First Aid – Page 2

First-degree burn
The least serious burns are those in which only the outer layer of skin is burned. The skin is usually red, with swelling and pain sometimes present. The outer layer of skin hasn’t been burned through. Treat a first-degree burn as a minor burn unless it involves substantial portions of the hands, feet, face, groin or buttocks, or a major joint.

Second-degree burn
When the first layer of skin has been burned through and the second layer of skin (dermis) also is burned, the injury is called a second-degree burn. Blisters develop and the skin takes on an intensely reddened, splotchy appearance. Second-degree burns produce severe pain and swelling.

If the second-degree burn is no larger than 3 inches (7.5 centimeters) in diameter, treat it as a minor burn. If the burned area is larger or if the burn is on the hands, feet, face, groin or buttocks, or over a major joint, treat it as a major burn and get medical help immediately.

For minor burns, including first-degree burns and second-degree burns limited to an area no larger than 3 inches (7.5 centimeters) in diameter, take the following action:

• Cool the burn. Hold the burned area under cold running water for at least five minutes, or until the pain subsides. If this is impractical, immerse the burn in cold water or cool it with cold compresses. Cooling the burn reduces swelling by conducting heat away from the skin. Don’t put ice on the burn.
• Cover the burn with a sterile gauze bandage. Don’t use fluffy cotton, which may irritate the skin. Wrap the gauze loosely to avoid putting pressure on burned skin. Bandaging keeps air off the burned skin, reduces pain and protects blistered skin.
• Take an over-the-counter pain reliever. These include aspirin, ibuprofen (Advil, Motrin, others), naproxen (Aleve) or acetaminophen (Tylenol, others). Never give aspirin to children or teenagers.

Minor burns usually heal without further treatment. They may heal with pigment changes, meaning the healed area may be a different color from the surrounding skin. Watch for signs of infection, such as increased pain, redness, fever, swelling or oozing. If infection develops, seek medical help. Avoid re-injuring or tanning if the burns are less than a year old — doing so may cause more extensive pigmentation changes. Use sunscreen on the area for at least a year.

Caution

• Don’t use ice. Putting ice directly on a burn can cause frostbite, further damaging your skin.
• Don’t apply butter or ointments to the burn. This could prevent proper healing.
• Don’t break blisters. Broken blisters are vulnerable to infection.

Third-degree burn
The most serious burns are painless, involve all layers of the skin and cause permanent tissue damage. Fat, muscle and even bone may be affected. Areas may be charred black or appear dry and white. Difficulty inhaling and exhaling, carbon monoxide poisoning, or other toxic effects may occur if smoke inhalation accompanies the burn.

For major burns, dial 911 or call for emergency medical assistance. Until an emergency unit arrives, follow these steps:

1. Don’t remove burnt clothing. However, do make sure the victim is no longer in contact with smoldering materials or exposed to smoke or heat.
2. Don’t immerse large severe burns in cold water. Doing so could cause shock.
3. Check for signs of circulation (breathing, coughing or movement). If there is no breathing or other sign of circulation, begin cardiopulmonary resuscitation (CPR).
4. Elevate the burned body part or parts. Raise above heart level, when possible.
5. Cover the area of the burn. Use a cool, moist, sterile bandage; clean, moist cloth; or moist towels.

• Sunburn:
  Signs and symptoms of sunburn usually appear within a few hours of exposure, bringing pain, redness, swelling and occasional blistering. Because exposure often affects a large area of your skin, sunburn can cause headache, fever and fatigue.

  If you have a sunburn:

  • Take a cool bath or shower. Adding 1/2 cup (about 120 milliliters) of cornstarch, oatmeal or baking soda to your bath water may provide some relief.
  • Apply an aloe vera lotion several times a day.
  • Leave blisters intact to speed healing and avoid infection. If they burst on their own, apply an antibacterial ointment on the open areas.
  • If needed, take an over-the-counter pain reliever such as aspirin, ibuprofen (Advil, Motrin, others), naproxen (Aleve) or acetaminophen (Tylenol, others). Don’t give children or teenagers aspirin. It may cause Reye’s syndrome, a rare but potentially fatal disease.

  Do not use petroleum jelly, butter or other home remedies on your sunburn. They can prevent or delay healing.

  If your sunburn begins to blister or if you experience immediate complications, such as rash, itching or fever, see your doctor.
   

• Electrical:
  An electrical burn may appear minor or not show on the skin at all, but the damage can extend deep into the tissues beneath your skin. If a strong electrical current passes through your body, internal damage, such as a heart rhythm disturbance or cardiac arrest, can occur. Sometimes the jolt associated with the electrical burn can cause you to be thrown or to fall, resulting in fractures or other associated injuries.

