What To Do
in a Medical
Emergency
MEDICAL
EMERGENCIES
WHAT YOU
NEED TO KNOW
FROM AMERICA’S EMEGENCY PHYSICIANS
www.EmergencyCareForYou.org
What To Do
in a Medical
Emergency
At what point does a fever or stomach ache become a medical emergency? If you slice your finger with a knife, or you
are having the worst headache you’ve ever had, should you
seek emergency care? How do you know?
The following information from the nation's emergency
physicians will help you identify the signs and symptoms of
emergency conditions. However, emergency physicians
will tell you — if you think you are having a medical emergency, seek emergency care right away. Better safe, than
sorry. Too many people, such as men with chest pain, wait
too long to seek care.
The advice in this publication is about how to handle common emergency medical conditions. It does not contain all
the signs or symptoms of medical emergencies, and the
advice is not intended to be a substitute for consulting with
a medical professional. If you think you are experiencing a
medical emergency, seek immediate medical attention.
www.EmergencyCareForYou.org
2
Abdominal Pain ..............................................................................................4
Asthma and Allergies.....................................................................................4
Anaphylaxis.....................................................................................................8
Adverse Drug Reactions ................................................................................9
Bites and Stings .............................................................................................9
Broken Bones...............................................................................................14
Burns ............................................................................................................15
Choking.........................................................................................................16
Colds and Flu ...............................................................................................18
Cuts and Abrasions .....................................................................................19
Diabetic Emergencies..................................................................................20
Drowning.......................................................................................................21
Earaches and Ear Infections.......................................................................22
Electrical Injury/Shock ................................................................................24
Eye Emergencies and Wounds ...................................................................24
Fainting.........................................................................................................25
Fever .............................................................................................................25
Food Poisoning.............................................................................................27
Foreign Bodies in Nose or Ears ..................................................................28
Headache .....................................................................................................28
Head Injury ...................................................................................................29
Heart Attack .................................................................................................30
Heat-Related Illnesses.................................................................................31
Hypothermia/Frostbite ................................................................................32
Neck or Back Injury .....................................................................................32
Nosebleeds ..................................................................................................33
Poisoning ......................................................................................................33
Puncture Wounds ........................................................................................34
Rashes..........................................................................................................35
Seizures ........................................................................................................35
Shock ............................................................................................................36
Sore Throat...................................................................................................37
Sprains and Strains .....................................................................................37
Stroke............................................................................................................38
Suicide ..........................................................................................................38
Sunburn ........................................................................................................40
Teeth (Dental Emergencies) ........................................................................41
Vomiting and Diarrhea.................................................................................41
Notes.............................................................................................................42
TABLE OF CONTENTS
Contents
3
ABDOMINAL PAIN / ASTHMA AND ALLERGIES
Abdominal Pain
Abdominal or belly pain can have many causes. It may be
due to food poisoning, an intestinal or gall bladder
obstruction, an infection or inflammation. It could also be
appendicitis, a kidney stone or peptic ulcer disease. In
women abdominal pain can result from an ectopic pregnancy, an ovarian cyst, pelvic inflammatory disease or
other female organ disorders. In addition, some people
with pneumonia, a bladder
infection or a heart attack
experience abdominal pain.
Acute abdominal pain can
also be caused by chronic
medical conditions, such
as pancreatitis; colitis, an
inflammation of the large
intestine (colon); or diverticulitis, an inflammation of
small out-pouchings along
the colon wall.
For mild abdominal pain,
call your doctor first. If the
pain is sudden, severe or
does not ease within 30
minutes, seek emergency
medical care.
Sudden abdominal pain is
often an indicator of serious intra-abdominal disease,
such as a perforated ulcer or a ruptured abdominal
aneurysm, although it could also result from a benign disease, such as gallstones.
Continuous, severe abdominal pain or abdominal
pain accompanied by continuous vomiting may
indicate a serious or life-threatening condition,
such as one of the types described below.
• Symptoms of appendicitis may include severe
pain (usually in the lower right abdomen, but may
start anywhere in the abdomen), loss of appetite,
nausea, vomiting or fever. Treatment generally
requires urgent surgical removal of the appendix.
Long delays in treatment can cause serious complications resulting from perforation (rupture) of
the appendix, which can lead to a life-threatening
infection.
• Symptoms of an ectopic pregnancy include severe
abdominal pain and vaginal bleeding. In an
ectopic pregnancy, a fertilized egg has implanted
outside of the normal site in the “womb” or
uterus, such as in the fallopian tubes.
4
• Symptoms of acute pancreatitis usually include
pain in the middle upper abdomen that may
last for a few days. The pain may become severe
and constant, or it may be sudden and intense.
It may also begin as mild pain that gets worse
when food is eaten. Other symptoms include
nausea, a swollen and tender abdomen, fever
and a rapid pulse.
Asthma and Allergies
Although asthma and allergies are two separate conditions — asthma is a chronic disease of the bronchial airtubes, whereas allergies involve an overreaction of the
body's disease-fighting immune system — the two conditions can be intertwined and often overlap.
For example, because most people with asthma also
have allergies, asthma attacks (sometimes referred to as
“exacerbations”) can be triggered by exposure to allergens, such as pollen, mold or animal dander. This type of
asthma is known as allergic asthma, and it is one of several types of asthma.
In addition, asthma and certain allergic conditions, such
as hay fever and peanut allergy, share the potential to be
life threatening. Allergies can be life-threatening when
they lead to anaphylaxis. Asthma can be fatal when a
severe asthma attack does not respond to inhaled bronchodilators and leads to symptoms of respiratory failure.
Finally, since many of the symptoms of asthma are the
same as they are for allergies, physicians may use some
of the same medications to treat both.
Asthma
Asthma is a chronic lung disease that results in 1.8 million emergency visits and about 4,000 deaths each year.
There are several types of asthma, and although the disease can be controlled, there is not yet a cure, which
means that asthma patients must manage their condition on a daily basis. Moreover, it is estimated that about
half of asthma sufferers do not have their condition under
control, making it more likely that these patients will end
up in an emergency department as a result of an asthma
attack. When poorly controlled, asthma is potentially lifethreatening.
The characteristics of asthma include inflammation
(swelling and irritation) of the airways and bronchoconstriction (tightening of the muscles surrounding the airways). Often worse at night, these problems shrink the
airways, making it more difficult to breathe.
• Waking at night wheezing
and/or coughing
• Requiring a quick-relief inhaler
more than twice a week
• Missing school or work
{ }
Asthma is a
chronic condition
that requires daily
management.
• Being unable to participate in
everyday activities
• Requiring emergency or urgent care in order
to breathe properly
Asthma patients should go to the emergency department if they have severe
asthma symptoms, especially if these
symptoms are accompanied by severe
sweating, faintness, nausea, panting,
rapid pulse rate, and pale, cold, moist
skin. (These may be signs of shock or a
potentially life-threatening drop in blood
pressure.) These patients may be experiencing a potentially fatal asthma attack.
ASTHMA AND ALLERGIES
The often-missed warning signs of
poorly controlled asthma are:
Seek immediate medical attention for the following
symptoms and warning signs associated with this
potentially life-threatening condition:
• Persistent shortness of breath or breathlessness
experienced even while lying in bed
• An asthma attack that is not relieved by a
usually effective rescue inhaler
• Lips or fingernails are turning blue (or gray
in persons with dark complexions)
• Straining to breathe or the inability to complete
a sentence without pausing for breath
• A feeling of chest tightness
• Feelings of agitation, confusion or an inability
to concentrate
Respiratory infections, such as the common cold or flu,
are common triggers of asthma exacerbations, (which is
why persons with asthma are advised to get a flu shot
each fall when the vaccine becomes available). Other triggers include exercise, laughing or crying hard, cold air
and irritants, such as poor air quality (e.g., Code Red
ozone pollution days in the summer), chemicals, smoke,
perfume and air fresheners. Some allergens also can
serve as triggers. Common inhaled allergens include
dust, pollen, mold or animal dander.
The symptoms of asthma include:
• Difficulty breathing
• Tightness in the chest
• Coughing and wheezing
Asthma attacks that appear to be severe or that do not
respond to the patient’s normal medication require immediate medical attention. Less serious attacks or an
increasing frequency of asthma attacks should be evaluated by a visit to one’s doctor. In some cases, the patient
may seek the advice of an asthma care specialist - such
as an allergist or pulmonologist.
• Hunching of shoulders, straining of abdominal
and neck muscles or sitting or standing to breathe
more easily
These are all signs of impending respiratory system failure, a potentially fatal condition. Be aware also that fatal
asthma attacks often occur with few warning signals, and
that they can come on quickly, leading rapidly to asphyxiation and death. Fatal asthma attacks are more common
among persons who have poor control of allergens or
asthma triggers in their daily environments and an infrequent history of using peak flow monitors and inhalers as
aids in controlling their asthma.
Finally, it is important to note that extremely severe,
potentially fatal asthma attacks may not feature more
wheezing and coughing - thus making such symptoms
unreliable in judging the severity of asthma attacks. In
such cases, the breathing airways have become so
restricted that there is not enough air going in and out of
the lungs to cause wheezing or coughing. (In addition,
wheezing also can be a sign of other health conditions,
such as respiratory infection and heart failure, so it is
important to seek prompt medical attention if these other
serious conditions are suspected.)
5
ALLERGIES
Emergency department treatment of asthma typically
includes oxygen, inhaled bronchodilators (such as
albuterol), and systemic corticosteroids (such as prednisone). Long-term asthma treatment includes inflammation “controllers,” such as inhaled corticosteroids, and
symptom ”relievers” such as inhaled bronchodilators.
Since the key to preventing asthma attacks is controlling
them, it is important to seek out proper medical care,
take medication as directed and become educated as to
how best to avoid previously described “asthma triggers.”
Allergies
• Panting
• Rapid or weak pulse rate
• Pale, cold, moist skin or skin redness
• Blueness of skin, including lips or nail beds
(or grayish for darker complexions)
• Loss of consciousness
To help prevent the need for emergency care
for allergy attacks, you can take the following
preventive measures:
Allergies involve an overreaction of the body's immune
system, which is responsible for fighting infections. There
are many types of allergies, including seasonal allergies
(which involve allergic reactions to pollens, grasses and
weeds), perennial allergies (which last for 9 or more
months out of the year), chronic allergies (to allergens
such as dust and mold), food allergies, medicine allergies, insect venom allergies, and animal allergies, among
others. In addition, some people develop a potentially lifethreatening allergy to latex, which is found in rubber
gloves, while others can become “sensitized” to substances they have been repeatedly exposed to at work, a
condition known as “occupational allergy.”
• Visit your physician regularly. The continuing
advice of a doctor is crucial to the long-term
treatment of allergic conditions. Your physician
may refer you to a medical specialist, known as
an allergist/immunologist, who has received
special training in diagnosing and treating allergic
diseases. This type of specialist can recommend
certain drug therapies or desensitization treatments
(also known as “allergy shots”).
Allergic responses range from mild to life threatening.
Common mildly annoying allergy symptoms include
sneezing, congestion, runny nose, watery eyes, headache
and fatigue. However, exposure to some allergens, such
as peanuts, shellfish, insect stings, medications, and
latex can quickly progress to severe life-threatening reactions or anaphylaxis.
— If you are allergic to shellfish, don't eat it; your first
reaction may be mild but additional exposures can
quickly lead to life-threatening reactions.
For that reason, seek emergency care right away if you
experience a mix of some of the following symptoms:
• Difficulty breathing
• Wheezing (along with high-pitched breathing
sounds)
• Confusion
• Anxiety, fear, apprehension
• Slurred speech
• Swelling of the face, eyes, tongue or extremities
• Trouble swallowing
• Severe sweating
• Faintness, lightheadedness, dizziness
• Heart palpitations (feeling one's heart beat)
• Nausea and vomiting
• Diarrhea
6
• Abdominal pain, cramping
• Know your allergies. If you and your physician
suspect you have allergies, you may be tested to
determine what is triggering your symptoms.
• Avoid allergens. Once you know what you are
allergic to, avoid the allergen. For example:
— If cats make you break out in hives, don't pet them
or keep them in your home.
— If you are allergic to insect venom, take precautions
when going out of doors, particularly at certain
times of year when such insects are more
prevalent or aggressive, or when picnicking or in
wooded environments. Persons with insect-venom
allergies should also carry self-injectable epinephrine (EpiPen or TwinJect), diphenihydramine or a
bee-sting kit (per a health provider's instructions);
injectable epinephrine should be used only on the
person for whom it has been prescribed.
— If you are allergic to pollen or mold, avoid the
outdoors on windy days or when you begin to
notice symptoms. The wind often stirs up pollen
and mold and carries it through the air. Also, don't
hang laundry out to dry. Pollen and molds can
collect on sheets and clothing And minimize
activity outdoors at dawn (5 a.m. to 10 a.m.)
when pollen is usually emitted into the air.
— To minimize exposure to outdoor allergens, keep
car windows closed when you drive, and consider
using air conditioning when your seasonal allergy
symptoms are at their worst, both in your car and
at home (provided the system is regularly cleaned
and maintained and filters are frequently
changed).
ALLERGIES
— If you are allergic to grass or molds, do not cut
your grass and avoid the outdoors when others are
mowing their lawns.
— If you are allergic to mold (or have an allergic asthmatic reaction to it) and experience heightened
allergic symptoms in your everyday home or work
environment, consider hiring someone to investigate and address the problem. (Do not attempt to
remove moldy insulation and other items from your
home yourself; doing so can cause an intense
allergic reaction.)
Additional Precautions and Prevention
People with allergies and asthma, which are often related,
should always carry medications with them and ask their
doctors about wearing medical alert bracelets or jewelry.
(The MedicAlert® Foundation sells medical identification
bracelets on their website at www.medicalert.org.)
More specifically, individuals with asthma should always
carry a quick-relief inhaler (bronchodilator), such as
albuterol, and avoid known asthma triggers when possible. Individuals at risk of anaphylaxis, for whom a doctor
has prescribed self-injectable epinephrine (such as an
EpiPen or TwinJect), should carry it at all times and know
how to use it in an emergency. Show your family and
friends how to use it on you as well.
over-the-counter medication, make sure you have
used it before and that it is effective.
• If using a nebulizer for delivering anti-asthma
medication, don't forget to take it on vacation,
along with an electrical current converter for it if
traveling abroad; portable nebulizers
that are plugged into auto cigarette
If your doctor has
lighter receptacles are also available.
Persons with allergic asthma and
related allergies should avoid exposure to pollution from poor air quality
prescribed an epi pen,
• If your doctor requests that you use
or tobacco smoke. If you live in a city
carry
it
with
you
at
all
a peak flow meter and record chart,
that measures and forecasts air qualbe sure to take these items with you.
ity, stay indoors as much as possible
times and know how to
when the forecast is poor (e.g., “Code
• Bring your allergy-proof pillow or beduse it in an emergency.
Red,” Code Orange”). If you are prone
ding to guard against dust mites.
to exercise-induced asthma, be aware
• If staying in a hotel or bed and breakfast, check
of your limitations, especially if you do strenuous activity
ahead of time to find out whether perfumed air
in polluted or high-pollen areas (e.g., places that have a
fresheners, deodorizers or other scented products
lot of trees, grass, weeds).
will be used. (Scented carpet cleaning agents also
may be a problem.)
