First Aid
(CONTUSIONS & ECCHYMOSES) What is a bruise? You fall off your bike, bang your shin on the coffee table (that you swore you would move months ago) or run into a wall and wake up with a wallop of a bruise. What is a bruise and what can you do about it? A bruise, or contusion, is caused when blood vessels are damaged or broken as the result of a blow to the skin (be it bumping against something or hitting yourself with a hammer). The raised area of a bump or bruise results from blood leaking from these injured blood vessels into the tissues as well as from the body's response to the injury. A purplish, flat bruise that occurs when blood leaks out into the top layers of skin is referred to as an ecchymosis. Why do bruises occur more frequently in some people than in others? The injury required to produce a bruise varies with age. While it may take quite a bit of force to cause a bruise in a young child, even minor bumps and scrapes may cause extensive bruising or ecchymosis in an elderly person. Blood vessels become more fragile as we age and bruising may even occur without prior injury in the elderly. The amount of bruising may also be affected by medications which interfere with blood clotting (and thus cause more bleeding into the skin or tissues). These drugs include many prescription arthritis medications called non-steroidal anti-inflammatories (e.g. ibuprofen/ADVIL, NUPRIN and naproxen/ALEVE ) as well as over-the-counter medications, such as aspirin. Warfarin (COUMADIN) is often prescribed by doctors specifically to prevent clotting in patients who have had blood clots in their legs or heart. Warfarin can cause particularly severe bruising, especially if the level of the medication becomes too high. Cortisone medications, such as prednisone, promote bruising by increasing the fragility of the tiny blood vessels in the skin. In addition, patients with inherited clotting problems (such as in hemophilia) or acquired clotting problems (such as in patients with liver diseases like cirrhosis), can develop extensive bruising or even life-threatening bleeding. What does a bruise look like and why does it change color? Bruises follow a predictable pattern and it is possible to tell by looking at a bruise how old it is. When it first appears, a bruise will be reddish looking, reflecting the color of the blood in the skin. By 1-2 days, the reddish iron from the blood undergoes a change and the bruise will appear blue or purple. By day 6, the color changes to green and at day 8-9, the bruise will appear yellowish-brown. In general, the body will repair the bruised area in 2-3 weeks after which the skin will return to normal. What if the bruise doesn't get better or the area stays swollen? On occasion, instead of going away, the area of a bruise will become firm and may actually start increasing in size. It may also continue to be painful. There are two major causes for this. First, if a large collection of blood is formed under the skin or in the muscle, instead of trying to clean up the area, the body may wall the blood off causing what is called a hematoma. A hematoma is nothing more than a small pool of blood that is walled off. This may need to be drained by your health care practitioner. A second and much less common problem occurs when the body deposits calcium, the material that makes up the majority of bone, in the area of injury. The area becomes tender and firm. This process is called heterotopic ossification or myositis ossificans. This condition is diagnosed by x-ray and requires a trip to your health care practitioner. What are some less common causes of bruising and what do they indicate? The terminology describing different types of bruising often refers to not only their appearance, but also to their cause. Petechiae refer to very small, one to three millimeters, accumulations of blood beneath the skin. These can appear like multiple tiny red dots on any part of the body (most commonly the legs). Most often these are multiple and they can suggest that there is serious health problem present. Examples of these are an infection of the valves of the heart (endocarditis) or abnormal function of the blood clotting elements (platelets). Bruising around the navel (belly button) can be a result of bleeding within the abdomen. Bruising behind the ear (Battle's sign) can indicate that there is a skull fracture. Lastly, bruises that are raised, firm, multiple and occur without any injury can be a sign of various types of "autoimmune" diseases (diseases in which the body attacks its own blood vessels). Your health care practitioner should evaluate these. What is the treatment for bruising? There are a couple of things that you can do to prevent or minimize bruising after an injury. First, try a cold compress. Put ice in a plastic bag, wrap the bag in a towel (applying the ice directly to the skin can cause frostbite), and place it on the injured area. Commercial ice packs are also available, but a bag of frozen peas makes an excellent substitute. It molds to the shape of the injured area and can then be re-frozen and used again (but don't eat them!!). The cold reduces the blood flow to the area and therefore limits bleeding into the skin and reduces the size of the bruise. The cold also decreases the inflammation in the area of the injury and limits swelling in this way as well. If possible, elevate the area above the level of the heart. The lower an extremity is below the heart, the more blood will flow to the area and increase the bleeding and swelling. Avoid taking the medications listed above that can contribute to bruising. If you have any questions about whether or not your medication can contribute to bruising, ask your health care practitioner or pharmacists. Do not stop any prescription medications without first contacting your health care practitioner. Finally, pressure applied to the area (by hand, not with tourniquets) can reduce bleeding. People who take medicines that reduce clotting ("blood thinners") or have clotting abnormalities should seek the advice of a physician or other health care provider immediately, as should the elderly or those who have experienced significantly severe trauma. CUTS, SCRAPES & PUNCTURE WOUNDS