  Dial 911 or call for emergency medical assistance if the person who has been burned is in pain, is confused, or is experiencing changes in his or breathing, heartbeat or consciousness.

  While helping someone with an electrical burn and waiting for medical help, follow these steps:

  1. Look first. Don’t touch. The person may still be in contact with the electrical source. Touching the person may pass the current through you.
  2. Turn off the source of electricity if possible. If not, move the source away from both you and the injured person using a dry nonconducting object made of cardboard, plastic or wood.
  3. Check for signs of circulation (breathing, coughing or movement). If absent, begin cardiopulmonary resuscitation (CPR) immediately.
  4. Prevent shock. Lay the person down with the head slightly lower than the trunk and the legs elevated.
  5. Cover the affected areas. If the person is breathing, cover any burned areas with a sterile gauze bandage, if available, or a clean cloth. Don’t use a blanket or towel. Loose fibers can stick to the burns.
      
• Chemical:
  If a chemical burns the skin, follow these steps:
  1. Remove the cause of the burn by flushing the chemicals off the skin surface with cool, running water for 20 minutes or more. If the burning chemical is a powder-like substance, such as lime, brush it off the skin before flushing.
  2. Remove clothing or jewelry that has been contaminated by the chemical.
  3. Apply a cool, wet cloth or towel to relieve pain.
  4. Wrap the burned area loosely with a dry, sterile dressing or a clean cloth.
  5. Rewash the burned area for several more minutes if the person experiences increased burning after the initial washing.

  Minor chemical burns usually heal without further treatment.

  Seek emergency medical assistance if:

  • The victim has signs of shock, such as fainting, pale complexion or breathing in a notably shallow manner.
  • The chemical burn penetrated through the first layer of skin, and the resulting second-degree burn covers an area more than 3 inches (7.5 centimeters) in diameter.
  • The chemical burn occurred on the eye, hands, feet, face, groin or buttocks, or over a major joint.
  • The victim has pain that cannot be controlled with over-the-counter pain relievers such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others).

  If you’re unsure whether a substance is toxic, call the poison control center at 800-222-1222. If you seek emergency assistance, bring the chemical container or a complete description of the substance with you for identification.

Heart attack:
A heart attack occurs when an artery that supplies oxygen to your heart muscle becomes blocked. A heart attack generally causes chest pain that lasts longer than 15 minutes. But a heart attack can also be silent and produce no signs or symptoms.
Many people who suffer a heart attack have warning symptoms hours, days or weeks in advance. The earliest predictor of an attack may be recurrent chest pain that’s triggered by exertion and relieved by rest.
Someone having a heart attack may experience any or all of the following:

• Uncomfortable pressure, fullness or squeezing pain in the center of the chest lasting more than a few minutes
• Pain spreading to the shoulders, neck or arms
• Lightheadedness, fainting, sweating, nausea or shortness of breath

If you or someone else may be having a heart attack:

• Dial 911 or call for emergency medical assistance. Don’t "tough out" the symptoms of a heart attack for more than five minutes. If you don’t have access to emergency medical services, have someone such as a neighbor or friend drive you to the nearest hospital. Drive yourself only as a last resort, if there are absolutely no other options. Driving yourself puts you and others at risk if your condition suddenly worsens.
• Chew a regular-strength aspirin. Aspirin can inhibit blood clotting. However, you shouldn’t take aspirin if you’re allergic to aspirin, have bleeding problems or your doctor previously told you not to do so.
• Take nitroglycerin, if prescribed. If you think you’re having a heart attack and your doctor has previously prescribed nitroglycerin for you, take it as directed. Do not take anyone else’s nitroglycerin.
• Begin CPR. If the person suspected of having a heart attack is unconscious, a 911 dispatcher or another emergency medical specialist may advise you to begin cardiopulmonary resuscitation (CPR). Even if you’re not trained, a dispatcher can instruct you in CPR until help arrives.

Pulmonary embolism:
An embolus is an accumulation of foreign material — usually a blood clot — that blocks an artery. Tissue death occurs when the tissue supplied by the blocked artery is damaged by the sudden loss of blood. Pulmonary embolism describes the condition that occurs when a clot — usually from the veins of your leg or pelvis — lodges in an artery of your lung.
Signs and symptoms of pulmonary embolism include:

• Sudden, sharp chest pain that begins or worsens with a deep breath or a cough, often accompanied by shortness of breath
• Sudden, unexplained shortness of breath, even without pain
• Cough that may produce blood-streaked sputum
• Rapid heartbeat
• Anxiety and excessive perspiration

As with a suspected heart attack, dial 911 or call for emergency medical assistance immediately.