Injectable epinephrine should not be used on persons
• In hotels, ask for a nonsmoking room, preferably
other than the person for whom it has been prescribed
on a nonsmoking floor.
(e.g., asthmatics or persons allergic to insect venom).
• If sensitive to mold, call ahead to determine
Some people may have underlying health conditions that
whether this might be a problem, particularly if
could be adversely affected by this drug.
you are staying in a cabin or a beach bungalow. If
driving, check your vehicle for mold and mildew
Preventing Attacks While Traveling
problems, and if camping, check tents and other
• Take all necessary medications with you in their
mold-prone items.
original prescription bottles, in case you need to
• If sensitive to sulfites, when eating out check with
refill prescriptions while away. Pack extra quantithe restaurant staff to find out whether this addities of medications to make sure you don't run out.
tive has been used as a food preservative. If so,
Do not pack medications in checked luggage in
ask if your meals can be prepared without it.
case your luggage is lost; keep it in a carry-on bag.
(Sulfites are commonly used as a preservative
• Carry topical hydrocortisone cream and antihistain wine, dried fruits and dried potato products.
mine medication with you - if you are using an
They also occur naturally in wine.)
{
}
7
ANAPHYLAXIS
• If food allergies are a significant problem, pack
snacks at home you can eat while traveling - in case
you find yourself without access to “safe” foods.
• If allergic to pollens (e.g., trees, grass, weeds),
check the pollen counts in the area you are
traveling to by calling the local Chamber of
Commerce or the National Allergy Bureau at
1-800-9-POLLEN. Also, call 1-800-7-ASTHMA for
local support group contacts who may be able
to offer useful local information.
• Check with your insurer on coverage limitations
and policies regarding out-of-state or out-of-network coverage.
• Difficulty swallowing
• Swelling of the tongue, throat and nasal
passages (nasal and throat congestion)
• Localized edema (or swelling), especially
involving the face
• Itchiness and redness on the skin, lips,
eyelids or other areas of the body
• Skin eruptions and large welts or hives
• Skin redness
• Bluish skin color, especially the lips or nail
beds (or grayish in darker complexions)
• Nausea, stomach cramping, vomiting/diarrhea
Anaphylaxis
• Heart palpitations (feeling the heart beating)
Anaphylaxis is a severe, life-threatening, multisystemic
allergic reaction that is triggered by common substances,
such as foods, insect stings, medications and latex.
• Drop in blood pressure
About half of all anaphylaxis episodes are caused by such
foods as peanuts, tree nuts (e.g., walnuts, pecans,
almonds and cashews), fish, shellfish, cow's milk and
eggs. Bees, wasps, hornets, yellow jackets and fire ants
are the cause of about 500,000 allergy-related emergency visits and at least 50 deaths each year.
Medications can cause anaphylaxis, particularly drugs in
the penicillin family. Other commonly used medications
and pain relievers that can trigger anaphylaxis include
aspirin, ibuprofen, anesthetics and antibiotics. People
who have had one or more previously mild episodes of
anaphylaxis may be at risk for more severe future
episodes. Repeat exposure to allergens, such as latex,
may also increase the risk of developing anaphylaxis.
Anaphylaxis symptoms can develop quickly, in some
cases within minutes or hours after exposure to an allergen. In some cases, the symptoms can abate and then
return hours later. The most dangerous symptoms of anaphylaxis affect the respiratory system (breathing) and/or
cardiovascular system (heart and blood pressure).
Specific symptoms may include:
• Difficulty breathing due to narrowing of
airways and swelling of the throat
• Wheezing or coughing
• Unusual (high-pitched) breathing sounds
• Confusion
• Anxiety
• Slurred speech
8
• Weak and rapid pulse
• Dizziness, fainting or loss of consciousness,
which can lead to shock and heart failure.
What To Do:
• If the person is having anaphylaxis, call 911
immediately.
• If the person is unconscious, lay him or her
flat and elevate the feet.
• If available, administer self-injectable epinephrine
(e.g., EpiPen, TwinJect), which should be carried by
all persons who know they are at risk for anaphylaxis. (Under new American Heart Association and
American Red Cross first-aid guidelines, first-aid
providers may help victims who are experiencing
a bad anaphylactic reaction use a prescribed
epinephrine auto-injector - as long as the first-aid
provider is trained to do so, the state law allows it
and the victim is unable to self-administer the epinephrine.) Also, check for a medical tag, bracelet
or necklace that may identify anaphylactic triggers.
• Friends, family and caregivers of children with
allergies should be given a list of the child's
emergency contacts and allergy triggers, and a
plan for dealing with an allergic emergency.
• Persons who have experienced anaphylaxis
should consider seeing an allergist (especially
if they are not sure what caused it). An allergist
consultation will help identify potential causes
and develop a plan of action for safeguarding
individuals against possible future episodes. Family
members and friends should also be educated.
• If the cause of the anaphylaxis - such as a
particular medication - has been identified,
that substance should be avoided in the future.
Bites and Stings
Many drugs cause side effects, and certain medicines can
trigger life-threatening reactions - allergic and non-allergic
- in some people. Some medicines also interact with other
medications and cause adverse drug reactions. People
who take three or four medications each day are more likely to have reactions to drugs. In addition, the use of herbal
supplements and alternative medicines, such as St.
John's Wort, can interact with certain drugs and cause
health problems.
Most bites and stings are easily treatable and non-threatening. However, some insects, snakes, jellyfish - and even
humans - can bite or break the skin and potentially introduce disease into your body.
Adverse drug reactions
can occur within minutes or within hours of
exposure. They are a
leading cause of death
in the United States,
resulting in more than
100,000 deaths each
year.
The most common symptoms of allergic
reactions to drugs are:
• Skin rash or hives
• Itchy skin
• Wheezing or other breathing problems
• Swelling
• Diarrhea or constipation
The most common drug that can cause problems is penicillin. Antibiotics, sulfa drugs, barbiturates, and insulin
also can cause adverse drug reactions. Some medicines
trigger a response from the immune system in people
with drug hypersensitivity. The body's immune system
perceives the substance as attacking the body, so it
attacks the system.
More than 90 percent of adverse drug reactions do not
involve an allergic immune system response. Instead,
these reactions may produce a range of symptoms involving virtually any system or part of the body - which often
makes them difficult to recognize.
Reactions to drugs may range from mild, such as upset
stomach or drowsiness, to severe, life-threatening conditions, such as anaphylaxis. These reactions can occur
with prescription medications, over-the-counter medications and supplements or herbal remedies.
Always tell your doctor if you have adverse reactions to
medications and wear an identifying bracelet or jewelry
such as a MedicAlert® bracelet.
Animal Bites
Animal bites can be frightening, and in some cases, are
medical emergencies. The most common animal bite in
the United States is from household pets, with dogs and
cats causing the most injuries. Cat bites and scratches
are especially prone to infection. Human or animal bites
can become infected or transmit illnesses such as rabies.
A tetanus shot may be required if you have not had one
within 10 years; if you are not sure when you had your last
tetanus shot, and you’ve been bitten, you should get one
within 72 hours after your injury.
ADVERSE DRUG REACTIONS / BITES AND STINGS
Adverse Drug Reactions
If bitten, but the bleeding is minor, cleanse and treat the
wound as you would a minor wound. Wash the area thoroughly with soap and water, apply an antibiotic ointment
(unless the person has allergies or sensitivities to antibiotics) and cover with a clean bandage.
If the bite creates a deep puncture or the skin is badly
torn and bleeding, apply direct pressure to stop the bleeding and get medical attention right away. If you develop a
fever or other signs of infection - swelling, redness, pain,
a bad smell or fluid draining from the area - see a physician immediately.
If an animal acts strangely and bites you, go to an emergency department or see your doctor immediately,
because the animal may have rabies. This is especially
true for bats, skunks, raccoons and foxes. If possible, capture the animal, if it is safe to do so, so it can be checked
for rabies, which is fatal in humans if left untreated. If
the animal is dead, wear gloves or use a shovel
to move it into a plastic
bag. Do not damage
the animal's head,
since rabies testing is
done on the brain, and
do not freeze the animal.
Clean the area and any
tools used to remove the
animal with a bleach solution. Some people avoid seeking treatment, because they
fear it will involve a series of
painful shots to the abdomen.
This used to be true, but a simpler, less painful treatment is
now involved.
9
BITES AND STINGS
Strange animal behavior may be a sign of rabies and typically includes an unprovoked attack. For example, if normally shy nocturnal (night) animals bite during the day,
they may be infected. Rabies is rare in dogs, cats, rodents
and plant-eating animals. Other signs of rabies in animals
include drooling, running in circles, appearing paralyzed
or exhibiting unusual or aggressive behaviors.
To prevent children from getting animal bites,
including from those that may have rabies:
If a bite or sting wound remains or worsens over several
days, seek medical treatment for possible infection. Get
immediate medical attention if you have been bitten or
stung and you exhibit signs of an extreme allergic reaction or anaphylaxis.
Symptoms of an allergic reaction include:
• Hives, itching or rash at the site or even away
from the bite area
• Swollen lips or eyelids
• Teach children to avoid unfamiliar animals,
particularly wild animals, and to understand that
any animal may bite when it is frightened, ill or
injured. Even pets that are normally friendly may
bite when startled by sudden noises or motions,
or disturbed when sleeping or eating.
• Never leave young children unattended with animals.
• Make sure your child has had a tetanus shot.
Insect Stings
Most people have mild reactions to insect bites, but some
have severe allergic reasons that require emergency
treatment. In addition, some insects carry disease, such
as West Nile Virus or encephalitis, although this is rare.
• Swelling of the throat
• Difficult or noisy breathing (wheezing)
• Loss of consciousness
While it's nearly impossible to prevent all insect
bites and stings, these are steps you can take to
minimize the risks:
• Use insect repellent. Repellents with DEET are
effective in preventing bites by mosquitoes, ticks,
fleas, chiggers, and biting flies. Repellents for
children should contain no more than 10 percent
DEET. Do not use DEET on babies.
• Don't use scented soaps, perfumes, hair sprays,
or sunscreens, which can attract bugs.
Insect bites or stings that cause severe pain and swelling
at the site of the bite, a generalized rash or any swelling
of the face or difficulty breathing, require immediate medical evaluation.
• Avoid going outdoors during peak hours when
insects are out - dusk and dawn.
If you are stung by an insect, such as a bee,
treat the area by:
• Don't leave food, drinks, or garbage out and
uncovered.
• Removing the stinger. Scrape or flick it out with
something stiff like a credit card, or even grasp
it with tweezers and pull it straight out, to avoid
squeezing more venom into the wound.
• Washing the wound with soap and water.
• Using cold compresses or ice to help reduce
any swelling and relieve pain.
• Monitoring for signs of severe allergic reaction.
• Avoid areas where insects nest or gather, such
as stagnant pools of water, garbage cans, and
orchards and gardens where flowers are in bloom.
• When outdoors in wooded, floral or grassy areas,
or in areas infested with ticks or mosquitoes,
wear long-sleeved shirts and pants and protective
shoes. Dress in light colors, if possible (so insects
will be easier to detect) and avoid dressing in
bright colors or flowery prints, which attract some
insects. Don't wear baggy clothing, which can trap
bugs.
• Check yourself and your children for ticks after
leaving infested areas. If you find one, and you
know how to remove it, do so. If not, see “How
to Remove a Tick.”
• If you have removed a tick, keep an eye on the
area and check for signs of Lyme disease or
Rocky Mountain Spotted Fever, and call your
physician if symptoms are present.
• Children and adults who are highly allergic
should wear medical identification bracelets,
and adrenaline auto-injectors (epi pens) should
be available at all times.
10
Jellyfish and Stingray Stings
Most spiders are not dangerous. For most bites, wash the
wound with soap and water and apply an antibiotic ointment.
The bite may cause some irritation or itching, but should heal
in five to seven days. Some bites can lead to local skin infections, which are easily treated with antibiotics.
Most jellyfish stings are harmless and occur by accident
when people come in contact with the tentacles. Some
varieties of jellyfish are more poisonous than others, such
as the box jellyfish from Australia. Most stingray injuries
require emergency care. To prevent injury, avoid swimming in areas where there are sightings of jellyfish or
stingrays.
{
Two of the most
poisonous spiders in the
United States are the
black widow and the
brown recluse.
}
Two of the most poisonous spiders in
the United States (more common in
southern states) are the black widow
(which is shiny with a red hourglass marking on belly) and
the brown recluse (has a violin-shaped marking on top,
and is about one-inch long). Always seek emergency care
if you are bitten by one of these types of spiders.
BITES AND STINGS
Spider Bites and Scorpion Stings
The tentacles of a jellyfish release a poison that results in
a skin eruption, in the form of a painful red rash that itches. The sting usually causes a sting mark, pain and
swelling, which may last several days to several weeks.
Both jellyfish and stingray stings also can cause lifethreatening shock and allergic reactions.
The sting of a stingray causes a bleeding wound that may
become swollen and turn blue or red. It causes excruciating pain and can result in death. Severe symptoms may
include nausea, fever, muscle cramps, paralysis, elevated
heart rate and seizures.
Black widows release a toxin when they bite that can
damage the human nervous system. Reactions to a black
widow bite can include pain at the bite site, nausea,
severe abdominal pain or muscle cramping.
Venom from a brown recluse can cause tissue damage.
Reactions from its bite may include fever, nausea,
headache, burning, pain or itching, or a deep blue or purple area around the bite, surrounded by a whitish ring and
then a red ring (similar to a bull’s eye).
If you are bitten by either one of these
poisonous spiders:
• Call 911 and explain what has happened.
• Wash the area with soap and water and cover
with gauze and a cold pack.
Scorpions in the United States typically are found in
Arizona, New Mexico and in California. Scorpion stings
are most dangerous to the very young and the very old. If
you are stung by a scorpion, you will feel immediate pain
or burning.
If stung by a jellyfish or stingray:
• Carefully remove any tentacles or stingers still on
the body. Make sure to cover your hand - do not
directly touch the tentacles or you will be injured.
• Soak jellyfish stings in salt water or vinegar
(fresh water will increase pain and may release
more of the toxin).
• Soak stingray stings in hot (but not scalding) water
until the pain diminishes.
• Wash and bandage.
Scorpion stings usually occur at night. Stings may cause
bite marks, swelling and pain, which can be treated with
medication. You also might apply ice to help with pain.
Seek immediate medical care for more serious symptoms, such as nausea, vomiting, rise in blood pressure,
diarrhea, or allergic reactions.
• For stingray stings, apply pressure to stop the
bleeding. If necessary, and you are trained to
do so, perform CPR.
• If an allergic or life-threatening reaction is
observed, call 911 or your local emergency
number immediately.
11
BITES AND STINGS
Snake Bites
Snake bites can be life-threatening if the snake is poisonous. Poisonous snakes found in the United States include
rattlesnakes, copperheads, cottonmouth water moccasins and coral snakes. If you see a snake, do not touch
it, but instead, back away from it slowly.
If you are bitten, remember the color and shape of the
snake. This information will help medical providers
treat you. If you are walking in
high water, and you are
not sure you have been
bitten by a snake,
look for a pair of
puncture marks at
the wound and for
redness and swelling,
as well as severe pain.