What is the best way to care for a cut or scrape? The most important first step is to thoroughly clean the wound with soap and water being careful to remove any foreign material, such as dirt or bits of grass, that might be in the wound and which can lead to infection. The area should then be kept clean and dry. Covering the area with a bandage (such as gauze or a band-aid) helps prevent infection and dirt from getting in the wound. A first aid ointment, such as BACITRACIN, can be applied to help prevent infection. Generally, however, these products are best avoided on the hands and feet beyond the first day because they can delay healing in these areas. Continued care to the wound is also important. Washing the area gently with soap and water daily without scrubbing is best as the wound heals. Avoid putting products such as hydrogen peroxide, alcohol, or iodine solutions in the wound. This only delay wound healing and does not do anything to prevent infection. Who should seek medical care for a cut? People who have diabetes, other long-term illnesses such as cancer, or are taking drugs that suppress the immune system such as steroids (cortisone medications like prednisone and prednisolone) or chemotherapy, are more likely to develop a wound infection and should be seen by a health care professional. Any cut that goes beyond the top layer of skin that might need stitches (sutures) should be seen by a health care professional. Generally, the sooner sutures are put in, the lower the risk of infection. Therefore, any cut that might need suturing should be seen as soon as possible. What are the signs of a wound infection? If the wound begins to drain greenish fluid (pus) or if the skin around the wound becomes red, warm, swollen, or increasingly painful, a wound infection may be present and medical care should be sought. Any red streaking of the skin around the wound may indicate an infection in the system that drains fluid from the tissues called the lymph system. This infection (lymphangitis) can be serious, especially if it is accompanied by a fever. Prompt medical care should be sought if streaking redness from a wound is noticed. How are puncture wounds different? There are two risks with puncture wounds. First, a wound infection can occur because of dirt pushed deep into the skin by the object (typically a nail) puncturing the tissue. As you can imagine, these wounds are very difficult to clean out. The second problem that can occur is an infection of the bone. If a nail penetrates deep into the foot, it can hit a bone and introduce bacteria into the bone. This risk is especially great if the nail has gone through a pair of tennis shoes. The foam in tennis shoes can harbor bacteria (Pseudomonas) that can lead to serious infection in the tissues. First aid for puncture wounds includes cleaning the area well and keeping the foot elevated for several days (depending on the severity of the puncture wound). Especially if the puncture wound occurred through tennis shoes, an evaluation by a healthcare professional should be sought. Additionally, diabetics, the elderly, those persons taking drugs that can suppress the immune system (such as cortisone-related medications), or any particularly deep puncture wound should be seen by a healthcare professional. This is particularly true if it was difficult to remove the nail, indicating that it may have penetrated the bone. Most puncture wounds do not become infected, but if redness and swelling persist, see your health care professional. Puncture wounds commonly occur when someone steps on a nail. It is a good idea to wear shoes to minimize the risk of a puncture wound, especially if you have diabetes or loss of sensation in the feet for any reason. Will I need a tetanus shot? Most people in the United States have been immunized against tetanus (lockjaw). If you have been immunized, you will need a booster shot if you have not had one in over five years. If you have never had a tetanus shot, or if your series is incomplete (fewer than 3 shots), you might need tetanus immunoglobulin, a medication that can prevent lockjaw. For more information about CUTS, SCRAPES & PUNCTURE WOUNDS, please visit the following sites: You’re Family Disaster Supplies Kit The information below is modified from that furnished by the Federal Emergency Management Agency (FEMA) of the United States government. Why a Family Disaster Supplies Kit? After a disaster, local officials and relief workers will be on the scene, but they cannot reach everyone immediately. You could get help in hours, or it may take days. Would your family be prepared to cope with the emergency until help arrives? Your family will cope best by preparing for disaster before it strikes. One way to prepare is by assembling a Disaster Supplies Kit. Once disaster hits, you won't have time to shop or search for supplies. But if you've gathered supplies in advance, your family can endure an evacuation or home confinement. Obviously, the types of disaster emergencies and conditions you and/or your family might encounter vary depending on your geographic location. Please consult your personal physician for further recommendations. How do I prepare my kit? Review the checklists in this document. Gather the supplies that are listed. You may need them if your family is confined at home. Place the supplies you'd most likely need for an evacuation in an easy- to-carry container. These supplies are listed with an asterisk (*). Remember that disasters happen anytime and anywhere. And when disaster strikes, you may not have much time to respond. A highway spill of hazardous material could mean instant evacuation. A winter storm could confine your family at home. An earthquake, flood, tornado or any other disaster could cut off basic services--gas, water, electricity and telephones--for days. WATER Store water in plastic containers such as soft drink bottles. Avoid using containers that will decompose or break, such as milk cartons or glass bottles. A normally active person needs to drink at least two quarts of water each day. Hot environments and intense physical activity can double that amount. Children, nursing mothers and ill people will need more. Store one gallon of water per person per day (two quarts for drinking, two quarts for food preparation/sanitation)* Keep at least a three-day supply of water for each person in your household. FOOD Store at least a three-day supply of non-perishable food. Select foods that require no refrigeration, preparation or cooking and little or no water. If you must heat food, pack a can of sterno. Select food items that are compact and lightweight. *Include a selection of the following foods in your Disaster Supplies Kit:
FIRST AID KIT Assemble a first aid kit for your home and one for each car. A first aid kit* should include:
NON-PRESCRIPTION DRUGS
Contact your local American Red Cross chapter to obtain a basic first aid manual. TOOLS & SUPPLIES There are six basics you should stock in your home: water, food, first aid supplies, clothing and bedding, tools and emergency supplies and special items. Keep the items that you would most likely need during an evacuation in an easy-to-carry container--suggested items are marked with an asterisk (*). Possible containers include a large, covered trash container; a camping backpack; or a duffle bag.
SANITATION
CLOTHING & BEDDING * Include at least one complete change of clothing and footwear per person.
SPECIAL ITEMS Remember family members with special needs, such as infants and elderly or disabled persons. For Baby*:
For Adults*:
IMPORTANT DOCUMENTS Keep these records in a waterproof, portable container:
SUGGESTIONS AND REMINDERS
CREATE A FAMILY DISASTER PLAN To get started...
Meet with your family.
Complete these steps.
Meet with your neighbors.
Remember to practice and maintain your plan.
Or write to: FEMA
Washington, D.C. 20024 FEMA L- 189 ARC 4463 EMERGENCY INFORMATION
Much of the information below was modified from that furnished by the Federal Emergency Management Agency -- FEMA -- an independent agency of the United States federal government. While this information is addresses the U.S. population, its message pertains to communities at risk of flooding worldwide.