Pneumonia with pleurisy:
Frequent signs and symptoms of pneumonia are chest pain accompanied by chills, fever and a cough that may produce bloody or foul-smelling sputum. When pneumonia occurs with an inflammation of the membranes that surround the lung (pleura), you may have considerable chest discomfort when inhaling or coughing. This condition is called pleurisy.
One sign of pleurisy is that the pain is usually relieved temporarily by holding your breath or putting pressure on the painful area of your chest. This is not true of a heart attack. See your doctor if a cough and a fever or chills accompany your chest pain. Pleurisy alone, however, isn’t a medical emergency.

Chest wall pain:
One of the most common varieties of harmless chest pain is chest wall pain. One kind of chest wall pain is costochondritis. It consists of pain and tenderness in and around the cartilage that connects your ribs to your breastbone (sternum).
Often, placing pressure over a few points along the margin of the sternum results in considerable tenderness limited to those small areas. If the pressure of a finger duplicates your chest pain, you probably can conclude that a serious cause of chest pain, such as a heart attack, isn’t responsible.

Other causes of chest pain include:

• Strained chest muscles from overuse or excessive coughing
• Chest muscle bruising from minor trauma
• Acute anxiety with rapid breathing
• Pain from the gastrointestinal tract, such as esophageal reflux, peptic ulcer pain, or gallbladder pain.

The universal sign for choking is hands clutched to the throat. If the person doesn’t give the signal, look for these indications:

• Inability to talk
• Difficulty breathing or noisy breathing
• Inability to cough forcefully
• Skin, lips and nails turning blue or dusky
• Loss of consciousness

If choking is occurring, the Red Cross recommends a "five-and-five" approach to delivering first aid:

• First, deliver five back blows between the person’s shoulder blades with the heel of your hand.
• Next, perform five abdominal thrusts (also known as the Heimlich maneuver).
• Alternate between five back blows and five abdominal thrusts until the blockage is dislodged.

If you’re the only rescuer, perform back blows and abdominal thrusts before calling 911 (or your local emergency number) for help. If another person is available, have that person call for help while you perform first aid.

To perform abdominal thrusts (Heimlich maneuver) on someone else:

• Stand behind the person. Wrap your arms around the waist. Tip the person forward slightly.
• Make a fist with one hand. Position it slightly above the person’s navel.
• Grasp the fist with the other hand. Press hard into the abdomen with a quick, upward thrust — as if trying to lift the person up.
• Perform a total of five abdominal thrusts, if needed. If the blockage still isn’t dislodged, repeat the "five-and-five" cycle.

If you’re alone and choking, you’ll be unable to effectively deliver back blows to yourself. However, you can still perform abdominal thrusts to dislodge the item.

To perform abdominal thrusts (Heimlich maneuver) on yourself:

• Place a fist slightly above your navel.
• Grasp your fist with the other hand and bend over a hard surface — a countertop or chair will do.
• Shove your fist inward and upward.

Clearing the airway of a pregnant woman or obese person:

• Position your hands a little bit higher than with a normal Heimlich maneuver, at the base of the breastbone, just above the joining of the lowest ribs.
• Proceed as with the Heimlich maneuver, pressing hard into the chest, with a quick thrust.
• Repeat until the food or other blockage is dislodged or the person becomes unconscious.

Clearing the airway of an unconscious person:

• Lower the person on his or her back onto the floor.
• Clear the airway. If there’s a visible blockage at the back of the throat or high in the throat, reach a finger into the mouth and sweep out the cause of the blockage. Be careful not to push the food or object deeper into the airway, which can happen easily in young children.
• Begin cardiopulmonary resuscitation (CPR) if the object remains lodged and the person doesn’t respond after you take the above measures. The chest compressions used in CPR may dislodge the object. Remember to recheck the mouth periodically.

Clearing the airway of a choking infant younger than age 1:

• Assume a seated position and hold the infant facedown on your forearm, which is resting on your thigh.
• Thump the infant gently but firmly five times on the middle of the back using the heel of your hand. The combination of gravity and the back blows should release the blocking object.
• Hold the infant faceup on your forearm with the head lower than the trunk if the above doesn’t work. Using two fingers placed at the center of the infant’s breastbone, give five quick chest compressions.
• Repeat the back blows and chest thrusts if breathing doesn’t resume. Call for emergency medical help.
• Begin infant CPR if one of these techniques opens the airway but the infant doesn’t resume breathing.