If bitten by a pit viper (rattlesnake, copperhead,
cottonmouth):
Tick bites can cause Lyme disease or Rocky Mountain
spotted fever, which must be treated by a physician. Ticks
cause 20,000 new cases of Lyme disease in the United
States each year, especially in the northeast, mid-Atlantic
and north-central states. Visit the Centers for Disease
Control and Prevention website and check their Lyme
Disease map to see how prevalent it is in your area:
http://www.cdc.gov/ncidod/dvbid/lyme/ld_statistics.ht
m. Several hundred to more than one thousand new
cases of Rocky Mountain spotted fever are reported each
year, although it is likely that many cases go unreported.
Lyme Disease
Lyme disease is usually treated easily when caught
early enough.
Early symptoms of Lyme disease usually appear
within a few weeks of infection and include:
• Call 911 or your local emergency number
immediately.
• A bull's-eye-shaped rash - white in the center and
bright red on the outside; but this is not true in
all cases.
• Cleanse the wound, but do not try to cut around
the fang marks and suck out the venom. People
who do this often do more damage than good.
• Flu-like symptoms, such as a feeling of weakness
or discomfort, sore throat, dry cough, stiff neck,
headache swollen glands and fatigue.
• Immobilize the bitten area and keep it at the
same level as the heart. Do not try to apply a
tourniquet.
• Photosensitivity (light sensitivity to the eyes
or skin).
• It's important for the victim to remain calm and
move as little as possible. That will help prevent
the spread of the poison through the body.
• Do not apply ice or flush the wound with water.
If bitten by an elapid snake (coral snake):
• Take an additional step of wrapping the area in an
elastic roller bandage so that it is snug but not
tight; the point farthest from the heart should be
wrapped first.
• Check the area for sensation, increased skin temperature and redness before and after bandaging.
• Minor swelling and itching can be treated with
cool compresses, over-the-counter oral antihistamines or hydrocortisone creams. Use only as
directed.
12
Tick Bites (Lyme Disease and
Rocky Mountain Spotted Fever)
{
If bitten by a snake,
do not try to suck out
the venom or
apply a tourniquet.
Call 911 instead.
}
Left untreated, Lyme disease
may spread to the heart,
brain and nervous system.
Later-stage symptoms of
Lyme disease are more
serious and can include:
• Arthritis, particularly in
the knees, which can
become chronic if the
infection goes untreated
• Severe headaches
• Abnormal heartbeats
• Bell's palsy (a condition that causes facial
muscles to weaken or become paralyzed)
• Cognitive difficulties
• Memory loss
• Numbness and tingling or coordination problems
• Extreme fatigue
• Chronic or extreme muscle pain
Rocky Mountain Spotted Fever
Rocky Mountain spotted fever is the most severe of the
tick-borne illnesses.
• Sudden onset of fever
• After removal, disinfect the area and wash your
hands with soap and water.
• Save the tick for identification in case you become
ill - put in a sealable plastic bag in your freezer.
• Headache
• Muscle pain
• Rash on hands and feet
The disease can be difficult to diagnose in the early
stages, and without prompt and appropriate treatment it
can be fatal. Antibiotic treatment is effective if it begins
early enough.
Preventing Tick Bites
To avoid exposure to disease-carrying ticks, ACEP
recommends taking the following preventative
measures:
• Cover up when you are outside, especially near
wooded areas or grasslands; wear a hat and
long-sleeved, light-colored clothing; and tuck pants
into socks so that ticks will be easier to spot.
• Avoid wooded areas, piles of leaves and tall
grasses, and, if hiking, stay on wide, clear trails.
• Use insect repellents, such as those containing
DEET (no more than a 10 percent formula for
children, and none on babies), on clothing and skin.
• Check yourself regularly for ticks, and shower
or bathe after potential exposure.
• Use tick repellents on your pets, and check their
fur, ears and paws for ticks, which can drop off
once inside and lurk in carpeting and upholstery.
• If bitten, remove the tick by pulling it straight up
with a tweezers (or between your fingertips if
tweezers are not available). Avoid twisting the tick,
which may cause its body parts to remain embedded underneath the skin, often causing infection.
• Get tested for Lyme disease if a tick bite is
detected, or if Lyme disease symptoms develop.
How To Remove a Tick
Adult deer ticks are approximately the size of a sesame
seed, but nymph ticks are much smaller - about the size of
a speck of dirt - and more difficult to detect. Avoid removing a tick with your bare hands, and do not crush the tick
because it may contain fluids infected with disease.
To remove a tick:
• Use tweezers to grasp it as close to the skin
as possible.
• Pull outward with steady pressure.
• Do not twist, which can cause parts of it to remain
in the skin.
Mosquito Bites (West Nile Virus)
BITES AND STINGS
After an incubation period of about 5 to 10 days,
people with Rocky Mountain spotted fever have
signs and symptoms that include:
First reported in the United States in 1999, West Nile
Virus has since spread rapidly. It typically appears in the
summer until fall.
For 20 percent of those who become infected, the virus
causes a mild, flu-like illness. It is considered a public health
concern because there is a risk of contracting a potentially
fatal brain infection in about one percent of cases. The
severity of the virus is greater for persons over age 50 and
for persons whose immune systems are compromised.
West Nile Virus is transmitted by mosquitoes, which
means the best way to reduce your chance of becoming
infected is to avoid getting bitten.
Here's how:
• When you are outside, use insect repellent such
as DEET (no more than 10 percent formula for
children; not intended for use on infants under
two months old) or natural oil of lemon eucalyptus
(not intended for use on children under age three)
on clothing and skin. For details on insect repellents and usage guidelines see www.cdc.gov/ncidod/dvbid/westnile/qa/insect_repellent.htm.
• Eliminate mosquito breeding sites by draining
sources of standing water, inserting mosquito
larvae pellets in drains, maintaining clean gutters
and keeping fountain waters flowing.
• Cover up as much as possible when you are
outdoors; wear long-sleeve shirts and pants.
• Stay inside between sunset and sunrise, when
mosquitoes are more active.
• Install or repair screens on doors and windows
to keep mosquitoes out.
• Never handle dead birds with your bare hands
(precautionary measure to prevent disease).
• Investigate and support your community's
mosquito-control program. Many communities
practice integrated pest management. For
details, see www.beyondpesticides.org.
{
Because there is no specific
treatment available for West Nile
Virus infection, prevention of
mosquito bites is critical.
}
13
BROKEN BONES
Identifying Mild and Severe Symptoms
• About one in five persons who become infected
show any signs of illness, and usually these
symptoms are mild. Most infected people will
experience fever, headache, fatigue, aches and
pains and, in some cases, swollen lymph nodes
and a skin rash on the trunk of the body.
• These symptoms generally last for a few days,
but in some cases can linger for a few weeks.
• Symptoms of serious infection include headache,
high fever, neck stiffness, stupor, disorientation,
coma, tremors, convulsions, muscle weakness
and paralysis.
• Symptoms of the most severe infections include
West Nile encephalitis (inflammation of the brain),
meningitis (inflammation of the tissue surrounding
the brain and spinal cord) and West Nile
poliomyelitis (inflammation of the spinal cord that
causes sudden weakness and/or paralysis in the
limbs and/or breathing muscles).
Because specific treatments are not available for West
Nile Virus, prevention of mosquito bites is critical.
Broken Bones
Broken bones (also called fractures) are a common injury
for adults and children. They may be caused by falls,
motor vehicle crashes, direct blows and even intentional
injuries, such as violence and child abuse.
Broken bones are a common injury for children under age 10. Children have additional
risks associated with breaking bones,
because their bones are still growing; this
includes damage to growth plates and growth
at wrong angles. Women who have gone
through menopause also are at increased risk
because they lose bone mass and their bones
become weaker. Bones can be strengthened
throughout life, however, through weight-bearing exercise and calcium diet supplements.
• Splint above and below the fracture site. Pad
the splints to reduce discomfort.
• Do not try to realign the body part. However, if
circulation is poor and the skin is turning pale,
and no medical assistance is available, gently
moving the injured part back into its normal
position may improve circulation.
• Avoid making the
splint too tight,
which can cut off
circulation. Check
for circulation,
numbness,
warmth and
skin color.
• If the bone is
sticking out from
the skin (open
fracture), do not
try to push it
back in. Use a
clean, dry cloth or
bandage to cover
it until medical
help arrives.
• Apply ice pack to
reduce swelling (except for small children and not
directly on the skin).
• Stop any bleeding by gently applying pressure to
the wound with a sterile bandage or
clean cloth.
{ }
Unless you have
to, never move
a person with
a broken bone.
Symptoms of a broken bone include swelling, bruising
and being unable to put weight on it or use it for normal
movement. Do not move a person with a broken bone
unless you are in a life-threatening situation involving further potential harm to the injured person (such as a car
accident that results in a car fire), especially someone
with a head, neck or back injury or a hip or pelvis fracture.
If it becomes necessary to move someone with a broken
bone, immobilize the injured area first with a splint. If you
don't have a splint, make one using a folded newspaper,
board or rolled up piece of clothing.
14
In addition:
• Splint the injury in the position it was found in.
• Prevent shock.
Tips for specific body parts:
• If a finger appears to be broken or
dislocated, tape the injured finger to
the finger next to it. For an injured
thumb, a splint may be used.
• For a broken leg, use a triangular bandage to
bind the injured leg to the uninjured leg.
• For a broken ankle/foot, use a soft splint (a
pillow or a heavy towel) to immobilize the area.
The person's shoe should not be removed.
• Most rib fractures heal on their own within two
months. However, in rare instances, broken
ribs can puncture the lungs and cause internal
bleeding. If you suspect someone has a rib
fracture, position a pillow or folded blanket
between the area where pain is occurring and
the arm, then bind the arm to the body to
support the injured rib area.
About 4,000 people die
each year in the United
States from fire and burn
injuries. Burns are one of
the leading causes of
childhood injury. They
can be caused by scalding from hot liquids or
cooking oils, contact with
flames, or from overexposure to the sun. Burns
also can be electrical
(e.g., when a child bites
an electrical cord) or
chemical (e.g., resulting from swallowing or spilling
bleach on your skin).
Minor Burns
For minor burns:
• Remove the person from the heat source and
remove any burned clothing, except clothing
imbedded in the burn.
• Run cool - not cold - water over the burn or hold a
clean, cold compress on it until the pain subsides.
Do not use ice. Do not use not butter or other
types of grease.
• Remove jewelry or tight clothing from around
burned areas, and apply a clean bandage.
You can also apply antibiotic cream.
Seek emergency care for more serious burns and for any
burns to the eyes, mouth, hands, and genital areas, even
if mild. If the burn covers a large area, get medical attention immediately.
Get immediate medical attention if you have any of
the following symptoms related to a burn:
In addition, know what to do in case you or your clothing
catches fire: stop (don't run), drop (to the floor, immediately), and roll (cover your face and hands while rolling
over to smother the flames).
BURNS
Burns
If you are helping someone else who has been burned,
remove the person from danger first, unless doing so puts
you in danger as well.
Chemical and Electrical Burns
For chemical and electrical burns, call 911 or your local
emergency number. Assess the situation to make sure
you (and the victim) will not be in contact with the burn
source. For electrical injuries, DO NOT approach an
injured person until you know the power source has been
turned off.
For chemical burns:
• Dry chemicals should be brushed off the skin
by a person wearing gloves.
• Remove the person's clothing and jewelry and
rinse chemicals off the skin by placing the
person in a shower for 15 to 20 minutes.
(Be careful to protect your eyes and the eyes
of the injured person.)
• Wet chemicals should be flushed off affected
areas with cool running water for 20 minutes
or longer or until emergency help arrives.
• If you or someone else has swallowed a chemical
substance or an object that could be harmful
(e.g., watch battery) call poison control first
(1-800-222-1222) and then 911. It is helpful to
know what chemical product has been swallowed.
Take it with you to the hospital.
Minor electrical burns can be treated with cool (not cold
or ice) compresses. After cleansing, a mild antibiotic ointment and bandage may be applied. A tetanus shot is also
recommended, especially if the person has not had one
in more than 10 years.
• Fever
• Puss-like or foul-smelling drainage
• Excessive swelling
• Redness of the skin
• A blister filled with greenish or brownish fluid
• A burn that doesn't heal in
10 days to two weeks
Never break blisters from a burn, and remember not to
remove clothing stuck to burned skin. If you are helping
someone with a serious burn, keep the burned areas elevated to reduce swelling.
For more serious electrical burns:
• Check for breathing. If the person is not breathing,
start rescue breathing if you know how.
• Raise burned arms and legs higher than the person's heart.
• Cover the person with cool, wet cloths. Do not use
butter, ointments or any other home remedy. Do
not break the blisters or remove burned skin.
Sunburns with extensive blistering or general symptoms
of nausea, vomiting, weakness or chills, are more serious
and need physician evaluation.
15
BURNS / CHOKING
Prevent burns by following safety precautions:
• Install smoke detectors on every floor and check
to make sure they are working and/or replace
batteries every six months.
• Teach children to avoid hot substances and
chemicals. If you have young children, use safety
latches in your home.
• When cooking, keep pot handles turned toward
the rear of the stove, and never leave pans
unattended.
• Do not leave hot cups of coffee on tables or
counter edges.
• Do not carry hot liquids or food near your child
or while holding your child.
• Always mix and stir then check the temperature of
food or beverages before serving a child, especially
foods or liquids heated in a microwave.
• Keep matches and lighters out of children’s reach
in a locked cabinet. Use only child-resistant lighters.
• Prevent scalding by keeping your water heater set
at 120º to 125º F; test bath water before putting a
child in the bathtub.
• Cover unused electric
outlets with safety
caps, and replace
damaged, frayed or
brittle electrical cords.
• Keep fire extinguishers
on every floor of your
house, especially in
the kitchen, and know
how to use them.
• Do not put water on
a grease fire - it can
spread the fire.
In the event of choking, the American Heart
Association and ACEP offer the following guidelines:
Conscious Adult
• In the event of choking, rescuers should take
action if they see signs of severe airway obstructions (including poor air exchange and increased
breathing difficulty, a silent cough, cyanosis or if
the person is unable to speak or breathe).
• To differentiate between mild airway obstruction
and severe airway obstruction, the rescuer should
ask, “Are you choking?” If the victim nods yes,
assistance is needed. Choking also is often
indicated by the Universal Distress Signal (hands
clutching the throat).
• If the person can speak, cough or breathe, do
not interfere.
• If the person cannot speak, cough or breathe,
give abdominal thrusts known as the Heimlich
Maneuver.
• To employ the Heimlich Maneuver, reach around
the person's waist. Position one clenched fist
above the navel and below the rib cage. Grasp
your fist with your other hand. Pull the clenched
fist sharply and directly backward and upward
under the rib cage six to 10 times quickly.
• In case of obesity or late pregnancy, give chest
thrusts.
Choking (Heimlich Maneuver)
ACEP recommends that the Heimlich Maneuver be
employed only when a person is choking and his or her
life is endangered by a windpipe obstruction. Choking is
signaled by an inability to speak, cough or breathe, and
may result in a loss of consciousness and death. Avoid
using excessive force in employing the Heimlich
Maneuver to avoid injury to the ribs or internal organs.
Given the potentially life-or-death nature of the situation,
use your best judgment.
• Continue uninterrupted until the obstruction is
relieved or advanced life support is available. In
either case, the person should be examined by
a physician as soon as possible.
Unconscious Adult
• Position the person on his or her back, arms
by side.
• Shout for help. Call 911 or the local emergency
number.