What is a flood? Floods are the most common and widespread of all natural disasters--except fire. Most communities in the United States can experience some kind of flooding after spring rains, heavy thunderstorms, or winter snow thaws. Floods can be slow, or fast rising but generally develop over a period of days. Dam failures are potentially the worst flood events. A dam failure is usually the result of neglect, poor design, or structural damage caused by a major event such as an earthquake. When a dam fails, a gigantic quantity of water is suddenly let loose downstream, destroying anything in its path. Floodwaters can be extremely dangerous. The force of six inches of swiftly moving water can knock people off their feet. The best protection during a flood is to leave the area and go to shelter on higher ground. Cars can be easily been swept away in just 2 feet of moving water. If floodwaters rise around a car, it should be abandoned. Passengers should climb to higher ground.
What is a flash flood? Flash floods usually result from intense storms dropping large amounts of rain within a brief period. Flash floods occur with little or no warning and can reach full peak in only a few minutes. Flash flood waters move at very fast speeds and can roll boulders, tear out trees, destroy buildings, and obliterate bridges. Walls of water can reach heights of 10 to 20 feet and generally are accompanied by a deadly cargo of debris. The best response to any signs of flash flooding is to move immediately and quickly to higher ground.
What areas are the danger zones? Floods and flash floods occur within all 50 states in the U.S. Communities particularly at risk are those located in low-lying areas, near water, or downstream from a dam. Did you know? Individuals and business owners in the U.S. can protect themselves from flood losses by purchasing flood insurance through National Flood Insurance Program. Homeowner's policies do not cover flood damage. Information is available through local insurance agents and emergency management offices. Flooding has caused the deaths of more than 10,000 people since 1900. Property damage from flooding now totals over $1 billion each year in the United States. More than 2,200 lives were lost as a result of the Johnstown, Pennsylvania flood of 1889. This flood was caused by an upstream dam failure. Nearly 9 of every 10 presidential disaster declarations result from natural phenomena in which flooding was a major component. On July 31, 1976, the Big Thompson River near Denver overflowed after an extremely heavy storm. A wall of water 19 feet high roared down the Big Thompson Canyon where many people were camping. 140 people perished and millions of dollars of property were lost. How can I help my community prepare for a flood disaster? The local media can raise awareness about floods and flash floods by providing important information to the community. Here are some suggestions: 1.) Publish a special section in your local newspaper with emergency information on floods and flash floods. Localize the information by printing the phone numbers of local emergency service offices, the American Red Cross, and hospitals. 2.) Interview local officials about land use management and building codes in flood plains. 3.) Work with local emergency services and agencies, such as the American Red Cross to prepare special reports for people with mobility impairments on what to do if an evacuation is ordered. 4.) Periodically inform your community of local public warning systems. How can I prepare for possible flooding? Mitigation pays. It includes any activities that prevent an emergency, reduce the chance of an emergency happening, or lessen the damaging effects of unavoidable emergencies. Investing in mitigation steps now such as constructing barriers such as levees and purchasing flood insurance will help reduce the amount of structural damage to your home and financial loss from building and crop damage should a flood or flash flood occur. BEFORE:
DURING A FLOOD WATCH:
DURING A FLOOD: If Indoors: Turn on battery-operated radio or television to get the latest emergency information. Get your preassembled emergency supplies. If told to leave, do so immediately.
If Outdoors: Climb to high ground and stay there. Avoid walking through any floodwaters. If it is moving swiftly, even water 6inches deep can sweep you off your feet.
If In A Car: If you come to a flooded area, turn around and go another way. If your car stalls, abandon it immediately and climb to higher ground. Many deaths have resulted from attempts to move stalled vehicles.
DURING AN EVACUATION: If advised to evacuate, do so immediately. Evacuation is much simpler and safer before floodwaters become too deep for ordinary vehicles to drive through. Listen to a batter-operated radio for evacuation instructions. Follow recommended evacuation routes--shortcuts may be blocked. Leave early enough to avoid being marooned by flooded roads.
AFTER A FLOOD:
INSPECTING UTILITIES IN A DAMAGED HOME:
HOW THE PUBLIC CAN HELP AFTER A DISASTER:
For more information about DISASTER AID, please visit the following sites: (BEE STINGS, WASP STINGS, OTHERS)
What are stinging insects? The majority of stinging insects in the United States are from Bees, Yellow Jackets, Hornets, Wasps and Fire Ants. Except for fire ants all of these insects are found throughout the United States. Fire ants are at this time found only in the southeastern United States.
Who is at risk? Over 2 million Americans are allergic to stinging insects. The degree of allergy varies widely. Most people are not allergic to insect stings and most insect stings result in only local itching and swelling. Many, however, will have severe allergic reactions. 50 to 150 deaths occur each year from these stings and up to a million hospital visits result form insect stings. If you are known to be allergic to insect stings, then the next sting is 60% likely to be similar or worse than the previous sting. Since most stings occurring in the summer and fall, you are at greatest risk during these months.
What types of insect sting reactions occur? Most insect sting reactions are not allergic and result in local pain, swelling and redness at the site of the sting. Some extension of the swelling is expected. Local treatment is usually all that is needed for this type of reaction. Disinfect the area, keep clean and apply ice. If the swelling increases antihistamines and possibly steroids may be needed. Occasionally, the site will become infected and antibiotics are needed. Large local non-allergic reactions (occurring 10% of the time) are often alarming and can persist for days. This is usually not a cause for concern and is best treated as above. The most serious reaction is the allergic reaction. The allergic reaction to insect sting varies from person to person. The most serious is called anaphylaxis and as indicated above can be fatal. Severe reactions are suspected if a person experiences hives and intense itching at sites other than the sting site. Difficulty breathing, swallowing, hoarseness, swelling of the tongue, dizziness and fainting are signs of a severe allergic reaction. These types of reactions usually occur within minutes of the sting, but have been known to be delayed for up to 24 hours. Prompt treatment is essential and emergency help is often needed.
