First Aid – Page 4

• There’s evidence of a head injury with an ongoing change in the person’s level of consciousness.
• The person complains of severe pain in his or her neck or back.
• The person won’t move his or her neck.
• An injury has exerted substantial force on the back or head.
• The person complains of weakness, numbness or paralysis or lacks control of his or her limbs, bladder or bowel.
• The neck or back is twisted or positioned oddly.

If you suspect someone has a spinal injury:

• Dial 911 or call for emergency medical assistance.
• Keep the person still. Place heavy towels on both sides of the neck or hold the head and neck to prevent movement. The goal of first aid for a spinal injury is to keep the person in much the same position as he or she was found.
• Provide as much first aid as possible without moving the person’s head or neck. If the person shows no signs of circulation (breathing, coughing or movement), begin CPR, but do not tilt the head back to open the airway. Use your fingers to gently grasp the jaw and lift it forward.
• If you absolutely must roll the person because he or she is vomiting, choking on blood or in danger of further injury, use at least two people. Work together to keep the person’s head, neck and back aligned while rolling the person onto one side.

Fainting can have no medical significance, or the cause can be a serious disorder. Therefore, treat loss of consciousness as a medical emergency until the signs and symptoms are relieved and the cause is known.

If you feel faint:

• Lie down or sit down.
• If you sit down, place your head between your knees.

Discuss recurrent fainting spells with your doctor.

If someone else faints:

1. Position the person on his or her back. Elevate the legs above heart level — about 12 inches (30 centimeters), if possible.
2. Check the person’s airway to be sure it’s clear. Watch for vomiting.
3. Check for signs of circulation (breathing, coughing or movement). If absent, begin CPR. Call 911 or your local emergency number. Continue CPR until help arrives or the person responds and begins to breathe.
4. Help restore blood flow. If the person is breathing, restore blood flow to the brain by raising the person’s legs above the level of the head. Loosen belts, collars or other constrictive clothing. The person should revive quickly. If the person doesn’t regain consciousness within one minute, dial 911 or call for emergency medical assistance.

If the person was injured in a fall associated with a faint, treat any bumps, bruises or cuts appropriately. Control bleeding with direct pressure.

For very young children and infants, even slightly elevated temperatures may indicate a serious infection. In newborns, a subnormal temperature — rather than a fever — also may be a sign of serious illness.

Don’t treat fevers below 102 F (38.9 C) with any medications unless advised to do so by your doctor. If you have a fever of 102 F (38.9 C) or higher, your doctor may suggest taking an over-the-counter medication, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others). Adults may also use aspirin. But don’t give aspirin to children. It may trigger a rare, but potentially fatal, disorder known as Reye’s syndrome. Also, don’t give ibuprofen to infants younger than 6 months of age.

How to take a temperature
You can choose from several types of thermometers. Today most have digital readouts. Some take the temperature quickly from the ear canal and can be especially useful for young children and older adults. Other thermometers can be used rectally, orally or under the arm. If you use a digital thermometer, be sure to read the instructions so you know what the beeps mean and when to read the thermometer. Under normal circumstances, temperatures tend to be highest around 4 p.m. and lowest around 4 a.m.

Because of the potential for mercury exposure or ingestion, glass mercury thermometers have been phased out and are no longer recommended.

Rectally (for infants)
To take your child’s temperature rectally:

• Place a dab of petroleum jelly or other lubricant on the bulb.
• Lay your child on his or her stomach.
• Carefully insert the bulb one-half inch to one inch into the rectum.
• Hold the bulb and child still for three minutes. To avoid injury, don’t let go of the thermometer while it’s inside your child.
• Remove and read the temperature as recommended by the manufacturer.
• A rectal temperature reading is generally 1 degree F (about 0.5 degree C) higher than a simultaneously taken oral reading.

Taking a rectal temperature is also an option for older adults when taking an oral temperature is not possible.

Orally
To take your temperature orally:

• Place the bulb under your tongue.
• Close your mouth for the recommended amount of time, usually three minutes.

Under the arm (axillary)
Although it’s not the most accurate way to take a temperature, you can also use an oral thermometer for an armpit reading:

• Place the thermometer under your arm with your arm down.
• Hold your arms across your chest.
• Wait five minutes or as recommended by your thermometer’s manufacturer. Then remove the thermometer and read the temperature.
• An axillary reading is generally 1 degree F (about 0.5 degree C) less than an oral reading.