• Perform a finger sweep to try to remove any
foreign body from the mouth. Only remove an
object you can see and easily extricate.
16
• Repeat sequence: Perform finger sweep, attempt
rescue breathing, perform abdominal thrusts, until
successful.
• Continue uninterrupted until the obstruction is
removed or advanced life support is available.
When successful, have the person examined
by a physician as soon as possible.
• After the obstruction is removed, begin CPR,
if necessary.
Conscious Infant (Under one year old)
• Support head and neck with one hand. Place the
infant face down over your forearm, head lower
than torso, supported on your thigh.
• Deliver up to five back blows, forcefully, between the
infant's shoulder blades using the heel of your hand.
• While supporting the head, turn the infant face
up, head lower than torso.
• Using two or three fingers, deliver up to five
thrusts in the sternal (breastbone) region. Depress
the sternum 1/2 to 1 inch for each thrust. Avoid
the tip of the sternum.
• Repeat both back blows and chest thrusts until
the foreign body is expelled or the infant becomes
unconscious.
• Do not perform blind finger sweeps or abdominal
thrusts on infants.
• Alternative method: Lay the infant face down on
your lap, head lower than torso and firmly supported. Perform up to five back blows. Turn the infant
on his or her back as a unit and perform up to five
chest thrusts.
Unconscious Infant (Under one year old)
• Shout for help. Call 911 or the local emergency
number.
• Perform the tongue-jaw lift. (Grip on the jaw by
placing your thumb in the infant's mouth and
grasping the lower incisor teeth or gums; the jaw
then lifts upward.) If you see the foreign body,
remove it.
• If trained to do so, begin rescue breathing.
• Perform the sequence of back blows and chest
thrusts as described for a conscious infant.
CHOKING
• Listen for breathing and watch for the chest to
rise and fall. If the person is not breathing,
perform rescue breathing. If unsuccessful, give six
to 10 abdominal thrusts (the Heimlich Maneuver).
To perform abdominal thrusts on an unconscious
person, kneel over the person and place the heel
of one hand on the person's abdomen, slightly
above the navel. Next, place your other hand on
top of the first. Press into the abdomen with
quick, upward thrusts.
• After each sequence of back blows and chest
thrusts, look for the foreign body and, if visible,
remove it.
• Resume rescue breathing.
• Continue with the sequence of back blows and
chest thrusts, and, after each sequence continue
to check for the foreign body, which should be
removed.
• If the foreign body is removed and the infant is
not breathing, begin CPR.
Conscious Child (Over one year old)
To dislodge an object from the airway of a child:
• Perform abdominal thrusts (the Heimlich
Maneuver) as described for adults. Avoid being
overly forceful in order to avert injury to ribs and
internal organs (use your best judgment).
Unconscious Child (Over one year old)
• If the child becomes unconscious, continue as
for an adult, except:
• Do not perform a blind finger sweep in children up
to 8 years old. Instead, perform a tongue-jaw lift
and remove the foreign body only if you can see it.
If you are choking and are alone:
• Do not panic; if possible, take slow breaths.
• Call 911 or the local emergency number immediately (even if you cannot speak); the dispatcher
should be able to recognize that an emergency is
occurring. If you are using a land-line, in some
(but not all) areas, he or she may then be able to
trace the call and send emergency personnel to
you. (Cell phone calls may not be traceable to an
exact location.)
• If available, lean over the back of a chair and
press hard on your abdomen and chest to expel
the object or attempt to use your fists to give
yourself abdominal thrusts (Heimlich Maneuver).
• To employ the Heimlich Maneuver, position one
clenched fist above the navel and below the rib
cage. Grasp your fist with your other hand. Pull the
clenched fist sharply and directly backward and
upward under the rib cage six to 10 times quickly.
• In case of obesity or late pregnancy, give chest
thrusts.
• Continue uninterrupted until the obstruction is
expelled or advanced life support is available.
In either case, you should be examined by a
physician as soon as possible.
17
COLDS AND FLU
Colds and Flu
It's hard to escape the common cold or the flu, and it can
be even more difficult telling them apart. Both are caused
by viruses, and therefore do not respond to antibiotics.
Flu symptoms usually are more severe than the typical
sneezing, stuffiness and congestion that go along with a
cold. Flu symptoms also tend to develop quickly - typically
between one and four days after a person is exposed to
the flu virus, and people are contagious from 24 hours
before they become ill until their symptoms resolve.
Colds
The signs and symptoms of colds include:
• An initial tickle in the throat
• A runny or stuffy nose and sneezing
from person to person by direct contact or through virusinfected droplets coughed or sneezed in the air. Most
people who get the flu recover completely in one to two
weeks, but some, especially elderly people, develop serious and potentially life-threatening illnesses, such as
pneumonia.
• Cough
• Sore throat
• Headache
• Mild fever
• Mild fatigue
The flu sometimes develops into bacterial pneumonia,
ear infection, sinus infection, dehydration and worsening
of chronic medical conditions. Very young children and
the elderly are more susceptible to complications of the
flu than the general population. About 36,000 people die
each year from the flu.
• Mild muscle aches
• Loss of appetite
• A change in nasal discharge from watery to
thick yellow or green
Colds may be treated with over-the-counter decongestants and cough medicines. Follow the instructions on the
label carefully. Note that, as of January 2008, the Food
and Drug Administration (FDA) has stated that cough and
cold medications not be given to children under age 2
(and they are considering expanding this restriction to
children up to age 6).
Signs and symptoms of the flu may include:
• High fever (usually 100 to 103 degrees F
in adults and often higher in children)
• Chills
• Headache
• Fatigue
Prolonged colds (lasting longer than one week) and those
associated with a high fever or a cough that produces yellow
mucus or phlegm may need evaluation by a physician.
{
As of January 2008, the Food and Drug
Administration (FDA) has stated that
cough and cold medications not be given
to children under age 2 (and they are
considering expanding this restriction
to children up to age 6).
}
Flu
Influenza, commonly known as “the flu,” is caused by a
virus, which infects the respiratory tract. The flu is spread
18
• Muscle aches
• Dizziness
• Loss of appetite
• Dry cough
• Sore throat
• Runny or stuffy nose
• Weakness
• Ear infection
• Diarrhea
Call your doctor if there are signs of dehydration, seizures,
earache, a cough that produces discolored mucus or difficulty breathing. Children with chronic conditions, such as
severe asthma or cystic fibrosis, may require hospitalization.
• Has symptoms that are serious
or get worse —- or starts to get
better and suddenly gets worse
• Has a temperature greater than
102 degrees F for more than a
few days
Keep in mind the flu usually lasts no
more than a week or two and is best
cured by getting rest, good nutrition and
plenty of fluids.
{
during flu season. It isn't a guarantee against getting sick,
though mainly because there are many viruses that can
cause the flu, and the vaccine only protects against a
handful of them. However, among those
persons who do get the flu after receiving
The ideal time to get
the flu shot, symptoms usually will be
flu vaccinations is
milder. (It should be noted that the seasonal flu shot does not offer protection against
usually October or
avian (or bird) flu, and it also would not be
November.
effective in the event of pandemic flu, a
virulent human influenza that causes a
global outbreak of serious illness and to
which there is little natural immunity.)
Flu Vaccination
The best way to protect against the flu is to get vaccinated
every year. The ideal time to get vaccinated is usually
October or November, before flu season begins; however
getting a flu shot later may still provide protection since
flu season typically peaks in January and lasts through
about March.
Emergency physicians highly recommend that persons
who are at high risk of having serious flu complications
and people who live with or care for high flu-risk individuals (including home caregivers and health care workers)
get vaccinated each year.
Persons in high-risk groups include:
• Children six months old through age five
• Pregnant women
• Persons age 50 and older
• Persons with chronic medical conditions
• Persons in nursing homes and long-term care
facilities
The flu vaccine is generally available beginning in October
and is distributed through health care providers, in-store
clinics, schools and many places of employment. Check
with your physician, your local government or community
services center. Getting a flu shot can reduce most
people’s chances of catching the flu by up to 80 percent
}
CUTS AND ABRASIONS
In the case of children who have the flu,
call the doctor if the child:
Cuts and Abrasions
Most cuts are minor, but it's still important to care for
them. Most can be treated by cleaning with soap and
water and applying a clean bandage. You also may want
to treat the cut with an antibiotic ointment. If you delay
care for only a few hours, even a minor wound can build
enough bacteria to cause a serious infection and
increase your risk of a noticeable scar.
Puncture wounds may
not seem very serious,
but because germs and
debris are carried deep
into the tissues, a physician evaluation may be
needed. In addition,
antibiotics or a tetanus
shot may be required.
Seek medical attention for a cut or a
wound that shows any
of the following signs:
• Long or deep cuts
that need stitches
• Cuts over a joint
• Cuts from an
animal or human
bite
• Cuts that may impair function of a body area,
such as an eyelid or lip
• Cuts that remove all the layers of the skin,
like slicing off the tip of a finger
• Cuts caused by metal objects or puncture wound
• Cuts over a possible broken bone
• Cuts that are deep, jagged or “gaping” open
19
DIABETIC EMERGENCIES
• Cuts that have damaged underling nerves,
tendons or joints
• Cuts that have foreign materials, such as dirt,
glass, metal or chemicals embedded in them
• Cuts that show signs of infection, such as fever,
swelling, redness, a pungent smell, pus or fluid
draining from the area
• Cuts that include problems with movement or
sensation, or increased pain
Seek emergency care if:
• The wound is still bleeding after a few minutes
of steady, firm pressure with a cloth or bandage.
• Signs of shock occur.
• Breathing is difficult because of a cut to the
neck or chest.
• Fast breathing
• There is a cut to the eyeball.
• Headache, trembling
• There is a cut that amputates or partially
amputates an extremity.
• Odorless breath
• There is a deep cut to the abdomen that
causes moderate to severe pain.
A tetanus shot may be required if you have not had one
within 10 years or if you are unsure of when you last had
one. Tetanus is a bacterial infection that affects the nervous system and is often fatal. Although most people are
aware that stepping on a rusty nail or a puncture wound
can cause a tetanus infection, most people do not know
that tetanus bacteria can also enter the body even
through a tiny pinprick, a scratch from an animal, splinters, bug bites and even burns that break the skin.
• Pale, sweaty skin
• Numbness in hands or feet
• Hunger
Symptoms of diabetic coma include:
• Weak and rapid pulse
• Nausea
• Deep, sighing breaths
• Unsteady gait
• Confusion
• Flushed, warm, dry skin
Diabetic Emergencies
• Odor of nail polish or sweet apple
• Drowsiness, gradual loss of consciousness
It is estimated that more than 20 million people in the
United States have diabetes, with an estimated six million
people being unaware they have it. The best way to prevent diabetic emergencies is to effectively manage the
disease through making healthy food choices, exercise
and frequently checking blood glucose levels.
Diabetics may experience life-threatening emergencies
from too much or too little insulin in their bodies. Too
much insulin can cause a low sugar level (hypoglycemia),
which can lead to insulin shock. Not enough insulin can
cause a high level of sugar (hyperglycemia), which can
cause a diabetic coma.
Symptoms of insulin shock include:
• Weakness, drowsiness
• Rapid pulse
20
First aid for both conditions is the same:
• If the person is unconscious or unresponsive, call
911 or your local emergency number immediately.
• If an unconscious person exhibits life-threatening
conditions, place the person horizontally on a flat
surface, check breathing, pulse and circulation,
and administer CPR while waiting for professional
medical assistance.
• If the person is conscious, alert and can assess
the situation, assist him or her with getting sugar
or necessary prescription medication.
• If the person appears confused or disoriented,
give him or her something to eat or drink and
seek immediate medical assistance.
DROWINING
Drowning
Drowning occurs most often among small children and
people who can't swim, but even experienced swimmers
may be susceptible, depending on weather conditions,
water currents, their health and other circumstances.
Drowning is one of the leading causes of death among
children ages one to four years of age. It only takes a few
seconds for a child to drown, and small children can
drown in just a few inches of water - in a bathtub, a toilet
or a bucket.
Parents need to keep a close eye on their children when
they are near any water sources, especially pools or at the
beach or a lake. In addition, parents need to know the limits of their child's ability to swim and to set firm ground rules
for play around the water, and to never leave kids unsupervised. For every child who drowns, more than 10 children
are treated in emergency departments for near drowning.
Keep in mind the
following safety
precautions:
• Teach your children
to swim.
• Never swim alone.
• Only swim in
places that are
supervised. Never
allow children to
swim without adult
supervision.
• Avoid cliff edges, stay behind fences and obey
warning signs.
• Never run and dive in the water. Even if you have
previously checked current conditions, those
conditions can change rapidly.
In addition, boating accidents can also result in drowning.
While life jacket use has increased, according to the
Centers for Disease Control and Prevention, 90 percent of
people who died in boating accidents were not wearing
any kind of flotation device. Just because you know how
to swim doesn't mean you should go boating without a life
jacket. Wearing a life jacket is important for anyone who
goes out on water.
To avoid ending up in the emergency department as
a result of your next boating trip:
• Install safety
fences with childproof latches
around swimming
pools.
• Always wear your life jacket and carry first aid
equipment in the boat.
• Never dive into
unfamiliar water.
• When changing seats, stay low and near the
center line of a small boat.
If you're at the beach:
• Always swim near a lifeguard tower and never
swim alone.
• Tell someone when you're going, who is with you
and how long you'll be away.
• On sailboats, keep alert to wind and sail activity
and stay low to avoid getting hit by the sail
“boom.”
• Monitor the weather carefully for signs of a storm.
• Check with lifeguards about surf and beach
conditions before going in the water. Obey
warning signs in dangerous areas.
• Don't overestimate your swimming ability. Never
depend on flotation devices for your safety.
• Never drink alcohol and swim.
• Always swim or surf in designated areas.
• Take a marine radio with you to call for assistance
in case there are any problems. (Cell phones
frequently do not work off-shore.)
• Never drink alcoholic beverages on a boat. Being
“tipsy” can result in falling overboard. Your ability
to swim safely or call for help is greatly reduced by
alcohol use.
21
EARACHES AND EAR INFECTIONS
If a person appears to be drowning (e.g., is flailing in the
water, yelling for help, coughing or going under, or
appears to be unconscious or floating in the water), check
the area, alert a lifeguard if one is nearby, then call 911
or your local emergency number.
In addition:
• Do not attempt to rescue a drowning person while
in the water yourself unless you are trained to do
so and have lifesaving equipment. People who are
drowning may panic and pull you underwater with
them; dangerous circumstances - such as strong
currents or rip tides - may also endanger you.
• If possible, reach out with or throw an object that
floats to the person from a secure out-of-water
position, such as a boat, a swimming pool ladder
or a dock.
• For a person pulled from the water, tilt the head
back, lift the chin and check for breathing and
other signs of life. Expel fluid or other objects
from the mouth.
• If the person is not breathing, give two slow
rescue breaths. If rescue breaths go in, give
CPR. If rescue breaths do not go in, reposition
the airway and reattempt.
• If the person is still not breathing after rescue
breaths are administered, see section on
unconscious choking.
Earaches and Ear Infections
Earaches and ear infections can have a variety of causes
- viral, bacterial and fungal - and can affect different parts
of the ear. Common infections include outer ear infections (or what is commonly known as “swimmer's ear”),
middle-ear infections and inner-ear infections.