How is a severe allergic reaction immediately treated? Honeybee’s stingers are barbed stingers, which are left behind in the person's skin and then the bee dies- a bee sacrifice! If the stinger is removed by pinching the stinger, more venom is injected into the skin. It is better to remove the stinger by gently lifting the stinger using a finger nail or knife-edge to 'flick' the stinger out of the skin. Other stinging insects do not leave stingers behind and this technique does not apply. An allergic reaction is treated with epinephrine (adrenaline). Several self-injectable devices are available by prescription including EPI PEN, ANA KIT, and others. These devices are filled with the epinephrine to be injected in to the subcutaneous tissue or muscle, preferably into the front of the thigh. These self-injected devices usually contain only one dose and, on occasion, more than one dose is needed. If a serious sting occurs medical attention is always needed even if you used the epinephrine and all seem stable. If epinephrine is not available contact with a doctor is needed. If you are known to be seriously allergic to insects you must remember to carry the epinephrine at all times especially when out of reach of medical care, such as in the woods or even on an airplane. At the same time as using epinephrine an oral dose of antihistamine (like BENADRYL) is taken which will take effect in about one hour. Sometimes epinephrine is not enough and intravenous fluids or other treatment is needed. As you can see one the key here is to first avoid the sting so such treatment isn't necessary.
How can I avoid insect stings? Obviously the best treatment is avoiding the insect sting. Certain precautionary measures will greatly decrease your chances of being stung. Honeybees are not aggressive and will usually not sting unless disturbed or injured. The majority of honeybee stings are one the bottom of the bare foot while stepping on the bee. Avoid walking bare foot on lawns where honey bees forage on succulent clover. Yellow jackets nest in the ground and in walls. Caution is used with unusual forms in walls and mound in the ground. Hornets and wasps often nest in bushes, trees and under roofs. Use caution too in these areas and in selecting employment-requiring exposure to these conditions. Bright colors attract insects seeking nectar. Stinging insects are attracted to food and strong smells. Avoid open food as in garbage cans, dumps and open picnic areas. Do not ware perfumes, hair sprays, and colognes. It is interesting that bees find black color very irritating and blue is comforting to them. Remember this when selecting your summer bathing attire. If you think that insect repellent of any kind is effective in repelling these stinging insect you are mistaken and in fact may attract them. Please do no use except for reasons other than to avoid stinging insects.
What can I do about becoming immune to insect allergy? All persons who have had a significant reaction to a stinging insect should be evaluated by an allergy specialist for possible venom immunotherapy (allergy shots that develop an immunity to insect allergy). If indicated by a well-recognized protocol, selected patients with significant sensitivity and specific symptoms should undergo allergy injection therapy for stinging insect allergy. Not all patients who have stinging insect reactions should get allergy shots, but many should. Allergy immunotherapy against stinging insects in these selected patients is almost 100% effective. This type of treatment usually involves gradual twice-weekly increase in the venom dose over 10-20 weeks. At this dosage level (achieved by 90% of patients) a "maintenance" dosage every 4-8 weeks is given. After approximately 5 years reevaluation discontinuation of the venom shot is considered. The risk of severe adverse reactions from this venom therapy is minimal (less than 0.2%) and to date no deaths have been reported. Knowledge in the field of stinging insect allergy has expanded greatly in the last 10 years and will likely continue to do so. What are the categories of burns? The treatment of burns depends on the depth, area and location of the burn. Burn depth is generally categorized as first, second or third degree. A first-degree burn is superficial and has similar characteristics to a typical sunburn. The skin is red in color and sensation is intact. In fact, it is usually somewhat painful. Second-degree burns look similar to the first-degree burns; however, the damage is now severe enough to cause blistering of the skin and the pain is usually somewhat more intense. In third degree burns the damage has progressed to the point of skin death. The skin is white and without sensation. Regardless of the type of burn, the result is fluid accumulation and inflammation in and around the wound. Moreover, it should be noted that the skin is the body's first defense against infection by microorganisms. Damage to the skin can predispose the burn victim to both infections at the site of the wound as well as internally.
What is the significance of the total body area affected? In addition to the intensity, the total area of the burn is significant. This is usually measured in terms of percent of total body burnt. The skin acts as a barrier from the environment, and without it, patients are subject to infection and fluid loss. Burns that cover more than 15% of the total body surface can lead to shock and require hospitalization for intravenous fluid resuscitation and skin care.
How important is the location of a burn? Burn location is even more important than the above factors.
Burns of the neck or signs of burns to the nose or mouth require
emergent guarding of the patient's airway, as swelling may results
in life threatening obstruction. Burned tissue shrinks and can
cause damage to underlying structures. Burns that extend circumferentially
around body structures require surgical release of the tissue,
often referred to as escharotomy. Finally, all eye burns require
special attention as soon as possible. Burns to the eye may lead
to clouded or lost vision.
BURN FIRST AID TREATMENT 1. First remove any constricting jewelry, such as rings. 2. Do NOT use butter or oils on a burn. 3. The effected area should be dowsed with cool water as soon as possible. It can be cleansed gently with chlorhexidine solution. Do NOT apply ice or cool to near-freezing temperatures (this can cause additional tissue injury). 4. A tetanus booster should be obtained if not administered within the previous 5 years. First degree thermal burns can be treated with local skin care such as aloe vera. Many topical antibiotics and antiseptics are available in the drug store for minor burns. All second and third degree thermal burns and the complicated locations listed above need immediate physician evaluation. Special topical antiseptic creams are used for more serious burns, including silver sulfdiazine, silver nitrate, and mafenide acetate creams. Burns can be caused by heat (thermal), as well as by electricity, and chemicals.
What about electrical burns? Any significant burn resulting from electricity requires immediate physician evaluation. These burns often result in serious muscle breakdown, electrolyte abnormalities, and occasionally kidney failure. The actual site of damage can be internal and may not be visible on the skin surface.
What about chemical burns? The treatment for chemical burns is similar to thermal burns except copious amounts of water should be used to irrigate the effected region. Contaminated clothing should be removed. Do NOT attempt to neutralize the burn with a reciprocal chemical. This may cause a chemical reaction that could result in a thermal burn too! Many chemicals have, in addition, specific treatments that can further reduce the resulting skin damage. If in doubt, call your local poison control center or make a quick trip to your local Emergency Room.