To take your child’s axillary temperature, sit your child in your lap with your child facing to the side. Place the thermometer under your child’s near arm, which should be against your chest.

Get medical help for a fever in these cases:

• If a baby is younger than 3 months of age and has a rectal temperature of 100.4 F (38 C) or higher. Even if your baby doesn’t have other signs or symptoms, call your doctor just to be safe.
• If a baby is older than 3 months of age and has a temperature of 102 F (38.9 C) or higher.
• If a newborn has a lower than normal temperature — less than 97 F (36.1 C) rectally.
• If a child younger than age 2 has a fever for more than one day, or a child age 2 or older has a fever for more than three days. If your child has a fever after being left in a very hot car, seek medical care immediately.
• If an adult has a temperature of more than 103 F (39.4 C) or has had a fever for more than three days.

Call your doctor immediately if any of these signs or symptoms accompanies a fever:

• A severe headache
• Severe swelling of the throat
• Unusual skin rash
• Unusual eye sensitivity to bright light
• A stiff neck and pain when the head is bent forward
• Mental confusion
• Persistent vomiting
• Difficulty breathing or chest pain
• Extreme listlessness or irritability
• Abdominal pain or pain when urinating
• Any other unexplained symptoms

When reporting a fever to your doctor, don’t attempt to convert from a rectal reading to an oral reading. It’s simpler to just report what the reading was and how you took it.

You may escape motion sickness by planning ahead. If you’re traveling, reserve seats where motion is felt least:

• By ship, request a cabin in the front or middle of the ship, or on the upper deck.
• By plane, ask for a seat over the front edge of a wing. Once aboard, direct the air vent flow to your face.
• By train, take a seat near the front and next to a window. Face forward.
• By automobile, drive or sit in the front passenger’s seat.

If you’re susceptible to motion sickness:

• Focus on the horizon or on a distant, stationary object. Don’t read.
• Keep your head still, while resting against a seat back.
• Don’t smoke or sit near smokers.
• Avoid spicy and greasy foods and alcohol. Don’t overeat.
• Take an over-the-counter antihistamine, such as meclizine (Antivert, Bonine), or one containing dimenhydrinate (Dramamine) at least 30 to 60 minutes before you travel. Expect drowsiness as a side effect.
• Consider scopolamine (Transderm Scop), available in a prescription adhesive patch. Several hours before you plan to travel, apply the patch behind your ear for 72-hour protection. Talk to your doctor before using the medication if you have health problems, such as asthma, glaucoma or urine retention.
• Eat dry crackers or drink a carbonated beverage to help settle your stomach if you become ill.

Wet or inadequate clothing, falling into cold water, and even having an uncovered head during cold weather can all increase your chances of hypothermia.

Hypothermia is defined as an internal body temperature less than 95 F (35 C). Signs and symptoms include:

• Shivering
• Slurred speech
• Abnormally slow breathing
• Cold, pale skin
• Loss of coordination
• Fatigue, lethargy or apathy
• Confusion or memory loss

Signs and symptoms usually develop slowly. People with hypothermia typically experience gradual loss of mental acuity and physical ability, so they may be unaware that they need emergency medical treatment.

Older adults, infants, young children and people who are very lean are at particular risk. Other people at higher risk of hypothermia include those whose judgment may be impaired by mental illness or Alzheimer’s disease and people who are intoxicated, homeless or caught in cold weather because their vehicles have broken down. Other conditions that may predispose people to hypothermia are malnutrition, cardiovascular disease and an underactive thyroid (hypothyroidism).

To care for someone with hypothermia:

1. Dial 911 or call for emergency medical assistance. While waiting for help to arrive, monitor the person’s breathing. If breathing stops or seems dangerously slow or shallow, begin cardiopulmonary resuscitation (CPR) immediately.
2. Move the person out of the cold. If going indoors isn’t possible, protect the person from the wind, cover his or her head, and insulate his or her body from the cold ground.
3. Remove wet clothing. Replace wet things with a warm, dry covering.
4. Don’t apply direct heat. Don’t use hot water, a heating pad or a heating lamp to warm the victim. Instead, apply warm compresses to the neck, chest wall and groin. Don’t attempt to warm the arms and legs. Heat applied to the arms and legs forces cold blood back toward the heart, lungs and brain, causing the core body temperature to drop. This can be fatal.
5. Don’t give the person alcohol. Offer warm nonalcoholic drinks, unless the person is vomiting.
6. Don’t massage or rub the person. Handle people with hypothermia gently, because they’re at risk of cardiac arrest.