Ear infections also can be caused by scratching the ear
canal when cleaning their ear, especially if a cottontipped applicator or dangerously sharp small object, such
as a hair clip, is used. In other cases, a middle ear infection (otitis media) can cause an external infection to
develop through the draining of pus into the ear canal
through a hole in the eardrum.
Swimmer’s Ear
Swimmer's ear involves
an infection of the ear
canal (the tubular opening that carries sounds
from the outside of the
body to the eardrum). The
infection can be caused
by many different types of
bacteria or fungi, and usually develops in teens and
young adults whose ears
are exposed to excessive
amounts of water, such
as the water in a swimming pool or lake. Often, people affected by swimmer’s
ear have been diving or swimming for long periods of time,
and usually in chlorinated or polluted waters, although
even water from the shower can transport infectious
bacteria directly into the ear canal. Swimmer’s ear is most
common in warm climates and occurs more often during
the summer months, when more people are swimming.
The infection typically begins gradually and usually within
a day of being immersed in water.
Symptoms of swimmer’s ear include:
• Severe ear pain that gets worse when the
outside part of the ear (also known as the pinna),
is pulled or pressed. (Itching may also occur in
the ear canal before the pain begins.)
• A reddened or swollen outer ear, with enlarged
and tender surrounding glands.
• A greenish-yellow pus discharge along with
possible difficultly in hearing (if passage of
sound through the ear canal is blocked by
the pus buildup).
• A slight fever, in some cases.
22
EARACHES AND EAR INFECTIONS
Prevent swimmer's ear by avoiding swimming in polluted
waters, using ear plugs for swimmers, as directed, and
administering over-the-counter drops after swimming if
you think you might be at risk. (Do not use these drops if
you have ear tubes or a hole in your eardrum.) In addition,
dry your ears thoroughly with a clean towel after swimming and keep objects out of your ear canals, especially
small or sharp objects such s cotton-tipped applicators or
bobby pins.
Seek emergency care for any of the
following symptoms:
• Pain in an ear with or without fever
• Itching of the ear or ear canal
• Loss of hearing or difficulty hearing in one
or both ears
• Pus or discharge from an ear, especially if it’s
thick, yellow, bloody, or foul-smelling
Medical treatment of swimmer's ear will depend on the
severity of the pain and the extent of infection. Mild infections may require your doctor to prescribe eardrops with
antibiotics or corticosteroids. If treated with medication,
swimmer's ear is usually cured within seven to 10 days,
although you may need to avoid the water for a longer
time. In addition, ear pain may increase for 12 to 24
hours following treatment, after which it should subside.
In more severe cases of swimmer's ear, the opening into
the ear may be narrowed by swelling, in which case the
ear may need to be cleaned and a cotton wick inserted
before the eardrops can be applied. In addition, a culture
of the ear may be taken to help identify the cause of the
infection, and oral antibiotics may be prescribed.
Middle Ear Infections (Otitis Media)
The middle ear is the small part of the ear just inside the
eardrum; it is connected to the throat through a small
tube. This part of the ear can get infected when germs
from the nose and throat are trapped following the blockage of the connecting tube, usually during a cold. A physician evaluation is required to make the diagnosis and to
begin appropriate treatment. Middle ear infections are
more common in young children and usually show up as
ear pain and fever, which can sometimes be high.
Symptoms of middle ear infections include:
• Earache (ranging from mild to severe). Babies
with middle ear infections may cry, fuss and tug
at their ears
• Fever
• A plugged feeling in the ears accompanied by
trouble hearing
• Thick, yellow discharge (when the infection has
caused the eardrum to burst, fluid to flow out and
pain to subside; this is not a serious condition and
the eardrum usually heals on its own)
Many ear infections go away without treatment; however,
eardrops or antibiotics may be prescribed, depending on
the severity of the infection and the age of the child. Overthe-counter pain relievers containing acetaminophen
(such as Tylenol or Tempra) may help, as does applying a
warm (not hot) washcloth or heating pad on the ear, and
rest. Do not give aspirin to persons under age 19.
Ear infections may cause temporary difficulty with hearing.
Seek medical attention especially for hearing in young
children, since the ability to learn to talk is affected by
hearing.
Inner Ear Infections
Infections of the inner ear (labyrinthitis) usually result
from viral illnesses, such as influenza, and can cause
vertigo (a feeling that things are moving when they are
not), dizziness, nausea, imbalance, difficulty concentrating, tinnitus (ringing in the ears), reduced hearing
and other symptoms. These symptoms also may be
caused by head injuries, drug reactions, allergies,
underlying medical disorders or aging. A physician evaluation is required to make the diagnosis and to begin
appropriate treatment.
If the symptoms are caused by a virus, the infection
usually improves on its own. However, a doctor may recommend taking prescription or over-the-counter antinausea medications, or receiving an injection to control
the symptoms. Recurrent symptoms may indicate
Meniere's disease, a disorder in which fluid builds up in
the inner ear and causes vertigo and balance problems.
23
ELECTRICAL INJURY / SHOCK / EYE EMERGENCIES AND WOUNDS
Whether a person survives an electric shock depends on
the type of circuit (AC or DC current), level of the voltage,
level of amperage, the way in which the current entered
the body, the duration of exposure, the victim's general
health, and the timing and adequacy of treatment.
Seeking immediate emergency assistance is vital in such
situations.
To assist someone with an electrical injury:
Electrical Injury/Shock
Causes of electrical injury and shock include accidental exposure to household or appliance wiring, arcs from power
lines, the severing of an electrical cord or sticking of foreign
objects into an outlet (typically in the case of a young child),
faulty machinery and occupational accidents. (Lightning is
a separate topic with a unique set of injuries.)
• Check breathing and pulse.
• Call 911 or emergency number.
An electrical injury to the skin or internal organ can occur
by accidental exposure to an electrical current. Although
the external burn may appear minor, severe or fatal internal damage still may have occurred, especially to the
heart, muscles or brain. Electrical injury can cause cardiac
arrest (from the electrical impact to the heart), muscle
and nerve destruction and thermal burns.
Approximately 3 percent to 4 percent of patients admitted to burn centers in the United States are victims of
electrical injuries; serious electrical burns carry a 40 percent chance of death. The two most common age groups
for electrical injury are children under six (e.g., exploring
toddlers) and young adults (electrical workers and construction workers in particular). Electrical injury is the fifth
leading cause of occupational death in the United States.
Symptoms of electrical injury or resulting
shock may include:
• Skin burns
• Numbness, tingling
• Weakness
• Muscle contraction or pain
• Bone fractures
• Headache
• Hearing impairment
• Seizures
• Irregular heart rhythms
• Cardiac arrest
• Respiratory failure
• Unconsciousness
24
Check to see if the person is still in contact with the electric
current. If so, don't touch the person, and find another way
to shut off the power, such as at the circuit or breaker
box. A victim in contact with an AC current (household current) may not be able to let go of the point of contact
because their muscles contract strongly in response to
the electricity.
• For lightning injuries, see the summer safety section in “How To Prevent Medical Emergencies.”
• For shock related to electrical burns, see
“How To Prevent Medical Emergencies.”
Eye Emergencies and Wounds
Eye wounds and emergencies can include cuts and
scratches, traumatic injuries from foreign objects, burns
and chemical exposure (e.g., cleaning solutions, garden
chemicals). Any of these conditions can potentially lead to
vision loss if left untreated. Always wear eye protection for
hazardous activities and impact sports.
Eye pain does not necessarily indicate a medical emergency; it can be caused by such problems as migraine
headaches, sinus infections or contact lens complications.
“Pinkeye,” or inflammation of the upper and lower eyelids,
is caused by a viral infection and will usually run its
course over time. If it leads to more serious infections,
physician evaluation will be needed.
Consult your doctor if fainting is associated with:
• A visible wound
• Irregular heartbeat
• A bloodshot eye appearance, even if a wound is
not visible
• Chest pain
• Loss of vision (partial or total)
• Leakage of blood or clear fluid from the injured eye
• Any eye contact with chemicals, including fumes
If someone is having an eye emergency, seek
immediate medical attention. In addition:
• If eye has been in contact with a chemical,
immediately flush the eye with water for at least
15 minutes, protecting the uninjured eye from
contaminated water. Hold under a faucet or
shower and keep the eye open as wide as possible.
Do not touch or rub the eye or bandage it.
• If there has been a blow to the eye, apply a cold
compress without putting pressure on the eye.
Crushed ice in a plastic bag can be taped to the
forehead to rest gently on the injured eye.
• Shortness of breath
• Blurred vision
• Confusion
• Trouble talking
• Fainting upon turning the head
• Fainting more than once in a month
If you feel faint, either lie down or sit down immediately. If
you sit down, bend forward with your head between your
knees, to help get the blood flowing to your brain. Wait until
you feel better before trying to stand up. If someone else
faints, position the person on his or her back and elevate
the legs above the heart, if possible. Check for signs of
breathing. Loosen belts or restrictive clothing. If the person
doesn't regain consciousness within a minute, call 911.
• If there is a cut to the eye, do not wash with
water or other liquid. Do not apply any pressure.
Fever
• If there is an object stuck in the eye, including a
contact lens, do not try to remove it. Do not rub
or apply any pressure. Protect the eye by covering
it loosely with gauze or a cloth patch.
Fever by itself is not an illness, but a symptom for a range
of medical conditions. It also can be a side effect of some
medications. Fever is one of the most common reasons
that parents visit an emergency department with a child.
Fainting
Fainting is a loss of consciousness caused when the
blood supply to the brain is momentarily interrupted.
While typically sudden and alarming, it usually is not
harmful (unless the person suffers fainting-related
injuries), and consciousness is typically regained quickly.
However, it may be indicative of underlying health conditions, such as low blood pressure, abnormal heart
rhythm, hypoglycemia or stress, so the person should
seek follow-up medical attention.
FAINTING / FEVER
The signs and symptoms of eye emergencies include:
Elevated body temperature also plays an important role in
the body's normal response to fighting infection. Most
people consider 98.6 degrees Fahrenheit (F) (37 degrees
Celsius [C]) a healthy body temperature, but a person's
normal body temperature may vary a degree or more, and
it fluctuates during the day (lower in the morning, higher
at night).
Fever in an adult usually isn't usually dangerous unless it
registers 103 degrees F (39.4 degrees C) or higher. If it is
accompanied by any of the following symptoms, it may
indicate a serious or life-threatening illness.
• If someone faints or appears to be fainting,
call 911 or your local emergency number.
• Assist the person by lowering him or her to the
ground or other flat surface, while facing up in
a horizontal position.
• Check for breathing and injuries.
• Rule out seizure, shock and stroke.
• If there are no injuries, elevate the legs up to
a foot off the ground.
• Loosen any restrictive clothing.
• Do not give the person anything to eat or drink.
25
FEVER
Seek immediate medical attention if your
symptoms include:
• Pain or tenderness in the abdomen
• Nausea or vomiting
• Severe headache
• Stiff neck that resists movement
• Light hurts eyes
Contact a physician for any child with a fever who:
• Is under three months of age and whose
temperature is greater than 100.4 degrees F
(38 degrees C), because infants don't have
well-developed immune systems and could have
serious infections
• Has a body temperature higher than 102
degrees F (38.8 degrees C)
• Difficulty breathing
• Looks very sick, is unresponsive and uninterested
in the surroundings, is sluggish and won't suck
on breast or bottle
• Strange behavior, altered speech
• Cries constantly, continuously or without relief
• Mental status changes, confusion, difficulty
waking, extreme sleepiness
• Is difficult to waken
• Rash (particularly if it looks like small
bleeding spots under the skin)
• Has purple spots on the skin
• Convulsions or seizures
• Has a stiff neck
• Has difficulty breathing
Drink plenty of fluids to avoid dehydration. For children
under age one, the best liquid is an oral rehydration solution, such as Pedialyte.®
For children, fever is considered a rectal temperature of
above 100.4 degrees F (38 degrees C) or an oral temperature above 99.5 degrees F (37.5 degrees C). (Rectal
temperature readings are usually about 1 degree F higher
than oral readings.)
Although rare, some children under age five can experience
seizures, especially if the child's temperature rises or falls
rapidly. Seizures can be very alarming to parents, but they
do not cause any permanent harm in most children.
Call your pediatrician or seek
emergency care if your child
Don’t use
has a fever of 104 degrees F
(40 degrees C) or higher. Until
alcohol or ice
you get help, remove any
water on a child
unnecessary clothing and try to
cool the child down. If at home,
with a fever.
you can sponge the child with
lukewarm water, place the child
in a tub of cool water or let the child rest under a single
layer of thin towels which have been dipped into cool
water and wrung out. Don't let the child get chilled. Don't
use alcohol or ice water. Take steps to ensure that the
child remains as cool and comfortable as possible while
enroute to the emergency department.
{ }
26
• Is drooling excessively or having great difficulty
swallowing
• Has symptoms of earache or sore throat
• Has a limp or will not use an arm or leg
• Has significant abdominal pain
• Has painful urination or difficulty urinating
• Has any amount of redness or swelling on
his or her body
• Has a seizure (fit or convulsion)
• Becomes dehydrated
Most illnesses associated with fever run their course over
a period of time and can be treated with acetaminophen
or ibuprofen (unless the person is allergic or has been
advised by a physician not to take these medications).
Aspirin should not be given to children or teenagers under
age 19 because of the possibility of developing Reye's
Syndrome, a rare but potentially fatal medical disorder. In
addition, ibuprofen is not recommended for infants
younger than six months of age.
{
Aspirin should not be given to children
or teenagers under age 19 because
of the possibility of developing Reye’s
Syndrome, a rare but potentially
fatal medical disorder.
}
Even the healthiest foods can become unhealthy if improperly handled, cooked or stored. In the United States approximately 10,000 people die each year from food poisoning,
and many more become ill and require medical attention.
Food poisoning can be caused by several different bacteria, such as salmonella or botulism. Although certain
types of food poisoning can be fatal, most cases run their
course in a couple of days.
Preventive Measures
• Keep a clean kitchen. Regularly wash or sanitize
counters, cutting boards and utensils.
• Wash your hands before preparing foods and
before eating.
FOOD POISONING
Food Poisoning
• Check dates on food labels and throw out
expired food.
• Use special care when preparing or storing meat,
poultry and shellfish. Separate raw foods from
other foods. For example, if you cut raw chicken
on a cutting board, make sure you wash the cutting board and your hands before you slice raw
vegetables on it. And don't use the same knife
without washing it.
• After handling raw foods, immediately and thoroughly
wash hands, utensils and preparation surfaces.
• Follow any recommended precautions on food
labels.
• Rinse foods that are not cooked before they are
eaten, such as fresh fruits and vegetables.
• Cook foods thoroughly. Never partially cook meat
or poultry and then finish cooking it later. Use a
food thermometer in cooking.
Symptoms of food poisoning are similar to those of the
flu, except for fever, which is more likely to occur with the
flu, and should be treated the same.
They usually begin from two hours to two days after
eating the tainted food and include:
• Refrigerate leftover meat, seafood, dairy products,
eggs, or poultry as soon as possible. Do not let
these foods sit out of the refrigerator longer than
two hours. Make sure your refrigerator maintains
a temperature of 40 degrees F (4 degrees C) or
below and your freezer is 0 degrees F or below.
Refrigerate or freeze perishable or prepared foods
within two hours of purchase or preparation.
Marinate foods in the refrigerator.