Trauma to the face or teeth can result from auto accidents, falls, and injury from sports such as football, hockey, soccer, volleyball, basketball, and baseball, etc. Patients suffering significant head, neck or facial trauma should be evaluated and treated in hospital emergency rooms. Such trauma may involve bleeding from the nose or ears, concussion, dizziness, lapse of memory, disorientation, severe headache and earache, or breaking (fracture) of the skull and/or jaws. Most hospitals have on their staff oral surgeons who can treat fractures of the upper or lower jaw and perform emergency tooth removal (dental extractions) and reconstruction of the dental arches. Wear and tear of cavities and chewing hard objects such as pencils, ice cubes, nuts, and hard candies, can also lead to tooth fractures. Dental accidents without associated head and neck trauma can be evaluated and treated in a dental office. Such dental injuries include broken (fractured) teeth, teeth totally knocked out of the mouth, or teeth displaced by unexpected external forces. These dental accidents may be associated with swelling of the gum and oral tissue. Cold packs or ice cubes placed either inside the mouth directly above the injured tooth, or outside on the cheeks or lips, can reduce pain and swelling before the patient reaches the dentist. TOOTH FRACTURES (CHIPPED OR BROKEN TEETH) Tooth fractures can range from minor (involving chipping of the outer tooth layers called enamel and dentin) to severe (involving vertical, diagonal or horizontal fractures of the root). Enamel and dentin are the two outer protective layers of the tooth. The enamel is the outermost white hard surface. The dentin is a yellow layer lying just beneath the enamel. Enamel and dentin both serve to protect the inner living tooth tissue called the pulp. The visible 1/3 of the tooth is called the crown, while the remaining 2/3 of the tooth buried in the bone is called the root. Dental x-rays are necessary in most instances to diagnose, locate, and measure the extent of tooth fracture. CHIPPED TOOTH A minor tooth fracture involves chipping of the enamel only. The tooth is not displaced, and there is no bleeding from the gums. The only symptom of such minor chipping may be sharp or rough tooth edges irritating the cheek and tongue. The injured tooth itself may not even be painful or sensitive to food or temperature. The risk of pulp injury is small, and treatment is not urgent. A small amount of orthodontic wax or sugarless gum can be placed over the rough edge until the dentist can be reached. Definitive treatment usually involves placing a dental filling, porcelain or gold crown, or a "cap" to protect the pulp of the tooth and to restore normal tooth contour. FRACTURE OF ENAMEL & DENTIN A deeper fracture can involve both the enamel and the dentin of a tooth. The tooth is still not displaced and the gums are not bleeding. These deeper fractures may be sensitive to cold temperature or food. Prolonged exposure of dentin to oral bacteria can cause the death of the inner pulp tissue. Death of pulp tissue can lead to serious tooth infection and abscess. Therefore, fractures involving the dentin should be treated promptly (within days of the injury). Treatment involves placing an anesthetizing cream over the exposed dentin, followed by a dental filling, porcelain or gold crown, or a "cap" to protect the pulp of the tooth. A follow up x-ray in 3-6 months may be needed to be sure that the pulp has not died. If the fracture has already significantly injured the pulp, then treatment involves either extracting the dying tooth or performing a root canal procedure to prevent serious tooth infection. The root canal procedure is used to save the dying tooth from extraction. This procedure involves removing all the dying pulp tissue and replacing it with an inert material. SERIOUS TOOTH FRACTURE A serious fracture that exposes both the dentin and the pulp tissue should be treated promptly. The tooth may be displaced and loose, and the gums may bleed. To prevent the loose tooth from falling out completely, the dentist can splint the loose tooth by bonding it to the adjacent teeth to help stabilize it while the underlying bone and gums heal. Because of the high risk of pulp death, a root canal procedure is commonly performed during the first visit. Alternatively, the dentist may elect to only apply a anesthetizing dressing on the splinted tooth. The tooth will then be reevaluated in 2-4 weeks for root canal procedure followed by a dental filling or crown. The splint is also removed at that time. The most serious injuries involve vertical, diagonal or horizontal fractures of the tooth roots. In most instances, fracture of the tooth root leaves the injured tooth very loose, thus necessitating tooth extraction. The extracted tooth is replaced with a removable plate containing a false tooth. Rarely, certain teeth with horizontal fractures near the tip of the root may not need extraction. However, root canal treatment for the injured tooth may be required in the future if symptoms of pulp death and tooth infection appear. Therefore, periodic x-rays of the fractured tooth are performed. TEETH KNOCKED OUT The upper front permanent teeth are the most common teeth to be completely knocked out. Children with forward-protruding front teeth that have not had orthodontic treatment to bring them into alignment are at increased risk. Knocked out baby or primary teeth are usually not reimplanted in the mouth, since they will be naturally replaced by permanent teeth later. However, knocked out permanent teeth should be retrieved, kept moist and placed back into their sockets (reimplanted) as soon as possible. The most important variable affecting the success of reimplantation is the amount of time that the tooth is out of its socket. Teeth reimplanted within one hour of the accident frequently reattach to their teeth sockets. The knocked out tooth is rinsed in clean water or milk, and placed back (reimplanted) into the socket from which it came. This can be done by the patient or parent and then checked by the dentist. Care should be taken to handle the tooth only by its crown and not by its root. If the parent or patient is unsure about reimplanting the tooth, then the tooth should be stored in milk (if available) or in water and brought to the dentist as soon as possible. Alternatively, in older children and adults who are calm, the tooth may be held within the cheeks inside of the mouth while traveling to the dental office. After reimplanting the tooth into its original socket, the dentist can then splint this tooth to adjacent teeth for 2-8 weeks. Splinting helps to stabilize it while the bone around it heals. During the splinting period, the patient eats soft foods, avoids biting on the splinted teeth, and brushes all the other teeth diligently to keep the mouth as clean as possible. In adults, the reimplanted tooth should have a root canal procedure within 1-4 weeks. On the other hand, reimplanted permanent teeth in children (where the tooth root has not yet completely