If the child is older than age 1, give abdominal thrusts only.
To prepare yourself for these situations, learn the Heimlich maneuver and CPR in a certified first-aid training course.

1. Stop the bleeding. Minor cuts and scrapes usually stop bleeding on their own. If they don’t, apply gentle pressure with a clean cloth or bandage. Hold the pressure continuously for 20 to 30 minutes. Don’t keep checking to see if the bleeding has stopped because this may damage or dislodge the fresh clot that’s forming and cause bleeding to resume. If the blood spurts or continues to flow after continuous pressure, seek medical assistance.
2. Clean the wound. Rinse out the wound with clear water. Soap can irritate the wound, so try to keep it out of the actual wound. If dirt or debris remains in the wound after washing, use tweezers cleaned with alcohol to remove the particles. If debris remains embedded in the wound after cleaning, see your doctor. Thorough wound cleaning reduces the risk of infection and tetanus. To clean the area around the wound, use soap and a washcloth. There’s no need to use hydrogen peroxide, iodine or an iodine-containing cleanser.
3. Apply an antibiotic. After you clean the wound, apply a thin layer of an antibiotic cream or ointment such as Neosporin or Polysporin to help keep the surface moist. The products don’t make the wound heal faster, but they can discourage infection and allow your body’s healing process to close the wound more efficiently. Certain ingredients in some ointments can cause a mild rash in some people. If a rash appears, stop using the ointment.
4. Cover the wound. Bandages can help keep the wound clean and keep harmful bacteria out. After the wound has healed enough to make infection unlikely, exposure to the air will speed wound healing.
5. Change the dressing. Change the dressing at least daily or whenever it becomes wet or dirty. If you’re allergic to the adhesive used in most bandages, switch to adhesive-free dressings or sterile gauze held in place with paper tape, gauze roll or a loosely applied elastic bandage. These supplies generally are available at pharmacies.
6. Get stitches for deep wounds. A wound that is more than 1/4 inch (6 millimeters) deep or is gaping or jagged edged and has fat or muscle protruding usually requires stitches. A strip or two of surgical tape may hold a minor cut together, but if you can’t easily close the mouth of the wound, see your doctor as soon as possible. Proper closure within a few hours reduces the risk of infection.
7. Watch for signs of infection. See your doctor if the wound isn’t healing or you notice any redness, increasing pain, drainage, warmth or swelling.
8. Get a tetanus shot. Doctors recommend you get a tetanus shot every 10 years. If your wound is deep or dirty and your last shot was more than five years ago, your doctor may recommend a tetanus shot booster. Get the booster within 48 hours of the injury.

Dislocations are common injuries in contact sports, such as football and hockey, and in sports that may involve falls, such as downhill skiing and volleyball. Dislocations may occur in major joints, such as your shoulder, hip, knee, elbow or ankle or in smaller joints, such as your finger, thumb or toe.

The injury will temporarily deform and immobilize your joint and may result in sudden and severe pain and swelling. A dislocation requires prompt medical attention to return your bones to their proper positions.

If you believe you have dislocated a joint:

1. Don’t delay medical care. Get medical help immediately.
2. Don’t move the joint. Until you receive help, splint the affected joint into its fixed position. Don’t try to move a dislocated joint or force it back into place. This can damage the joint and its surrounding muscles, ligaments, nerves or blood vessels.
3. Put ice on the injured joint. This can help reduce swelling by controlling internal bleeding and the buildup of fluids in and around the injured joint.

• The person is unresponsive, isn’t breathing or isn’t moving. Begin cardiopulmonary resuscitation (CPR) if there’s no respiration or heartbeat.
• There is heavy bleeding.
• Even gentle pressure or movement causes pain.
• The limb or joint appears deformed.
• The bone has pierced the skin.
• The extremity of the injured arm or leg, such as a toe or finger, is numb or bluish at the tip.
• You suspect a bone is broken in the neck, head or back.
• You suspect a bone is broken in the hip, pelvis or upper leg (for example, the leg and foot turn outward abnormally).

Take these actions immediately while waiting for medical help:

• Stop any bleeding. Apply pressure to the wound with a sterile bandage, a clean cloth or a clean piece of clothing.
• Immobilize the injured area. Don’t try to realign the bone, but if you’ve been trained in how to splint and professional help isn’t readily available, apply a splint to the area.
• Apply ice packs to limit swelling and help relieve pain until emergency personnel arrive. Don’t apply ice directly to the skin — wrap the ice in a towel, piece of cloth or some other material.
• Treat for shock. If the person feels faint or is breathing in short, rapid breaths, lay the person down with the head slightly lower than the trunk and, if possible, elevate the legs.