• Headache
• Don't eat raw shellfish. Don't eat or drink
unpasteurized dairy products.
• Nausea
• Eat foods soon after they have been cooked.
• Diarrhea and/or vomiting
• Do not keep leftovers long. If you have any doubts,
throw them out.
• Stomach cramps or pain
More serious symptoms can include blurred vision,
fatigue and a dry mouth.
Actions
• Never give honey to infants, even in small
amounts, because of the risk of botulism.
For more information about food safety,
visit www.foodsafety.gov.
Sip water or diluted juice as soon as vomiting has
decreased. If symptoms continue for more than 24 hours,
or if you are unable to tolerate any fluids, contact your primary care doctor or visit the emergency department. Also
seek emergency care if you become dehydrated. Most
adults can handle one day without nutrition, but continued vomiting to the point of dehydration requires medical
attention. Finally, be aware that adults can handle dehydration better than small children and that high fever also
can indicate a more serious illness.
27
FOREIGN BODIES IN NOSE OR EARS / HEADACHE
Foreign Bodies in Nose or Ears
As many parents know, young children, especially those
under age five, sometimes put items, such as marbles,
beads, dried beans, tiny button-shaped batteries or
small toys in their ears, noses and mouths. These items
can be harmful, so it's important to seek immediate
medical attention to remove them, if they are not easily
removable. It's also important recognize the symptoms
of foreign bodies, in case you did not know they were
inserted.
In other cases, insects may crawl or fly into the nose or
ear canal, causing discomfort or pain and potential
harm. Or small pieces of hair may become imbedded
in the ear canal (especially within a day or two after a
haircut).
Symptoms caused by such objects may include discomfort and pain, difficulty hearing, rattling sensations in the
ear, rasping noises in breathing, problems with swallowing or choking, a bloody nose or ear or nose drainage
sometimes accompanied by a bad odor. Drainage from
only one nostril also may be an indicator of a foreign
object in the nose.
Unless the object is visible and easily removed, physician
evaluation and treatment are recommended. If the foreign body is visible and the child is cooperative, you can
ask the child to sneeze (or blow hard through his or her
nose) to remove it.
If the object is not visible or easily removed, do not
attempt to remove it yourself, and do not ask the child
to blow hard through the nose. Do not use Q-tips, hairpins or other small, insertable objects to attempt to
remove the stuck item, particularly in the ears. (Foreign
objects inserted in the ears can rupture or damage the
eardrum.)
Seek immediate emergency care if the person has difficulty breathing. Foreign items in the nose and ears
should be removed promptly by a physician. If the
object is in the ear, a physician may use special instruments or magnets (if the object is metal) to remove it.
The doctor also may clean the ear canal with water or
fill the ear with mineral oil to suffocate an insect or
use a suction machine to help pull the object out. In
the case of foreign bodies in the nose, sedation may
be necessary, and instruments, such as forceps or
suction machines, may be used. The doctor also may
prescribe nose drops or antibiotic ointments to treat or
prevent infection.
28
Headache
Headaches have a variety of causes. Some are caused by
stress and muscle tension, while others may be caused
by lack of sleep, a delayed meal, an injury or even foods
(e.g., lack of caffeine, alcohol, chocolate, cheeses, nuts,
food preservatives). People also may get headaches from
chemical irritants and odors, such as perfumes, smoke
and fresh paint.
Nearly 30 million Americans experience migraine
headaches, which usually are accompanied by vision
changes (or auras) and sensitivity to light and/or sound.
Pain from a migraine usually occurs as throbbing on one
side of a person's head and nausea or vomiting might
occur. In some cases, a person might experience a combined tension and migraine headache. Migraine
headaches can occur from changes in estrogen levels in
women.
A less common form of headache comes in the form of a
“clustering” of several painful daily attacks over a period
of weeks or months. Known as a “cluster headache,” this
ailment is five to eight times more common in men than
in women and may be either episodic or chronic. The cluster headache usually peaks within five minutes and lasts
for an hour or so. The pain is almost always one-sided and
localized behind the eye. Pain with this type of headache
may originate as a stabbing sensation behind one eye
and may be severe. The affected eye may also become
teary.
Most headaches can be relieved with over-the-counter
pain relievers, sleep, ice packs or even massage.
Chronic or worsening headaches should be evaluated by
a physician. A physician also should evaluate changes in
the frequency, length or severity of your headaches or any
over-use of pain relievers.
• The headache is accompanied by high fever,
confusion, stiff neck, prolonged vomiting, slurred
speech or numbness or weakness, especially
on one side of the body.
• Headache medication does not relieve chronic
or excruciating pain.
• Head pain prevents eating or drinking, making
one susceptible to dehydration or malnutrition.
• You experience major side effects to medication,
such as severe drowsiness, sedation or nausea
and vomiting.
• The nature, frequency or severity of the headache
changes, or the pain feels different from pain
associated with previous headaches.
• You experience a sudden, severe headache with
no known cause, which may indicate stroke (a
non-traditional symptom).
Children also get headaches, but they usually are not serious. Children with frequent headaches or serious symptoms should be evaluated by a medical professional.
HEAD INJURY
Seek emergency care if:
consciousness, and brain injuries can occur without a
loss of consciousness.
Danger Signs - Adults
Severe head injuries can involve bruising, fracture,
swelling, internal bleeding or a blood clot.
Seek emergency care if you notice any of these signs
of severe head injury:
• Headaches that worsen, despite over-the-counter
pain medications
• Weakness, numbness or decreased coordination
• Repeated vomiting
• Loss of consciousness for more than
one minute
• Person is unconscious or cannot
be awakened
• Sleepiness
{
It is not necessary
to prevent a person
with a head injury
from sleeping.
}
• Unequal pupil sizes - one pupil (the black part
in the middle of the eye) is larger than the other
• Convulsions or seizures
Head Injury
Head injuries can be caused by falls, motor vehicle crashes and even violence. It's important to prevent injuries by
buckling your seat belt in your car and wearing safety
equipment, such as helmets, while biking or playing sports
or construction hats for heavy construction work. Protect
your children and take steps to make yourself safe.
If a person loses consciousness after a head injury, then
the person has had a “concussion,” which may be serious
because it means there has been a temporary loss in
brain function. Some people with concussions do not lose
• Slurred speech
• Increased confusion or agitation
You do not need to prevent a person with a head injury
from sleeping as a safeguard against going into a coma;
this concept is a myth. If the person has neck pain, try to
prevent any movement of the neck.
Danger Signs - Children
Seek emergency medical assistance if the child:
• Exhibits any of the danger signs listed for adults
• Won't stop crying
• Can't be consoled
• Refuses to eat or nurse
• In infants, exhibits bulging in the soft spot on
the front of the head
• Shows any sign of skull trauma or obvious abnormality of the skull, such as bruising on the scalp
or a depressed area at the location of the injury
Parents should note that vomiting is more common in
young children, and they should only seek medical attention for a suspected head injury if a child vomits repeatedly in a brief period of time (e.g., more than once or twice
within an hour) after a head injury.
29
HEART ATTACK
Heart Attack
• Unexplained anxiety, weakness, or fatigue
Heart attack (myocardial infarction) remains the leading
killer of both men and women in the United States. More
than 400,000 Americans die from heart attacks each year.
Getting emergency medical help immediately can dramatically increase your chances of survival and recovery.
A heart attack is not always a sudden, deadly event. Often
it is an evolving process during which a clot forms in an
artery of the heart, depriving the heart of blood and oxygen. The longer the heart attack process continues, the
more permanent damage is done to otherwise healthy
heart muscle.
Many people ignore the warning signs of a heart attack or
wait until their symptoms become unbearable before
seeking medical help. Others wait until they are absolutely
sure it's a heart attack because they worry they will look
foolish if it is a false alarm. These reactions can result in
dangerous delays.
Only skilled medical professionals can determine if someone is having a heart attack. Your responsibility is to recognize the warning signs and act quickly. If you are having a
heart attack, you may be moved from the emergency
department to a catheterization lab to receive angioplasty or
a stent, or possibly heart bypass surgery. In addition, hospitals have lifesaving medications that are designed to stop a
heart attack by dissolving the clot and restoring blood flow
to the heart, although these medications work best when
given within the first one or two hours after the onset of
heart attack symptoms, when the damage is still limited.
People often will experience some, but not all, of the
following symptoms, which may come and go:
• Uncomfortable pressure, fullness, squeezing
sensation or pain in the center of the chest,
lasting more than a few minutes, or it goes away
and comes back
• Pain that spreads to the shoulders, neck, jaw,
arms or back
• Chest discomfort accompanied by lightheadedness, fainting, sweating, nausea or shortness
of breath
Some less common warning signs of heart attack
that should be taken seriously - especially if they
accompany any of the above symptoms - include:
• Shortness of breath and difficulty breathing
• Abnormal chest pain (angina), stomach, or
abdominal pain (Symptoms may feel like
indigestion or heartburn.)
30
• Nausea or dizziness
• Palpitations, cold sweat or paleness
The most common heart attack symptom for both women
and men is chest pain or discomfort. Women are more
likely than men to experience shortness of breath, nausea/
vomiting and back or jaw pain.
If you suspect someone is having a heart attack:
• Call 911 or your emergency services number
immediately. Stay with the person until the
ambulance arrives. Do not attempt to drive the
person to the hospital; if his or her condition
should worsen, there is nothing you can do to help
while driving.
• After 911 is called, the EMS dispatcher will likely
give pre-arrival instructions (when appropriate) for
the administration of aspirin (not acetaminophen,
ibuprofen or naproxen) and nitroglycerin (if prescribed) while emergency-response units are
enroute to the scene The ideal aspirin dose in
such instances is two to four baby aspirin or one
full or extra strength tablet (325 or 500mg), and
chewing helps get the aspirin into the bloodstream
faster than swallowing it whole. (The patient
should not be given aspirin if his or her physician
has advised otherwise, e.g., because of allergies or
possible harmful interactions with other medications or known disease complications).
• If the person is conscious, keep the person calm
and help him or her into a comfortable position.
The victim should stop all physical activity, lie
down, loosen clothing around the chest area,
and remain calm until the ambulance arrives.
• If the person becomes unconscious, make sure
the person is lying on his or her back. Clear the
airway and loosen clothing at the neck, chest and
waist. Check for breathing and pulse; if absent,
and if trained to do so, begin cardiopulmonary
resuscitation (CPR).
• If you are with someone, tell that person you may
be having a heart attack and want to get to the
hospital immediately. Have the person call 911
or the emergency services number.
• If you are alone, call 911 or the emergency
services number immediately. Do not drive
yourself to the hospital.
• Once you have called 911, you likely will be
instructed to chew and swallow an aspirin unless
your physician has advised you otherwise (e.g.,
because of allergies or contraindications, including
possible harmful interactions with other medications
or known disease complications). Keep in mind
that chewing helps get the aspirin into the bloodstream faster than swallowing it whole.
Automated External Defibrillators (AEDs)
Lay rescuers can be trained to operate portable, computerized, automated external defibrillators (AEDs) used to apply
electric shock to restart a heart that has developed a
chaotic rhythm called ventricular fibrillation, the most common cause of sudden cardiac arrest. Survival is directly
linked to the amount of time between the onset of sudden
cardiac arrest and the
treatment with an electric
shock to stop the abnormal heart rhythm. If an
AED is available where
you work or live, ACEP recommends taking a training course to learn to use
it. In September 2004,
the U.S. Food and Drug
Administration approved
over-the-counter sales of
AEDs, available for use in
the home and without a
prescription.
• Heredity (including race). Children of parents
with heart disease are more likely to develop it
themselves. African Americans have more severe
hypertension than whites and consequently, are
at greater risk.
• Smoking. A smoker's risk of heart attack is more
than twice that of non-smokers.
• High cholesterol. The risk of coronary heart
disease rises as blood cholesterol levels rise.
HEAT-RELATED ILLNESSES
If you think you may be having a heart attack:
• Physical inactivity. Regular, moderate-to-vigorous
exercise plays a significant role in preventing
heart and blood vessel disease.
• Body weight. People with excess body fat are
more likely to develop heart disease and stroke,
even if they have no other risk factors.
• Diabetes. This condition seriously increases the
risk of developing cardiovascular disease.
You can reduce your chances of having a heart attack by
quitting smoking, and nonsmokers should not start.
People can also lose excess weight, exercise regularly, eat
a low cholesterol diet, and take medications to reduce
cholesterol if prescribed. It's also important to maintain a
healthy blood pressure, control diabetes, and avoid excessive alcohol consumption. Talk to your physician about
taking aspirin if you have major risk factors for heart disease. Get regular checkups, and if you have a family history of heart disease, it's especially important that you
maintain a healthy lifestyle. More information can be
found on the American Heart Association's website
www.americanheart.org.
Heat-Related Illnesses
Heat-related illness can be caused by overexposure to the
sun or any situation that involves extreme heat.Young
children and the elderly are most at risk, but anyone can
be affected.
Heat Cramps
Heart Attack Prevention
The major risk factors for coronary heart disease are:
• Increasing age. About four out of five people
who die of coronary heart disease are ages 65
or older.
• Gender. Men have a greater risk of heart attack
than women, and they have attacks earlier in life.
At older ages, women who have heart attacks are
twice as likely as men to die from them within a
few weeks.
• Symptoms include muscle spasms, usually in
the legs and stomach area.
• To treat, have the person rest in a cool place
and give small amounts of cool water, juice or
a commercial sports liquid. (Do not give liquids
if the person is unconscious.)
• Gently stretch and massage the affected area.
• Do not administer salt tablets.
• Check for signs of heat stroke or exhaustion.
31
HYPOTHERMIA/FROSTBITE / NECK OR BACK INJURY
Heat Stroke and
Exhaustion
• Symptoms of early heat
exhaustion symptoms include
cool, moist, pale or flushed
skin; headache; dizziness;
weakness; feeling exhausted;
heavy sweating; nausea; and
giddiness.
• Symptoms of heat stroke (late stage of heat
illness) include flushed, hot, dry skin; fainting;
a rapid, weak pulse; rapid, shallow breathing;
vomiting; and increased body temperature of
more than 104 degrees.
• People with these symptoms should immediately
rest in a cool, shaded place and (if conscious)
drink plenty of non-alcoholic, non-caffeinated
fluids.
• Apply cool, wet cloths or water mist while fanning
the person.
• Seek immediate medical attention by calling 911
or your local emergency number for symptoms
that include cool, moist, pale skin, rapid pulse,
elevated or lowered blood pressure, nausea,
loss of consciousness, vomiting or a high body
temperature.
• For late stage heat stroke symptoms, cool the
person further by positioning ice or cold packs on
wrists, ankles, groin and neck and in armpits.
• Administer CPR if the person becomes
unconscious.
Hypothermia/Frostbite
Hypothermia is a potentially life-threatening condition
caused by overexposure to cold air or cold water. Although
most people typically are not at risk of developing
hypothermia, the condition can strike anyone, depending
on their individual circumstances, weather conditions
and level of exposure in a cold or wet environment.
Therefore, it is important to know the risks involved and
to take precautions against them.
The symptoms include:
• Slurred speech
• Sluggishness
• Confusion
Other signs may include a lack of sensation in the affected
area; and skin that appears waxy, cold to the touch or discolored (flushed, white, gray, yellow, blue or purple).