formed) may not need a root canal procedure. These teeth are observed for at least five years for symptoms of dying pulp, such as pain, discoloration, gum abscesses, or abscesses seen on an x-ray. In most patients who have had tooth reimplantation, over-the-counter medications like acetaminophen (TYLENOL) or ibuprofen (ADVIL) are sufficient for pain relief. Chlorhexidine (PERIDEX) mouth rinse may be prescribed to prevent and control gum inflammation (gingivitis), since the splinted teeth cannot be brushed normally and the splint usually collects extra dental plaque and food debris. Oral antibiotics and tetanus toxoid injections are considered for patients with accompanying significant soft tissue cuts (lacerations). TEETH DISPLACED Instead of being completely knocked out of the mouth, a tooth can be displaced. A displaced tooth may be pulled out and appear elongated, or be pushed in and appear shorter. A displaced tooth can also be pushed forward, backward, sideways, or rotated. While not an emergency, the sooner the dentist can splint or realign the tooth with orthodontic brackets and wires, the easier it can be brought back into proper alignment. Trauma significant enough to cause tooth displacement can also lead to pulp injury. Therefore, a displaced tooth should be evaluated periodically for several months to determine if a root canal procedure or tooth extraction is needed. PREVENTION Prevention of dental injuries involves aligning protruding front teeth by dental braces and using facemasks and mouthguards while participating in sports. Mouthguards have been shown to reduce trauma not only to teeth, gums, and the surrounding jawbone, but also to reduce injury to the temporomandibular joints (TMJ) and to reduce the intensity and number of head concussions. Mouthguards also reduce pressure and bone deformation of the skull when a force is directed to the chin. Before the mandatory use of facemasks and mouthguards for high school and college football players in l963, 50% of all football injuries involved the face and the mouth. Since the mandatory use of these protective devices, dental injuries in football players have almost been eliminated. It is now recommended that mouthguards be worn, not only for organized football, but also for unorganized football, baseball, basketball, racquetball, soccer, ice, field, and street hockey, wrestling, boxing, martial arts, volleyball, rollerblading, skating, skateboarding, and bicycling. Mouthguards can be purchased in pharmacies and sports supply stores and molded at home. They can also be custom made by the dentist. Store-bought mouthguards are less expensive than custom made ones. However, the store bought ones may not fit the athlete's mouth, may become loose, may be uncomfortably bulky, and may interfere with speech or breathing. The ideal mouthguards are custom made by a dentist. An impression is made of the athlete's upper dental arch to make a mold of his/her teeth and gums. A custom mouthguard made of a vinyl acetate ethylene copolymer (a special plastic) is then fabricated from this mold in the dental office or by a dental laboratory. A well-fitting custom mouthguard is comfortable and will not interfere with breathing and speech. EMERGENCY INFORMATION
Much of the information below was modified from that furnished by the Federal Emergency Management Agency -- FEMA -- an independent agency of the United States federal government. While this information is addresses the U.S. population, its message pertains to communities at risk of earthquakes worldwide.
What is an earthquake? An earthquake is a sudden, rapid shaking of the Earth caused by the breaking and shifting of rock beneath the Earth's surface. This shaking can cause buildings and bridges to collapse; disrupt gas, electric, and phone service; and sometimes trigger landslides, avalanches, flash floods, fires, and huge, destructive ocean waves (tsunamis). Buildings with foundations resting on unconsolidated landfill, old waterways, or other unstable soil are most at risk. Buildings or trailers and manufactured homes not tied to a reinforced foundation anchored to the ground are also at risk since they can be shaken off their mountings during an earthquake. Earthquakes can occur at any time of the year.
What are the danger zones for earthquakes? Earthquakes occur most frequently west of the Rocky Mountains, although historically the most violent earthquakes have occurred in the central United States. All 50 states and all U.S. territories are vulnerable to earthquakes. Forty-one states or territories are at moderate to high risk. The greatest immediate danger exists directly outside buildings, at exits, and alongside exterior walls. Many of the 120 fatalities from the 1933 Long Beach earthquake occurred when people ran outside of buildings only to be killed by falling debris from collapsing walls. Ground movement during an earthquake is seldom the direct cause of death or injury. Most earthquake-related casualties result from collapsing walls, flying glass, and falling objects. The best protection during an earthquake is to get under heavy furniture such as a desk, table, or bench.
Did you know…?
Earthquakes strike suddenly, violently and without warning. Identifying potential hazards ahead of time and advance planning can reduce the dangers of serious injury or loss of life from an earthquake.
How can I help my community be ready? The media can raise awareness about earthquakes by providing important information to the community. Here are some suggestions: 1.) Publish a special section in your local newspaper with emergency information on earthquakes. Localize the information by printing the phone numbers of local emergency services offices, the American Red Cross, and hospitals. 2.) Conduct a weeklong series on locating hazards in the home. 3.) Work with local emergency services and American Red Cross officials to prepare special reports for people with mobility impairments on what to do during an earthquake. 4.) Provide tips on conducting earthquake drills in the home. 5.) Interview representatives of the gas, electric, and water companies about shutting off utilities.
How can I be ready? BEFORE:
Check for hazards in the home:
Identify safe places in each room:
Locate safe places outdoors:
Have disaster supplies on hand:
Develop an emergency communication plan:
DURING: If indoors:
If outdoors:
If in a moving vehicle:
AFTER:
Be prepared for aftershocks:
Help injured or trapped persons:
General:
Pets after an Earthquake:
Inspecting utilities in a damaged home:
MITIGATION Mitigation includes any activities that prevent an emergency, reduce the chance of an emergency happening, or lessen the damaging effects of unavoidable emergencies. Investing in preventive mitigation steps now such as repairing deep plaster cracks in ceilings and foundations, anchoring overhead lighting fixtures to the ceiling and following local seismic building standards, will help reduce the impact of earthquakes in the future. For more information on mitigation, contact your local emergency management office.
