a few days after biting anyone it may be assumed that he had
rabies. Its head should be sent to the local health authorities who can
tell after examination if it was mad. If there is any reason to assume
that the dog was infected, the child should receive the Pasteur
treatment. This treatment will, if conducted under favorable
circumstances, absolutely prevent hydrophobia.
The mother should sterilize the wound as thoroughly as possible. This
may be done by using pure hydrogen peroxide. A little piece of absorbent
cotton is wound round the end of a tooth-pick or match, dipped in the
peroxide and the incision thoroughly rubbed clean. This may be done a
number of times to ensure thorough cleansing. No effort should be made
to cauterize the wound. It is not considered proper to employ this
method with dog bites. When the physician examines the wound he may or
may not open it further for more extensive inspection and sterilization.
Mothers should remember that there are thousands of bites by dogs that
never cause any trouble, and if it is known that the dog is healthy no
worry need trouble the family. It is also wrong to inform the child of
the probability of hydrophobia. The child may worry himself sick with
fear and if the mother is nervous and excitable he is apt to be made
sick with the dread of what may follow. It is better, therefore, to
remain quiet, to keep cool, and not to excite the little patient at all.
Sprains.--Every joint is held together by ligaments which are attached
to the bones forming the joint. If these ligaments are subjected to a
sudden twist in a direction in which the joint is not constructed to
move, the resulting injury is known as a sprain. The ligaments are
stretched, though they may be torn apart and even small pieces of the
bone may be split off if the wrench is great enough. The injury is an
exceedingly painful one and frequently renders the limb useless for some
time. It is always accompanied with some degree of swelling and more or
less inflammation.
A sprained joint should be immediately put at absolute rest. The best
dressing is the lead and opium wash. Two pints of it may be obtained at
the drug store. Pour into a large bowl, saturate a large piece of thick
absorbent cotton, wrap around the joint and bind in place. This dressing
may be repeated as often as the cotton becomes dry. When the swelling
has disappeared and the pain is gone, it is desirable to have the joint
supported with strips of adhesive bandage. These must be put on in a
certain way in order to properly support the joint. Consequently a
physician should put them on. If a sprain is not attended to effectively
there is danger of the joint being more or less incapacitated for life.
Dislocations.--A dislocated joint is one that has been put out of
place. It is best to allow a physician to treat a dislocation. Unskilled
handling of a dislocated joint may not only increase the damage but it
may permanently put the joint out of business. Until the physician
arrives the part should be kept absolutely at rest.
Wounds of the Scalp.--Children frequently get injuries of the scalp.
These wounds bleed freely and as a rule they occasion a great deal of
unnecessary worry and apprehension. Usually they are not of much
importance. We must keep in mind, however, the probability of fracture
as a consequence of severe injury. The first thing to do when there is
bleeding from the scalp is to cut or shave away the hair surrounding the
wound. This should be done for an inch around the wound so that thorough
disinfection may be possible. The wound should now be cleansed as
previously instructed and an effort made to stop the bleeding. The best
method is to first apply pads of gauze wrung out of very hot water. When
success is evident a pad made of boiled cotton should be placed on the
wound and held tightly in place for some time. If the wound is of such a
character as to demand stitches a physician should of course put them
in.
Run-Around: Felon: Whitlow.--When pus germs enter around a finger nail
and lodge in the soft tissue a "run-around" is the result. It is
accompanied with pain, swelling, redness and inflammation. The loss of
the nail may follow.
A felon or Whitlow is a more extensive and a more serious condition. It
is not always possible to trace the cause of a felon. The fact that
germs gain an entrance, however, is soon established. Sometimes a
bruise, or scratch, or a wound is the primary cause. The last joint of
any of the fingers may be the seat of a felon. A end of the finger
becomes hot, tense, swollen and very painful; the pain is intense if the
hand is held down. The surface may or may not be red. There is as a rule
some fever. If the felon is on the little finger or thumb the condition
is worse than on the others as a rule,--the inflammation extending to
the hand and often into the arm. The condition affects the palmar
surface of the fingers. If the felon results in the "death" of the bone,
the last joint will have to be taken off and the hand may be distorted,
crippled, and rendered permanently disabled. Blood poison may set in and
death is possible as a result of this complication.
Treatment.--Every effort should be made to abort a felon. Continuous
application of equal parts of alcohol and water night and day may abort
it. Tincture of iodine applied to the entire end of the finger may be
effective. The hand must be at rest, carried in a sling during the day
and slung over the head to the bed-board at night. If these efforts are
not successful after twenty-four hours hot poultices should be resorted
to, but they must be changed every twenty minutes. If, at the end of
another twenty-four hours, there is no improvement the finger must be
freely cut open by a surgeon and the poultices continued.
Treatment of "Run-Around."--Apply iodine freely, cold applications,
and if the inflammation persists use poultices. It is frequently
necessary to incise the run-around. Patients suffering from either of
these conditions need general tonic treatment and should be under the
care of a physician.
Burns and Scalds.--Burns result from undue exposure to dry heat.
Scalds are produced by the action of hot liquids and steam.
There are always produced two results from a burn or a scald. First the
local effect, and, second, the general effect. The general effect may
produce shock, the symptoms of which have been described in the previous
pages. The degree of shock depends upon the extent of the local injury
and may be severe enough to result in death. If the local injury covers
more than two-thirds of the body death as a rule takes place within two
days.
How to Extinguish Burning Clothing.--The thought to keep in mind is to
smother the flames effectively. If we deprive the flame of all air or
oxygen it will immediately subside. This may be done quickly by wrapping
the burning part in a carpet, rug, blanket, overcoat or any large woolen
material at hand. If none of these articles are at hand the victim may
roll on the floor and try to smother the flame by pressure, aided by the
hands. It is a good plan to throw water on the patient immediately after
the fire has been put out, so as to extinguish the smoldering fire.
When a person is scalded by steam or boiling water or other liquid, it
is advisable to pour cold water freely over the wound.
How to Remove the Clothing.--When it is necessary to remove the
clothing it is essential to be gentle in order not to do greater injury.
The clothing must not be pulled. The garment should be cut so that they
fall off. If any part sticks to the skin, it must be left, not torn
away. Later, it may be removed by moistening it with salt water.
Treatment of Scalds and Burns.--All slight burns or scalds may be
effectively treated with Unguentine. This substance may be obtained in
any drug store. It is spread on a cloth and applied directly to the
injured part, bound securely on and renewed every day until the wound is
healed. If Unguentine is not readily obtainable the part may be covered
with any of the following mixtures or oils: carbolated vaseline, equal
parts of linseed oil and lime water, olive oil, castor oil or kerosene,
cloths soaked in a solution of baking soda, or a solution of phenol
sodique.
In severe burns or scalds the mother should not attempt to treat the
child. A physician should be summoned at once. The child may be given a
little whisky or brandy in warm water, and if the pain is great a dose
of laudanum may be given. The dose of laudanum is one drop for each year
of life. If the child has a chill he may be put into a warm bath of
100°F. It is not wise to cut a burn blister. The water may be let out by
puncturing with a sterile needle, but the skin must be left intact until
the new skin is grown. The treatment of burns must be done with the
greatest cleanliness because if infected with germs they may prove
serious.
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MISCELLANEOUS