To prevent hypothermia, avoid prolonged exposure to the
cold, ensure adequate heating, and dress appropriately
for the environment and circumstances. In addition, avoid
excessive alcohol consumption and the use of illegal substances, which can increase the risk of hypothermia.
If you suspect hypothermia, call 911 or your local
emergency number. In addition:
• Remove any jewelry and wet clothing, if possible.
• Frostbitten skin should be handled with great
care. Do not rub.
• Gently treat the affected area by soaking it in
warm water (100 degrees F to 105 degrees F)
until normal skin color appears and the area
feels warm again.
• Cases of severe frostbite may require medical
follow-up.
Neck or Back Injury
Suspected neck or back (spinal cord) injuries should be
taken seriously because of the risk of paralysis and even
death. When someone has a head or neck injury, he or
she should not be moved because movement may cause
further damage to spinal cord nerves (which carry messages between the brain and body), resulting in possible
paralysis below the site of the injury.
The causes of neck or back injury include:
• Accidents or falls that cause direct trauma to
the face, neck, head or back (e.g., car or bike
accidents, diving)
• Any activities that result in landing on one’s head
• Extreme or abnormal twisting of the body trunk
• Sports activities (such as football)
• A major blow to the head, neck or chest
The symptoms of serious neck or back injury include:
• Head or body contorted in an unnatural or
unusual position
• Numbness or tingling sensations that radiate
through an arm or a leg
• Shallow, slow breathing
• Weakness in back, neck or limbs
• Unusual behavior
• Difficulty standing or walking
• Slow, irregular heartbeat
• Inability to move arms or legs
32
• Shock (pale, clammy skin; blue or gray lips,
fingernails; dazed or semi-conscious appearance)
• Unconsciousness
• Neck pain, stiff neck or headache that won't
go away
Nosebleeds
A nosebleed, especially one that arises spontaneously in
a child, can be alarming, but most nosebleeds are not
serious and often look much worse than they really are.
Nosebleeds most often are caused by dry or thin mucous
membranes in the nose (which may be linked to indoor
heat in the winter), sinusitis, and nose picking. Less often
nosebleeds result from colds, allergies, injuries, sticking
small objects up the nose or cocaine use. In older persons, they may be linked to atherosclerosis (“hardening of
the arteries”), high blood pressure, blood-clotting disorders or infections, or sometimes they are caused by
aspirin and other drugs that interfere with blood clotting.
In rare instances, frequent nosebleeds may be linked to a
serious illness or disease.
NOSEBLEEDS / POISONING
• Loss of bladder or bowel control
To stop a nosebleed:
• Sit with head forward while pinching the nostrils
together continuously for at least 5 minutes, or if
bleeding persists, for 10 minutes. Do not tilt head
back (so as to avoid swallowing blood, which may
cause nausea, vomiting and diarrhea).
If any of the above causes or symptoms are involved,
assume that the person has a spinal cord injury, and
take the follow steps:
• Call 911 or the local emergency number.
• Immobilize the head, neck and shoulder area to
prevent movement.
• Do not attempt to reposition, bend or twist the
neck or body; and do not move or roll the person
unless he or she is in danger (e.g., he or she is
in a burning vehicle).
– If you must roll the person, do so only if he or she
is vomiting or choking on blood, or because you
must check that the person is still breathing.
– Rolling a person requires two people, with one
person stationed at the head and the other along
the victim's side. The person's head, neck and
back should be kept in line while rolling occurs.
• If the person is wearing a helmet, do not
remove it.
• If the person is not breathing, and if trained to do
so, begin rescue breathing (CPR). (Do not move or
tilt the head back when attempting to open the
airway; instead, position your fingers on each jaw
along the side of the head and lift the jaw open
or forward.)
• If the person has no pulse, begin chest
compressions.
• Stop pinching the nose if it becomes particularly
uncomfortable, or the bleeding is not easily
controlled by this technique.
• If the nosebleed is the result of an injury or blow
to the nose, placing a cold compress or ice pack
across the bridge of the nose may help alleviate
some swelling and discomfort.
If a nosebleed occurs after a fall or car crash, seek immediate medical attention; this could be a sign of internal
bleeding. If bleeding persists for more than 15 minutes,
seek a medical assistance. If bleeding persists and is
related to a blow to the face, head or nose, physician evaluation is needed to determine whether the person has a
broken nose or a facial or head fracture.
Poisoning
More than 500,000 people seek emergency care each
year in the United States because of poisoning - either
accidental or deliberate - and nearly 30,000 people die.
Unintentional poisoning is the second leading cause of
unintentional injury death in America.
Poisons are found in nearly every home. They may be
accidentally swallowed, breathed, touched or injected.
They may be in liquid form, such as cleaners, antifreeze
or bug spray, or solid form, such as pills or plants; they
also may be in a gas form, such as carbon monoxide.
33
PUNCTURE WOUNDS
Some materials are not poisonous on their own, but
become poisonous when combined with certain other
substances.
Prevent poisoning by making sure your home is as safe
as possible, wearing protective clothing and equipment
when using chemicals and following the directions on
warning labels found on medicines and household
chemicals.
{
If you or someone else has come in
contact with poison, call the National
Poison Control Center at 800-222-1222.
}
If you or someone else has come in contact with poison,
call the National Poison Control Center at 800-222-1222.
The National Poison Control Center answers this number
24 hours a day, 7 days a week. If there is a life-threatening emergency, call 911 (or local emergency number).
Chemicals in the Eye
• Rinse with running water for 15 to 20 minutes.
Make sure the water is flowing away from the
uncontaminated eye.
• If you cannot hold the eyelid open during the rinsing, do not force it. Instead, have the person blink
as much as possible while flooding the eye.
• For information regarding chemical injuries to the
eye related to terrorist attacks.
• Keep in mind that using proper eye protection,
such as goggles, when working with hazardous
chemicals can prevent eye injuries.
Puncture Wounds
Most cuts are minor, but it is still important to properly
care for them. Sometimes it's hard to determine what
wounds can be treated at home and which require a trip
to the emergency department.
Wounds that need emergency medical care are:
In addition, if a person swallows a poison:
• Read the label on the product for safety
instructions. Follow the instructions.
• Be ready to describe the poison to the poison
control experts - what it was, how much was
ingested and how long ago it was taken. Also be
ready to describe the person's age and weight.
• Those that will not stop bleeding after a few
minutes of applying direct pressure
• Deep, gaping, jagged or potentially disfiguring
cuts, to avoid the formation of scar tissue
• Long or deep cuts that need stitches
• Cuts over a joint
• If it's safe to do so, take the poison with you to
the emergency department.
• Cuts that may impair function of a body area
such as an eyelid or lip
• Make sure the person is breathing. If not, and if
you are trained to do so, start rescue breathing.
• Cuts that remove all of the layers of the skin
like those from slicing off the tip of a finger
• Cuts from an animal or human bite
Smoke or Chemical Inhalation
• Immediately get the person to a place where he or
she can breathe fresh air. Avoid breathing fumes
yourself.
• Seek prompt medical attention if you suspect
carbon monoxide poisoning. (See the CDC Web
site at http://www.cdc.gov/co/guidelines.htm
for details.)
• If the person is not breathing, and if you are
trained to do so, start rescue breathing.
Chemical Contamination (Skin)
• Remove contaminated clothing and rinse
the skin with water for 15 to 20 minutes.
34
• Cuts that have damaged underlying nerves,
tendons, or joints
• Cuts over a possible broken bone
• Cuts caused by a crushing injury
• Cuts with an object embedded in them
• Cuts caused by a metal object or a puncture
wound
Also call 911 or emergency services immediately if:
• Bleeding from the cut does not slow during the
first few minutes of steady direct pressure.
• Signs of shock occur.
• Wash the skin gently with water, then rinse.
• Breathing is difficult because the cut is in the
neck or chest.
• If there is continued irritation, seek medical
evaluation.
• The wound is a deep cut to the abdomen that
causes moderate to severe pain.
• The cut amputates or partially amputates an
extremity.
To help stop the bleeding:
• Apply firm, direct pressure over a bleeding wound
with clean cloth or sterile bandage. (Don't use
heavy pressure if the wound is on the person's
head.) Maintain pressure until bleeding subsides,
or (if an ambulance has been called) until trained
medical help arrives.
• If bleeding is occurring in a limb, keep applying
pressure and elevate the limb above the heart,
unless you suspect the limb is broken.
• Deep cuts should not be cleansed. Do not apply
antiseptic, as it could damage healthy tissue. If
blood soaks through, do not remove bandages (as
removal may interfere with clotting); instead apply
more bandages directly on top.
• For wounds that are still bleeding after applying
steady, firm pressure for more than five minutes,
call 911 immediately. Continue applying firm,
direct pressure over the wound with a clean cloth
or sterile bandage. Maintain pressure until trained
medical help arrives.
• If bleeding is severe, and you think the person’s
life is in danger, wrap a 3" wide tourniquet above
the wound area and pull tightly.
• If the person has been impaled (by a knife, pole
or other similar object), do not pull the offending
object out of the wound. (Doing so may cause
uncontrolled bleeding or organ damage.)
• A tetanus shot may be recommended as follow-up,
especially if the person has not had one in more
than 10 years.
Be aware that injuries that cause bleeding may also
cause shock.
Rashes
Rashes (also called skin lesions or erythema) have a variety
of causes and involve changes in skin color and texture,
and can be quite common, especially in children. In most
cases, rash symptoms and characteristics help to determine what is causing the rash; in other cases, medical
testing is needed.
The most common type of simple rash is inflammation of
the skin known as dermatitis. Contact dermatitis is
caused by substances that come in contact with the skin,
such as chemicals, particularly those found in latex and
rubber; cosmetics, soaps and detergents; clothing dyes
and materials; and poison ivy, oak or sumac. These types
of rashes are not associated with fever.
Other causes of rashes without fever include allergic
reactions, drug reactions and fungal infections such as
ringworm. Physician evaluation is generally necessary for
diagnosis and treatment of these types of rashes.
RASHES / SEIZURES
• The wound is a cut to the eyeball.
Rashes that occur in association with moderate fever
(less than 102 degrees F) are usually due to viral infections, such as roseola, which runs its course without
treatment. The rash typically appears after the resolution
of the fever.
Seek immediate medical evaluation for rashes:
• That look like small bleeding spots under the
skin; these types of rashes are typically associated
with high fevers or unusual sleepiness
• That appear in the eye(s) or inside the mouth (a
possible sign of a serious illness or a drug reaction)
Seizures
Seizures involve sudden involuntary alterations in behavior or consciousness resulting from excessive electrical
activity in the brain. Seizures are common in persons who
have epilepsy and normally last two to three minutes. In
other cases, seizures may be caused by head injuries,
brain tumors, lead poisoning, inadequate brain development, genetic deficiencies, infectious disease and fevers.
Seizures may also be caused by alcohol abuse and alcoholism, Alzheimer's Disease, lupus, kidney failure, stroke
and other illnesses. In approximately 50 percent of
seizures, no cause can be identified.
In persons with epilepsy, there are two types of seizures:
generalized seizures, which include tonic-clonic seizures
(also known as grand mal seizures); and partial seizures,
which affect only part of the brain. Anti-seizure medications are available for person's diagnosed with epilepsy.
In the case of most epileptic seizures, it is usually not necessary to call 911 or the local emergency number.
However, it is important to keep the person away from
harmful objects and to make sure his or her airway
remains clear.
The symptoms of a seizure includes:
• A preceding warning or aura (in some cases)
• A complex partial seizure or a convulsion
involving rhythmic jerking
• A loss of responsiveness or alertness, with the
eyes generally remaining open
35
SHOCK
• Barely detectable breathing during the seizure
followed by deep breathing during recovery
Shock
• Incontinence or loss of urine (in some cases)
Shock is a serious, often life-threatening medical condition and a leading cause of death for critically ill or injured
people. Shock results when the body is not getting
enough blood flow and may lead to hypoxia (a lack of oxygen in the body tissues) or cardiac arrest, in which the
heart stops.
• A transition back to the person's normal state
known as the “post-ictal period”; this is a recovery
period for the brain, which may last anywhere
from a few seconds to several hours and may
involve combativeness
In some cases, seizures may also involve isolated abnormal
movements of a limb, periods of staring or abnormal stiffening without rhythmic jerking.
Take the following actions if someone is
having a seizure:
• Move harmful objects out of the way, cushion
the head and protect the person from falling.
Depending on the cause and type of shock,
symptoms may include:
• Loosen ties, scarves or other neckware.
• Pale, cool, clammy skin
• Do not put anything in the person’s mouth.
• Restlessness, anxiety or agitation
• Do not attempt to restrain the convulsions.
• Drowsiness or fatigue
• After the convulsion ceases or if the person is
vomiting, roll the person onto his or her left side
to protect the airway and to help drain away any
mouth secretions.
• Dizziness, light-headedness or faintness
• Make sure the airway is clear and the person is
breathing. If not, start rescue breathing and seek
immediate medical attention.
• Thirst
• Observe the length of the seizure, the movements
involved, direction of head and eye movements
and the time it takes to return to full consciousness
and alertness, so you can report this information
to a medical professional.
• Rapid, weak breathing
Call 911 or the local emergency number
immediately if:
• The seizure lasts five minutes or longer,
or is repeated
• Injuries have resulted from the seizure
• The person experiences persistent breathing
difficulty
• The person having the seizure also has a fever
• The person experiences persistent confusion
or remains unconscious
• The person is pregnant, is a diabetic, is injured
or appears to have life-threatening conditions
• This is the first time the person has had a seizure,
or, in the case of an established epileptic, the
seizure represents a marked change from the type
or duration of seizure typically experienced
36
Shock may result from allergic reactions, poisoning, trauma or serious injury (including spinal injuries), heavy
bleeding, dehydration or heatstroke. It may also be associated with heart problems, infections or damage to the
nervous system.
• Profuse sweating, moist skin
• Irritability
• Rapid pulse
• Enlarged pupils
• Nausea or vomiting
• Blue tinge to lips or fingernails (or gray in
the case of dark-complexions)
If the person is having or is suspected of having an allergic
reaction, he or she may also be experiencing symptoms of
anaphylaxis, which may lead to or overlap with shock
symptoms.
To help someone in shock, first call for help
(911 or your local emergency number) and then:
• Lay the person down, with his or her feet elevated
about 12 inches (unless there is a head, neck or
back injury or if you suspect broken bones in the
hips or legs); do not elevate the head.
• Keep the person warm and comfortable, and
loosen restrictive clothing.
• Do not give the person anything by mouth,
including anything to eat or drink.
• Do not move the person unless he or she is
in danger.
SORE THROAT / SPRAINS AND STRAINS
• Make sure the person is breathing and has a
pulse. If the person is not breathing, and you
are trained to do so, do rescue breathing.
• Continue to check breathing every five minutes
until help arrives.
• Take measures to control any bleeding.
• Provide appropriate first aid for any injuries
or illnesses.
• If the person vomits or bleeds from the mouth,
turn the person on his or her side to prevent
choking (provided there is no suspicion of spinal
injury).
• Do not wait for mild shock symptoms to get worse
before seeking emergency help.
Sore Throat
The symptoms of a serious sprain or a strain include:
• Pain, swelling and bruising
Sore throats and their hallmark signs - including dry
scratchiness, redness, swelling and painful swallowing that go with them are typically a symptom of a common
underlying illness such as colds or the flu.