How can the public help after a disaster? When disaster strikes, people everywhere want to help those in need. To ensure that this compassion and generosity are put to good use, the media can highlight these facts:
For more information about DISASTER AID, please visit the following sites: For information about CURRENT EARTHQUAKE ACTIVITY visit: http://quake.wr.usgs.gov/QUAKES/WEEKREPS/weekly.html FROSTBITE & OTHER COLD INJURIES
Winter cold and snow provide a number of opportunities to get outside and participate in activities such as skiing, sledding and snowmobiling. However, without proper protection, cold injuries, such as frostbite, can occur even when the temperature is above freezing (32 degrees F, 0 degrees C). This is especially true if there is a high wind or if a glove or sock gets wet. The information below describes these types of cold injuries as well as what to do to prevent and treat them prior to reaching a healthcare provider.
What type of injuries can be caused by the cold? Cold injuries are divided into two general groups: those that occur without any freezing of the body tissues and those that result from the freezing of the skin or a body part (generally the fingers, toes, ears or nose). Examples of cold injuries without tissue freezing include chilblains and "trench foot." Frostbite is a cold injury that is associated with tissue freezing. COLD INJURY WITHOUT TISSUE FREEZING CHILBLAINS: Chilblains is the most common type of cold injury and occurs when there is exposure of the affected area to a dry cold. There is no tissue freezing with a chilblain injury. If you have chilblains, you might notice that the affected area may itch, turn reddish-blue, and be swollen and painful. With time, blisters containing clear fluid may form. The injured area may be very sensitive to the cold in the future. However, there is usually no other permanent damage.
"TRENCH FOOT" (IMMERSION INJURY): The cold injury called "trench foot" was named after the condition suffered by many soldiers in the trenches during World War I. "Trench foot," also known as immersion injury, occurs when a body part is exposed to a cold, wet environment. This type of injury may occur when a glove or sock becomes wet. As with chilblains, the affected area is not frozen. The symptoms of immersion injury are similar to those of chilblains, but the damage is usually more serious. The blisters are deeper and resemble the blisters that form after a burn. Again, there is no permanent injury other than cold sensitivity. COLD INJURY WITH TISSUE FREEZING FROSTBITE: Frostbite occurs when there is freezing of the injured area. When an area of the body freezes, ice crystals form within the cells. These ice crystals cause the cells to rupture, leading to cell death. Frostbite goes through several stages. When only the surface skin is frozen, the injury is called "frostnip" (a first-degree injury). Frostnip begins similarly to chilblains with itching and pain. The skin then "blanches" or looses its blood supply. Eventually, the area loses feeling and becomes numb. Frostnip generally does not lead to permanent damage because only the top layers of skin are involved. Long-term sensitivity to cold can occur from frostnip. If the freezing continues, the skin may become frozen and hard (a second-degree injury). However, the deep tissues of the affected part are spared and remain soft and normal. This type of injury generally blisters 1-2 days after freezing. The blisters may become hard and blackened. However, they usually look worse than they are. Most of these injuries heal over 3-4 weeks. Again, the affected area may remain sensitive to heat and cold permanently. Should blistering occur, the injury should be seen by a healthcare practitioner. If further freezing continues, a deep frostbite occurs (a third or fourth degree injury). When this occurs, all of the muscles, tendons, blood vessels, and nerves of the affected extremity are frozen. The extremity is hardened, feels woody, and use of the involved part is lost temporarily, and in severe cases, even permanently. The involved area is deep purple or red with blisters; usually these blisters are filled with blood. It is this type of severe frostbite that results in lost fingers and toes. However, it can take several months to determine how much damage has actually occurred in the freezing process. For this reason, surgery to remove tissue that is not capable of surviving is frequently delayed.
Who is most likely to get a cold injury and what can be done to prevent it? Anybody can develop a cold-related injury, but the young and the elderly are especially prone to this type of injury. In the young, the small size of their extremities makes them more likely to freeze. In the elderly, poor circulation may contribute. In both of these groups, mobility may be limited and the cold injury occurs before the person is able to move indoors. Certain drugs, such as alcohol and other drugs or medications that depress the ability to feel accurately, make it more likely that the individual will develop a cold injury. These drugs make it less likely that a person will recognize that he or she is in danger of becoming frostbitten. Alcohol also causes the skin to flush, allowing warm blood to become cooled at the surface of the skin. Additionally, any underlying illnesses, which are characterized by poor circulation, such as diabetes, hypothyroidism (low thyroid), and arteriosclerosis, can make it more likely that one will develop a cold injury. The best way to prevent a cold injury is to dress warmly and move indoors once your fingers or toes begin to feel cold. Always keep your hands and feet dry and your ears covered. Several drugs have been tried to help prevent frostbite. One of the most commonly used drugs is nifedipine (PROCARDIA). Nifedipine increases circulation to the extremities by dilating the blood vessels. While it makes sense that it would help prevent frostbite, all of the evidence is anecdotal. No studies have been conducted to determine whether or not nifedipine prevents frostbite. Beta-blockers (LOPRESSOR, TENORMIN, INDERAL, and others), which are often used to treat high blood pressure and heart disease, reduce the circulation to the hands and feet. These medications are more likely to contribute to the problem of frostbite.
How should frostbite and other cold injuries be treated? It is important not to thaw the extremity if there is a risk of it re-freezing!! As was mentioned above, injury is caused when ice crystals form in the cells. For this reason, it is better to leave the part frozen until it will remain thawed when warmed. Re-freezing will only lead to more severe damage. If you are camping and unable to get indoors, leave the extremity frozen. The best way to warm a frozen part or one that has a chilblain or trench foot (immersion injury) is to put it into a tub of hot water (104-108 degrees F (40-42 degrees C)). Make sure to test the temperature of the water with a thermometer or a hand that is not frozen!! It is important to avoid burning the injured area (which may lack feeling). There may be quite a bit of pain when the injured area is re-warmed. Acetaminophen (TYLENOL and others), aspirin (BAYER and others), naproxen (ALEVE and others) or ibuprofen (ADVIL and others) may be used to help the discomfort. If stronger pain control measures are required, contact your health care practitioner. One common "folk remedy" is to rub the extremity with snow; this should be avoided. Any rubbing may aggravate the injury. The injured tissue can be fragile and must be handled gently. Warming over a fire or next to a heater should also be avoided. These methods have a high risk of burns and tend to dry out the injured tissue, thereby causing more damage.