The good news is that most sore throats last only a few
days and can be relieved by over-the-counter pain relievers
such as aspirin, acetaminophen or ibuprofen. (Do not give
children under the age of 19 aspirin; doing so can cause
Reye's Syndrome, a potentially fatal illness.) Gargling several times a day with warm salt water may also give some
relief. Some sore throat causes, such as strep, tonsillitis
and abscesses, are tied to a bacterial infection. These
infections must be treated with antibiotics.
When to seek medical for a sore throat:
• If the pain is severe or lasts more than a
few days
• If the sore throat is accompanied by swollen
glands that cause difficulty breathing or
prevent the person from swallowing fluids
• In children in particular, if there is presence of
excessive salivation, inability to swallow liquids,
difficulty speaking, irritability or the inability
to move the neck. In these instances, seek
immediate medical attention
Sprains and Strains
A ligament is the tissue that connects a bone to a joint,
and a sprain is a stretched or torn ligament. A sprain is an
injury to ligaments, while strains are stretch injury to the
muscle. Sprains and strains are typically caused by
falling, twisting or getting hit. Sprains and strains are
common in fingers, wrists, ankles, knees and foot arches.
• Inability to move a joint
• Feeling a pop or a tear when the injury occurs
A physician should evaluate finger injuries to check for
fracture, dislocation or unstable ligaments.
Other minor injuries are initially treated following the
RICE (rest, ice, compression, elevation) principle:
• Rest the injured area for 24 to 48 hours.
• Apply ice for 10 to 15 minutes, four times a day,
for the first 48 hours after the injury.
• Gently wrap and compress the area with an
elastic bandage gently. Wrap loosely to avoid
cutting circulation.
• Elevate the injury for first 24 hours; keep the
injured area above the heart. Use a sling or a
soft splint (such as a pillow) to keep the injured
area from moving. If the pain does not improve or
other signs of a fracture develop, seek medical
attention.
Seek emergency care if:
• You experience a popping sound or feeling in the
joint upon injuring it, or if you are unable to use
the joint. Apply ice or a cold pack on the way to
the doctor.
• The area is hot and inflamed and you have a fever
(indicating a possible infection).
• The sprain is severe, in which case a delay in
treatment might result in chronic pain or long-term
joint problems.
• Joint pain doesn't diminish after two or three days.
37
STROKE / SUICIDE
Stroke
Stroke is a life-threatening condition that constitutes a
medical emergency. It is the third leading cause of death
in the nation. Stroke occurs when blood flow to the brain
is interrupted by a clogged or burst artery. The interruption deprives the brain of blood and oxygen, and causes
brain cells to die. Seek emergency care immediately if a
stroke is suspected.
• Control diabetes.
• Manage heart disease. Be aware of your family's
medical history of stroke.
• Promptly report warning signs to your doctor.
Stroke symptoms in general include:
• Sudden numbness, weakness or paralysis and
drooping of the face, arm or leg, especially on
one side of the body
• Suddenly blurred or decreased vision in one or
both eyes
• Slurred speech, difficulty speaking or inability
to understand or be understood
• Loss of balance or coordination
Some people may have additional, nontraditional (sometimes non-neurological) symptoms, including severe
headache, especially if the onset is abrupt or if accompanied by other symptoms (such as a change in consciousness), in which case a brain hemorrhage may be a cause
for concern.
Stroke symptoms that last for only a few minutes and
then subside may indicate a “mini-stroke,” or a transient
ischemic attack (TIA). TIAs are serious medical events
and require treatment; they are also a warning sign that a
more dangerous stroke may occur in the future.
It is important to know that stroke often goes unrecognized; people often wait to see if their symptoms improve
and unknowingly put themselves in greater danger.
However, because stroke can incapacitate or kill within
minutes, doctors recommend treating a suspected stroke
as a medical emergency and seeking immediate medical
care.
If stroke is suspected, it should be communicated directly
immediately. Call 911 and tell the dispatcher or the triage
nurse or doctor, “I think this is a stroke.”
How to Reduce Your Risk of Stroke
Occasional passing thoughts about death or suicide usually are harmless, particularly in people who otherwise
seem healthy and happy, with no signs of depression,
mental illness, drug or alcohol abuse or crises in their
lives. However, any persistent thoughts of or conversations about wanting to die or committing suicide should
be taken seriously. While predicting whether someone is
serious about committing suicide is often difficult, certain
groups are more vulnerable. For example, white men
have the highest rates of suicide, although women and
teens attempt suicide more often.
Risk factors for suicide include:
• A prior suicide attempt
• Alcohol or drug abuse problems
• Mental illness (such as depression or
bi-polar disorder)
• A family history of substance abuse or
mental disorder
• Family violence, including physical or
sexual abuse
• Control your blood pressure.
• Firearms in the home
• Don't smoke.
• Arrest or incarceration
• Eat a healthful diet that is low in sodium and fat.
• Recent release from a psychiatric hospital
(an often overwhelming time of transition)
• Have your cholesterol checked; if it is high follow
your doctor's instructions on how to control it.
• Exercise regularly.
38
Suicide
• The recent suicide of a relative, friend,
co-worker or classmate
• People in occupations involving high stress
or high burnout rates, such as law enforcement
or hospice care
If you are in crisis and
feeling suicidal, you are not
alone and there is help:
SUICIDE
• Unrelenting long-term pain, or a disabling or
terminal illness
Warning signs of suicide include:
• Feeling depressed, or excessively sad
• Feelings of hopelessness, worthlessness or
having no purpose in life
• A preoccupation with death, dying or violence,
or talking about wanting to die
• Seeking access to weapons, medications or
other means of killing oneself
• Wide mood swings (feeling extremely “up”
one day and terribly “down” the next)
• Feelings of great agitation, rage or uncontrolled
anger, or wanting to get revenge
• Changes in eating and sleeping habits
(including sleeping too much or too little)
• Changes in appearance, behavior or personality,
including withdrawing from family members and
friends or suddenly becoming outgoing when
the person is typically shy
• Risky or self-destructive behavior, such as
taking illegal drugs or driving recklessly
• Sudden calmness (when the person had
made the decision to end his or her life)
• Life crises, traumas or setbacks (including
difficulties at school, work or in relationships;
job loss; divorce; death of a loved one; financial
difficulties; diagnosis of a terminal illness)
• Putting one's affairs in order - including giving
away belongings, visiting family members and
friends, drawing up a will or writing a suicide note
In some cases, the person will not reveal any suicidal behaviors; in others, the person will consider or attempt suicide at
a point in which it is assumed he or she is feeling better.
In any event, if you have suicidal thoughts or you suspect
someone you know has them, it's important not to ignore
the situation. However, keep in mind that most people who
attempt suicide do not really intend to kill themselves, and
that in many cases the attempt is a cry for help.
The good news is that medications and therapy usually
can help people with suicidal impulses. In addition, treating
underlying causes such as mental illness and substance
abuse can reduce the risk of suicide. Finally, oftentimes
just talking with a friend or a counselor can bring some
relief and can help the suicidal person regain hope.
• Immediate assistance is available by calling
the Suicide Prevention Hotline toll-free at
1-800-SUICIDE (1-800-784-2433),
1-800-273-TALK (1-800-273-8255). Deaf persons
should call 1-800-799-4889; for assistance in
Spanish (en Español), call 1-888-628-9454.
• When you call, you will be connected to the
nearest available suicide prevention and
mental health service provider. (To learn more,
see www.suicidepreventionlifeline.org.)
If someone you know is threatening to commit suicide,
take it seriously. Remain calm and take the following
steps to help manage the crisis:
• Do not leave the person alone, and eliminate
access to firearms, knives, medications or any
other tool the person could use to try to commit
suicide.
• Don't try to handle a suicide threat or attempt
alone. Involve other people. You don't want to risk
your own health and safety.
• Call 911 or the local emergency response number,
if necessary. Contact the person's doctor, the
police, a crisis intervention team, or others who
are trained to help.
• While waiting for help to arrive, listen closely to
the person. Let the person know you are listening
by maintaining eye contact, moving close to the
person or holding his or her hand, if appropriate.
• Ask the person questions. Find out if the person
has a specific plan for suicide. Try to determine
what method of suicide the person is considering.
• Acknowledge the person's feelings. Be understanding, not judgmental or argumentative.
• Remind the person that help is available, change
is inevitable and things will get better. Stress that
suicide is a permanent solution to a temporary
problem.
• Don't promise the person threatening suicide
that you will keep his or her suicidal thoughts
confidential. You may need to speak to a physician or mental health professional in order to
protect the person from injury.
39
SUNBURN
• Stay with the suicidal person until you are sure
they are in the hands of competent professionals.
If you have to leave, make sure another friend or
family member can stay with the person until they
can receive professional help.
• If a person attempts suicide, immediately call for
emergency medical assistance. Administer first
aid, if necessary. If you know the person has
swallowed poison or drugs, call the Poison Control
Center at 1-800-222-1222. Be prepared with the
name of the poison or drug used.
Sunburn
Although sunlight in small doses (15 to 20 minutes per
day) is vital to a person's health, damage caused by
spending too much time in the sun can be dangerous, as
well as irreversible and can result in a medical emergency. Overexposure to the sun's ultraviolet (UV) rays,
even for short periods, can damage skin and eyes. Longterm effects of the sun's damage include wrinkles, leathery skin, cataracts, moles, “age spots” and skin cancer.
• If you become overheated or uncomfortable,
go indoors or sit in the shade.
• Check with your doctor before going out into the
sun if you take any prescription drugs. Some
medicines can increase your risk of sunburn or
interact with the sun to cause rashes or other side
effects. Remember, once skin is sunburned
it is more sensitive to further exposure.
• Persons with fair skin, moles or a family history
of skin cancer are especially at risk of sunburns,
damaged skin and skin cancer and should avoid
overexposure.
• Even darker-skinned people need protection
from the sun's damaging rays.
• For symptoms of sunburn:
– Take a cool (not cold) bath, or apply cool,
wet compresses.
– Apply topical moisturizing creams to soothe
discomfort and rehydrate the skin. Avoid
petroleum-based products because they
prevent heat and sweat from escaping.
– Take a pain reliever with acetaminophen or ibuprofen
according to product label directions, if needed.
Take precautions before venturing into the sun:
• Wear sunscreen with the maximum level of sun
protection when outside (usually SPF 15, or SPF
30 if in a tropical environment or when engaging
in prolonged outdoor activities such as sports).
• Check the label to make sure it protects against
both UVA and UVB rays.
• Use sunscreen even on cloudy, cool or overcast
days, because UV rays are not filtered by clouds or
pollution. In fact, a cloudy day may be more dangerous than a sunny day, because it is cooler and
people may spend more time outdoors.
• Apply sunscreen at least 30 minutes before going
outside. Use it liberally and reapply every two
hours, after swimming or perspiring heavily. Be
sure to follow the directions on the product label.
Do not use sunscreen on babies younger than six
months - they should be kept out of the sun as
much as possible.
• Avoid activities between 10:00 a.m. and 3:00
p.m. in the summer (in the Northern Hemisphere),
when the sun is at its highest, and, therefore,
strongest level.
• Keep in mind that harmful UV rays are more
intense in the summer and at higher altitudes but
also can be damaging in the winter, especially
where there is snow, which reflects sunlight.
• Protect yourself further by wearing a hat and
loose fitting, light-colored clothing.
40
– Resist the urge to scratch and peel loose skin.
– Stay in the shade until the sunburn heals and limit
sun exposure in the future, keeping in mind that
previously sunburned skin burns much easier.
• Seek immediate medical care for:
– A severe sunburn with blisters
– Fever or chills
– Nausea or vomiting
– Confusion
Dental emergencies typically involve pain or injury to the
teeth, gums, lips or cheek and tongue. Sometimes an
infection is involved. In any case, any significant pain or
injury to the mouth or the teeth should not be ignored.
Knocked-Out Tooth
• A permanent tooth that has been knocked out
should be rinsed gently to remove dirt and debris (do
not scrub) and stored in the mouth, where saliva will
help preserve it; take care not to swallow the tooth.
(Do not store the tooth in the mouth of a young child
or someone who may become unconscious.)
• Alternately, place the tooth or teeth in a cup of milk
and immediately see a dentist or an oral surgeon.
• Do not attempt to place the tooth back in its
socket because this could cause further damage.
• Seek immediate medical attention. (After two
hours, the tooth usually cannot be saved.)
Broken Tooth
• If the tooth is broken, rinse the mouth out with
warm water and place cold compresses over the
face in the area of the injury.
• Locate and save any broken tooth fragments.
• Seek immediate medical attention.
• Long-term dental problems can result from
broken teeth.
Loose Tooth
• If a tooth is moved slightly forwards or backwards,
gently use light pressure with your finger to reposition the tooth to its normal alignment. Do not try to
force the tooth back into its socket. Hold the tooth in
place with a moist tissue or gauze. Seek medical
attention within 30 minutes of the injury, if possible.
• If bleeding does not stop after 15 minutes or it
cannot be controlled by simple pressure, go to a
hospital emergency department.
Vomiting and Diarrhea
Vomiting and diarrhea (symptoms of gastroenteritis) may
be caused by a virus or bacteria. Food poisoning also can
cause these symptoms. Viral illnesses usually run their
course without medical treatment while food poisoning, if
severe, may require medical attention.
TEETH / VOMITING AND DIARRHEA
Teeth (Dental Emergencies)
Other symptoms associated with vomiting
and diarrhea include:
• Fever.
• Stomach cramps and nausea.
• Headache, tiredness and muscle aches.
Effective ways to respond include:
• Getting rest and restricting activities until
symptoms subside
• Drinking plenty of clear liquids, including
ginger ale, cola, water, tea, broth and gelatin,
for the first 24 hours or until symptoms subside
• Eating bland foods such as crackers, rice, soup,
bread, pasta, eggs, baked potatoes, applesauce
or cooked cereals (for one day)
• Avoiding fruits, vegetables, fried or spicy foods,
candy, dairy products and alcoholic beverages
for two to three days
• Drinking 8 to 12 glasses of liquids per day
until you feel better (to avoid dehydration)
• Taking ibuprofen or acetaminophen for fever and
muscle aches (Do not give aspirin to anyone
under age 19.)
Toothache
• Toothaches can be extremely painful and cause
headaches, fever and sleeplessness.
• If you have a toothache, do not place aspirin on
the aching tooth or gum.
• Rinse the mouth with warm water. Floss to remove
food that may be trapped.
Cut or Bitten Tongue, Lip or Cheek Lining
• These wounds should be cleaned gently with a
clean cloth. Apply cold compresses to reduce
swelling and bleeding. If bleeding does not
stop, seek immediate medical attention.
• Apply ice to bruised areas. If there is bleeding, apply
firm but gentle pressure with a clean gauze or cloth.
Seek emergency care if:
• Vomiting and/or diarrhea continue for more
than 24 hours (12 hours in an infant) to avoid
the danger of dehydration.
• There is severe stomach or rectum pain.
• There is a high fever.
• Blood, mucus or worms are found in the stool.
• Signs of water loss, such as dry mouth, excessive
thirst, crinkled skin, little to no urination, or
dizziness or lightheadedness are experienced.
If repeat vomiting follows a head injury, seek
emergency care.
41
42
NOTES
NOTES
43
2121 K Street, NW, Suite 325
Washington, DC 20037
800.320.0610
www.EmergencyCareForYou.org