When should I seek medical care? Chilblains can usually be treated at home. However, if you have a true frostbite injury or any blistering of the injured part, it should be seen by a healthcare professional, such as a physician or physician's assistant. If there is any sign of infection (increasing redness, warmth, etc.), a healthcare professional's care should be sought. Lastly, if there is a lot of blistering and you are not up to date on your tetanus shot (within the last 10 years), you should receive a tetanus booster. If you are unable to obtain medical care chilblains, try to leave
the blisters intact. As long as they remain closed, it is unlikely
that they will become infected. Once opened, make sure that the
blisters drain freely and trim off any dead tissue with a sterile
pair of scissors. Keep any open areas clean and covered. A first
aid cream, such as BACITRACIN ointment, may be used. Seek medical
care as soon as possible. A healthcare practitioner should evaluate
trench foot (immersion injury) and frostbite. These injuries can
require long-term evaluation for complications and treatment.
(EPISTAXIS) Why do people get nosebleeds? The nose is a part of the body that is very rich in blood vessels (vascular) and is situated in a vulnerable position on the face. As a result, any trauma to the face can cause bleeding. The bleeding may be profuse, or simply a minor complication. Nosebleeds can occur spontaneously when the nasal membranes dry out, crust, and crack. This is common in dry climates, or during the winter months when the air is dry and warm from household heaters. People are more susceptible to bleeding if they are taking medications, which prevent normal blood clotting (COUMADIN, warfarin, aspirin, or any anti-inflammatory medication). In this situation, only a very minor trauma could result in significant bleeding. The incidence of nosebleeds is higher during the colder winter months when upper respiratory infections are more frequent, and the temperature and humidity fluctuate more dramatically. In addition, changes from a bitter cold outside environment to warm, dry, heated home results in drying and changes in the nose, which will make it more susceptible to bleeding. Nosebleeds also occur in hot dry climates with low humidity, or when there is a change in the seasons. The following list of factors predispose people to nosebleeds:
How do you stop the common nosebleed? Most people who develop nose bleeding can handle the problem without the need of a physician if they follow the recommendations below: 1. Pinch all the soft parts of the nose together between your thumb and index finger. 2. Press firmly toward the face - compressing the pinched parts of the nose against the bones of the face. 3. Hold the nose for at least 5 minutes (timed by the clock). Repeat as necessary until the nose has stopped bleeding. 4. Sit quietly, keeping the head higher than the level of the heart; that is, sit up or lie with the head elevated. Do not lay flat or put your head between your legs. 5. Apply ice (crushed in a plastic bag or washcloth) to nose and cheeks.
How do you prevent the nose from bleeding again? 1. Go home and rest with head elevated at 30 to 45 degrees. 2. Do not blow your nose or put anything into it. If you have to sneeze, open your mouth so that the air will escape out the mouth and not through the nose. 3. Do not strain during bowel movements. Use a stool softener (for example, COLACE). 4. Do not strain or bend down to lift anything heavy. 5. Try to keep your head higher than the level of your heart. 6. Do not smoke. 7. Stay on a soft cool diet. No hot liquids for at least 24 hours. 8. Do not take any medications which will "thin the blood" (aspirin or aspirin products). If your primary care physician has prescribed these, you need to contact him or her regarding stopping these medications. 9. Your doctor may recommend some form of lubricating ointment for the inside of the nose (see below). 10. If re-bleeding occurs, try to clear the nose of clots by sniffing in forcefully. You can try using a nasal decongestant spray, such as AFRIN, DURATION, or NEO-SYNEPHRINE. These types of sprays constrict blood vessels. (NOTE: If used for many days at a time, these can cause addiction.) 11. Repeat the steps above on how to stop the common nose bleed. If bleeding persists, then call your doctor and/or come to the emergency room.
What precautions can you take to prevent nose bleeding? The most common cause of a nose bleeds is drying of the nasal membranes. If you are prone to recurrent nosebleeds, it is often helpful to try lubricating the nose with an ointment of some type. This can be applied with a Q-tip or your fingertip up inside the nose, especially on the middle portion (the septum). Many patients use A & D ointment, MENTHOLATUM, VICKS VAPORUB, polysporin/neosporin ointment, or VASELINE. Saline mist nasal spray is often helpful (OCEAN SPRAY).
When should you call your doctor or report to the emergency room?
If the nosebleeds persist or are recurrent, you should see your doctor, who may then recommend stopping the bleeding with a heating instrument (cautery of the blood vessel that is causing the trouble). Blood tests may be ordered to check for general bleeding disorders. If bleeding is still persistent, the doctor may place nasal packs, which compress the vessels and stop the bleeding. In rare situations, you may have to be admitted to the hospital or require surgical treatment or a procedure where material is used to plug up the bleeding vessels in the nose (angiographic embolization).
What should I do if the doctor has placed nasal packs? Nasal packs are used when less conservative measures fail (see above). These packs are frequently placed in both sides of the nose. The packs are usually made of a material called "merecel" which is a compressed sponge-like material used to help compress the area of the nose that is bleeding. The doctor usually does not remove them for several days (2 to 5 days). Make sure you have an appointment for follow-up. You will need someone to drive you and bring you home after the nasal packs are removed. During this time, you will be prescribed antibiotics and pain medications as needed. It is not uncommon for the nose to drain a blood-tinged material. Folded gauze taped under the nose (a mustache dressing) is often useful. Your doctor may permit you to clean your nostrils with hydrogen peroxide soaked Q-tips. Finally, you should consider the prevention methods described above to help to avoid bleeding again. Remember that patients with nosebleeds should not to take aspirin or any other blood thinning products. If patients are already taking these medications when the nosebleed is noticed, they should consult their healthcare practitioner. |
